thebeave

Sorry, I'm not Dr. Rick, but I'll give my two cents here:

Much like herbal remedies and alternative medicines, with a little research I think you will find that the benefits of organic produce are grossly overstated. Personally, I think they are borderline fraudulent, but I know people who would put my nuts in a vise for saying that. Many double blind studies have shown that organic produce are neither more healthful, tasty, safer or more nutritious than conventionally produced agricultural products (even the heads of organic produce associations will admit this). And contrary to popular belief, a fairly high percentage of randomly sampled organic produce have been shown to have detectable (though small) levels of pesticide residue, presumably due to cross-contamination by nearby non-organic farms. However, the pesticide levels found on produce (whether organic or conventional) are so miniscule that they can be safely ignored.

Organic produce also generally has higher surface bacteria levels than conventional produce, and generally speaking, bacterial contamination on food causes far more illnesses and death worldwide than microscopic pesticide residues ever have. Also, the many natural pesticides (generated by the plant and residing within the produce itself) are several orders of magnitude higher concentration than that added by man during crop production. And we do not always know the long term health problems those natural pesticides can create. Remember, natural does not necessarily mean safe. I do not see any reason to pay the extra money for organic myself, and don't waste my money on it. Some advocates say there is an environmental benefit due to the fact that you are not spraying pesticides into the earth, but this is offset at least somewhat by the fact that the yield for, say, an acre of organic produce is significantly less than that of conventionally grown produce. This means destruction of more land (and thus wildlife habitat) to produce the same amount of food as conventional agriculture. Not sure in my mind which is the lesser evil.

repoman

Mad Kally,

I am not taking that medicine right now, mostly because my naturopath/MD doctor told me to lay off while on ketoprofen.

So what i am trying to find out basically is what chemical structures in herbal medicines have side effects on the liver. I am also trying to find out if the fact that these are cox-2 inhibitors like the pharm meds means that they may have similar effects on the liver. I am assuming that there are only so many ways that cox-2 inhibitors can work and only so many types of reaction sites.

As I said before in a previous post it is the quinone metabolite of tylenol that damaged the liver. Perhaps some of main ingredients of the herbs work well but also have damaging metabolites.

As an aside how would you folks (Mad Kally, Dr. Rick and others) keep your liver in tiptop shape so you can weather liver damage and maximize toxin elimination from whatever kinds of drugs you may need to take herbal or pharmaceutical? I am going to guess that you'll say to drink adequate fluids, vitamins (NOT megadoses), avoid excess alcohol and too much sugar or starch. But how about getting enough selenium -- is it overrated? Boy, the liver really is a complicated beast isn't it?

Dr Rick

Nothing, in fact it's great, but one needs to understand the research and not mis-interpret it.

For instance, a review linking exposure to environmental contaminants with endometriosis is not evidence of herbal medication efficacy and in fact as absolutely nothing at all to do with herbal medications. Nor from such a review can one conclude "hence organic produce should be consumed" because it's not at all clear from the review that you can avoid the environmental contaminants by eating organic produce.

Conclusions about herbal medications should only be drawn from studies on those herbs or medications, and conclusions about organic produce should only be drawn from studies on produce.

It gets even more complex, however; to be valid, studies can and should be designed in such a way that they cannot be influenced by bias, negative or otherwise. There are many potential sources of bias, and they can come from the researchers or the subjects.

Take for instance the study posted above on fifty women with endometriosis. The researchers documented objective abnormalities by laparoscopy and manometric criteria in the study group but did not publish any post-intervention data to show that these abnormalities were corrected by a change in diet. There was a report of symptom improvement from the test subjects, but since there was no comparison (control) group, we can't know if the symptom changes were really due to dietary changes or some other factors.

The reported improvements in the endometriosus study may have nothing at all to do with diet; the women may have felt better simply because of the attention that study participation afforded; that's a well-documented phenomenum, which is why control groups and blinding of both the participants and researchers so that neither knows if they are getting the intervention under analysis are so important.



Nope, there are none. In fact, in almost all studies that are properly performed and controlled, even the placebo group will experience and report "side-effects;" that's why claims that an intervention, alternative or otherwise, is "free of side effects" should be viewed skeptically; there's really no such thing.

It's a good to look at the research and take responsibility for one's self, but one should also take the responsibility of learning how to look at the research so that it is correctly understood.

Rick

Dr Rick

repoman, I'm not so sure that those herbs are specific inhibitors of cox (cyclo-oxygenase) type 2 to begin with. That's what we reserve the term for; to distinguish compounds that are specific for cox-2 from those that are not selective in their inhibition. The marketers of the herbals may claim that their product is a cox-2 inhibitor, but there's really no way for us to know if that is true and no one to call them on it if it's not. Actually, ketoprofen, like aspirin and ibuprofen, is not considered a cox-2 inhibitor; it is non-selective in its actions upon cox's in contrast to the newer NSAIDS such as Vioxx and Bextra.

There's not so much that is special about the cox-2 inhibitors when it comes to the liver, anyhow. Cyclo-oxygenase is a critical enzyme in what is known as the arachodonic-acid pathway, which in turn plays a vital role in many metabolic and reactive processes, including inflammation and cell-growth regulation.

Taken in pahrmacologic doses, all of the NSAIDS reduce inflammation. Unfortunately, they also all can cause damage to the liver and kidneys, though such injury is rare. Cox-2 inhibitors aren't any easier on the liver, but they are less injurious to the stomach and intestines than non-selective NSAIDS. That's really important if you are pre-disposed to peptic ulcers (ie have had ulcers before), but for most people the cox-2's offer no advantages over the older and much cheaper NSAIDS.

