Complimentary and Alternative Medicine February 21, 2006 Questions and Answers
Does garlic clove thin the blood like garlic herb? Yes it does. In fact, the raw garlic clove, in large amounts (much more than what you would find with simple cooking amounts) has the key compounds which will actively thin the blood. Are doctors well versed in the interactions of medicine with complimentary and alternative medicine? Some are and some aren‟t. This is something that you can find out quickly for yourself by simply asking your physician. There are several resources available for physicians and patients which specifically address the potential interactions of prescribed medications with CAM. I placed several of these resources in your PowerPoint handout. More and More physicians are obtained continuing education on this topic to better address the needs of their patients. What are the harmful effects of Endothil-CR for body building? Is a 16 year old boy at risk for using it? There are quite a few discussion sites on the internet about Endothil-CR. I have observed both good and bad comments about it. Its major ingredient of any importance appears to be riboflavin which can be purchased at a much cheaper rate than Endothil-CR. It seems that the most benefit to muscle mass gain is through the awkward work out regimen they enforce with their product. Talk about Aleve, please. Is it bad for kidneys? Aleve is known generically as naproxen sodium. It is a non-steroidal anti-inflammatory drug much like aspirin and Advil. Aleve is eliminated by the kidneys and, as such, must be used with caution. Some individuals have high sensitivity to the kidney function altering effects of Aleve (~15% of the public). Those individuals at especially high risk are those who use Aleve frequently for chronic pain and discomfort such as that associated with osteoarthritis. The following web site provides good detailed information about Aleve. Your clinician can tell you if you are a good candidate for Aleve. (http://www.rxlist.com/cgi/generic/naprosyn_wcp.htm) What is lecithin and why is it supposed to be a good supplement? Lecithin is also known as phosphatidyl choline and is an important building block of cell membranes. It is deemed to be important in neural and cardiovascular health although this is a very general statement since lecithin is important for everything anyway. Our livers do a fine job of making all of the lecithin we need if our diets are appropriate. Most supplemental lecithin comes from eggs or soy. Any lecithin you obtain from your supplement that you don‟t utilize is simply eliminated from your body. Again, if your diet is well-managed, then more than likely, you probably don‟t need the supplement. Your clinician can help you determine if lecithin supplementation is necessary for you. Tell us about polycosonol for lowering cholesterol. Dosages? Does it work? Policosanol is an extract from the wax of the sugar cane plant or from bees wax. It has also recently been extracted from soy. There are some studies which suggest it may be as effective as the “statin” group of prescribed medications for cholesterol lowering. Unfortunately, the advocates
for polycosonol also suggest that it must be used with coenzyme Q10 supplements and others. Here is some of the scientific research information: systematic review and meta-analysis of 52 randomized trials with 4,596 patients weighted estimates of % change in LDL (compared with placebo) -11% (vs. -2.3%) for plant sterol and stanol esters 2-9 g/day based on 23 trials with 1,662 patients -23.7% (vs. +0.11%) for policosanol 5-40 mg/day based on 29 trials with 2,934 patients pooled withdrawal rates due to adverse effects 0 for plant sterols and stanols and 0.86% for policosanol Reference - Pharmacotherapy 2005 Feb;25(2):171 policosanol natural mixture of higher aliphatic primary alcohols isolated from sugar cane wax about 60 studies with about 3,000 subjects, but nearly all studied funded by product developer in Cuba; no published data on non-Cuban populations mean LDL cholesterol reductions have ranged from 11% to 24% with 5 mg/day, 21% to 27.5% with 10 mg/day, and about 30% with 20 mg/day; no further reduction with 40 mg/day; long-term maintenance demonstrated in studies lasting 1-5 years policosanol 10 mg/day and lovastatin 20 mg/day had similar efficacy in 12-week randomized trial of 53 patients with diabetes with hypercholesterolemia (Int J Clin Pharmacol Res 1999;19(4):117) very few side effects in postmarketing surveillance studies with 27,879 patients (Curr Ther Res 1998;59:717) and 6,611 patients (Cur Ther Res 1999;60:458) Reference - Alternative Medicine Alert 2004 Apr;7(4):37
o
