integrative medicine nutritional implications. complementary and alternative medicine (cam):...
Post on 15-Jan-2016
247 views
TRANSCRIPT
Integrative Medicine Integrative Medicine
Nutritional ImplicationsNutritional Implications
Complementary and Complementary and alternative medicine alternative medicine (CAM): (CAM): Complementary and alternative Complementary and alternative
medicine (CAM): alternative, medicine (CAM): alternative, adjunctive health care practices: not adjunctive health care practices: not presently an integral part of presently an integral part of conventional medicine; includes conventional medicine; includes botanical use, mind-body botanical use, mind-body approaches, musculoskeletal approaches, musculoskeletal manipulation, energy medicine, manipulation, energy medicine, nutrition-diet interventionsnutrition-diet interventions
Thomson in Krause, p. 470
CAM Therapies IncludeCAM Therapies Include
Alternative medical systems, such as Alternative medical systems, such as naturopathy, traditional Chinese naturopathy, traditional Chinese medicine, ayurveda, and homeopathymedicine, ayurveda, and homeopathy
Mind-body therapies, such as meditation, Mind-body therapies, such as meditation, prayer, art or music therapyprayer, art or music therapy
Biologically based therapies such as Biologically based therapies such as herbs, whole foods diets, and herbs, whole foods diets, and supplementationsupplementation
Manipulative therapies such as massage, Manipulative therapies such as massage, chiropractic medicine, osteopathy, yogachiropractic medicine, osteopathy, yoga
Whole medical systems based on energy Whole medical systems based on energy therapies such as qi gong, magnetic therapies such as qi gong, magnetic therapy, and reikitherapy, and reiki
Integrative medicineIntegrative medicine
Integration of these approaches Integration of these approaches into conventional medicine; into conventional medicine; nutritional care is a primary nutritional care is a primary therapy in this modeltherapy in this model
Focused on combined use of Focused on combined use of conventional and CAM approachesconventional and CAM approaches
Evidence-basedEvidence-based Includes wellness and preventionIncludes wellness and prevention
Thomson in Krause, p. 471
National Center for National Center for Complementary and Complementary and Alternative Medicine Alternative Medicine (NCCAM)(NCCAM)Part of the National Institutes of Health Part of the National Institutes of Health
——Investigates and evaluates alternative Investigates and evaluates alternative therapies and their effectivenesstherapies and their effectiveness
Theoretical Basis of Theoretical Basis of Holistic TherapiesHolistic Therapies Health as a vital, dynamic state; more Health as a vital, dynamic state; more
than the absence of diseasethan the absence of disease The healing force of natureThe healing force of nature Self-healing power of living things; Self-healing power of living things;
organisms have inherent self-defense organisms have inherent self-defense mechanisms against illnessmechanisms against illness
Includes naturopathy, chiropractic, Includes naturopathy, chiropractic, homeopathy, traditional Oriental homeopathy, traditional Oriental medicine, acupuncture, phytotherapymedicine, acupuncture, phytotherapy
Health is more than the absence of disease.The body can heal itself.Health is more than the absence of disease.The body can heal itself.
