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A faulty production line

An apple a day keeps the doctor away

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If only that was true. If the simple ‘Granny Smith’ prevented the swathe of minor ailments that came in each day, I’m sure a GP’s workload would be far better. But did you know that eating an apple daily could stave off the discomfort of acid reflux? And so it would seem can many items found in your local supermarket.

Recently, I’ve had two incidences of positive feedback (yes - it’s amazing!) regarding treatment advice I gave for nausea. In both cases, I had advised eating a humble ginger biscuit and in both cases the feedback was it worked surprisingly well. One patient was shocked that a young-ish doctor like myself would suggest ginger over a prescribed anti-emetic. From personal experience of being on a boat pre- scuba diving, ginger was a great cure for my sea-sickness.

Following on from those episodes, a colleague emailed everyone asking if there were any non-pharmalogical cures for reflux. Homeopathy was mentioned but I suspect a millionth dilution of ‘eye of newt’ or such like is unlikely to cure acid reflux. And that’s where using Dr Google brought up a plethora of websites toting natural remedies for reflux - some of which I had previously heard of such as chewing gum and some that seemed counter-intuitive, but seemed to work, like necking a teaspoon of mustard.

GPs tend to prescribe a lot of medications for common ailments, based on patient demand and the evidence base, but often the horrible side effects can put people off taking the drugs, further leading to re-attendance. I recently found out that a drug I used to prescribe regularly as a hospital doctor, has a less than flattering nickname in some circles because it can make some patients quite paranoid and anxious - not a side effect you want to get just for treating sickness!

Whilst I’m not advocating natural remedies for all ailments, many doctors are probably already suggesting treatments because of previous knowledge or experience, for example sage for menopausal hot flushes, peppermint tea for bowel cramps (peppermint oil is a prescribable drug anyway!), camomile tea for relaxation to name a few.  Since the time of Hippocrates, the bark extract of the willow has long been used in medicine for treating inflammation and fever and now is prescribed regularly for secondary prevention in cardiac disease. Any ideas what it is?

If suggesting natural remedies with little or no side effects can improve a patients’ well-being, save the NHS a few pennies and increase my positive feedback rate, I reckon that’s no bad thing!


Dr Avradeep Chakrabarti is a locum GP in Bristol

Readers' comments (11)

  • I'm sorry but this is the same approach as homeopaths use. No evidence on cure/improvement rate, dose, side effect, comparison with alternative treatments etc etc.

    Don't get me wrong, I'm not against using non medicinal approach - but we can only give professional opinion if we can demonstrate reasonable justifications. Hence we tend to use medications made by pharmaseutical companies as they have been trialled (well kind of).

    Imagine yourself infront of a judge and panel of prominant doctors when you are being prosecuted and telling them you thought ginger nut biscuites were a good idea based on your personal experience with scuba diving and preferred them over "psycho-zine". I know the prosecution will have a field day with that.....

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  • I agree that evidence based medicine should certainly prevail as a general rule. However for very min

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  • Ctd However for certain minor ailments if ginger is likely to help and much less likely than cyclizine to cause side effects than overall is that not a sensible choice. And the evidence base for many of our pharmacological treatments and doses is very poor anyway

    Plus who will fund for a trial of cyclizine vs ginger? Therefore we will always use the pharmacological (and expensive to nhs?) solution...

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  • "if ginger is likely to help and much less likely than cyclizine to cause side effects"

    If you can demonstrate this, that's fine. If not - how would you convince your medical director/GMC panel/Judge/Pt's angry daughter why you thought this was a good idea? I know the author is First5 (i.e. relatively new to primary care) and may not have experienced the wrath of regulators/court but believe me, it'll be more then unpleasant.

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  • Some preliminary studies do support the use of ginger for the treatment of nausea:
    1. 2009 Annual Meeting of the American Society of Clinical Oncologists (ASCO): Abstract 9511. To be presented May 30, 2009.ASCO 2009: Ginger Helps Relieve Chemotherapy-Associated Nausea.
    2. Journal of the American Board of Family Medicine
    Effects of Ginger for Nausea and Vomiting in Early Pregnancy
    A Meta-analysis
    Maggie Thomson, MD, Renee Corbin, MSc, Lawrence Leung, MBBChir, MFM(Clin)Disclosures
    J Am Board Fam Med. 2014;27(1):115-122.
    Don't know about ginger nut biscuits, but the above studies may help convince the jury...

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  • Confusing homeopathy with natural remedies has been exploited by Big Pharma to confuse issues and distract attention from their profiteering. bark of willow is of course the source of aspirin. All opiates are originally natural medicines. The contraceptive pill has source in nature. Anesthetics sourced from snake venom, to name but a few. Most "real drugs" are sourced from animal, vegetable or mineral.
    Too many people who consider themselves to be rational science based types, are ranting like Daily Mail readers every time natural Medicine is mentioned. These loonies have been duped. Of course there is no reason to accept homeopathy, but natural remedies are at the root of almost every prescribed medication.

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  • Medicine is supposed to be something that is good for you that cures problems. If it doesn't cure the problem and brings along new ones, then I wonder at the thought processes of doctor and patient in both prescribing and using. Natural remedies have been around since the dawn of time whereas prescription meds often only a decade or two. The lack of evidence is cited as the reason simple and cheap remedies are not recommended but as the commentator above already stated, evidence based medicine often lacks just that...evidence. As for Homeopathy....I treated 2 of my cats for cancer and heart disease with it (when conventional treatment wasn't even an option) and myself for gall bladder disease. Both cats thrived and survived and lived their full lifespan and my gallbladder does it's job now without problems. 3 out of 3 in just 1 family? That is good enough evidence for me!!!

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  • Clinical hypnotherapy could be considered for many non drug approaches. Used with CBT techniques can aid IBS for instance. This could reduce the drugs bill and patient stress for some. The willing!

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  • Iain,

    You seem to forget "evidence" doesn't just point toward ability to cure but also it's ability to cause harm. Whilst effect of older medication may lack the evidence for effectiveness, we do know the adverse effects. This cannot be said for "natural remedies" hence it's similarities with homeopathy (in terms of evidence)

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  • I suepcted this would be a thorny topic.

    In both cases an evidence based anti-emetic eg Prochlorperazine was prescribed as the primary option for their symptoms with the non-pharm option as a choice. In both cases the patients decided to go for the ginger and didn't take the medication. That was their choice.

    Of course, there are many scenarios eg treatment of sickness due to chemo in cancer patients, where medications are first choice to avoid the risk of severe dehydration and giving something 'herbal' would be risky or simply negligent. I'm not advocating homeopathy but giving appropriate patients (those with mild symptoms) some choice might reduce the flood of minor ailments into GP surgeries each week.

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