A few evenings ago I was sitting on a rough cedar deck, watching sunlight orange across the tops of the poplar and maple canopy, and thinking how nice it was to be visiting my friend’s house in the forest: the nestled feeling, the total privacy, the familiar smells. He confessed that, sometimes, he too liked to imagine his house from the perspective of a guest, walking through his gardens, up the wooden steps, and into the kitchen with the eye of an outsider, taking the time to appreciate it without the preconceptions and perceptual habits that develop after living in a place for an extended period of time. Perhaps it was the effects of the mixture of Schisandra kombucha, gin, and tonic water we were drinking, but this short exercise in mindfulness seemed to me as both a useful habit to practice and also a profoundly important skill for the modern human. We are so entrenched in our politics, our communities, our niches and worldviews that, without occasionally looking at life from outside the fences, we might run the risk of missing out on an important and useful perspective.
I have also been thinking a lot about the Food and Drug Administration recently. Don’t get me wrong – there are serious issues around funding, connections to the food and pharma lobbies, and separation from nature that continue to concern me about this regulatory body’s work. But I have been trying to walk these familiar corridors (herbalists versus the FDA) with an outsider’s eye. In the last year, there have been more and more inspections of natural product manufacturing facilities. The government is trying to identify “new” dietary ingredients and regulate their use. There is both clamor and confusion rising up from those who make and sell products that are used under the umbrella of “complementary and alternative medicine”. What is going on here, and why? What might we learn by observing the situation?
Since 1994, when the US Congress passed the Dietary Supplements Health and Education Act (DSHEA), we have seen many, many new “dietary supplements” on the shelves of our food stores and pharmacies. Many of these products have come on to the market because DSHEA allows a fuzzy “gray zone” between food and medicine: while recognizing that supplements are more than vegetables, it doesn’t require that they be tested for safety and efficacy the way prescription and over-the-counter drugs are. This has allowed a profitable industry to grow in the United States, where annual sales of products labeled as “natural” and falling under the legal aegis of DSHEA top $28 billion, according to the Nutrition Business Journal. (http://newhope360.com/2010-supplement-business-report-0)
Out of these annual sales, herbal products account for about five billion annual dollars, or just under 18% of the total. Within this five billion, it is hard to assess what percentage of products are made from refined, concentrated botanical constituents (such as curcuminoids, or silymarin) versus crude whole-plant encapsulations, tea blends, and tinctures – but suffice it to say, the bulk of that five billion annual dollars is not finding its way into the pockets of small-scale, heart-centered local herbalists! So, in sum, at least 82% and probably over 90% of what makes up the “natural products” industry isn’t “natural” at all: it is either a cocktail of vitamins and minerals, a sports nutrition or meal replacement product built up from processed constituents, or some other mixture of naturally-derived, refined, or outright synthetic ingredients. We may have encountered pieces of these products in nature at some point, but never at these doses. In certain cases, they are completely new to our physiologies.
Take the case of grapefruit seed extract. The FDA has been warning manufacturers of this “natural” antiseptic and antibiotic agent that their products may contain triclosan (an antiseptic linked with bacterial resistance and toxicity); the American Botanical Council suspects that these extracts are adulterated purposefully to increase their antibiotic power (http://cms.herbalgram.org/herbalgram/issue94/QUALCONTROL_gfse.html). Others feel that the extensive processing that the original grapefruit seed slurry undergoes actually generates triclosan-like compounds (http://herbsandinfluenza.com/blog/2006/12/22/grapeseed-extract-explained/). Regardless, you either have an adulterated product (falsely labeled!), or a product that has undergone extensive chemical alteration, resembling grapefruit seeds less than high fructose corn syrup resembles an ear of corn. This isn’t a natural product at all.
So whether it be an antibiotic derived from chemical manipulation, a mega-dose vitamin, a solvent-extracted slurry of connective tissue from a shark, or a digestive enzyme obtained from a genetically-modified Aspergillus fungus, I fear that our “natural” products bear little resemblance to those found on the shelves of natural food stores in the 1980s. Even more disturbingly, most of what’s out there (with a few rare exceptions, like folic acid) shows very little evidence of helping for any problem whatsoever. Where do we see a consistent body of research and a rich depth of traditional use? It’s in herbal medicine – less than 1/5 of what’s on the shelves. Most of these other “natural” products are marketed on the basis of petri dish experiments, fruit fly studies from fifty years ago, anecdotal testimonials, or in some cases, just snazzy packaging. Some of them contain toxic, drug-like ingredients. It is no wonder the FDA is trying to get a handle on this situation (as it already has with the amphetamine-like additive DMAA http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm302133.htm). It is also no wonder that we are starting to see more and more reports of vitamins, minerals, and other supplements potentially doing us more harm than good: they are at best weak drugs, and at worst untested, potentially unsafe, chemical additives.
What put this over the top for me was a discussion I had when I recently visited Bastyr University, the premier training ground for naturopathic physicians in the United States. Out of the 299 credits required for graduation, there are five credits devoted specifically to botanical medicine. Over seventeen are assigned to physical medicine (somatic therapies involving touch, manipulation, etc), and over eight for homeopathy (http://www.bastyr.edu/academics/areas-study/study-naturopathic-medicine/naturopathic-doctor-degree-program#Curriculum). Where are the herbal materia medica classes? Where are the topics on complexity in medicine, the study of interactions between multilayered living botanicals and multilayered living humans? These are the roots of naturopathic medicine, but they seem to be nourishing less and less of the Bastyr curriculum these days. So can we really be surprised that some practitioners recommend abstracted, drug-like “natural” products to their patients instead of teaching them to brew tea and walk in the forest?
Natural products aren’t real, folks – but fortunately, herbal medicine is. Herbal medicine is traditional medicine – for over 80% of the world, but for us in the “developed” world, too. Along with ancient somatic and energetic therapies like massage and acupuncture, all tied together by a rich and meaningful mythology, herbal medicine makes up this tradition. Modern alternatives – be they the mainstream technological medicine, or “CAM” technological medicine – are just that: a different choice, some of which is well validated for use in health care, some of which lacks any validation whatsoever. But neither prescription drugs, over-the-counter pills, or that 80% of “natural” dietary supplements can come close to providing the breadth, depth, and accessibility of true traditional medicine.
It is time for herbalists to affirm that our plants are not “complementary and alternative” to technological medicine. Our medicine is real, and just as real vegetables are not a complement to frozen dinners and meal replacement shakes, true botanical medicine is not some kind of extra adjunct to pharmaceuticals and surgical interventions. It is a birthright. It is a daily gift. Its memory is visibly encoded in our genetic material. And it is being practiced everywhere, in kitchens and apothecaries, in modern production facilities and improvised forest clinics. We as herbalists – the growers, the clinicians, the wildcrafters, the medicine-makers, the keepers of wortcunning, the storytellers – have been sinking our roots back into the tradition over the last few decades. Now, having moved well past the embryonic stage, and our cotyledons fully unfurled, it is time to rise up and proclaim what makes us unique: we are traditional medicine, we are integrated ecology, we are plants. Argue all you want about what is “mainstream” and what is “alternative” – we as herbalists are neither. We are tradition, we hold the roots. Now let’s stand up and let others know the deal. As Rima Staines simply put it (http://intothehermitage.blogspot.com/2012/01/rise-root.html): rise and root. Think as a plant does: up, up! and down, down! One movement in many directions, many directions with one focus.