Are statin drugs safe and effective? Do they affect enzymes in your heart? The statin drugs are prescribed agents that have been shown to effectively lower certain types of cholesterol and perhaps even improve HDLs (your good cholesterol). No drugs are completely safe and the statins do have a history of rather bad side effects in certain individuals. The statins can raise cardiac enzymes including troponin, CPK and CPK-MB. Is there something other that statin drugs to lower cholesterol? There are several categories of prescribed medications for lowering cholesterol. Your clinician is the key to successfully selecting the appropriate medication for your needs since each person is different in terms of their cholesterol ratios and responses to these drugs. There are several CAM modalities for lowering cholesterol and these can be found on the NCCAM web site that I provided during the lecture. Also, look at this web site for a nice overview of CAM and cholesterol: (http://www.clevelandclinic.org/health/health-info/docs/3700/3713.asp?index=12110&src=news) Probably the best way to manage cholesterol is to eat a balanced diet and maintain a regular exercise program (as directed by your clinician). Please discuss complementary or alternatives for lowering cholesterol other than statin drugs, Niacin or gemfibrozil. If Red Yeast, how much, where obtained? Please see the answer above. Red yeast has been suggested to provide for improved cardiovascular health. Some suggested doses range around 600 mg twice a day with 50 mg
coenzyme Q10 twice a day. I direct you to an article found here: (http://www.medicinenet.com/script/main/art.asp?articlekey=14999) Any facts on Red Yeast Rice, said to lower cholesterol? Should it be taken with CoQ10? Please see answer above. Why is there not more nutritional education taught in medical school? Shouldn’t this be the first avenue of wellness for everyone? Most medical school curricula incorporate a vigorous program of nutritional education. At DMU, nutrition and preventive medicine/wellness are a major constituent of our students‟ didactic and clinical experience. Other than the fact of being “coated” what is the significant health issue of the coated vs. uncoated supplement? Some supplement materials may be upsetting to the stomach lining. As such these supplements often come with a coating that allows it to be dissolved later in the digestive tract. Usually, however, they just recommend taking their supplement with food or beverage. My husband was told by his doctor to take Niacin along with prescription drugs to help with his cholesterol/HDL/LDL. How do we know that the OTC Niacin is really what it says it is? OTC niacin can actually come in a couple of forms (nicotinic acid or nicotinamide). The dose is the major important factor. If niacin were prescribed, it would usually come as a 1000mg or 2000mg dose given one to three times a day. Lower doses just don‟t seem to have any major effect on cholesterol. OTC doses are relatively small although I have seen 500mg and 1000mg OTC doses. These can be relatively expensive and therefore it may be cheaper to simply get a prescription dose from the physician. Again, this depends on the physician‟s recommended dose. Higher doses tend to cause flushing of the face and neck. If this occurs, consult the physician for further advice. Certainly, the quality of OTC niacin can be a concern although most brands sold in the US are relatively contaminant-free. Do you know of any effective complementary and/or alternative medications for Parkinsons? (antioxidant to fight free radicals, anything to help with depression) A new fruit, ACAI, is said to have 5 times the amount of antioxidants as blueberries. Is this necessarily helpful since the body can only metabolize a certain amount of anything at one time. Parkinson Disease is primarily a degenerative type of CNS disease where the patient simply cannot produce appropriate amount of neurotransmitter dopamine. Recently, several studies looking at acupuncture and Parkinson Disease have been funded by the NIH (NCCAM). Antioxidant supplementation, alone, has not been shown to provide resolution, prevention or palliative assistance to patients with Parkinson Disease. A full regimen of dietary change may be useful as a pilot study in 1991 carried out by Dr. Stanley Fahn of Columbia University suggested that one can lower the risk of developing Parkinson's disease by reducing one's intake of animal fats and sugar, avoiding excessive exposure to metals such as aluminum, iron, manganese, mercury, cadmium and copper, and by ensuring an adequate intake of antioxidants.
What’s the deal now with calcium? How much or how little will cause kidney stones? Is the recommended dosage still 1500 units a day? Calcium should be supplemented with the advice of a clinician since some individuals are more prone to stone development than others. The recommended dosage changes with age although most supplement at 1000-1200 mg per day. Any dose of calcium supplement should be taken with sufficient hydration to reduce the incidence of stone development. Can you tell me anything about milk thistle for liver disease? Is one company any better than the other (more reliable) in the supplements and herbs they sell? I direct your attention to an article from the National Library of Medicine: (http://www.ahrq.gov/clinic/epcsums/milktsum.htm) Milk thistle does appear to contain compounds that may be protective of the liver. There does not appear to be a gold standard for milk thistle sources although a German source (Madaus) appears to have the most attention from the general public.
