Integrative Medicine: Common Therapies and Uses

By: Katherine Anderson, ND FABNODirector, Naturopathic Medicine

Southwestern Regional Medical CenterFor: OAPA Conference

Date: 10/25/2012

Terminology

• Alternative Medicine• Complementary Medicine• Complementary and Alternative Medicine (CAM)• Integrative Medicine

© 2011 Rising Tide

Learning Objectives:

• To name the most common integrative therapies utilized.

• To assess the clinical applications of curcumin, vitamin D, probiotics, fish oil, and soy.

• To evaluate the benefits of acupuncture.

• To recognize the common interactions and safety in the use of natural supplements.

Common Integrative Therapies:

• Neutraceuticals– Curcumin, – Vitamin D– Probiotics – Fish oil – Soy

• Acupuncture• Prayer and Meditation• Exercise (QiGong)• Diet• Massage • Chiropractic

CAM Usage

• 83.3% had used at least one CAM therapy concurrent with their conventional treatment

• When psychotherapy and spiritual practices were excluded, 68.7% had used at least one CAM therapy

• 40% of these had not discussed CAM usage with their physician

• 24.7% of participants used seven or more CAM therapies

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Curcumin

Anti-inflammatory, anti-proliferative and antioxidant properties

Curcumin Pathways

Anti-Inflammatory

• Inflammation plays a major role in chronic illnesses• Blocks NF-kB and Cox-2, inhibits pro-inflammatory

pathways.• Randomized pilot study on curcumin vs diclofenac

sodium (NSAID) on patients with rheumatoid arthritis.– Patients showed significant improvement in both

groups.– Curcumin group showed the highest percentage of

improvement in overall Disease Activity Score and American College of Rheumatology criteria for reduction in tenderness and swelling of joint scores.

Antioxidant

• Potent antioxidant effect, protecting liver cells from oxidative stress

• In vivo study investigating dietary supplementation with curcumin in male rats– Significant increases in

antioxidant activity and phase II metabolic enzyme activity in the liver and the kidney

Anti-Proliferative: Reduced Cancer Rate

• Chemoprevention in colon cancer

• Anti-cancer activity of cancer cell lines including breast, cervical, colon, gastric, hepatic, leukemia, ovarian, prostate, and pancreatic

Vitamin D

• Vitamin D supports immune function.• Deficiency increases risk of autoimmune

conditions.• Research supports use of vitamin D in:

• Cancer• Insulin resistance• Anxiety• Depression.

Vitamin D

• Fat soluble vitamin, acts like a hormone.

• Regulates blood and bone levels of calcium and phosphorous.

• The normal range is 30.0 to 74.0 nanograms per milliliter (ng/mL).

Vitamin D

Autoimmune• Vitamin D is beneficial for

MS patients by suppressing immune mediated disease activity and reducing disease complications.

• 25OH vitamin D levels found to be inversely related to RA disease activity; increased vitamin D intake is associated with lower risk of RA.

Boost immunity

• Children with deficiency in vitamin D have increased incidence of respiratory infections

• Supplementing with Vitamin D in the winter may reduce risk of Influenza A in children

Vitamin D

Insulin Resistance• Low vitamin D levels

associated with risk of insulin resistance and metabolic syndrome.

Anti-Cancer• Daily intake of 1000-2000

IU/day of vitamin D(3) could reduce the incidence of colorectal cancer.

• Levels over 50 ng/ml associated with lower incidence of breast cancer.

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Probiotics

• Beneficial Bacteria• Helps to prevent upper respiratory infections• Enhances mucosal immunity

Weizman Z at al:, Pediatrics 115:5-9, 2005

Hatakka K et al, Clin Nutr Aug; 24(4):481-91,2005

Probiotics

• Reside mostly in our intestines

• Aid in digestion and support healthy immune system

• Promote detoxification, improve colon health, increase nutrient absorption

• Dysbiosis – Poor diet, antibiotic use,

increased stress

Probiotics and Stress

• Stress can cause a deficiency in beneficial bacteria.

• Adding beneficial bacteria can have a positive effect on mood.

• Subjects taking probiotic had reductions in depression and anxiety and improved coping skills to stress.

Probiotics and Cancer

• Probiotics may inhibit growth of bacteria that convert pro-carcinogens into carcinogens.

• Animal studies show inhibitory effects on precancerous lesions in the colon.

• Improvements in chemotherapy-induced diarrhea in colon and breast cancer patients.

Soy: Food Sources

• A plant in the protein family, soy (Glycine Max) produces seeds known as soybeans.

• Soybeans contain protein, vitamins, minerals, fiber and isoflavones (estrogen-like compounds thought to offer various health benefits).

