Pills, And Better Than Pills (February 12, 2019)
So the last time I forced my way into your Inbox, I was lamenting the unnatural love affair that Americans have with pills. We may be trying to shun medications, but that doesn’t mean that we don’t enjoy the emotional comfort of swallowing a pill. (Or powder. Or extract. Or capsule. Which I consider to be all pill-like objects, so for the sake of brevity, I’m lumping all supplements into the category of “pill”.)
I am unhappy about this inclination because pills are most emphatically NOT the best way to get and stay healthy. We do THAT by eating properly, sleeping and exercising enough, keeping our weight within normal limits, and shunning alcohol and tobacco. Stuff that is a lot harder to do than taking a pill – and usually far more effective as well.
When you starting internet’ing around for alternatives to drugs and surgery, the reason that you tend to first stumble on ads for pills is NOT because they are the best solution to a health problem. You see those ads for pills not because supplements are so helpful, but because they are so profitable.
Almost no one actually manufactures their own supplements. You see a zillion different products out there because any random idiot can buy the components (the vitamin E, the curcumin, the bee spit, whatever) from one of the very few companies that DO manufacture them. Then he can have them mixed up all up together, packaged it in a colorful bottle with a clickbait-type name, and sell it to you for ten times what it cost him to put it together. That's how your doctor can sell you a bottle of vitamin C with his name on it for far more than it would cost you at Costco. And it's not one whit better.
A new supplement (especially one with a trendy ingredient) is appealing. It’s kind of sexy, and doesn’t require a lot of thinking to buy and swallow. A new pill has all the promise of the out-of-town expert (who inevitably turns out to be no more than a guy with good hair and a briefcase), and in the end is just as big a disappointment.
Supplements are relatively cheap, easy to take, and something you can talk about to other people when you’re tired of hearing about THEIR medical problems. Does that make us bad people for liking them? Are they really so worthless?
Well, no. They aren’t worthless at all. You just need to go about this rationally. Anyone who is thinking about taking a supplement should be thinking
1) Exactly why do I want to take this thing? (For example, “because I have sleep issues” is too vague an assessment of the problem. You need to get specific, like “I want to stop waking up at 1:00 every morning with the theme from ‘Game of Thrones’ racketing around my head”. Something that helps you stay asleep works differently from something that gets you to sleep, so you need to clarify your problem down as precisely as you can. A lot of people think their problem is "arthritis" when it's really just "my shoulder hurts after I mow the lawn".)
2) What does the supplement do exactly? (How does it work? if that’s known.) Does it address the problem you want it to address?
3) Is this pill the best solution to the problem identified in 1)? (There may be supplements that help you stay asleep. But a mindfulness procedure is far better than any supplement out there for that purpose. See Andrew Weil's "4-7-8" procedure.
Anyone who wants a non-conventional solution to a health problem should start with a medical website. I know that sounds counterintuitive. But the respectable medical websites designed for laypeople, like https://www.webmd.com and
have undergone a profound change in the last ten years. They've lost the game, and they know it. People are going to go alternative whether they like it or not. So since they can't beat 'em, they've joined 'em. You can research any alternative you are curious about on their websites and get good, evidence-based information. Wa hoo! Score one for the good guys.
Medical people used to pooh-pooh the heck out of every alternative treatment out there. The good ones no longer do that. You know why? Because not only is there now considerable evidence for a number of alternative treatments for different conditions, but those treatments will almost never get you in trouble.
Any doctor worth his/her salt realizes that the human collateral damage resulting from standard American medical care is horrendous. If you want to try glucosamine for your knee instead of the arthroscopy that your doctor already knows has nothing to recommend it, or fish oil instead having your chest cracked, any decent doctor is 100% behind you – as long as what you’re trying has at least a smidgen of evidence to support it.
Now if it turns out that there really IS a great supplement out there for what you need, you look on www.consumerlab.com
to find out which brands actually deliver. (Plus you can turn around and look up disorders on that site as well, to see which supplements have evidence for helping the problem you have.)
So, after all that, there are two rules of thumb to keep in mind when you are considering a New Pill. The first one is that a lifestyle change is almost always far more effective in changing a health condition than any supplement you can take. The other one is that usually old pills work better than new ones – or, at least we have a lot more evidence for their efficacy, which is practical terms is the same thing. And you can check out both those things on the internet very easily and reliably.
I know I’ve said a lot of this before. I repeat it because it is sound, accurate, and won’t get you in trouble. How much in the real world meets those three tests? Not much in the area of medical treatment, that's for sure – so I’ve said it all again. And probably not for the last time.
--dr. diane holmes
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