Below is a fictional scenario designed to assess how complementary and alternative medicine can be applied to a variety of situations. In this case, herbal supplements are considered for their health benefits, especially weight loss. Lee has been referred to my office by her physician. This is due to our work with complementary and alternative medical practices, including nutrition. Lee’s doctor is working to assist her with her asthma and heart health concerns. Additionally, Lee was previously diagnosed with a functional hypothyroidism. On top of all of this, one of Lee’s greatest concerns, especially at age 50, is that she has continued to put on weight and is somewhat desperate to find some way to slim down. Some friends have recommended a supplement to her that contains Ma Huang. This is my evaluation of her situation, especially in light of possibly using Ma Huang.
A Letter to Lee Concerning Ma Huang
Lee, I want to thank you for visiting our office and for your honesty related to your concerns for health. It sounds as though your doctor is working diligently to ensure that you have all of the resources and information that you need in order to make wise decisions.
Let me start by saying that although I appreciate that your friends want to help you with your health and weight goals, the recommendation to use “E-Z Lose” will take you in the wrong direction. The reason that “E-Z Lose” has been a successful weight loss treatment for some is because of the ingredient, Ma Huang. Ma Huang, by another name is known as Ephedra. A synthesized form of Ephedra is Ephedrine or Pseudoephedrine, which is a prescription drug found mostly in decongestants (Manore, 2012). The reason it is a prescription drug is because it is a primary ingredient in the production of Methamphetamine, which is a highly addictive illegal, synthetic drug more commonly known as “Ice.” People who become addicted to “Ice” tend to mentally and physically waste-away.
In fact, I am not sure how your friends have legally acquired “E-Z Lose” since Ephedra, or Ma Huang, was essentially outlawed in the US in 2004 (Manore, 2012). Someone would have to order this product from overseas which means that the quality and purity of the product are even more in question.
In your specific case, “E-Z Lose” is even more of a concern. Although some people have tried to use Ephedra in the past as a type of home-remedy for asthma, that use demonstrated some very severe side effects (George, & Topaz, 2013). Additionally, with your heart concerns, Ephedra is an even greater risk (Song, Shim, Ryu, Kim, Jung, & Yoo, 2008).
The risk factor for those struggling with heart conditions is extremely high (Singh, Rajeev, & Dohrmann, 2008). Even prior to the FDA’s choice to ban the substance, the American Association of Clinical Endocrinologists (AACE) determined that any potential benefits from Ephedra use were negated by the potential risks (AACE, 2003).
Given all of these details, I would have to say that “E-Z Lose” and any other Ephedra based products would not be a good choice for you, or anyone else for that matter. Although it has helped others lose weight in the past, that is because its effectiveness is based in the same ingredients used to produce illegal, highly addictive drugs.
Second Meeting Dialogue
Me: Good morning Lee, thank you for coming back in.
Lee: Oh sure Dr. Arnold. Thank you for looking into my situation.
Me: No problem, that’s why I’m here. Did you have a chance to look over my email to you about Ephedra?
Lee: I did. I guess I have to reluctantly agree with you about the Ephedra. In fact, when I shared your information with some of my friends they said they were going to stop taking it too. They mentioned that they noticed that they had been having trouble sleeping since they started on the “E-Z Lose” and since stopping they’ve noticed that their sleep is getting back to normal.
Me: Well, I’m glad that they were honest with you about their experience and that the information helped. I was hoping to gather some additional information though (AACE, 2003).
Lee: Oh, OK.
Me: Are you taking anything else other than the corticosteroids that your doctor has prescribed?
Lee: Not really. I take a multi-vitamin and some stuff to help sleep, but that is about it.
Me: Hmmmm. OK. You did not list a sleep aid on our first intake forms. What is the brand name?
Lee: Well, there isn’t really a brand name. My family’s from Mississippi and there is an herb that folks have used for years to help with sleep and insomnia. My grandmother used it to. We call it Bugleweed (Yarnell, & Abascal, 2006). I’m not sure what the fancy, scientific name is.
Me: (Smiling) That’s OK, I don’t know the fancy name off the top of my head either, however I am familiar with bugleweed. I know that folks have used it for insomnia; however, studies have also shown that it is effective at reducing thyroid activity (Yarnell, & Abascal, 2006).
Lee: What! Really? Wow!
Me: Indeed. Did you share that information with your doctor?
Lee: No. I guess I need to let her know.
Me: I would definitely recommend that. But do not stop taking any medication until she tells you to do so. OK?
Lee: Oh, right.
Me: So what is your nutrition like? What foods do you typically eat?
Lee: Well, I try to eat healthy, so fruits and vegetables mostly. We try to grow our own food as much as possible. We have a small farm outside of town a bit, so we have plenty of fruit trees and a variety garden. I bake my own bread. I love to bake.
