Dr Tierowna Low Dog, MD, said in a session at the recent International Conference on the Science of Botanicals that the increasing complexity of dietary supplements means they’re getting farther away—not closer—to the comfort zone of mainstream healthcare providers.
The ICSB is an annual meeting put on by the National Center for Natural Products Research at the University of Mississippi in Oxford, MS.
Common plant language distorted in modern marketplace
Dr Low Dog herself is a highly experienced herbal practitioner. On her property in northern New Mexico alone she grows 64 different varieties of medicinal plants. She has made a number of ethnobotanical discovery trips around the world, including a recent visit with traditional herbal medicine practitioners in Uganda.
“Everywhere you go when you’re with plant people there is a common language that we speak,” she said.
But that traditional knowledge gets put through a modern industrial supply chain and product formulation wringer and comes out not bearing much resemblance to what a practitioner such as herself might learn in the field.
“For a dedicated integrative medicine physician, it’s hard to find on the shelves what they are recommending to a patient. Take something simple like echinacea. There are 15 different products out there,” she said.
Complexity of formulas daunting even for experienced practitioners
Even with her vast knowledge, she said she can still be stumped by the products referred to her by patients. The addition of multi ingredient supplement formulas throws a big wrench into an already crowded wellness visit.
“In a 20 minute visit you’re supposed to be looking at all their supplements plus checking their labs and then actually engaging with them. For most physicians, even if they’re interested in supplements, it’s just too much,” she said.
Dr Low Dog gave an example of two products brought to her by one of her patients. Each had a laundry list of ingredients, and one housed many of those within a proprietary blend which masks amounts and precise information on the types and strengths of extracts being used. So she said there was little information to go on when trying to answer the question of whether using those products was a good idea in that particular case.
What hope, then, for the mainstream physician?
“What would I feel safe recommending to a pregnant woman? There are legitimate concerns over quality. There are legitimate concerns about safety,” she said.
“A lot of patients who are in primary care are on multiple pharmaceuticals. These concerns about potential drug interactions are real,” she said.
Pharmacists to the rescue
Dr. Low Dog said dietary supplements often contain an admonition to consult a physician before use. But the sad truth is that few physicians know more than their receptionists do about supplements.
As a solution, Dr Low Dog said pharmacists could step forward to plug that breach. Compounding pharmacies were at one time a source of botanical-based medicinal information in this country before the industry embarked on the single constituent pharmaceutical journey.
“There is a huge arena that botanicals can play in to improve people’s lives. I have long advocated for the pharmacists to reclaim this area,” she said.