Tonics, Tinctures and Toxicology: Naturopathy

by , | May 2, 2024 | 0 comments

naturopathy

In the pursuit of holistic health and wellness, individuals often turn to naturopathy as a beacon of alternative medicine, seeking relief and healing outside the realm of conventional treatments. Yet, amidst the allure of natural remedies and lifestyle adjustments, there is a concerning degree of possible iatrogenic harm. This post seeks to address the use of naturopathy in pediatric medicine; common toxicities, interactions with pharmaceutical products, and potential toxicities. 

  • Naturopathy and Alternative Medicine uses in pediatrics: 
    • Use of naturopathy and alternative medicine in pediatrics
    • Frequently used pediatric naturopathic products
  • Toxicities in naturopathic products
    • Common toxicities: heavy metal poisoning, allopathic adulterants, herbal toxicities
    • Interactions with pharmaceutical products
    • Rare but fatal toxicities in pediatric naturopathic use

 

Challenges in Naturopathic Research

 

  1. Variability: There is a broad and diverse inclusion in some studies to what constitutes the landscape of “complementary alternative medicine” and includes massage, acupuncture, herbal remedies and some natural health food products.
  2. Limitations in published data: Due to the broad definition, and limitations to patient disclosures and knowledge of naturopathic remedies there are limitations in the body of published research. We will highlight areas where there is a lack of clarity.
  3. The following terms will be used interchangeably; “Complementary alternative medicine”, “Naturopathy”, and “Homeopathy” to contrast terms such as “western”, “prescription”, and “pharmaceutical”

Pediatric Alternative Medicine Use

 

Frequency of use [1]

  • 54% of children in a Quebec general pediatrics clinic used naturopathic remedies
  • Rises to 72% in children with a chronic illness (asthma, CF, JIA)
  • 11% of Canadian children estimated to have paid to see a naturopathic practitioner

naturopathy

Figure 1: The highest use at CHEO is in our Oncology population where 50% reported alternative medicine use. Evidence suggests that the longer you have a chronic illness, the greater likelihood you have to use alternative medicine. [2]


Key: what qualifies a naturopathic practitioner?

The naturopathic community makes an important distinction in practitioners.  A “naturopathic doctor” is regulated by their college and permitted prescribing privileges. However, anyone with any degree of training can call themselves a “naturopath”. One must attend an accredited training program, or equivalent experience to meet the regulatory requirements. It is licensed only in Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia. It is not a regulated profession in Quebec. [3]

A large discrepancy: Physician Knowledge

  • Physicians estimate < 10% of their population use CAMs [4]
  • Physicians are aware of ¼ of CAM users in their clinic [5]
  • Up to 66% of pediatric patients do not disclose homeopathy use [6]

 

Key: Why don’t patients disclose naturopathy use? [5]

  1. Providers did not ask.
  2. Parents were afraid to be judged or to receive a negative response from the western healthcare system.
  3. They did not think physicians needed to know. Many naturopathic users think their product is safe and could have no harm. In fact, ¾ of naturopathy users could have absolutely no adverse effects or drug interactions.

 

It’s important to ask specifically about naturopathic remedies. 

 

Association with vaccines 

  • Results from parents polled in a naturopathy clinic showed 9% of pediatric patients were completely unvaccinated, 4.4% partially vaccinated [7]
  • Only 12% of naturopathic providers recommend full vaccination
  • Of those vaccinated, 30% reported side effects
    • Mostly typical, expected side effects
    • However, also included higher than baseline rates of behavioural and developmental concerns, vaccine-targeted disease, transient paralysis attributed by parents to vaccination

 

Why is there rising use of Naturopathic Medicine?

Family Rationale

  1. Most (75%) believe they are completely safe [4]
  2. Fear of permanent or persistent negative side effects from Western medicine and pharmaceutical industry [7]
  3. Parental positive experiences with naturopathy, and positive recommendations from family members [7]

 

naturopathy

 

Commonly Used Pediatric Naturopathic Products

A chart review published in Pediatrics was done of pediatric patients and their presenting concerns at the Canadian College of Naturopathic Medicine in Toronto. Most commonly, children presented for typical complaints seen in the ED or family practice. [9]

  • Age range 4 days – 18 years
  • Most common: Rashes (24%) – diagnosed with eczema and unspecified
  • Next: GI pains and behaviour (most commonly ADHD)
  • Other: allergies/asthma, viral symptoms/bacterial infections/”immune dysfunction”, “wellness” and vaccines, pain, weight loss, dental health, jaundice.

 

1. Vitamins

 

Tox pearl: Unknown doses, at unknown preparation can lead to vitamin toxicities. Vitamin D toxicity presents with hypercalcemia and renal failure.

 

2. Minerals and ‘Nutritional’

  • Minerals, probiotics, and essential fatty acids
  • Includes commercial and practitioner-created
  • Oils/fats
    • Fish oils, omega fatty acids commonly (+emu/other marine animals) [11]
  • Minerals: calcium, iron, “multiminerals/unspecified”, zinc, magnesium, potassium
  • Probiotics

Tox pearl: Herbal interactions can lead to medication adverse events such as high doses of omega-3 fatty acids interfering with antiplatelet therapies to cause life-threatening bleeding.

