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  • Writer's pictureDr. Bow Tie

Meme-d Misinformation About Medical Management, Part 2: Let's Tackle The Meme

If you haven't already, read Part 1 of this 2-part post, which is sort of my mea culpa on behalf of the field of medicine - acknowledging those who have been mistreated, and calling out those who have taken advantage of the mistreated to spread fake medicine.



Now that you've done that...let's talk about the disinformation in the meme.


"Magnesium instead of stool softeners (which apparently “dehydrate the bowel”)": Magnesium comes in several different forms, different anions attached to the magnesium cation. Magnesium oxide is the most common form for replacement. Magnesium hydroxide however, and some of the other forms, can work as laxatives, because a side effect is diarrhea. There is a particularly funny Reddit post of someone describing their explosive diarrhea after drinking magnesium citrate (they wrote it humorously).

However, while magnesium works well for some people, it does not work the same way for all. Some people have to take magnesium for a deficiency or for muscle cramps and they get the diarrhea. Some don't! Some even get constipated, which is the opposite of what this meme intends. Which, admittedly, is part of the problem with some supplements - which we'll get to later.

Also, stool softeners aren't known for dehydrating your bowel. That's a concern with overuse of laxatives (like many of these magnesium products). So this is encouraging you to take the supplement which could potentially cause the problem (if overused)! These product names are not interchangeable. And there you see the problem with posts like these.


Changing diet instead of giving Prilosec:

WE DO recommend that! That is always part of the treatment - figuring out which foods trigger one's heartburn (because that recommendation is not one-size fits all). That's not always enough or possible. Some folks can't afford to buy and eat less acidic foods. Some try to eat healthy and they still get heartburn. Every time they lay down to rest they cough or they hurt. Enter medications like omeprazole (Prilosec).

That said, proton-pump inhibitors like omeprazole are not meant to be long-term medications for everyone. We have found that long-term use of PPIs may be associated with osteoporosis and colon cancer (LONG-term use only, not short-term, and causation is not 100%). That's something we didn't know at first and have since learned, so we have stopped leaving people on PPIs indefinitely - we switch them to another medication or decide if the GERD requires further investigation.

But, uh...leave food fermenting in your body? There was some suspicion that they may alter fermentative processes in the body, but that has not been borne out in research. This is fearmongering.


Herbs and certain foods also heal: No idea what this is supposed to mean. It is way too broad a platitude in terms of what "herbs and certain foods" are and also what "heal" means.


"Lower toxic chemicals in your home when you have constant headaches and allergies": This is an overly simplistic attempt at a solution. Any chemical is toxic in a high enough amount, and everything in our life is chemicals. "Toxic chemicals" is meaningless until you find out which substance is triggering your headache or allergy, which often takes time and consideration, which if given enough time, a doctor will try to go through with you. Again - EVERYTHING is chemicals. For example, water is a chemical and too much (especially in the wrong route) can kill you (an example is drowning).


"Grapefruit will 'naturally' lower your blood pressure and that's why you can't eat it while on blood pressure medications":

This is a fundamental misunderstanding of what happens in the human body. If grapefruit worked as a natural blood pressure treatment, we probably wouldn't see nearly as much high blood pressure as we do. It certainly would not be one of the most common conditions throughout the US (of course, I would probably still get high blood pressure because I can't stand grapefruit).

Grapefruit interacts with an enzyme called CYP3A4 in the body. This enzyme affects a lot of different types of medications, including one of the components of Paxlovid (remember when I talked about this a few posts ago?). Grapefruit inhibits the enzyme, which may prevent the body from breaking down certain meds (causing them to linger in the body longer) or render others less effective if your body can't metabolize them. That's why you have to be careful with grapefruit and certain medications.


Activated charcoal for headaches/bloating/gas, skin issues, colds, food poisoning?: Apparently it's a miracle substance - which is how you know this claim is probably false. There is no evidence to show that activate charcoal helps with most of that. "Binding toxins" is a buzzword phrase that is often used in the pseudoscience community with very little evidence behind it. Activated charcoal is used sometimes in the immediate aftermath of ingesting an overdose of certain medications or a poisonous or toxic substance (there is a time window) for a progress called chelation, but that does not solve anything but the immediate problem, and it does not work on all substances. It will not work on corrosive substances like bleach, or on alcohol, and it definitely does not work on viruses.


