Chapter 18

Complementary and Alternative Medicine

I. Complementary and Alternative Medicine (CAM): What It Is and Who Uses It?

    A. Nonallopathic medicine is known as complementary/alternative medicine (CAM).

       1. Is generally not taught in medical schools, although many medical schools are offering a course or two in CAM

       2. Is generally not reimbursed by third-party insurance.

    B. One in three American sought some form of alternative care in 1993. In 1998 that jumped to  47%

        1. Estimated expenditures for alternative medical services are about $27 billion.

        2. The most frequently used alternative include relaxation techniques, chiropractic car, massage, self-help, energy healing as well as others.     

        3. Americans also used acupuncture, homeopathy, herbal therapies and supplements, and spiritual healing, to name a few (see table 18.1).

        4. Nutraceutical use is on the rise. Combined nutritional and pharmaceutical benefit derived through the use of foods or food supplements.

    C. The National Center for Complementary and Alternative Medicine (NCCAM) resides within the National Institute of Health. It broadly groups CAM practices into five major domains:

        1. Alternative Medical Systems

        2. Manipulative and Body-Based Methods.

        3. Energy Therapies.

        4. Mind-body Interventions.

        5. Biologically Based Treatments

II. Alternative Medical Systems

    A. Eastern medicine has been influential in today's alternative therapies

        1. Ayurvedic medicine, a method of treatment from ancient India, Uses observation and touch to assign patients to one of 3 types. Once classified, diet and herbs are used to help heal.

        2. Traditional Oriental Medicine diagnoses are based on history, observation of the body (especially the tongue), on palpation, and on pulse diagnosis. Considerable skill is required.
              a. Treatment includes dietary change, massage, medicinal teas and other herbs, and acupuncture.   

        3. Surveys confirm that CAM has been used for decades through the world. Chinese medicine is thousands of years old

    B. Other alternative systems include homeopathy and naturopathy.

        1. Homeopathic medicine is an unconventional Western system that is based on the principal that "like cures like." Substances that cause illness in large doses can cure it in small doses.   

        2. Naturopaths view diseases as the body's effort to ward off impurities and harmful substances from the environment. 

                a. Treatment uses substances and forces found in nature: water, magnets, gravity, heat, crystals, and minerals, herbs, and the sun.
                b. Returning to a natural, purified state restores health.
                c. Naturopathic Doctors receive four year graduate degrees from accredited schools.   Accreditation means a certain set of classes were in the program does not attest to the quality of the information.

III. Manipulative and Body-Based Methods.

    A. Chiropractic medicine is based on the idea that life-giving energy flows though the spine via the nerves system, and subluxations can disrupt that force.

        1. A chiropractor usually has had the same number of hours of training as a non-specialized physician.

                a. They are licensed and regulated by the state in which they practice.

        2. Other specialties that involve manipulation of the body include doctors of osteopathy (D.O.)

IV. Energy Therapies    

    A. Energy therapies focus on energy fields originating with the body or on fields from other sources. Examples include qi gong, reiki, and therapeutic touch.    

        1. Qi gong is a component of traditional Chinese medicine and combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi), improve blood circulation, and enhance immune function.    

        2. Reiki is based on the belief that by channeling spiritual energy through the practitioner, the spirit is healed, and heals the body.

        3. Acupuncturists in the U.S. have either completed a postgraduate program or become certified and are sate-licensed.

    C. Acupressure does not use needles, the practitioner applies pressure to critical points to balance yin and yang.

V. Min-body Interventions.

    A. Mind-body interventions facilitate the mind's capacity to affect bodily function and symptoms.

    B. Yoga is one of the most popular alternative fitness programs available.

        1. It focuses on contemplation and meditation as well as breathing techniques.

        2. The program enhances flexibility, calms the spirit, and reduces stress, strengthens the back and reduces pain, while promoting personal control.

    C. Tai Chi is an ancient exercise program called moving meditation. It improves balance, fitness, and bodily control.

    D. Body work consist of several different forms of exercise:

        1. Feldenkrais work is a system of movements, floor exercises, and body work designed to retain the CNS to get around blockage or damage. Great for rehabilitating trauma victims.

        2. Rolfing is aimed at restructuring the musculoskeletal system by working on tension held in deep tissue. Rolfing involves applying deep pressure and can cause release of repressed emotions.

        3. Shiatsu makes use of firm finger pressure on the specific points on the body to increase circulation of vital energy.

        4. Trager work uses gentle rocking and bouncing motions to induce deep, pleasant relaxation.

VI. Biologically Based Therapies

    A. Biologically based therapies include use of dietary supplements.

    B. Herbalists and homeopaths practice herbal medicine based on the theory that the administration of extremely diluted doses of potent natural agents that produce disease symptoms in healthy people will cure sick people.

        1. Herbal and homeopathic medicines are common in Europe and Asia.

        2. Care must be taken to be sure that the practitioners are well trained in herbal nutrition, diagnosis, mixing of herbs and in follow-up skills.

    C. Up to 80 percent of the world population relies on traditional medicinal systems including the use of herbal medicine

        1. Some Important considerations when considering herbal remedies include:

            a. Tinctures contain grain alcohol to prevent spoilage and are the best herbal option.
            b. Freeze-dried extracts are also very stable.
            c. Standardized extracts are among the more reliable forms of herbal preparations. Not all extracts are standardized in their potency or composition.
            d. Herbal remedies are milder than their synthetic counterparts, however they are still drugs and should be taken with care.
            e. Herbal remedies can interact with food and other drugs so care must be taken to understand their effects.

