Patients come up with the strangest questions. What the heck is St. Johns Wort? Nutritional advice no longer applies to just the basic food groups.
Cathleen Terhune Alty, RDH
Your employer starts selling a line of nutritional supplements in the office. He expounds on the benefit he has noticed while taking them. He encourages the staff to try them, and you admit that you are feeling more energetic and alert since you began taking them yourself. Feeling confident in your nutrition know-how, you feel perfectly qualified to suggest several specific nutritional supplements to patients complaining of feeling run down and stressed. The patient hears the glowing staff testimonials about the products, and you encourage him to purchase some to try them for himself.
Or maybe you`re not prescribing supplements. But, when taking a health history for a new patient, you listen to a dizzying smorgasbord of unfamiliar herbs and vitamin preparations she takes every day. What is valerian root, Astragalus, black cohosh, Echinacea? St. Johns Wort sounds like something a dermatologist needs to clear up, not something to swallow. What are these strange-sounding supplements, and are they going to affect treatment?
Or maybe a patient questions you about the latest tabloid TV program or health food store magazine where they heard about the incredible health benefits of daily coffee enemas - or eating two raw potatoes a day - or cabbage soup for weight loss. As a health professional, they want to know what you think.
Welcome to the world of alternative or nutritional medicine! Some call it instant science, nutrition nonsense, multilevel marketing beyond rational understanding, or quackery. Others say these products or procedures have been used for centuries to promote good health and healing and need to be used today as a shift away from traditional medicine, an alternative to harsh prescription drugs or environmental concerns. In other words, we`re exploring the envelope way outside the basic four food groups. As a general rule, when people can`t find a solution to their health problem in the modern medical world, they often will pursue a nontraditional approach.
Patients frequently expect all health professionals to be on top of all of these therapies and to give an opinion, if not outright advice. Where do all these therapies, remedies, and sometimes crazy ideas come from? Do nutritional supplements really make a difference in how you feel? As consumers, what should we be asking ourselves before purchasing these items? Where do we look for the latest information on these fads, as well as the scientific evidence of their effectiveness? And what do we tell our patients when they ask questions?
Alternative nutrition philosophies come from several sources, particularly out of the past. It is true that many herbal remedies have been used successfully in many cultures for hundreds of years. Native Americans shared their herbal remedies with the pilgrims when they landed in America, and the Chinese have used herbal formulas to promote healing. The use of folk remedies has been recorded throughout American history to relieve anything from a headache to hammer toe. My grandmother was convinced that sweet oil cured ear aches and bacon fat would coax out a stubborn splinter.
Many of these remedies are silly. Some are sound, especially the herbal formulas. Some of these formulas, as well as some vitamin supplements, have been scientifically proven to be effective. But as various herbs are discovered to have medicinal value, some have become regulated by the government so that levels of the herb in supplements are strictly controlled, just like drugs. Therefore, the active, helpful agents are so small that you can`t get them in high enough concentrations to derive any benefit from some of them.
Another source of this information appears to be fueled by greed. In the past, snake oil salesmen pitched tonics and elixirs that promised youth, beauty, vitality and other desirable qualities, all from the magic contained in their products.
We laugh at the idea of these slick charlatans going from town to town selling their do-nothing products. But many snake oil salesmen still exist today, promoting their products to cure cancer, make you lose weight, correct heart disease and other illnesses. They live far outside the realm of science, relying on the placebo effect to sustain their income and word-of-mouth advertising to provide new prey. They dwell in infomercials and questionable nutrition publications, full of amazing testimonials and guaranteeing your money back if not completely satisfied. Some have developed sophisticated multilevel marketing plans where people are carefully admonished to not make specific medical claims about their products, just to give testimonials of what good it has done for others - all in the name of profit. These product names are changed quickly and their manufacturers come and go, so it is nearly impossible to get them out of the nutrition business for good.
Not all multilevel marketing plans are making false or misleading claims or pushing their products of dubious value. But so many of them are that it gives the legitimate ones a bad name.