Maybe, but without some specific studies to reference, I can't tell you if that is the case.

Absolutely; also, don't get overweight (that can damage the liver) and don't share needles or cocaine straws if you're one that uses those kinds of tools (both can transmit viral hepatitis)

Yup, completely. We need very little selinium, its ubiquitous in our diets, and a deficiency can only occur in states of extreme starvation.

That's why I spent an extra two-years of university fellowship training just studying it and the rest of the digestive system to become a sub-specialist in this area

Rick

Jackalope

Milk thistle extract has been hyped as a possible agent for treating cirrhosis of liver. As far as I know, the studies done so far have only measured liver enzyme levels. So the only thing they've proven is that for some subjects, standardized silymarin can lower your liver panel results. I don't think anyone's done studies that included liver biopsies (not suprising, since I've seen that bloody great needle they use for that). I have a feeling they'd have a hard time finding experimental subjects who'd consent to have not one, but two liver biopsies done.

An awful lot of arthritis patients I know use milk thistle extract in an attempt to stave off liver damage from painkillers, anti-inflammitories, and the various DMARDs. Methotrexate and Arava are probably the ones that most commonly cause damage. The folks taking milk thistle extract have reported that their liver panels did indeed come down, but I'm wondering if it's actually having any real effect on potential damage.

Most of these patients are desperate to continue taking their current drug regimen, as finding a combination of drugs that actually works for arthritis is hell on the patient. And from my person experience, getting yanked off a drug because your liver tests look bad can cause a serious crash'n'burn. So even if you end up on a new drug that will eventually work, you may have accumulated more damage in the meantime. (I'm on my fifth DMARD, and I'm really hoping that Enbrel works)

So the real question is, are these patients simply masking drug-induced damage, or is silymarin a viable damage reduction strategy? Quitting the damaging drugs has its own set of serious consequences, after all.

MadKally

From my Herbal Minefield link posted on previous page:

The April 2000 issue of D Magazine reported that -- at its request -- a leading laboratory had tested five brands of DHEA, ginger, ginkgo biloba, ginseng, melatonin, saw palmetto, St. John's wort, and milk thistle purchased at five stores in the Dallas area. The ginger and melatonin products contained the stated amounts, but 10 of the other 30 products did not, and a few products had capsules that easily fell apart.

Since it's so unregulated, you have no way of knowing if you are taking milk thistle, what amount, or even if there's any in the capsule you purchase. There is no way I would take any herbal supplement untill regulated by the FDA and shown to be safe. Don't be fooled by the words "clinical trials" you see on the commercials. It means nothing! Don't believe a doctor who would stand up there and promote such things on TV to to cash in on a big money making field. On 60 minutes one time they discovered that one of the so-called doctors was actually a dentist. Others had nothing to do with medicine at all.

Kally

jayh

What suggests "organic produce" will do any good. Many of the points there had to do with unbalanced diet, not 'organics'. There is no reason to assume that plants that evolve chemistry for their own internal purposes have any evolutionalry mechanism whatsoever to make sure that chemistry is 'ideal' for human consumption. There are naturally occurring harmful substances in most plants.

....

This exemplifies the sad mischaracterization of herbal treatments. The can and DO have side effects, sometimes very serious ones, though many of them are undiscovered because the research was never done. Any chemical potent enough to modify the body's chemistry is potent enough to modify it in undesirable ways. Additionally herbals (unline pharmaceuticals) always containg many other substances in the plant, which have little benefit or can even be counterproductive or harmful. Plants do not evolve their chemistry for human benefit.

MadKally

What I do NOT understand is why people want to go back in time before decent medical research. Sort of like neanderthals eating roots and plants! You either live or die, or it works or doesn't work. Who in the hell knows?

Before WWII no one would invest money in Penicillins. THe US wouldn't do it. Finally the British did because most of soldiers used to die of infections from their injuries. What if no one had bothered to mess with a funny mold in a petri dish in a man's bathtub.

Where will the money come from for studying all these herbal substances? And is there a good reason? Why not just see a real doctor? Like Rick. (he's the best xoxox)

Kally

Dr Rick

Nice summary of the whole milk thistle thing, Jackalope. Many of my patients also take it, and as MadKally points-out, they really can't know what they are taking or at what dosage. I'm not opposed to herbals; 1/3 of all prescrition meds are derived from herbs and plants. The problem with the herbal med market is that it's largely unregulated and its products are not tested well for either efficacy or purity.

Thanks, Kally...xoxoxo to you, too, but being a nurse and all, didn't you really mean to post this for me: :notworthy?

[re-edited to add: oh, never mind.]

It's being done right now as we post; I was updated on the study design at a conference this past May, and it will look at the effects of silymarin, the active ingredient in milk thistle and compare liver biopsies between treated and untreated people both pre- and post-treatment.

I do liver biopsies, and you're right; it is a goddamn big needle that we use, but with all the good drugs provided during the procedure, most patients really don't seem to mind

I hope it does for you, too; RA is a nasty disease, but Enbrel can often provide dramatic results. Let me know how you do.

That's what I wonder, too. We'll have some answers in the next 1 to 2 years, hopefully.

Rick

MadKally

Being a nurse my ass! We save lives everyday correcting your errors. We are legally liable for your mistakes because we are supposed to know better than to give a lethal dose of something without calling you first. Hello Doctor, you don't really want to give Miss Louise 1,000,000 mg of Lasix IVP do you?

Honestly Rick, I would never insult you!!! The milk thistle thing was not posted to you, silly man. You were at the top of your class. I'm sure of it.

oxox Kally

Just to clarify. I was teasing Ricky about errors and all that crap I said. I really love him, he's my hero. My knight in shining armour who married someone else.