Sh*t Naturopaths Say, part 7: Mismanaging erectile dysfunction, collagen diseases, and gynecology

Welcome once again to Sh*t Naturopaths Say, my periodic look at what naturopaths say behind closed doors (metaphorically speaking). At least, it’s a look at what they say when they are discussing patient management with their peers. It is a series to which I can add new entires from time to time, thanks to Naturopathic Chat (NatChat, for short), a discussion forum with hundreds of naturopaths as members that also includes someone who goes by the ‘nym Naturowhat and occasionally leaks the content of the forum to a Pastbin. Also, it never hurts to remind my readers of the quackery that is naturopathy given that there is a bill, HB 4531, currently being considered in the Michigan House of Representatives that, if passed, would give naturopaths a broad scope of practice almost equivalent to primary care physicians, like family practitioners or internists. (The only difference would be that naturopaths couldn’t prescribe controlled substances.) So, until this bill is defeated (assuming it’s defeated), I’m going to be writing about naturopathy more than I have in the past.

Before I delve into the latest installment, I fell obligated to emphasize yet again that the vast majority of naturopathy is quackery. Naturopathy, as regular readers know, is a medical “profession” that claims to use the “healing power of nature” to treat disease instead of evil pharmaceutical medicines and surgical steel. Originating in the 19th century German “natural living” movement, naturopathy is based on a vitalistic, prescientific worldview. True, naturopathy does purport to embrace diet, exercise, and lifestyle interventions as a means of disease treatment and prevention, but the problem is that such interventions are already part of science-based medicine and all naturopathy does is to infuse them with pseudoscience. In any event, if you have any doubt just how much naturopathy is quackery, consider this. The One Quackery To Rule Them All, homeopathy, is an integral part of naturopathic training, taking up big chunks of curriculum time in naturopathy schools and even being a part of the naturopathic licensing examination, the NPLEX. In other words, you can’t have naturopathy without homeopathy. Moreover, we have copious examples of the disaster that strikes whenever a naturopath tries to treat a real disease. As if their embrace of homeopathy weren’t enough, naturopaths are also, by and large as a profession, antivaccine to the core, the attempts of the American Association of Naturopathic Physicians (AANP) and other groups to argue otherwise notwithstanding.

When last we left our intrepid band of NatChat naturopaths, they were discussing how to treat a potentially deadly disease, bipolar disorder, a disease that can easily lead to suicide during a depressive phase, with homeopathy. We now pick up on a similar thread that demonstrates naturopaths’ embrace of the ultimate pseudoscience known as homeopathy, this time to treat erectile dysfunction. A naturopath named Melanie Whittaker asks:

Younger gentleman (early 30's) with myasthenia gravis not willing to do Viagra. Asking for some herbal or specific nutritional support for difficulty keeping erections. Suggestions for something that will help? He is on a constitutional homeopathic which will help overall, but of course he is asking for something now to help. Just checking in for more ideas.

Myasthenia gravis (MG), for those unfamiliar with the disease, is an autoimmune neuromuscular disease in which circulating antibodies block nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction; i.e., the receptors that transmit the message from the nerve to the muscle. As a result, the ability of motor neurons to stimulate the muscle to contract is impaired. The main symptom of the disease is painless weakness of specific muscles, rather than fatigue. The muscle weakness becomes progressively worse during periods of physical activity and improves with rest. About 2/3 of the time, the first muscle weakness noted is in the muscles around the eye. There can also be weakness of the muscles involved in swallowing and voice, and facial muscles can be affected. There are different variants of MG, but the usual treatment involves medication that increases the amount of acetylcholine and immunosuppressants. Thymectomy can also alleviate symptoms.