Another source of alternative or nutritional medicine information is health publications, some legitimate and some not. Often, it is difficult for the consumer and the professional to make a judgment call on which publications are worthy of our trust. Some are based on rational scientific investigation, clinical efficacy and controlled studies. Others are full of manipulated statistics that infer a product`s effectiveness or have misinformation, designed only to sell products. There are publications that refute all alternative nutrition as quackery and a waste of time, hope and money, and others that promise a new life if you will buy what they peddle. Some groups go off half-cocked, attacking the butter on movie popcorn and the snacks from the favorite fast-food joint, only to find the alternatives they demand often are less healthy than the original. Then there are publications that fall between all these extremes.
Often, the news media becomes a source of nutrition information when it reports on what is printed in these publications, taking the information to a new level of consumer awareness. Consumers often believe the news media reports only newsworthy and factual information; suddenly, claims become facts, whether based on science or quackery.
Michael Gleason, PhD, DDS, says believing in the latest health fad is a big problem.
"People always want to look better and feel better," said Gleason, associate professor of the department of biomedical sciences at the University of Detroit Mercy School of Dentistry. "People aren`t dumb; they just want an easy way to get what they want. Our vanity is preyed upon because we want to be better. The press tends to jump on things, often reporting without thinking. Those who hear it reported think if its being talked about so much it must be true. If everyone else is jumping on the band wagon, perhaps we should, too."
For example, products that claim to help lose weight are too numerous to count. Pills, powders, herbs, capsules, tablets, chants, massages, etc. all claim to get that weight off for good. But studies show Americans are heavier than ever. As a spokesperson for a fitness club once said in a commercial, "If you could get a great body out of a bottle, everyone would have one." Maybe it`s our information and technology appetite that has gone haywire, gorging on every tidbit of the latest nutrition fad.
What should we do before buying into the latest nutritional supplement fad? "If the claims sound too good to be true," says Dr. Gleason, "they probably are."
What about testimonials? Don`t these people really benefit from these products? "Most multilevel marketing companies are convinced their products work," Gleason says. "There is great power in the mind. In the 1950s, there was the classic study about the placebo effect. At least 30 percent or more felt better when taking a placebo instead of the product. More recent studies say the placebo effect is more like 40 to 50 percent of those taking the inactive product. The use of double-blind studies take out the mind effect. I can take something and feel better. I think I got better because I took it, but I may have felt better without it as well."
So if you feel better after taking something, how can you know absolutely if it was caused by the products? Only from examining the results of a controlled, scientific study.
Why can`t science keep up with all these new products and their claims so they can tell us scientifically if they are effective? Dr. Gleason cites several reasons. "First of all, it costs money to do research. Scientific studies that are double-blind can cost thousands of dollars. A promoter of a new product doesn`t have to test it. He can take it to the marketplace and claim it works great for him. Second, research takes time. Scientific studies take hundreds of hours to design, implement and report. Third, there is often nowhere to publish results. Journals want to see information on things that work, not about things that are found not to work. Plus, there is often a one- to two-year backlog for a research article to be published. Fourth, it is harder to do good science than sloppy science. It`s easy to hold a press conference, print up a brochure and sell something."
So where do we go for information that we can feel somewhat sure about? Dr. Gleason recommends that hygienists find appropriate resources, such as hospital dietary departments, local health departments, or a university in the area that has a department of nutrition. The Internet is full of nutrition information, both faddish and factual, so surf with a healthy dose of skepticism. Or visit Web sites by the FDA, the Center for Food Safety and Applied Nutrition, the International Food Information Council, the American Council on Science and Health and the National Council Against Health Fraud. They are good for learning what`s new. (A list of Web sites and/or addresses is included with this article.)
Dr. Gleason does caution hygienists about taking on the role of "nutritional counselor." "There is nothing wrong with suggesting a person eat a well-balanced diet," he says. "In general, a well-balanced diet, avoiding excess fats and sugars is good advice. But when it comes to recommending a specific diet, suggesting supplements or these kind of things, it should be handled by a qualified professional. You may know what`s wrong, but defer to a dietitian or other nutrition professional, unless you are highly trained in this area."
We still have much to learn about health and nutrition, but the availability of good scientific data can keep us up-to-date and somewhat prepared to meet the nutritional information needs of our patients.
Cathy Alty, RDH, is a consulting editor for RDH, and she is based in Rochester Hills, Mich.