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Don't Fall For The "Naturalistic Fallacy" When It Comes To Health And Ageing

When you search the internet for "natural medicine", around 2.46 billion hits appear, "Holistic Medicine" has 166 million, "Modern Medicine" 889 million and "Drugs" have 5.5 billion.

As an Integrative Health Clinic, we encounter many patients who are seeking a "natural approach", whether it is for their health or in their appearance. The majority of them have already sought these types of treatments elsewhere with varying levels of success.

What is interesting, is that in some patients, the idea that only "natural" is "good" for the body and anything that is "artificial", "synthetic" or "man-made" is toxic or harmful to the body, without truly understanding the scientific process or evolutionary perspective, may have left them at a disadvantage when it comes to making choices.

The Naturalistic Fallacy is a type of moral judgement that we place on the property of something. When something (eg. treatment or modality) is 'natural', it is good, and when something is 'unnatural' it is bad. Fortunately, however, when we apply the scientific process to evaluate the risks and benefits to a tool, treatment or method, we aim to remove or minimise biases (or moral judgements and conditioning) in order to be able to evaluate in context, what is the best approach for an individual.

There are a few examples that I often hear from patients, and I want to share with you why there are traps in this way of thinking:

1. Whether you think it is natural or not, many women will live well past menopause

"I don't want any hormones for my menopause symptoms as they are dangerous and unnatural. I only want natural solutions". Or on the other hand, "Is there any way I can delay menopause with hormone therapy?"

Up until 100 years ago, a woman's average life expectancy was around 54.6 in the US. With the average age of menopause being 51, most women didn't live much longer beyond that. With life expectancy today being around 81 and continuing to rise, it is no wonder that many women are seeking solutions.

Unfortunately, when it comes to hormone replacement therapy or HRT, the medical community has been lagging behind in proactively managing this natural transition in a woman's life. However, there are many medical societies, such as the International Menopause Society, Newson Health Menopause Charity and others that have been educating doctors and patients on what is the standard of care for women in the menopause transition. These have all agreed that the new methods for prescribing hormone replacement therapy, or what is now known as menopause hormone therapy (MHT), is a safe and first-line option for any woman experiencing bothersome symptoms during menopause or peri-menopause. Health professionals have a responsibility in counselling all women on their individual risks. With many studies showing protection and benefits with MHT for women's bone, heart and brain health with body-identical hormones (same chemical structure as what your body makes, but in a lab) and if appropriately and regularly monitored, can be given indefinitely. Woman are now possibly spending 1/3 of their lives in post-menopause, and should be given unbiased, evidence-based and updated options, without the moral judgements and inaccurate information about the tools that modern medicine has developed.

While there are other natural alternatives for symptoms, and some have been shown to be effective, they do not confer the same level of benefit in terms of bone, brain or heart protection. The negative messaging around menopause and the fear of loss of functional capacity and vitality is changing, many lifestyle strategies specific to women, compliment menopause management. There are a wide variety of options available to women, whether it is a lab synthesised medicine, herb or nutrient. Importantly, how safely and effectively can it support a woman's physiology should be the priority. Medicines, herbal supplements and vitamins in its modern form takes advantage of the advances that science has to offer. Free information regarding dietary supplements can be searched at the National Institute Of Health.

2. Decline in functional capacity vitality is a natural process to aging

This brings me to the next misconception that as we age, we should avoid lifting anything heavy, in case we hurt ourselves, is a common belief, especially in Asian or Oriental cultures. Unfortunately, this is also the ethnicity that has a high risk of osteoporosis, due to their smaller body frames. Physical activity, especially strength or resistance training (with bands, free weights or machines), in contrast to endurance exercise (jogging, cycling, swimming), have been shown to protect bone loss and skeletal muscle loss (sarcopenia) as we age.

Physical strength, is correlated with reduced mortality and cognitive health. While it is 'natural' that we lose bone and muscle strength as we age, these can be mitigated with maintaining physical activity, instead of reducing it. Studies show that older individuals who continue to stay active at around the same level of intensity, can maintain their cardiorespiratory (heart and lung) fitness and can reduce their muscle loss by 50%. But, if you are sedentary or resistance training is new, ease into it as the greatest improvements are seen in those who go from the lowest 20th percentile to the next. There is also the option of finding a professional who can guide you into physical activity safely.

3. Effectiveness of natural alternatives:

"I have high cholesterol, but I was told that statin drugs can cause dementia and diabetes. What about taking red-yeast-rice as this is more natural?"

There appears to be some misinformation amongst some holistic practitioners, but despite good intentions, unfortunately, have not provided the context to the information that they are giving. Statin therapy has clear benefits for patients with atherosclerotic cardiovascular disease (ASCVD) as secondary prevention. These are patients who have had previous events or known cardiovascular disease, and statin therapy to lower LDL cholesterol has been shown to reduce further stroke or heart attacks. There are no 'natural' alternatives that have shown the same clear benefits.

In primary prevention, however, it appears that it requires a nuanced approach, as age, individual behaviours, genetics and residual risks have important implications for the individual, and the issue is not a matter of an interventions being 'natural', but rather a balance of long-term risk, effectiveness of the intervention and the potential side-effects - all of which can be measured, monitored and managed. Apart from red yeast rice, other 'natural' interventions that have been reported to lower cholesterol or prevent heart disease include omega-3 fatty acids, niacin and plant sterols.

Unfortunately, in cases where significant levels of cholesterol reduction is required, these therapies have not been shown to be effective when compared to drug therapy or have the outcome studies to show that it prevents cardiovascular disease. In addition, the doses required for benefit for some of these molecules such as omega-3 are quite high and has to be taken with caution. (ie. increased risk of bleeding and bruising). In the case of niacin, high doses lead to an unpleasant flushing of the skin.

Observational studies showing increased risk of diabetes and dementia does not indicate a causal relationship, as there are too many confounding variables. At this current time, and until we have better evidence, the benefits on cardiovascular protection, still outweigh the risks.

While I appreciate that more people who are taking drug therapy for primary prevention can also prevent it's progression with lifestyle changes, rather than only relying on medicines, this requires a completely different structure and framework of healthcare that currently exists. This is another topic altogether. And the lesson here is that we need to be cautious with blanket statements about any kinds of therapies, as there are many nuances when managing complex conditions.

When it comes to navigating natural therapies there are a few points that I suggest you consider:

  1. Is there a gold standard treatment for the condition and what is it? How does the effectiveness and risks compare?

  2. Is there a known mechanism of action for this treatment?

  3. What is the standard dose and length of time required for efficacy?

  4. Is there a safety profile for this therapy? ie. is there a toxic level and in what organ?

  5. Is there a way to objectively measure treatment progress?

  6. What is the level of evidence for its use? eg. cell studies, animal studies or human clinical trials?

  7. Are there any side effects and how likely are they to occur? eg. liver dysfunction, nausea, headaches, skin rash

  8. Are there any potential interactions with other medicines, supplements or herbs? eg. reduced absorption of hormones, delayed metabolism of antibiotics and increasing their side effects etc.

Navigating natural therapies can be confusing. Since this area is not stringently regulated, and there are no repercussions for mis-information, it is often left to the patient to discern for themselves. But being systematic in asking for the evidence, risks and benefits of therapy is an essential skill when seeking a health provider for advice. Remember to ask those questions, do your research from reliable sources, and don't fall for the "Naturalistic Fallacy" that anything natural is safe, equally effective and without side effects.

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