I did a bit of searching on erectile dysfunction (ED) and MG because I’m not an expert in myasthenia gravis. Given that MG is a disease that primarily affects the nicotinic receptors in the skeletal muscle, there is no a priori reason to expect that MG would cause ED. There is, however, a syndrome called Lambert Eaton Myasthenic Syndrome (LEMS), which is related to MG in that it is caused by auto-antibodies to voltage-gated calcium channels at the presynaptic (nerve) side of the neuromuscular junction leading to a reduction in the amount of acetylcholine released from nerve terminals, that has ED as one of its symptoms. Whether or not the MG or LEMS was a direct cause of this man’s ED, I can say for sure that homeopathy won’t help him, nor is whatever homeopathic remedy he’s getting helping him.

So if homeopathy isn’t doing it for this man unwilling to take Viagra or another drug for ED, what is the suggestion? Fortunately it’s not more homeopathy. Unfortunately, it’s saffron, recommended by someone named Jacob Schor:

Daniel Landers reviewed an interesting article for NMJ recently on topical saffron salve.

Topical Saffron for Diabetic Erectile Dysfunction
image
Topical Saffron for Diabetic Erectile Dysfunction
ReferenceMohammadzadeh-Moghadam H, Nazari SM, Shamsa A, et. al. Effects of a topical saffron (Crocus sativus L) gel on erectile dysfunction in diabetics: A ra...
View on www.naturalmedicine...
Preview by Yahoo

and Heather H. wrote a longer review not too long before..... easy, cheap, not viagra.....

Saffron Improves Sexual Dysfunction
image
Saffron Improves Sexual Dysfunction
ReferenceKashani L, Raisi F, Saroukhani S, et al. Saffron for treatment of fluoxetine-induced sexual dysfunction in women: Randomized double-blind pla...
View on www.naturalmedicine...

The articles referenced appear to be this review article and this one, which has nothing to do with ED given that it’s a discussion of a trial in women. In any event, there are apparently a couple of small randomized controlled trials suggesting that saffron rubbed on one’s member can improve sexual function in men with ED due to type II diabetes. One of the reviews mentions that a much larger study failed to find an effect due to saffron. So basically, there’s conflicting evidence: A couple of small trials with positive results and a larger one with a negative result. When faced with such evidence, a science-based physician would likely conclude that saffron either doesn’t work or that there isn’t enough high quality evidence to conclude one way or another.

Not Melanie Whitaker:

WOW, thanks Jacob. I think I should try this on some of my patient population.

Although my M. G. patient does have neurological disease, who knows, maybe this will help even a little.

I was wondering about purity and potency of product for all these trials (like the one that had no results) and where I might get the purist form? or even get some gel-which sounds like I should make it? Saffron is so expensive that there is a lot of fake product out there.

Oh, wait. Saffron is expensive? In any case, one can’t help but wonder how much money is to be made selling saffron to men with ED. Also, one can’t help but point out that MG is not a neurological disease. The nerves function normally; it’s the receptors after the nerves that have a problem, and that problem is caused by autoantibodies to those receptors.

Next up, Ehlers-Danlos syndrome (EDS, to be distinguished from ED), this time from naturopath Pina LoGiudice:

Hello Friends!
Happy 4th of July weekend. I am looking for some assistance with Ehlers-Dalos Syndrome. I have never treated it before and could really use some amazing resources, information, pearls, words of wisdom.

Even if there is any ND that you know out there that has a large knowledge base on the subject or experience, I am happy to refer. The family is here in NY, but they are more than happy to do phone/skype visit.

Thanks for the help!

Ehlers-Danlos Syndrome (EDS) is a collection of diseases of connective tissue caused by a defect in the production, structure, or processing of collagen, the major structural protein in the body. It’s a disease that’s been known for a very long time, its features having been described by Hippocrates. There are several types of EDS with signs and symptoms that can vary from patient to patient but often include hyper-flexible joints, unstable joints, fragile skin, easy bruising, and hyperelastic skin that can be stretched much farther than normal skin. There can be cardiovascular effects, such as valvular heart disease, arterial aneurysms and rupture due to weakened connective tissue in arteries, and GI symptoms, such as gastroesophageal reflux, hiatal hernia, and anal prolapse. Basically, it’s a disease that’s challenging to deal with because collagen is such a critical structural protein, with different collagens being found in basically every body structure, hence the wide variety of problems associated with EDS. Treatment of EDS is basically supportive and palliative. In other words, it’s directed at alleviating symptoms and preventing complications. EDS patients can have a normal lifespan, but if there is blood vessel involvement there is a high risk of arterial rupture and a much-shorted lifespan.

