Integrative Pediatric and Adolescent Health: Educational Web Column

August 2008: Herbs and Supplements Part I:
From the personal to the professional

What do you like to start your morning with: Coffee? Tea? A multi-vitamin? Fish oil supplement? (Finding one that doesn’t have too much fishy aftertaste is the trick). Depending on the definition you use, any of these are considered either an herb or a supplement. Even among those skeptical of the ‘herb and supplement’ world, there are likely products used that fall into this category, whether they think of it that way or not. On the other hand, some families use herbal preparations, homeopathic remedies, and or supplements on a daily basis. These can be for a specific medical purpose, general health, or just for the taste or enjoyment. Regarding safety and efficacy, some find enough comfort in many generations of experience; others would prefer repeated randomized controlled clinical trials before feeling comfortable. I think there’s a middle ground here.

A personal experiment

For a few weeks now, I’ve been frustrated with a persistently sore shoulder, the result of a minor injury several months ago. While I have used over-the-counter anti-inflammatory drugs off and on in the past, I tend not to take them right away, or very often. But after meeting with my Orthopedist, he suggested I may be headed for surgery if this doesn’t get better.

Why turn to herbs or supplements? There is an extensive pharmacopoeia of drugs that are frequently very effective for specific conditions. Here are several reasons some people consider herbal medicines or supplements:

More ‘natural.’ This is more important for some than others. See below for a discussion of what is ‘natural.’
Fewer side effects
To reduce pharmaceutical use which may have significant side effects
To complement other treatments – pharmaceutical or otherwise

So to help reduce the inflammation and get the pain controlled enough to allow me to start regular rehabilitation exercises, I took some ibuprofen. I also started a topical Arnica gel (7%) at the same time. Within 2 hours the pain was much improved.

But, instead of keeping up with a three-times-a-day regimen of ibuprofen - which I knew would be necessary to get the anti-inflammatory effects in addition to the pain relief - I decided to see what would happen with the Arnica alone. As I’m writing this, it’s now 3 days later and the pain has almost completely resolved. Is this a coincidence? What’s the evidence for the effectiveness of Arnica? My shoulder had been aching fairly severely for a few weeks straight. Why is it suddenly so much better?

According to Memorial Sloan-Kettering’s Integrative Medicine website, arnica has several potential mechanisms of action, including anti-inflammatory. So what worked for me? A single dose of ibuprofen? Unlikely. While significant pain relief from a single dose is expected, it would not likely lead to lasting relief of a fairly chronic problem. A single, long bike ride to build up supportive muscle in my shoulder? Also unlikely. The topical arnica? Possibly. I suspect it was a combination of reasons, but I’m much more convinced of arnica’s effectiveness now that I’ve experienced it myself.
Which brings me to the point of this personal interlude.

How do we integrate them into healthcare?

One of the hallmarks of an integrative model of care is the willingness to consider therapies for which we have limited data. Yes, there is a growing body of research on herbs and supplements. For example, numerous research studies have demonstrated that increasing the proportion of omega-3 fatty acids in our diet (whether naturally through fish, flax, or grass-fed meat sources in our foods; or with concentrated supplements) has wide-ranging positive effects. But for the bulk of herbs and supplements available, the data are limited. And while there are people with tremendous knowledge of common usage of herbs, like my friend Tieraona Low Dog, they are few and far between (particularly among ‘traditional’ physicians!). So, with limited information, how does one choose which herbs or supplements to use in which circumstances and for how long?

But what is ‘natural?’: Today many companies claim that their products are ‘natural’, yet there are no accepted definitions for what that means, nor adequate regulation to enforce them even if there were. Herbs or supplements are processed to varying degrees, and many of our common pharmaceuticals are derived from plants. Some naturally occurring substances are toxic (eg mercury), so not everything in our natural environment is good for us. I generally consider natural therapies to be treatments that…

1) do not incorporate the use of synthesized chemicals, preservatives, coloring or flavoring; and

2) foster the individual’s innate healing capacity while minimizing external harm.

First, consider the reasons why you would use an herbal approach to begin with. In my case, I liked the idea of reducing my ibuprofen use since it can be associated with gastritis. Next, consider what possible herbal approaches are known; research their possible side effects, interactions with other medicines you may be taking, and what is known about their effectiveness. Finally, decide how long you are going to use it.

This may seem daunting. For most simple herbal remedies such as chamomile tea at bedtime, calendula cream for infant rashes, or ginger for upset stomach, such extensive research is not usually necessary. But when approaching more complex medical problems, potential interaction with medications or long term use, it becomes more important to be thorough in your research (and in the questions you ask your physician or other provider – as discussed in an earlier column).

In the next column (Part II of Herbs and Supplements) I’ll give some specific examples of herbs I use in practice with pediatric and adolescent patients, and a set of helpful references.

About the Column

This column presents an integrative medicine view on a range of topics relevant to children, teens and early adolescents including: nutrition, herbs & supplements, mind-body and self-regulation skills, and general health and wellness.

If you’re new to the concept of integrative medicine, take a few minutes to browse the UCSF Osher Center web site, particularly the page what is integrative medicine?

Broadly speaking, integrative medicine is practicing good medicine. It is an approach to a child’s health that:

places illness in the context of the child, rather than the child in the context of illness;
takes into account family and environmental factors;
neither rejects conventional medicine nor accepts complementary or alternative medicine (CAM) uncritically.

Integrative pediatric consultations are available at the Osher Center with Kevin Barrows, MD, Rick McKinney, MD, and Priscilla Abercrombie, RN, NP, PhD, AHN-BC. To make an appointment, please call the main clinic line at 415.353.7720.

David Becker, MD, MPH is an Assistant Clinical Professor in the Department of Pediatrics at the University of California, San Francisco, and Affiliate Faculty at the Osher Center for Integrative Medicine at UCSF. He is starting the Pediatric Integrative Pain Clinic in July 2008. This is a referral-based service for children and adolescents with chronic pain. For questions about referrals, please contact the main Mt. Zion Pediatric number: 415.885.7478.

In addition, we offer two healthy parenting stress reduction classes: Mind in Labor and Mindfulness-Based Childbirth and Parenting.

Integrative Pediatric and Adolescent Health: Educational Web Column

August 2008: Herbs and Supplements Part I: From the personal to the professional

August 2008: Herbs and Supplements Part I:
From the personal to the professional