Integrative TherapiesIntegrative Therapies
NaturopathyNaturopathy HomeopathyHomeopathy Traditional Chinese medicineTraditional Chinese medicine AcupunctureAcupuncture PhytotherapyPhytotherapy
NaturopathyNaturopathy
Practitioners diagnose and treat at the primary Practitioners diagnose and treat at the primary care levelcare level
Train in 4-year postgraduate institutionsTrain in 4-year postgraduate institutions Most states require licensureMost states require licensure Uses natural methods of healing (light, heat, Uses natural methods of healing (light, heat,
air, water, and massage)air, water, and massage) Training includes pathology, microbiology, Training includes pathology, microbiology,
physical and clinical diagnosis, physical and clinical diagnosis, pharmacognosy, hydrotherapy, physical pharmacognosy, hydrotherapy, physical therapy, nutrition, therapy, nutrition,
Treatments include phytomedicines, Treatments include phytomedicines, electrotherapy, physiotherapy, minor surgery, electrotherapy, physiotherapy, minor surgery, mechanotherapy, nutrition, nutritional mechanotherapy, nutrition, nutritional supplements, and natural forcessupplements, and natural forces
Chiropractic ConceptsChiropractic Concepts
Body has the ability to heal itself; Body has the ability to heal itself; Practitioner’s role is to assistPractitioner’s role is to assist
The structure and condition of the body The structure and condition of the body influences how well it functionsinfluences how well it functions
The mind-body relationship is important The mind-body relationship is important in maintaining health and promoting in maintaining health and promoting healinghealing
Locate and eliminate subluxations, Locate and eliminate subluxations, musculoskeletal problems that interfere musculoskeletal problems that interfere with the body’s ability to maintain healthwith the body’s ability to maintain health
Primary therapy is manual Primary therapy is manual manipulations, along with lifestylemanipulations, along with lifestyle
Chiropractic Chiropractic PractitionersPractitioners Do not prescribe drugs or perform Do not prescribe drugs or perform
surgerysurgery Licensed and regulated in all 50 Licensed and regulated in all 50
states and 30+ countriesstates and 30+ countries Practitioners must graduate from Practitioners must graduate from
4-year accredited college of 4-year accredited college of chiropractic and pass a nationally-chiropractic and pass a nationally-administered examadministered exam
ChiropracticChiropractic
The most widely-used of the The most widely-used of the complementary and alternative complementary and alternative treatments, particularly for low back treatments, particularly for low back pain, neck pain, and headachepain, neck pain, and headache
Effectiveness is being studied by the Effectiveness is being studied by the Consortial Center for Chiropractic Consortial Center for Chiropractic Research, a consortium of Research, a consortium of chiropractic schools and universities, chiropractic schools and universities, established by NCCAMestablished by NCCAM
HomeopathyHomeopathy
Law of similars: Substances in Law of similars: Substances in large doses that produce large doses that produce symptoms of a disease in healthy symptoms of a disease in healthy people will cure the same people will cure the same symptoms when administered in symptoms when administered in very dilute amountsvery dilute amounts
Remedies become Remedies become potentizedpotentized through repeated dilution and through repeated dilution and succussionsuccussion (shaking) (shaking)
HomeopathyHomeopathy
Results of research on the Results of research on the effectiveness of homeopathy have effectiveness of homeopathy have been contradictorybeen contradictory
Appears to have more than a placebo Appears to have more than a placebo effect, but scientific basis uncleareffect, but scientific basis unclear
Generally regarded as safe (many Generally regarded as safe (many homeopathic remedies are so dilute homeopathic remedies are so dilute that the healing substance is that the healing substance is nondetectable by chemical meansnondetectable by chemical means
Traditional Chinese Traditional Chinese MedicineMedicine
Based on the concept of body Based on the concept of body life force chi (Qi)life force chi (Qi)
Forces that must be balancedForces that must be balanced
——Yin and yang and blood Yin and yang and blood
Invisible energy circuits called Invisible energy circuits called meridiansmeridians carry chi and blood carry chi and blood throughout the bodythroughout the body
Nutrition in Traditional Nutrition in Traditional Chinese MedicineChinese Medicine Components: Food as a means of Components: Food as a means of
obtaining nutrition, food as a obtaining nutrition, food as a tonic or medicine, fastingtonic or medicine, fasting
Foods classified by taste (sour, Foods classified by taste (sour, bitter, sweet, spicy, salty) and bitter, sweet, spicy, salty) and property (cool, cold, warm, hot property (cool, cold, warm, hot and plain)and plain)
