Reader QnA: Do natural remedies like cranberry juice and honey really work?
A look at: urea; honey; probiotics; cranberry juice; cloves
Dear community,
Here we are in the thick of summer, many of us grappling with increased home demands (hello, lack of affordable childcare and summer camps or school in many places). And some of us are trying to find our equilibrium amongst visions of what we think summer should be about and what we’re dealing with day-to-day.
I hope many of you are able to find ease and moments of unhurried leisure and connection in this season. Remember that we are the only ones who can make the changes that allow for this to happen. I’ve started re-reading a childhood favorite book — and it’s been lovely.
Today’s letter settles the score on several natural remedies that affect health, inspired by a question from ST from New York, USA — some of which may be familiar and some not. Let me know in the comments what’s new or surprising for you here — I’d love to hear from you.
Please let me know here if you have another question or two you’d like me to look into in the future.
For paid subscribers, we’re gearing up for our next Ask Dr Devika B ‘community corner’ chat, where we get together by Zoom to learn from each other and build community. If you’d like to participate, please take 1 minute to fill out this survey.
Yours in health,
Dr Devika Bhushan
Settling the score on 5 natural remedies
From turmuric chai lattes to jade stones, going ‘natural’ seems to be all the rage these days.
And many of us assume that if it’s found in nature and is relatively unprocessed, that it must be good — or at least better than the alternatives — for us.
But remember that deadly poisons abound in nature, too, from snake venom to botulinum toxin (when ingested) — and we’d be wise to apply the same degree of scrutiny to our considerations around natural remedies as manufactured ones. Let’s examine the evidence together for health impacts of five common natural remedies.
1. Urea
Remember that Friends episode where after jellyfish stings, various of the Friends peed on each others’ wounds? Turns out they were on to something.
Urea is a byproduct of protein breakdown that we pee out and it’s also an essential component of the outermost layer of our skin (the stratrum corneum in the epidermis), helping with skin integrity, moisture, and keeping microbes out.
It’s been used by humans for centuries in the form of urine and today, a synthetic formulation is commonly used in topical ointments to treat dry skin and conditions like eczema, psoriasis, ichthyosis, and others, and when used in combination, can help other topical agents penetrate further (like in a fungal infection). I’ve seen urea-based treatments do wonders for skin rashes of all kinds, including diaper rashes. And it’s generally well tolerated with few side effects at low concentrations, but at higher concentrations, some people experience burning or irritation.
Takeaway: Use urea-based topical products as needed with confidence, knowing they have a long tradition in human history and are safe and well tolerated.
2. Honey
There’s good news here. But first, an important caveat: In the first year of life, consuming honey in any amount is not safe because of the small but serious risk of ingesting the bacterial botulinum toxin (also found in dirt and other foods, like those canned at home). This can lead to botulism, whereby the nerves controlling muscles are inhibited or stunned (same mechanism for how botox works cosmetically), which can cause babies’ respiratory and other muscles to weaken and even become paralyzed, requiring hospital-level support. (The reason young babies are more susceptible to botulism has to do with their immature immunity and lower level of gastric acidity — acidity kills the spores in older people).
However, for children older than 12 months and adults, honey can have beneficial properties, especially in viral colds — as an antioxidant and antimicrobial agent.
Based on randomized controlled trials, ingesting honey once a night for up to three nights (with no additional benefits beyond this time span) shortens the duration of viral colds, specifically reducing cough frequency and improving nighttime sleep, when compared to no treatment or usual supportive treatments, and at a rate similar to cough suppressants. Of note, pharmaceutical cough suppressants are not safe for kids 4 years and below, so honey makes for a cough-suppressing alternative that’s safe and just as effective. And when used topically in pressure injury dressings, honey can even speed up wound healing by 2 days.
Potential side effects of ingesting honey, presumably related to the sugar content, could be hyperactivity or even trouble sleeping (thrice the risk, relative to the cough suppressant dextromethorphan, but low overall at 9.3% of kids treated with honey).