Me: Well that sounds nice. Is your family vegetarian then?
Lee: Oh no. We will regularly cook up some chicken, fish, and some steak now and then, and of course we have our laying hens, so we regularly have eggs, usually for breakfast.
Me: Hmmmm. With the asthma, have you ever been treated for allergies?
Lee: Not really. It has kind of always been with me.
Me: It may be worth getting tested. There are situations in which people are found to have an allergic reaction to different foods, which trigger asthma. Eggs and different types of fish or shellfish are some of the trigger foods (Jacobs, Greenhawt, Hauswirth, Mitchell, & Green, 2012).
Lee: Really? I had never thought about that.
Me: It is probably worth doing the testing to see if there is anything that might be triggering your asthma at all.
Lee: Yeah, definitely.
Me: So, for your weight loss goals, I know that you have said that you are planning on avoiding the “E-Z Lose” product, right?
Lee: Yes. For sure.
Me: OK, and your goal is long-term weight loss, right? Not just some quick drop.
Lee: Right. If I just wanted to try to drop weight fast I would just stop eating. I’m not going to do that, but I guess that would get the weight down.
Me: True, but you would definitely not be happy. The thing with weight loss is that it is simple and complex all at the same time. Theoretically it is calories in, calories out. But not all calories are equal. For example, you mentioned that you bake your own bread, and that you love to bake. So do you eat a lot of baked goods?
Lee: Well, I guess it depends on your definition of “a lot.” My family enjoys their sweets, and the homemade bread doesn’t last long. (smile).
Me: I can understand that. I like my sweets too. However, understanding your nutritional choices is going to make a big difference. Supplements for weight loss are not the answer. There are products on the market to help with nutritional shortages, but it sounds like you have a good mix of nutrition available to you. Herbal treatment options for health have been used for years (Freeman, 2009). So, there are a number of herbal choices that you could consider, but we would want to talk with your doctor about them before you begin making changes (Li, 2011).
Lee: OK. Want do I need to do first?
Me: First, before you make any real changes, I would like for you to keep an intake journal for a week. You can ask your doctor about the bugleweed, and stop using that if she says it is OK, but other than that, for a full 7 days, I would like for you to keep a journal in which you record everything that you put in your body. If you do not have a food scale, go ahead and pick one up and either weigh or measure everything that you eat or drink. Try to be as specific as possible. Track your water, and any other beverages. Do you drink anything other than water?
Lee: We make our own sweet tea, and I’ll have a coke every so often. Maybe some wine every once in a while.
Me: OK. Let me know how you make the sweet tea. That is going to have a good amount of sugar in it. We all tend to drink more calories than we realize. Once we see what your current food choices are like for a week, we can analyze it all and see where you can begin to make some adjustments. It is possible that you are already getting enough exercise just working around the farm, at least to get started. If you, your doctor, and me can make some headway with the functional hypothyroidism, the asthma and your weight goals, then you can begin to add in more exercise later. How does that sound?
Lee: That sounds pretty good to me.
Me: OK. So, for all this to work, you have to take complete ownership of it. The next step is for you to start writing down everything that enters your mouth, even a stick of gum, by the way.
Lee: Oh. OK.
Me: So, what I would like to do is set up an appointment with your doctor with the three of us after you have tracked your food for a week. That way we can talk about your nutrition, your medication, and also see what we can all agree upon for a plan for long-term weight loss for you. Does that sound good?
Lee: Yeah. That sounds great.
Me: And by the way, we haven’t even touched on other weight loss treatment options like hypnosis. So don’t let yourself get discouraged, we are just getting started and a large part of all this is figuring out what works for you.
Lee: OK. Thank you. I really appreciate it.
Summary
Lee’s case is not terribly unique. Many Americans are struggling with health concerns that may stem from long term health and nutrition choices. In Lee’s case, with some collaborative effort on the part of her primary care physician and the CAM doctor, she should be able to find ways to move forward with her weight loss goals, as well as possibly in some of her other health concerns.
Most likely her primary care doctor has already talked to her about her diet and exercise habits, but it is possible that Lee felt like they were not realistic. Hopefully by hearing a similar message from the CAM provider Lee will take serious steps toward improving her health.
By giving Lee some concrete, time sensitive steps to take it is very likely that she will follow through. Also, by letting her know that her CAM provider is willing to walk this path with her, it gives her the extra support that is required for weight loss success. I believe that she has a high likelihood for success.
References
AACE Nutrition Guidelines Task Force (2003). American Association of Clinical
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https://www.aace.com/files/nutraceuticals-2003.pdf
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Freeman, L.W. (2009) Mosby's complementary & alternative medicine: A research-based approach. (3rd ed). St. Louis, MO: Mosby.
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