Regulate yin, yang, chi, bloodRegulate yin, yang, chi, blood
Acupuncture and Acupuncture and MoxibustionMoxibustion Acupuncture: Use of thin needles, Acupuncture: Use of thin needles,
inserted into points on the meridians, inserted into points on the meridians, stimulating the body’s energy or chistimulating the body’s energy or chi
Moxibustion: application of heat Moxibustion: application of heat along meridian acupuncture points, along meridian acupuncture points, affecting chi and blood, balancing affecting chi and blood, balancing substances and organssubstances and organs
Treat disharmony in the bodyTreat disharmony in the body
Acupuncture as Acupuncture as AnesthesiaAnesthesia Has been used to produce regional Has been used to produce regional
anesthesiaanesthesia Appears to act through needle Appears to act through needle
stimulation, triggering the release of stimulation, triggering the release of opioidsopioids
Research has been mixedResearch has been mixed Has been shown to be efficacious in Has been shown to be efficacious in
adult postop management, adult postop management, chemotherapy-induced nausea, chemotherapy-induced nausea, postoperative dental painpostoperative dental pain
Traditional Chinese Traditional Chinese HerbsHerbs Includes herbs and minerals as Includes herbs and minerals as
well as animal productswell as animal products Pharmacopoeias published as Pharmacopoeias published as
early as the third century BCearly as the third century BC Most medicinals include multiple Most medicinals include multiple
substancessubstances
PhytotherapyPhytotherapy
Science of using plant-derived Science of using plant-derived substances to treat and prevent illnesssubstances to treat and prevent illness
Botanicals: come as bulk herbs, Botanicals: come as bulk herbs, tinctures, capsules and tablets; includes tinctures, capsules and tablets; includes herbs and other plant materialsherbs and other plant materials
Sometimes the active ingredient has Sometimes the active ingredient has been identified; sometimes notbeen identified; sometimes not
Have a long history of research and use Have a long history of research and use in Europein Europe
Botanical FormulationsBotanical Formulations
Teas: weak concentration Teas: weak concentration prepared by steeping fresh/dried prepared by steeping fresh/dried herbs for a few minutes in waterherbs for a few minutes in water
Infusions: more concentrated Infusions: more concentrated than teas; steeped for 15 minutesthan teas; steeped for 15 minutes
Decoction: Most concentrated of Decoction: Most concentrated of beverages; botanical is boiled for beverages; botanical is boiled for 30-60 minutes30-60 minutes
Botanical FormulationsBotanical Formulations
Extracts: herbs are extracted with an Extracts: herbs are extracted with an organic solvent to dissolve the active organic solvent to dissolve the active components; concentrated formcomponents; concentrated form
Tincture: extract in which solvent is Tincture: extract in which solvent is alcoholalcohol
Glycerite: extract in which the Glycerite: extract in which the solvent is glycerol or mixture of solvent is glycerol or mixture of glycerol, propylene glycol, and water; glycerol, propylene glycol, and water; more suitable for childrenmore suitable for children
Botanical FormulationsBotanical Formulations
Capsules: Herbal material enclosed in a hard Capsules: Herbal material enclosed in a hard shell made from gelatin or celluloseshell made from gelatin or cellulose
Tablets: herbal material is mixed with filler to Tablets: herbal material is mixed with filler to form the hard tablet; may be coated or form the hard tablet; may be coated or uncoateduncoated
Lozenges (troches): active components are Lozenges (troches): active components are released in the mouth when chewed or suckedreleased in the mouth when chewed or sucked
Soft gels: used to encase liquid extracts, such Soft gels: used to encase liquid extracts, such as omega-3 fatty acids or vitamin Eas omega-3 fatty acids or vitamin E
Essential oils: fragrant, volatile plant oils used Essential oils: fragrant, volatile plant oils used for aromatherapy, bathing; not to be used for aromatherapy, bathing; not to be used internally unless specifically directedinternally unless specifically directed
American Herbal Products American Herbal Products Assoc Botanical Safety Rating Assoc Botanical Safety Rating SystemSystem
Class 1: herbs that can be safely Class 1: herbs that can be safely consumed when used appropriatelyconsumed when used appropriately
Class 2: herbs for which restrictions apply, Class 2: herbs for which restrictions apply, e.g. for external use only, not to be used e.g. for external use only, not to be used during pregnancy, nursing, etcduring pregnancy, nursing, etc
Class 3: herbs labeled “To be used only Class 3: herbs labeled “To be used only under the supervision of an expert under the supervision of an expert qualified in the appropriate use of this qualified in the appropriate use of this substance.”substance.”
