HOLISTIC HEALTH - January 2019

Complementary/Integrative Therapies that Work

 

by Nancy Russell, M.D

 

About one-third of U.S. adults in 2012 reported that they used complementary therapies in the preceding year, according to data from the Centers for Disease Control and Prevention. Studies show that 12 percent to 64 percent of patients do not disclose this use to their physician. The American Academy of Family Physicians advocates for evidence-based evaluations of integrative medicine to facilitate education, treatment, and counseling of patients. An article from the American Family Physician Journal, published September 1st, 2016 discusses evidence for eight of the best-studied integrative interventions, which primary care physicians should consider incorporating into their practices. The article was entitled, Complementary/Integrative Therapies That Work: A Review of the Evidence. 

 

1. Acupuncture in general, is extremely safe, with the most common risk being transient mild discomfort. Acupuncture is a component of traditional East Asian medicine that involves the insertion of needles at specific points on the body to facilitate the recovery of health. A 2012 meta-analysis of pooled data from 29 studies involving 17,922 patients found that acupuncture was effective for treating chronic low back pain compared to sham acupuncture and no treatment. 

 

2. Coenzyme Q10 (CoQ10), also called ubiquinone, is an antioxidant found in high concentrations in the heart. It has a role in mitochondrial electron transport and in supplying myocardial energy. CoQ10 levels may independently predict mortality in heart failure patients. A 2013 meta-analysis of 13 randomized controlled trials found that CoQ10 increased net ejection fraction by 3.7% and was safe, well tolerated, improved symptoms and reduced major cardiovascular events in patients with heart failure. It was advised that CoQ10 is an adjunctive therapy and not be used alone to treat heart failure.

 

Exercise for Anxiety was studied with a review of 37 meta-analyses studies with a total of 42,264 participants to show a small but meaningful average anti-anxiety effect. Most studies evaluated the effect of aerobic exercise, although strength training may be effective as well. For patients unable to perform vigorous exercise, qi gong, a gentle form of exercise that originated in China and yoga also show promise in reducing anxiety symptoms. Exercise may have a modest benefit in treating depression. 

 

Fish Oil, the omega-3 fatty acids EPA and DHA treatment, have been shown in multiple studies to lower triglycerides. EPA/DHA at a dosage of 4 grams or 4000mg per day decreased triglycerides by 25 to 30%. Although elevated triglycerides levels are associated with increased cardiovascular mortality and fish consumption two to four times a week is associated with lower cardiovascular mortality in cohort studies, it is not known if the triglyceride-lowering effect of fish oil supplements decrease cardiovascular events. Given the safety of fish oil, it seems reasonable to consider it as a means to lower triglyceride levels, while recognizing that its effect on patient-centered outcomes must still be determined. Nordic Naturals and Metagenics fish oil have some of the best safety records for pure fish oil without contaminants. 

Ginkgo biloba leaves have been studied extensively for the treatment of Alzheimer’s dementia and vascular-type dementias. Its proposed mechanism of action include preservation and improvement of mitochondrial function, promotion of hippocampal neurogenesis and neuroplasticity, and enhancement of cerebral blood flow. The extract EGb 761, a dry extract of the leaves standardized  to 22% to 27% gingko flavanoids, has been most extensively studied. An analysis of 7 controlled studies with 2,684 patients with Alzheimers or vascular type dementia showed that standard measures of overall cognition and activities of daily living improved in those who received ginkgo extract at 240 mg per day wheras 120 mg per day was ineffective. Effectiveness of gingko biloba was similar to those of anticholinesterase medications currently available for the treatment of Alzheimers-type dementia. It is reasonable to recommend gingko biloba as an alternative first-line treatment for dementia. 

Mind-body Interventions for insomnia such as hypnosis, meditation, guided imagery, mindfulness-based stress reduction, cognitive behavioral therapy (CBT), biofeedback, yoga, traditional Chinese practices (e.g. qi gong, tai chi) and music therapy represent safe and cost-effective treatment options. A 2015 systematic review found that CBT was the most effective mind-body intervention for insomnia. Explore which option is best for you based on cost and availability. 

Probiotics for prevention of antibiotic-associated diarrhea have been researched. The most commonly studied probiotics include Lactobacillus species, Bifidobacterium species and saccharomyces boulardi, a non-pathogenic yeast. A preventative effect occurred regardless of species, age group or duration of therapy. Typical dosages studied were 5 to 10 billion colony-forming units in children to 10 to 20 billion per day in adults. Patients should be advised to start the probiotics within one to three days of starting antibiotics and take for one week after stopping. It is important to take the probiotic at least 3 to 4 hours away from the antibiotic. 

St. John’s Wort, or Hypericum perforatum, have been evaluated for treatment of depression symptoms and major depressive disorder in adults. In a 2008 Cochrane review, St. John’s wort was found to be more effective than placebo in mild to moderate depression. Therapeutic doses range from 500 to 1200 mg per day; a commonly recommended dosage is 300 mg three times a day or 450mg twice a day. The mechanism of action in not entirely clear, however it is generally safe with side effects comparable to placebo. Caution is advised as it can interfere with serotonin psychiatric medications, birth control pills, some antibiotics, digoxin, protease inhibitors and certain immunosuppressive medications. For patients with mild to moderate depression who prefer not to use conventional antidepressants, St. John’s wort is a reasonable first-line treatment. 

 

The lack of adequate regulation of herbs and supplements by the U.S. Food and Drug administration makes it difficult for consumers to be assured of the quality and safety of a specific supplement. Ask you physician for names of reliable brands of high quality or assess them at ConsumerLab.com and the U.S. Pharmacopeial Convention http://www.usp.org/dietary-supplements/overview.

 

 

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