• Soybean-based foods include tofu, soy milk, tempeh and miso. Soy also is available in supplement form.

Value of Soy

• Cardio-protective

• Reduce cholesterol

• Bone protective

• Protective against breast cancer

Soy and Menopause

• Epidemiological data implies lower incidence of menopausal symptoms among women who consume higher intake of soy food isoflavones.

Soy and Breast Cancer

• Soy food consumption did not increase the risk of cancer recurrence or death among survivors of breast cancer.

• Women in the highest intake category of more than 23 mg per day had a 9 percent reduced risk of mortality and a 15 percent reduced risk for recurrence, compared to those who had the lowest intake level

• Results indicate soy consumption may be beneficial regardless of breast cancer diagnosis

Fish Oil: Benefits

• Several studies report possible anti-cancer effects of n−3 fatty acids found in fish oil, particularly breast, colon, and prostate cancer.

• The American Heart Association recommends the consumption of 1g of fish oil daily, preferably by eating fish, for patients with coronary heart disease

• Diets supplemented with cod liver oil. have shown beneficial effects on psoriasis.

Fish Oil: Dose

• The FDA says it is safe to take up to 3000 mg of omega-3 per day. – Note: This is not the same as 3000 mg of fish oil. A

1000 mg pill typically has only 300 mg of omega-3; 10 such pills would equal 3000 mg of omega-3.

• Healthy Greenland Eskimos and found an average intake of 5700 mg of omega-3 EPA per day.

Fish Oil as Prescription Drugs

• Lovaza (EPA and DHA ethyl ester)• Vascepa (EPA ethyl ester) Approved by FDA

2012.

Fish Oil: Cautions and Concerns

• Decreased clotting when taking with blood-thinning medications such as aspirin, warfarin or clopidogrel.

• Those with bleeding disorders such as hemophilia

• Sources of omega-3 may contain the active form of vitamin A. Caution: Hypervitaminosis A.

Fish Oil: Cautions

• Consumers of oily fish should be aware of the potential presence of heavy metals and fat-soluble pollutants like PCBs and dioxins, which are known to accumulate up the food chain.

• After extensive review, researchers from Harvard's School of Public Health in the Journal of the American Medical Association (2006) reported that the benefits of fish intake generally far outweigh the potential risks.

• pregnant and nursing women are advised to avoid eating fish with high potential for mercury contaminants including mackerel, shark, or swordfish.

Garlic

• Antiviral activity– Prevents flu attacks and speeds recovery when

infection occurred (Advances in Therapy, 200, vol. 18 no. 4)

• Caution– Anticoagulant

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Oscillococcinum

• Small, homeopathic dosing• Reduces flu symptoms and duration of the flu• Safe• Avoid

– Coffee– Mint & menthol products

• Take away from food and other medications

Qi Gong and Tai Chi

• Meditative, dance-like movements

Benefits• Increased bone health• Lower blood pressure• Improved heart function• Increased balance• Improved strength and

flexibility• Pain reduction• Less anxiety• Improved immune system

Prayer and Meditation

• Many believe that prayer can aid in recovery, not due to divine influence but due to psychological and physical benefits.

• It has also been suggested that if a person knows that he or she is being prayed for it can be uplifting and increase morale, thus aiding recovery.

Prayer and Exercise

• Other practices such as yoga, t'ai chi, and meditation may also have a positive impact on physical and psychological health.

• Others feel that the concept of conducting prayer experiments reflects a misunderstanding of the purpose of prayer.

• The American Heart Journal study published in the American Heart Journal indicated that some of the intercessors complained about the scripted nature of the prayers that were imposed to them, saying that this is not the way they usually conduct prayer.

Prayer

• Many studies have suggested that prayer can reduce physical stress, regardless of the god or gods a person prays to, and this may be true for many worldly reasons.

• According to a study by Central State Hospital, "the psychological benefits of prayer may help reduce stress and anxiety, promote a more positive outlook, and strengthen the will to live.“

Meditation

• Well known that long term mindfulness meditation enhances cognition

• Study shows evidence of short term meditation (4 day training) improves working memory, attention and executive brain functioning

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Healthy Mind

• Try to decrease stress– Stress adversely affects the immune system.– Certain hormones are released during times of stress

that literally change the biochemistry of your body and your entire immune system.

Medical Qi Gong and Cancer

• Studies show improvements in quality of life• Side effect reduction• Anti-inflammatory effect may provide physical

benefit• Enhances mood

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Regular Exercise

• Reduces stress• Improves circulation• Moves lymph• Increases antibodies and T cells

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Acupuncture

• Widely practiced in the United States and strongly supported with evidence based medicine results.