Class 4: insufficient data for classificationClass 4: insufficient data for classification
Dietary Supplement Health and Dietary Supplement Health and Education Act of 1994 (DSHEA)Education Act of 1994 (DSHEA)
Defined dietary supplements as “a Defined dietary supplements as “a product intended to supplement the diet product intended to supplement the diet that bears or contains one or more of that bears or contains one or more of the following dietary ingredients: a the following dietary ingredients: a vitamin, a mineral, an herb or other vitamin, a mineral, an herb or other botanical, an amino acid, a dietary botanical, an amino acid, a dietary substance for use by man to substance for use by man to supplement the diet by increasing the supplement the diet by increasing the total daily intake, or a concentrate, total daily intake, or a concentrate, metabolite, constituent, extract, or metabolite, constituent, extract, or combinations of these incredientscombinations of these incredients
Reclassified botanicals as dietary Reclassified botanicals as dietary supplements, distinct from food or supplements, distinct from food or drugsdrugs
Dietary Supplement Health Dietary Supplement Health and Education Act of 1994 and Education Act of 1994 (DSHEA)(DSHEA) Plant extracts, enzymes, vitamins, Plant extracts, enzymes, vitamins,
minerals, hormonal products available minerals, hormonal products available without prescription may carry without prescription may carry “structure-function” claims“structure-function” claims
Cannot claim to prevent or cure Cannot claim to prevent or cure specific conditionsspecific conditions
Must display disclaimer, “This Must display disclaimer, “This statement has not been evaluated by statement has not been evaluated by the Food and Drug Administration. This the Food and Drug Administration. This product is not intended to diagnose, product is not intended to diagnose, treat, cure or prevent any disease.”treat, cure or prevent any disease.”
Required Labeling of Required Labeling of Dietary Supplements Dietary Supplements under DSHEAunder DSHEA Name (echinacea, for example) Name (echinacea, for example) Ingredient information Ingredient information Disclaimer: "This statement has not been Disclaimer: "This statement has not been
evaluated by the Food and Drug evaluated by the Food and Drug Administration. This product is not Administration. This product is not intended to diagnose, treat, cure or intended to diagnose, treat, cure or prevent any disease." prevent any disease."
Supplement Facts panel, which includes Supplement Facts panel, which includes serving size, amount and active ingredient. serving size, amount and active ingredient.
Name and address of manufacturer, packer Name and address of manufacturer, packer or distributor. or distributor.
Supplement Facts Supplement Facts PanelPanel
Dietary Supplement Dietary Supplement ClaimsClaims Health claim: describes the Health claim: describes the
relationship between a substance and relationship between a substance and a disease condition; FDA does not a disease condition; FDA does not approve, but must be notifiedapprove, but must be notified
Qualified health claim: based on Qualified health claim: based on emerging scientific evidence; must be emerging scientific evidence; must be approved by FDAapproved by FDA
Structure-function claim: most Structure-function claim: most common; does not claim to prevent common; does not claim to prevent disease, but a physiological effect is disease, but a physiological effect is noted, e.g. “increases blood flow to the noted, e.g. “increases blood flow to the heart.”heart.”
Labeling Under DSHEALabeling Under DSHEA
AllowedAllowed This product helps to This product helps to
increase blood flow to increase blood flow to the heart.the heart.
This product promotes This product promotes urinary tract healthurinary tract health
This product improves This product improves absent-mindedness. absent-mindedness.
This product reduces This product reduces stress and frustration stress and frustration
Not AllowedNot Allowed This product prevents This product prevents
heart diseaseheart disease This product prevents This product prevents
urinary tract urinary tract infections.infections.
This product reduces This product reduces risk of Alzheimer’s risk of Alzheimer’s Disease.Disease.
This product improves This product improves depression.depression.