        2. For more information, consult The Complete German Commission E Monographs which has evaluated more than 380 herbal remedies and approved over 250 for use (see Table 18.2)   

        3. Ginkgo Biloba is used to treat depression, impotence, premenstrual syndrome, diseases of the eye, general vascular disease and to improve short-term memory and concentration.

            a. Some research has supported its minor benefits in improving memory in people with mild to moderate dementia.
            b. If using, take 40 mg tablet three times a day for a month and look for signs of improvement. If there is none, stop using  this supplement.
            c. Ginkgo acts as a blood thinner and so care should be taken not to combine it with other blood thinners such as aspirin. Other side effects include headache, dizziness, stomach upset, and allergic reactions.

        4. St. John's Wort is used to treat mild depression by maintaining serotonin levels, help as a sleep enhancer, support immune system function in fighting viral infections.

            a. Some research has supported its mild antidepressant and immune supportive effects.
            b. Side effects include GI upset, fatigue, dry mouth, dizziness, skin rash, and itching.
            c. Never use St. John's Wort with any other antidepressants because of the risk of overdose. It is not recommended for women who are pregnant or nursing.

        5. Echinacea is known to stimulate the immune system increasing the effectiveness of white blood cells against bacteria and viruses.

            a. It helps in treating colds and flu symptoms, but the jury is still out on its preventive ability.
            b. Do not use if you have autoimmune disorders such as arthritis, are pregnant, breastfeeding, have diabetes, multiple sclerosis, or are allergic to daisies.

    D. Dietary supplements are produced that are intended to supplement or add to the diet and contain one or more of the following ingredients: vitamins, minerals, amino acids, herbs, or other substances that increase total dietary intake, and is intended for ingestion in the form of a capsule, powder, soft gel, or gel cap and is not represented as a conventional food or as a sole item.

    E. Ergogenic aids are taken to increase work output and to include bee pollen, caffeine, glycine, carnitine, lecithin, brewer's yeast, and gelatin.

        1. Muscle enhancers include androstenedione, typically called "andro", and creatine.

            a. "Andro" is produced in the human body naturally and is the precursor to testosterone.

                i. It is said to enable an athlete to train harder and recover more quickly from workout.
                ii. The NCAA, NFL, and the Olympic Committee have banned the use of "andro".
                iii. Its chemical structure is similar to anabolic steroids, making it dangerous.

            b. Creatine is said to help optimize the muscles' energy levels, but research does not bear this out. Side effects include muscle cramping, muscle strain, and liver and kidney damage.

        2. Ginseng is believed to effect the pituitary gland, increasing resistance to stress, affecting metabolism, aiding skin and muscle tone, and providing hormonal balance necessary for healthy sex life. There are many other purported benefits.

            a. Where the ginseng is grown greatly affects its usefulness and potency.
            b. Side effects include nervousness, insomnia, high blood pressure, headaches, skin eruptions, chest pain, depression, and abnormal vaginal bleeding.

        3. Glucosamine stimulated the manufacture of a substance necessary for proper joint function and joint repair. It is effective in the treatment of osteoarthritis and related degenerative joint diseases. It also relieves swelling and decreases pain. It is very safe for use.    

        4 SAMe has been reported to treat mild to moderate depression by affecting nor adrenaline, serotonin, and dopamine. It is also reported to be effective for bone and joint health.    

            a. Seems to trigger heart problems in people with family history of heart disease.

            b. Care should be taken with this drug until more research is done.

        5. Antioxidants include beta-carotene, selenium, vitamin C, and vitamin E. Taken in large doses these can have adverse effects. Care should be taken not to use in amounts greater than recommended. See the nutrition chapter for more information.    

    F. Functional foods are often used for their health benefits (see Table 18.3).

        1. Excellent sources of antioxidants include sweet potatoes, tangerines, and red peppers.

        2. Alliums, which reduces blood clotting, are found in onion and garlic. Garlic lowers cholesterol, lowers blood pressure and has antibiotic properties as well. 

        3.Oat fiber lowers LDL and stabilizes blood sugar levels.    

        4. Soy protein lowers risk for heart disease, helps with symptoms of menopause, lowers risk of osteoporosis in postmenopausal women and may protect against some cancers.

VII. Protecting Consumers and Regulating Claims.

    A. The United States does not regulate over the counter products as strictly as other countries such as Germany. Issues of consumer safety and protection from fraudulent claims pose serious questions about our current regulatory system

    B. Pressure is mounting to establish consistent standards for labeling the precise amount of chemicals in a product, and how much should be used.

    C. The German Commission E  is an expert panel which conducts formal evaluations of herbal remedies. It reviews all research and claims and makes decisions on how the herb should be used best.

    D. The National Center for Complementary and Alternative Medicine has an annual budget of $50 million. It is housed in the National Institute of Health. It's function is to fund projects and research to show whether claims are true or false.

VIII. Health Living in the New Millennium.

    A. CAM is gaining widespread acceptance in the United States, however mainstream medical practice has been slow to catch on.

    B. Insurers are hiring alternative medicine practitioners or covering their care as routine benefit in  many cases.

    C. When considering alternative treatments, remember that natural is not always safe, herbal supplements may not be pure in the United States, dosage levels of herbs are not regulated in the U.S., always look for the word standardized on the herbal products and these are not miracle cures.