• Research to uncover additional indications for acupuncture

• Healthcare reform may include alternative medicine therapy language

http://consensus.nih.gov/1997/1997Acupuncture107html.htm

http://www.healthcmi.com/index.php/acupuncturist-news-online/222-obamaacupuncturestlouis56398

StressDepression

Joy

Worry

Grief Sadness

FearFright

Meridian System

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Lung 7

• Weakness or pain of the wrist and hand, pain of the thumb, and shoulder pain

• Headache and stiffness of the neck

• Toothache

• Point Location: On the radial aspect of the forearm, approximately 1.5 cun proximal to Yangxi L.I.-5, in the cleft between the tendons of brachioradialis and abductor pollicis longus.

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Large Intestine 4

• Headache• Hypertension• Nosebleed• Toothache • Tinnitus

• Point Location: On the dorsum of the hand, between the first and second metacarpal bones, at the midpoint of the second metacarpal bone and close to its radial border.

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Stomach 36

• Nausea• Vomiting• Poor appetite• Abdominal pain• Lumbar pain

• Point Location: Below the knee, 3 cun inferior to Dubi ST-35, one fingerbreadth lateral to the anterior crest of the tibia.

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Spleen 6

• Diarrhea• Irregular menstruation• Dysmenorrhea• Infertility• Impotence• Insomnia• Hypertension• Point Location: On the medial side of the lower

leg, 3 cun superior to the prominence of the medial malleolus, in a depression close to the medial crest of the tibia.

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Stomach 36

• Nausea• Vomiting• Poor appetite• Abdominal pain• Lumbar pain

• Point Location: Below the knee, 3 cun inferior to Dubi ST-35, one fingerbreadth lateral to the anterior crest of the tibia.

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Gall Bladder 34

• Tightness of the muscles and joints

• Stiffness of the neck and shoulders

• Sciatica

• Point Location: Below the lateral aspect of the knee, in the tender depression approximately 1 cun anterior and inferior to the head of the fibula

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Liver 3

• Headache and dizziness• Hypertension• Breast pain• Insomnia• Irregular menstruation• Vomiting, nausea, constipation

and diarrhea• Lumbar pain

• Point Location: On the dorsum of the foot, in the hollow distal to the junction of the first and second metatarsal bones.

Theories of Acupuncture:

• Augmentation of Immunity Theory• Endorphin Theory• Neurotransmitter Theory

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Augmentation of Immunity Theory:

• This theory states that Acupuncture raises levels of triglycerides, specific hormones, prostaglandins, white blood counts, gamma globulins, opsonins, and overall anti-body levels.

• http://www.acupuncture.com/education/theory/acuintro.htm

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Antibodies

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Endorphin Theory:

• This theory states that Acupuncture stimulates the secretions of endorphins in the body, specifically Enkaphalins. Enkaphalins are pentapeptides that have opiate qualities and are found in the brain, spinal cord, and other body parts.

• http://www.acupuncture.com/education/theory/acuintro.htm

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Endorphin Release

• The term endorphin consists of two parts: endo- and �orphin, which come from endogenous and morphine, thus creating endorphin, a morphine-like substance originating in the body. The endorphins are released into the blood, and enter the brain in small quantities, and give a good feeling throughout

the body.

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Neurotransmitter Theory:

• This theory holds that neurotransmitter levels are altered by acupuncture.

• http://www.acupuncture.com/education/theory/acuintro.htm

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Role of Acupuncture

Symptoms treated:

– Fatigue– Nausea and Vomiting– Pain– Digestive Complaints– Peripheral

Neuropathies– Hot Flashes

– Headache / Migraine– Insomnia– Xerostomia(dry mouth)– Anxiety– Hypertension

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Acupuncture Precautions/Contraindications

• Thrombocytopenia• Neutropenia• Fever / Active infection• Lymphedema• Edema• Vulnerable Pathological Sites • Diabetics• Confusion and Consent• Hemorrhagic Diseases

Natural Therapies

Evidence-Based Natural Therapies• Published Evidence of Clinical Effectiveness• Scientific Rationale• Safety• Complementary or Alternative?• Risk vs. Likely Benefit• Cost vs. Likely Benefit

© 2011 Rising Tide

Supplement Quality

• Supplements are not well regulated by the FDA.• Supplement Authenticity, Purity, and Potency are

often compromised. 25% of all products tested by ComsumerLab.com are inauthentic, impure, sub-potent, and/or mislabeled.

• Consumers have no way to determine supplement quality by looking at a label.

• CTCA has created a Vendor Quality Assurance program to ensure that products provided to our patients are authentic, potent and pure.

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Thank you