Regulation of Dietary Regulation of Dietary SupplementsSupplements Dietary supplements are not subject to Dietary supplements are not subject to
the same standards as prescription or the same standards as prescription or over-the-counter drugsover-the-counter drugs
Manufacturers do not have to prove Manufacturers do not have to prove their products are safe or effective their products are safe or effective before they put them on the marketbefore they put them on the market
FDA can pull supplements proven to be FDA can pull supplements proven to be dangerous, but only after the fact; it is dangerous, but only after the fact; it is up to the FDA to make its caseup to the FDA to make its case
Regulation of Dietary Regulation of Dietary Supplements: Supplements: MedwatchMedwatch The FDA’s Medwatch system can The FDA’s Medwatch system can
be used to report possible be used to report possible adverse reactions to dietary adverse reactions to dietary supplements supplements http://www.fda.gov/medwatch/report/hcp.htmhttp://www.fda.gov/medwatch/report/hcp.htm
Examples of FDA Examples of FDA WarningsWarnings
January, 2004: FDA warns consumers not January, 2004: FDA warns consumers not to feed their babies “Better than Formula to feed their babies “Better than Formula Ultra Infant Immune Booster 117" being Ultra Infant Immune Booster 117" being sold over the internet as a dietary sold over the internet as a dietary supplementsupplement
February, 2002: Consumers warned to February, 2002: Consumers warned to stop using the products PC SPES and SPES stop using the products PC SPES and SPES capsules because they contain undeclared capsules because they contain undeclared prescription drug ingredients that could prescription drug ingredients that could cause serious health effects cause serious health effects
Examples of FDA Examples of FDA WarningsWarnings November, 2001: consumers warned to November, 2001: consumers warned to
immediately stop use of LipoKinetix, a immediately stop use of LipoKinetix, a weight loss product; implicated in a weight loss product; implicated in a number of serious liver injuries. number of serious liver injuries.
March, 2002: consumers advised of risk March, 2002: consumers advised of risk of severe liver injury associated with of severe liver injury associated with the use of kava-containing dietary the use of kava-containing dietary supplements to ease stress and anxiety. supplements to ease stress and anxiety.
February, 2004: issues final rule February, 2004: issues final rule forbidding sale of ephedra-containing forbidding sale of ephedra-containing weight loss products; associated with weight loss products; associated with significant adverse health effects significant adverse health effects including heart attack and stroke including heart attack and stroke
Dietary Supplement and Dietary Supplement and Nonprescription Drug Nonprescription Drug Consumer Protection Act 12/06Consumer Protection Act 12/06
Requires manufacturers and distributors of Requires manufacturers and distributors of dietary supplements and OTC drugs to dietary supplements and OTC drugs to report all serious adverse events to FDAreport all serious adverse events to FDA
Requires manufacturers to keep all adverse Requires manufacturers to keep all adverse event records, serious and non-serious, for event records, serious and non-serious, for six years; allows FDA to inspect these six years; allows FDA to inspect these records. records.
Sets a 15-day time limit for manufacturers Sets a 15-day time limit for manufacturers to give FDA the serious reports they to give FDA the serious reports they receive. receive.
Cautions Regarding Cautions Regarding Dietary SupplementsDietary Supplements There may be a discrepancy There may be a discrepancy
between the ingredients on the label between the ingredients on the label and what’s insideand what’s inside
This is especially true of herb This is especially true of herb mixtures, such as Chinese herbsmixtures, such as Chinese herbs
The dosage of the “active The dosage of the “active ingredient” in herbals can vary ingredient” in herbals can vary widely depending on the variety of widely depending on the variety of plant, where it’s grown, climate, etc.plant, where it’s grown, climate, etc.