So what do naturopaths suggest for EDS? Anne Van Couvering suggests:

I have been working with a patient who is seeing some progress, but would love to tap in to a doc with more knowledge.

So far, bone broth, cell salts, proteoglycans (aloe, Lions Mane mushrooms) and hormone balancing have been somewhat helpful. Check for SIBO.

A curious note: a colleague in transgender medicine is noticing a larger percentage of her trans patients have ED

That's all I know besides what's in the literature (supremely unhelpful literature, IMHO)

Please keeps me in the loop if you do find someone who knows more!

]

Meanwhile, Phillip Cooper suggests:

Excellent article
Suggests very large co q10 doses among others, hopes this helps. BTW, excellent blog for fibro and CFS.

http://www.healthrising.org/blog/2016/07/01/chronic-fatigue-fibromyalgia-ehlers-danlos-syndrome-diagnosis/

Remember how I like to quote Clint Eastwood as Dirty Harry Callahan in Magnum Force, when he says, “A man’s got to know his limitations”? First, I quote it because it’s true. Second, I quote it because naturopaths don’t know their limitations. I’m sorry, but EDS is a disease of collagen or its associated proteins. bone broth, cell salts, and the like are incredibly unlikely to help.

But what is SIBO?

Glad you asked! SIBO stands for “small intestinal bacterial overgrowth” and is a favorite dubious diagnosis of naturopaths. That’s not to say SIBO isn’t a real condition. It can be. Basically, it’s a condition in which colonic bacteria somehow find themselves growing in the small intestine. The problem is that what real doctors call SIBO and what fake doctors (naturopaths) call SIBO are related only by coincidence, or so it would seem. Basically, if you go to a naturopath with almost any GI complaint you’ll either be diagnosed with SIBO or tested for SIBO. As Mark Crislip remarks, it’s yet another One True Cause of Disease, albeit GI disease, based on naturopaths taking preliminary associations and cementing them into dogma.

Finally, we have this case from Sara Norris:

I've been working with a 41 year female with persistent vaginitis and vulvodynia for the last 5+ years. Pt currently co-maged with a uno-gynecologist and is on ketokonazole qod, caprylic acid po, boric acid pv 2x a week, and vaginal and oral probiotics. Despite this onslaught of anti-candidal treatments her vulvodynia and vaginitis persist, and on 3 repeated DD vaginosis profiles I've seen a 4+ positive for enterococcus faecalis. (I'd love to get her off some of the anti-candida treatments, but she is resisted until current sx resolve)

I've thrown GSE 500 mg bid x 14 d and Cipro 500 mg bid x 5 d, at the enterococcus without any decrease. I see on the sensitivity testing that it will also respond to silver (mod. response), caprylic acid (mod. response), GSE (highly sensitive), ampicillin, and vancomycin.

I'm unable to find any protocols either natural or conventional for this bacteria, yet I read over and over again that this has multi-drug resistance.

Persistent vaginitis can be a difficult problem to manage, but there are treatment options that are still science-based, even after persistence or recurrence after initial treatment. That is, of course, not what Norris’ fellow naturopaths suggest, though. For instance, Kim Furtado suggests a mixture of somewhat sensible with ridiculous:

For this patient, I would suggest some more testing: circadian cortisol and Dhea ; cycling female hormone profile; vitamin D; thyroid panel.