 

3. Homeopathy and Herbals

  • Typically “unspecified homeopathy” [12]
  • Very difficult to ascertain what these products may contain
  • Homeopathy and naturopathy accounted for 39%, and 23% of alternative medicine use, respectively

 

Tox pearl: The route of ingestion of homeopathy includes liquids, sprays, inhalation, and infusions. There is a risk of sepsis with nonsterile injectional therapies.

Most common herbals in pediatrics:

  • Most commonly echinacea, goldenseal, and calendula [13]
  • Also included: garlic, eucalyptus, psyllium, licorice, “Unspecified herbals”, black walnut, ginseng, camphor

Tox pearl: Recall CYP3A4? It metabolizes up to 50% of pharmaceutical medications, thus mixing with St. John’s Wort and Goldenseal can result in high-risk drug toxicities and decreased efficacy.

Other Common Alternative Therapies:

  • Commonly mentioned: chiropractors, osteopathy, massage therapy, reiki, “bone setters”, acupuncture, aromatherapy, relaxation
  • In oncology patients, Faith healing is used in 27%
  • Rare use included folk remedies, hypnosis, energy healing, hormone products, chi, craniosacral manipulation, ear candling, and lifestyle [14]

 

Tox pearl: Many products regulated or banned from sale in the pharmaceutical industry are still federally approved for sale as a naturopathic product – including ethanol in colic drops.

 

Leading Toxidromes with Homeopathy and Herbal Use

Heavy Metal Toxicity [15]

  • Poison Control: 12% of reported cases symptomatic with heavy metals were from homeopathic remedies
    • Includes lead, arsenic, mercury
  • A multinational case series of heavy metal poisoning from homeopathy use had 31 patients with lead, arsenic, mercury, and magnesium poisoning
    • Youngest patient: 9 months

 

naturopathy

 

Allopathic Adulterants [15]

  • 30% of herbal analgesics contain pharmaceutical-grade drugs
  • Most commonly analgesia (acetaminophen) and steroids (prednisolone)
  • 8/11 Chinese herbal creams for eczema contained dexamethasone at inappropriate pediatric doses
  • 40% of herbal asthmatic medications contain steroids

 

Direct Toxicities [15]

 

naturopathy

Figure 2 : Direct organ toxicities from common herbal supplements. There is a specific list of herbal supplements contraindicated in patients with renal disease as well from the National Kidney Foundation. [16,17]

Toxicology Trivia

Unpasteurized breast milk

  • Estimated 50% of infant acquired HIV is through breastmilk
  • “… Exposure to infectious diseases, including HIV, to chemical contaminants, such as some illegal drugs, and to a limited number of prescription drugs that might be in the human milk, … it could, like any type of milk, become contaminated and unsafe to drink.” [18]

 

Camphor

  • Risk of seizures and CNS depression with ingestion, dermal and inhalational exposures to camphor[19]
  • FDA restricts products to have a limited amount of camphor due to seizure risk in pediatrics though many products fail this requirement
  • Seizures may be delayed and require monitoring for a minimum 4 hours

 

Nosodes

  • Health Canada does allow “nosodes” or diluted infectious diseases
  • Cases in Canada have included use of cankers from syphilis patients, other STI, tuberculosis for teething pain, CSF from meningitis patients, and rabies [20]

 

Key learning points

  1. Ask specifically about naturopathic use in pediatric patients.
  2. Consider naturopathic and homeopathic exposures in unusual toxidromes and heavy metal poisonings.
  3. Check with your local pharmacist or online drug manual, and counsel parents, that there can be important drug interactions with naturopathic medications.

Not all things labelled “Naturopathic” are “Natural”, there is a high risk of allopathic adulterans, and pharmaceutical grade drugs contained in naturopathic remedies that also present with toxicities

 

 

 