Read the Dietary Read the Dietary Supplement Label and Supplement Label and Verify….Verify…. Complete botanical name of the Complete botanical name of the
product (make sure it is the right product (make sure it is the right botanical)botanical)
The part of the plant used to make the The part of the plant used to make the product; it should be the part that product; it should be the part that contains the active componentscontains the active components
The concentration of the botanical and The concentration of the botanical and if it is appropriate, neither too weak or if it is appropriate, neither too weak or two strongtwo strong
Debusk, RM. A practical guide to herbal supplements for nutrition practitioners. Top Clin Nutr 16:53, 2001
Read the Dietary Read the Dietary Supplement Label and Supplement Label and Verify….Verify…. The daily dosage needed to obtain the The daily dosage needed to obtain the
desired effectdesired effect The list of ingredients used to identify The list of ingredients used to identify
fillers, potential allergensfillers, potential allergens Lot numberLot number Expiration dateExpiration date Recognized seal of approval (Good Recognized seal of approval (Good
Housekeeping, USP, Consumerlab)Housekeeping, USP, Consumerlab) Compare prices: prices vary widelyCompare prices: prices vary widely
Debusk, RM. A practical guide to herbal supplements for nutrition practitioners. Top Clin Nutr 16:53, 2001
Evaluating Dietary Evaluating Dietary SupplementsSupplements Obtain unbiased evaluative information Obtain unbiased evaluative information
from resources like Supplement Watch from resources like Supplement Watch and Consumer Lab and Consumer Lab www.consumerlab.com www.consumerlab.com
Encourage patients to purchase Encourage patients to purchase supplements from well-known supplements from well-known manufacturersmanufacturers
ConsumerLab Study of ConsumerLab Study of 20 Multivitamins20 MultivitaminsVitamins that failed:Vitamins that failed: The Vitamin Shoppe Multivitamins Especially for The Vitamin Shoppe Multivitamins Especially for
women: Contaminated with leadwomen: Contaminated with lead — — Hero Nutritionals Yummi Bears: Had twice the Hero Nutritionals Yummi Bears: Had twice the
labeled amount of vitamin Alabeled amount of vitamin A — — Nature's Plus Especially Yours for Women: Took Nature's Plus Especially Yours for Women: Took
twice as long as allowed to disintegratetwice as long as allowed to disintegrate — — AARP Maturity Formula: Took nearly twice as AARP Maturity Formula: Took nearly twice as
long as allowed to disintegratelong as allowed to disintegrate — — Eniva VIBE: Only 54 percent of claimed vitamin Eniva VIBE: Only 54 percent of claimed vitamin
AA — — Pet-Tabs Complete Daily Vitamin-Mineral Pet-Tabs Complete Daily Vitamin-Mineral
Supplement for Dogs: Contained leadSupplement for Dogs: Contained lead– Accessed at MSNBC Accessed at MSNBC http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/– Released 1/2007Released 1/2007
ConsumerLab Study of ConsumerLab Study of 20 Multivitamins20 Multivitamins
Vitamins that passed:Vitamins that passed: Centrum SilverCentrum Silver Member's Mark Complete MultiMember's Mark Complete Multi One A Day Women'sOne A Day Women's Flintstones CompleteFlintstones Complete
http://www.msnbc.msn.com/id/1665516http://www.msnbc.msn.com/id/16655168/8/ January, 2007 January, 2007
Tips for Picking a Tips for Picking a Multivitamin from CSPIMultivitamin from CSPI Choose well-known mainstream brands by Choose well-known mainstream brands by
companies that have a lot at stake.companies that have a lot at stake. Buy from large, trusted retailers, not unknown Buy from large, trusted retailers, not unknown
sellers on the Internet.sellers on the Internet. Look on the bottle for a stamp from USP, NSF or Look on the bottle for a stamp from USP, NSF or
ConsumerLab.com. While the stamp doesn't ConsumerLab.com. While the stamp doesn't guarantee the product is safe and effective, it guarantee the product is safe and effective, it does indicate that the manufacturer has does indicate that the manufacturer has submitted the product for testing to show that it submitted the product for testing to show that it contains what is stated on the label.contains what is stated on the label.
Don’t spend a fortune on vitamins. Pricey Don’t spend a fortune on vitamins. Pricey products toting all sorts of "extras" aren't products toting all sorts of "extras" aren't necessary and may be trouble.necessary and may be trouble.