I have used coumadin blood thinner for over 20 years. The insurance company insisted that I try warfarin. My blood thinned dangerously. Why is it supposedly the same as coumadin? I direct your attention to the following web site: (http://www.coumadin.com/coumadin/home/index.jsp?BV_UseBVCookie=Yes) Your insurance company should have discussed with you that Coumadin is the company trade name for the drug warfarin. Most all drugs have at least three names: a generic name, a trade name, and a chemical name. Coumadin is simply the trade name and warfarin is the generic name. They are one and the same. Additionally, the insurance company should have discussed this with your prescribing clinician before making the change. Occasionally, the generic version of the drug can have some slight manufacturing differences; these should be taken into account in a discussion with your clinician. What foods, minerals or vitamins should be taken with iron? I direct your attention to the following web site: (http://ods.od.nih.gov/factsheets/iron.asp). Iron supplements should only be considered after a discussion with your health care professional. That same discussion should include any other food, mineral or vitamin concerns. Most often, iron supplements are taken alone with any other food or vitamin recommendations or concerns. However, additionally dietary red meat can raise your total iron intake to non-recommended levels. I take calcium, Omega – 3 fish oil, and vitamins A –E. Any supplemental suggestions to add or subtract? How much medication is too much medication? I also like Centrum multivitamins. (I am an 18 year old male) The supplements sound fine although at the young age of 18, your diet will mostly command your need for supplements. If you are eating a normal balanced diet, your need for supplements is minimal (and may save you some money). Often the recommended daily intake on the supplement container is a safe choice for dosage. Any excess you will simply eliminate from your body unused. How does one discern between herbal remedies and other non-prescription cures? For example, where does Zycam fall? Zycam would legally fall under the category of “supplement” since its main „active‟ ingredient is the metal „mineral‟ zinc. Herbal remedies have their basis in plant sources.
Talk about bottled water. I‟m for it. I drink it myself. I suppose it really depends on the source and the content of the bottle water. If it is simply purified water, then it is primarily substantive. If it is from a „spring‟, it probably has nutritive value with the mineral content. My major concern would be the use of bottled water in infants and children. If it is their primary source of water, then they would be missing out on the fluoride supplement of the „tap‟ water and therefore would not receive the benefits to dental health. How do you choose what complementary medicine to use and how should begin researching a complementary treatment? I am especially interested in cancer treatment. Begin with your curiosity as a guide. The internet has much information for you. Begin with a “Google Search” (www.google.com) using the key words „CAM‟ and „cancer‟. I would direct you to the following web site at the National Cancer Institute: (http://www.cancer.gov/cancertopics/factsheet/therapy/CAM) This is a nice place to start in your search. Why don’t truth in advertising laws prevent fraudulent health claims? Often the advertiser follows the truth in advertising stipulations of federal law. Unfortunately, semantics can often be employed to vary the truth and this is where good common sense and a critical conscience can provide the best protection. Is psychotherapy a complementary therapy? Psychotherapy is not considered a complementary or alternative therapy. It is a portion of our current western medicine and is clinically useful in supplementing other therapy modalities. We know that the success of treatment of many diseases often requires successful application of psychotherapy. For example, clinical depression, alcoholism, drug abuse, schizophrenia, anxiety, attention deficit hyperactivity disorder (ADHD), etc. What is to say that complementary and alternative medicines aren’t just under the bias of “if I believe it will work, then it will?” This same statement can be applied to our current medical system. It is difficult to surmise the efficacy of treatments without also including the „placebo effect‟. That is, how much of the healing occurs simply through faith, belief, trust, self will? Perhaps this may be the key to successful healing with some drug therapies, healing touch, acupuncture, cancer remission, etc. There is some funded research being done on this and can be found on the NCCAM web site. How do you explain people who improve their health by taking supplements that did not contain any medications? Please see the answer above. Do you anticipate insurance companies will pay for acupuncture? How long does it take for such to become effective? I believe there are some companies that will pay for acupuncture procedures although I do not have that information immediately available. Often, it takes quite a bit of time for the insurance company to research the efficacy of the modality to determine if it is in their financial best interest and the interest of their insured members to cover the cost of such treatment. For an example of the time it takes, only recently has chiropractic been covered by some insurance providers.
What, if any, opinion do you have on the book “Natural Cures” by Kevin Trudeau? I have read the book and find that some of it is simply a history of what we already know about certain compounds. However, some of the book is rife with information that makes me react quite critically about claims that the author makes for some of these substances. He has not performed any research himself and simply gleans the most remarkable accounts of the products he presents. Very little book space is allotted to discounting, dispelling or critically analyzing any product. He uses lots of !!!‟s. My advice is to read with caution and good common sense. Be critical and let your conscience be your guide.