References

  1. [1] Jean, Dany, and Claude Cyr. “Use of complementary and alternative medicine in a General Pediatric Clinic.” Pediatrics, vol. 120, no. 1, 2007, https://doi.org/10.1542/peds.2006-3105.
  2. [2] Denise, Adams, et al. “Complementary and alternative medicine use by pediatric specialty outpatients.” PEDIATRICS, vol. 131, no. 2, 2013, https://doi.org/10.1542/peds.2012-1220d.
  3. [3] “Apply for Registration.” College of Naturopaths Of Ontario, 29 Sept. 2022, www.collegeofnaturopaths.on.ca/applicants/apply-for-registration/. “What Is the Difference between Naturopath and a Naturopathic Doctor? .” Canadian Association of Naturopathic Doctor, 3 July 2019, www.cand.ca/what-is-the-difference-between-naturopath-and-a-naturopathic-doctor/.
  4. [4] Jean, Dany, and Claude Cyr. “Use of complementary and alternative medicine in a General Pediatric Clinic.” Pediatrics, vol. 120, no. 1, 2007, https://doi.org/10.1542/peds.2006-3105.
  5. [5] Denise, Adams, et al. “Complementary and alternative medicine use by pediatric specialty outpatients.” PEDIATRICS, vol. 131, no. 2, 2013, https://doi.org/10.1542/peds.2012-1220d.
  6. [6] Crawford NW, et. al. A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales. BMC Complement Altern Med. 2006 May 2;6:16. doi: 10.1186/1472-6882-6-16. PMID: 16670012; PMCID: PMC1475886.
  7. [7] Wilson, Kumanan, et al. “Characteristics of pediatric and adolescent patients attending a Naturopathic College Clinic in Canada.” Pediatrics, vol. 115, no. 3, 2005, https://doi.org/10.1542/peds.2004-1901.
  8. [8] Crawford NW, Cincotta DR, Lim A, Powell CV. A cross-sectional survey of complementary and alternative medicine use by children and adolescents attending the University Hospital of Wales. BMC Complement Altern Med. 2006 May 2;6:16. doi: 10.1186/1472-6882-6-16. PMID: 16670012; PMCID: PMC1475886.
  9. [9]The following section is based on an summary of these 4 key studies:Jean, Dany, and Claude Cyr. “Use of complementary and alternative medicine in a General Pediatric Clinic.” Pediatrics, vol. 120, no. 1, 2007, https://doi.org/10.1542/peds.2006-3105.Denise, Adams, et al. “Complementary and alternative medicine use by pediatric specialty outpatients.” PEDIATRICS, vol. 131, no. 2, 2013, https://doi.org/10.1542/peds.2012-1220d.Wilson, Kumanan, et al. “Characteristics of pediatric and adolescent patients attending a Naturopathic College Clinic in Canada.” Pediatrics, vol. 115, no. 3, 2005, https://doi.org/10.1542/peds.2004-1901.Porcino, Antony Joseph, et al. “Pediatric Natural Health Products recommended by chiropractic and Naturopathic Doctors in Canada.” Complementary Therapies in Medicine, vol. 43, 2019, pp. 196–200, https://doi.org/10.1016/j.ctim.2019.02.001.
  10. [10] Auguste, Bourne L., et al. “Use of vitamin D drops leading to kidney failure in a 54-year-old man.” Canadian Medical Association Journal, vol. 191, no. 14, 2019, https://doi.org/10.1503/cmaj.180465.
  11. [11] Levy, Ilana, et al. “Adverse events associated with interactions with dietary and herbal supplements among inpatients.” British Journal of Clinical Pharmacology, vol. 83, no. 4, 2016, pp. 836–845, https://doi.org/10.1111/bcp.13158.
  12. [12] Engelhart, S., et al. “Severe Serratia liquefaciens Sepsis following Vitamin C Infusion Treatment by a Naturopathic Practitioner.” Journal of Clinical Microbiology, vol. 41, no. 8, 2003, pp. 3986–3988, https://doi.org/10.1128/jcm.41.8.3986-3988.2003.
    [13] ASHER, GARY, et al. “Common Herbal Dietary Supplement–Drug Interactions.” American Family Physician, vol. 96, no. 2, 15 July 2017, https://www.aafp.org/pubs/afp/issues/2017/0715/p101.pdf.
    [14] Legislative Services. “Consolidated Federal Laws of Canada, Controlled Drugs and Substances Act.” Controlled Drugs and Substances Act, 1996, laws-lois.justice.gc.ca/eng/acts/C-38.8/FullText.html
  13. [15] Baker, David. Essentials of Toxicology for Health Protection: A Handbook for Field Professionals. Oxford University Press, 2012.
  14. [16] Phua, D. H., et al. “Dietary supplements and herbal medicine toxicities—when to anticipate them and how to manage them.” International Journal of Emergency Medicine, vol. 2, no. 2, 2009, pp. 69–76, https://doi.org/10.1007/s12245-009-0105-z.[17] “Herbal Supplements and Kidney Disease.” Edited by National Kidney Foundation, National Kidney Foundation, 19 Oct. 2023, www.kidney.org/atoz/content/herbalsupp#:~:text=Some%20herbal%20supplements%20that%20act,also%20have%20bad%20side%20effects.
  15. [18] Commissioner, Office of the. “Use of Donor Human Milk.” U.S. Food and Drug Administration, FDA, 22 Mar. 2018, www.fda.gov/science-research/pediatrics/use-donor-human-milk#:~:text=Risks%20for%20the%20baby%20include,has%20not%20been%20adequately%20screened.
  16. [19] Royal Children’s hospital melbourne. “Camphor poisoning.” The Royal Children’s Hospital Melbourne, June 2020, www.rch.org.au/clinicalguide/guideline_index/Camphor_poisoning. Khine, Hnin, et al. “A cluster of children with seizures caused by camphor poisoning.” Pediatrics, vol. 123, no. 5, 2009, pp. 1269–1272, https://doi.org/10.1542/peds.2008-2097
  17. [20] Lindsay, Bethany. “Health Canada Says It Takes Safety ‘very Seriously’ in Face of Concerns about Homeopathic Remedy.” CBC News, 18 Apr. 2018.

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