Natural remedies: when it is time to see a doctor

It usually starts the same way. A tiredness that will not lift, a stomach ache that comes and goes, sleep that no longer restores you, a cough that sounds different. Someone suggests a tea, someone else a supplement, and you decide to wait and see. For a mild symptom in an otherwise healthy adult, a few days can be reasonable. But a baby with a fever, a pregnancy, an older adult, someone on a blood thinner, or a person with cancer, diabetes or heart disease should not wait: call a doctor soon.

The trouble starts when wait and see becomes weeks. Meanwhile, the underlying cause, which could be anemia, a slow thyroid, high blood sugar, high blood pressure, reflux irritating the esophagus or an infection, is still there and nobody has looked at it. A remedy that takes the edge off can make a symptom feel tolerable, and that delays the very visit that would explain it.

This guide is not a list of remedies. It is a guide to deciding when going it alone stops making sense, what “natural” really means, and what a medical visit can do for you. It is general information, not a diagnosis, and it does not replace an evaluation by a doctor.

“Natural” describes where something comes from, not whether it is safe. The National Center for Complementary and Integrative Health (NCCIH) at NIH says safety depends on the specific product and that each one should be considered on its own. A plant can be strong, can interact with other medicines and can harm an organ: NCCIH notes, for example, that kava, a plant, can cause liver disease.

A supplement is not held to the same test as a medicine. According to NCCIH, a dietary supplement maker does not have to prove a product is safe or effective before selling it, and what is in the bottle may not match the label. Labels on supplements also cannot claim to diagnose, treat, cure or prevent a disease.

Evidence varies widely from one product to the next. Evidence is stronger for some uses than others; for many products it is limited or mixed and more research is needed. A useful question is: what does the research say about THIS product, for THIS problem, in someone like me?

Natural and medical are not opposing camps. Sleep, regular movement, a balanced diet, stress care and not smoking support general health; they are part of good medical care and do not replace treatment. What does not help is using a remedy to avoid a diagnosis.

Dr. Diana Nieves Castro is a general practice physician licensed in Puerto Rico with several years of emergency-department experience. In an online visit she evaluates what is going on, asks questions and, depending on your case, treats, prescribes when appropriate or orders labs.

She is a licensed medical doctor and her approach is integrative within medical care: a medical assessment first, then sleep, nutrition, movement and stress, with medicine when it is needed, along with a review of EVERYTHING you take, including prescriptions, over-the-counter medicines, supplements, herbs and teas.

Lab orders help move from guessing to knowing. Depending on your case, she can order lab work when it is clinically appropriate for what you describe, at a nearby lab. The follow-up visit is for reviewing results and refilling non-controlled medicines. For ongoing problems, see chronic care and primary care.

What to have on hand: the bottles or a photo of what you take (with doses), since when, and what you hoped it would do, plus a short list of symptoms with dates. Tell us what you already take or want to try; the medical assessment comes first, and then you decide together what fits, including what the evidence supports and where it is limited or mixed.

Online visits are only for people physically in Puerto Rico, including visitors and cruise passengers. If this is an emergency, call 911.

If a symptom has been with you for weeks, or you take herbs or supplements along with prescribed medicines and nobody has reviewed them, book an online visit. Bring your bottles to the video call so she can review them along with your symptom. Supplements are not approved to treat disease, and this guide is general information, not a diagnosis.