Takeaway: In addition to other home remedies for a cold (like fluids, anti-pain/fever medications as needed, exposure to humidified air, nasal saline or petroleum jelly, cold or frozen foods, gargling with salt water, and mentholated rubs on the chest), a teaspoon of honey at night for up to 3 nights can reduce nighttime coughing and improve sleep.
3. Probiotics versus fermented foods
Probiotics are a multibillion-dollar industry: they package up a combination of healthy gut microbes into a supplement that can be taken by mouth and can in theory populate the gut with healthier and more diverse flora, with potential immune and other health benefits.
In gut diseases like inflammatory bowel disease and irritable bowel syndrome, certain probiotic formulations can be helpful in reducing relapses.
But in many healthy people, these supplements can turn out to do more harm than good: taking probiotics can actually make gut microbiome less diverse and less healthy by tipping the balance of microbes in your gut to predominantly the few types in the supplement and crowding out other needed strains. This can be counter-productive.
In one randomized study of healthy adults, after a course of antibiotics — which generally wipes gut flora — people either received a probiotic supplement, a stool transplant collected from their guts prior to the antibiotics, or nothing.
The results? Stool transplants normalized gut flora fastest — within 8 days — followed by the control group, who had no intervention after antibiotics — and normalized within 3 weeks.
And the probiotic group’s microbiomes? They hadn’t normalized even after 5 months. In other words, taking probiotics significantly delayed microbiome normalization after antibiotics. Even the group who did nothing afterwards fared far better.
According to another randomized study, the better way to increase gut diversity and lower inflammation is to target fermented foods like kombucha, yogurt, and kimchi — making use of nature’s best sources for not just probiotics (the microbes that set up shop in our gut), but also of prebiotics (the fiber that the microbes eat) and postbiotics (the nutrients they make). The study also found immune benefits from high-fiber diets.
Takeaway: Consume a wide variety of high-fiber, nutritious foods, including fermented items, for optimal gut health and immune function.
4. Cranberry juice
Guess what? The old adage that drinking cranberry juice will prevent urinary tract infections (UTIs) has been extensively studied — and it turns out to be… TRUE.
A Cochrane review (which formulates available evidence into an overall conclusion and possible recommendation) found that based on 50 studies of varying quality (26 included in calculations, including randomized trials):
Compared to placebo or no treatment, cranberry products (juice, tablets, cranberries) reduce the risk of recurrent UTIs in women by 26%, in children by 54%, and in anyone undergoing a surgical intervention (which increases of infection) by 53%.
However, cranberry products are of minimal help to those with greater underlying risk for UTIs, like elderly people who are institutionalized, people with bladder emptying problems from neuromuscular causes, and pregnant people.
A word of warning: cranberries do not treat an active infection — so they’re not of help once you begin to have symptoms — but can be preventive if you’re prone to UTIs.
What are the mechanisms here? Cranberries prevent adhesion of UTI-causing bacteria like E coli to the urinary tract and can also reduce bacterial virulence.
Takeaway: If you’re at risk for repeated UTIs after having had 1 or more — especially serious infections — consider regularly consuming solid cranberries (the data doesn’t imply a specific dose just yet). Though juice has been studied more often, solid cranberries should also contain the active ingredients that work against infection and are healthier, given the much less sugar absorption for any solid fruit over its juice formulation.
5. Cloves
Last one for you today: let’s look at cloves — which are antioxidant; antimicrobial; anti-inflammatory, and anesthetic.
I’m going to focus in on their anti-pain uses in the mouth. As someone who had their wisdom teeth into adulthood and had an acute infectious episode requiring urgent surgical removal on a Sunday (good luck with this, even in Boston, MA, where the density of dentists is absurdly high): I can tell you that cloves made all the difference for me while I was awaiting removal.
Clove gel has shown anesthetic benefit for children and adults prior to dental injections, in one case comparable to the topical anesthetic, benzocaine.
Takeway: If you have mild oral pain, try chewing or pressing a whole clove or two at the site of pain for some relief. To liberate more anesthetic, you might even consider juicing or mashing the clove and applying the pulp to the site. Of course, don’t delay seeking dental attention as needed, but this can be very helpful while you’re waiting for that call back and definitive action.