In most persistent cases of vaginitis that I have treated, the key to resolution is treating the underlying environment, not the anti microbial. Very commonly there are severe luteal defects and progesterone balancing helps a lot. I like to use Thymus glandular for restoring immune function. And balancing stress response if adrenal hormones are not balanced. Stress response hinders immune response and maybe why she is not responding.

Also some practical matters, asking about relationship issues, digging a little deeper into her relationship with partner. I refer to Louise Hayes work and Christiane Northrup who write eloquently about vaginitis and vulvodynia and energetic root cause. I generally go so far as to discuss with the woman that the vaginitis or vulvodynia is a physical manifestation of that relationship dysfunction and foster that personal exploration for her to undertake. Also... Asking about sexual practice, anal sex in particular with vaginal penetration afterwards can be a factor with vaginitis. Worth asking about, maybe not relevant.

Yes, in the case of persistent vaginitis, considering the underlying environment can be important. However, thymus glandular is not going to “restore immune function” and get rid of the infection. This is basically voodoo, not unlike the use of bear bile or rhino horn in traditional Chinese medicine. Of course, the part about the “energetic root cause” is nothing more than pure naturopathic vitalism, particularly the part about the vaginitis or vulvodynia being a “physical manifestation” of the woman’s relationship with her partner.

If “engaging the energy” doesn’t work, Nan Dunne Byington wonders if this will:

I have just begun to work with a postmenopausal woman similarly infected. Prior to getting the DD vaginosis panel results that identified the bugs, metronidazole was ineffective but Wise Woman Healing Suppositories were and remain effectively soothing at 1 q 12 hrs. She shows positive for proteus as well, and zero lactobacilli.

Here’s the protocol we have started with:
1. In the evening prepare 1 cup warm water with 1 cap of grapefruit seed extract dissolved and use as a 10 minute retention douche; repeat for 5 nights
2. Take 1 capsule of grapefruit seed extract by mouth 4 times daily
3. Continue Healing suppositories 1 every 12 hrs vaginally for comfort as needed.
4. Thorne Undecylenic acid formula SF722 take one cap by mouth 3 times daily
5. Juglans nigra tincture 1 tsp (120 drops ) three times daily for 5 days, then 3/4 tsp (90 drops) three times daily for 5 days then 1/2 tsp (60) drops) until bottle is finished
6. Continue Enterogenic concentrate by mouth 2 x daily. After the 5 days of grapefruit seed extract douche, start inserting one cap HLC lactobacillis and bifidis vaginally at bedtime
7. She would like to consider vaginal estriol when things have normalized after this antimicrobial course.
8. She will be in touch if not clearly improved in 72 hrs

I’m not sure how effective adding a coco butter based suppository and a probiotic capsule at the same time is going to be, but we’ll find out. I am hoping the retention douche will be the ticket. I will let you know!

I didn’t know what Wise Woman Healing suppositories were; it turns out—surprise! surprise!—that they are homeopathic, calendula 6X based in cocoa butter and vitamin A, which are listed as the “inactive ingredients.” (One wonders why one would bother to put vitamin A into the suppository if it is “inactive.”) Be that as it may, the advice given is a mixture of vitalistic nonsense and herbal remedies galore.

To be honest, I have to conclude that this batch of NatChat leaks isn’t quite as bad as some previous ones. At least, for instance, the naturopaths seemed implicitly to realize that the “constitutional homeopathy” wasn’t working for the MG patient with ED. OTOH, there is also a case of a child with persistent constipation for which constitutional hydrotherapy was recommended. Basically, constitutional hydrotherapy involves the placement of hot and cold damp towels over the chest and abdomen and looks like this:

The bottom line is that naturopathy is at least 95% quackery, and I might be being too generous in my characterization. Naturopaths mix vitalism, herbalism, and a weak understanding of science. Licensing them as health care providers on par with family practice doctors would be a travesty and endanger patients in Michigan and every other state in which bills like HB 4531 are being considered.