Herbs and herbal teas to support immune and digestive functions:

Again, really broad claim here, with no evidence to support it. Yes, there are certain herbal teas that work for some folks' digestion, but they don't have the same effect for all, or their side effects are not tolerable (cramping, etc.). None of them "support immune function."


Daily probiotic (immune functions, clean/balance bowels, regular absorption and elimination, stop colds and allergies):

The evidence for probiotics is sparse, outside of certain specific situations. I often prescribe it alongside certain antibiotics to prevent diarrhea and certain bowel infections which can arise, but for the average person? The data is not as clear if it does anything at all. That said, if you take one and it is working for you, that seems generally okay.


Diet/lifestyle plans instead of pills (because diet & lifestyle are a major cause of all illnesses):

So, the meme creator is almost correct here, in that doctors have not always had enough training in nutrition. I did have some education, and I have learned some things over the years, but I also rely on hospital dieticians to help me in my job, and in primary care it's the same, except that outpatient dieticians are not always covered by insurance or available to patients. So that part is difficult. That said, diet and lifestyle only go so far. They are certainly not "a major cause of all illness" (again, far too broad of a claim with no substance and some try to use this to lead into germ theory denialism).

Yes, a healthy diet, exercise, keeping stress down, healthy socialization, all can contribute to health, and people love to say that if someone is obese or sick (this happened a lot with COVID-19) that they should just exercise and eat right (leaving off that for some folks, even with proper exercise it's HARD to lose weight). In recent years we have realized that a HUGE factor in health is socioeconomic status. It is hard to consistently buy healthy foods (which are often more expensive), make time to exercise, and avoid stress without money to support good habits. Hell, it's hard to go to the doctor and afford one's medication without money to pay for it and a way to get there. But insurance will actually cover some medication costs, way more than it will cover non-pharmaceutical services.


So yes, many of us do try to discuss diet and lifestyle with patients, but either it's not feasible due to external factors or we are simply not granted the time, which is a frustrating limitation.


Take supplements before you get sick: There is no evidence that supplements will "boost your immune system" (because that's not how the immune system works, which I have discussed previously). As my friend Dr. Zachary Rubin puts it, the immune system is not a muscle that you can exercise. As long as you eat a somewhat balanced diet and don't have any specific vitamin deficiencies, no supplement will help your immune system or prevent you from catching COVID-19 or any other communicable illness. DEFICIENCIES in these substances can be problematic, but there is no evidence that "extra" will help.

This is an example of what's called the "appeal to nature" fallacy. "Because it's natural it must be better, right?" Except that all of the "natural" supplements are unregulated. There are some companies that are supposedly more reliable than others, but just because they aren't strictly a pharmaceutical company does not mean they aren't made by a corporation (or a disinformation-mongering grifter like one from the Disinformation Dozen I talked about in Part I) looking for your money. There are examples of supplements that may help with certain conditions (red yeast rice for cholesterol, saw palmetto for enlarged prostate), though often the evidence is scant, even with somewhat larger trials, and the supplements themselves have such varying (unregulated) amounts that it's hard to know if you're getting an effective dose.

I was reminded of a resource on the Wellness: Fact vs. Fiction podcast - fact sheets on most known supplements (and the evidence or lack thereof behind them), linked below.


Besides, if these supplements were really as foolproof as they say, some corporation would be seizing on that. They aren't some big secret that "doctors will never tell you about!"


Bottom line - memes are not reliable health information sources, and even though people claim to be "just asking questions," the misinformation can be dangerous.


Continuing my points from Part I: Healthcare is a challenging aspect of our lives these days, and doctors have not always done the best job of meeting patients where they are to tackle that. We are increasing awareness of that and trying to change (but institutional inertia is hard to shake). That includes both admitting our mistakes while continuing to fight disinformation and regain public trust.


As a patient, if your doctor does not make you feel heard, bring that up if you feel comfortable or - and this is okay - find a new one. If the doctor gets upset at you for seeking a second opinion, that's on the doctor, not you. You deserve a doctor who is both evidence-based but also understanding of your needs. We cannot always condone an alternative approach if there is not enough evidence to support it, but we can discuss it.


I hope this has helped. As always, I welcome your questions.


Resources:

Proton-pump inhibitors for GERD: https://pubmed.ncbi.nlm.nih.gov/26742290/

Grapefruit Interactions With Meds: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3589309/

Uses of Activated Charcoal (and where it doesn't work): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620762/


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