Center for Science in the Public Interest accessed at Center for Science in the Public Interest accessed at http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/ 1/07 1/07
Evaluating Dietary Evaluating Dietary SupplementsSupplementsUnited States Pharmacopeial Convention United States Pharmacopeial Convention
(USP) Dietary Supplement Verification (USP) Dietary Supplement Verification Program (DSVP)Program (DSVP)
Certification mark (Certification mark (USP®)USP®) indicates that indicates that the product contains the dietary supplement the product contains the dietary supplement listed on the label in the stated amount and listed on the label in the stated amount and that the product is manufactured properlythat the product is manufactured properly
Does not speak to the safety or efficacy of Does not speak to the safety or efficacy of the ingredients, only to good manufacturing the ingredients, only to good manufacturing practicespractices
CAM Providers: CAM Providers: MDs/DOsMDs/DOs Over 1/3 of medical schools offer Over 1/3 of medical schools offer
instruction in alternative medicineinstruction in alternative medicine More than half of family More than half of family
physicians in the US regularly physicians in the US regularly prescribe alternative treatments prescribe alternative treatments or have used themselvesor have used themselves
CAM Providers: RDsCAM Providers: RDs
Nutrition in Complementary Care DPG, Nutrition in Complementary Care DPG, a subunit of the American Dietetic a subunit of the American Dietetic Association Association http://www.complementarynutrition.orhttp://www.complementarynutrition.org/g/
Some RDs are incorporating Some RDs are incorporating counseling about CAM into their counseling about CAM into their practicespractices
CAM Providers: OtherCAM Providers: Other
RNsRNs RPhRPh ND: naturopath providerND: naturopath provider DC: chiropractorDC: chiropractor OMD: oriental medical doctorOMD: oriental medical doctor AccupuncturistAccupuncturist Massage TherapistMassage Therapist HypnotherapistHypnotherapist HerbalistHerbalist
Tips for Patients: Tips for Patients: Evaluating CAM Evaluating CAM ProvidersProviders Check for licensing, education, Check for licensing, education,
accreditation of provideraccreditation of provider Check for complaints (BBB, Board Check for complaints (BBB, Board
of Health, Attorney General’s of Health, Attorney General’s office, patient support groups)office, patient support groups)
Speak with the practitioner in Speak with the practitioner in person, evaluate facilities and person, evaluate facilities and neighborsneighbors
Trends in Use of CAM Trends in Use of CAM by US Adults 1997-by US Adults 1997-20022002 The number of Americans using The number of Americans using
CAM remained stable at 72 millionCAM remained stable at 72 million 50% 50% ↑ in use of herbal ↑ in use of herbal
supplements, from 12.1% in 1997 supplements, from 12.1% in 1997 to 18.6% (38 million). to 18.6% (38 million).
Yoga increased 40%, from 3.7% to Yoga increased 40%, from 3.7% to 5.1% (10 million adults)5.1% (10 million adults)
Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in the use of complementary
and alternative medicine by US adults: 1997-2002. Alternative Therapies in Health and Medicine; 1; 1: 2005.
Trends in Use of CAM Trends in Use of CAM by US Adults 1997-by US Adults 1997-20022002 Use of CAM therapies including Use of CAM therapies including
acupuncture, biofeedback, energy acupuncture, biofeedback, energy healing, hypnosis remained essentially healing, hypnosis remained essentially unchangedunchanged
Use of homeopathy, high-dose vitamins, Use of homeopathy, high-dose vitamins, chiropractic, and massage therapy chiropractic, and massage therapy declined slightlydeclined slightly
Increased use of herbal medicine Increased use of herbal medicine practitioners among those who use herbs practitioners among those who use herbs (5% to 15%)(5% to 15%)
Commonly Used Commonly Used BotanicalsBotanicals EchinaceaEchinacea GarlicGarlic GingerGinger Gingko bilobaGingko biloba GinsengGinseng
HawthornHawthorn Milk thistleMilk thistle Saw palmettoSaw palmetto St. John’s wortSt. John’s wort ValerianValerian
EchinaceaEchinacea
Source: Source: Purple cornflowerPurple cornflower Indication: Indication: Stop or moderate Stop or moderate
colds colds or fluor flu
Action: Action: Macrophages and Macrophages and their their secretionssecretions
Cautions: Cautions: Avoid if immune Avoid if immune system is system is hampered and do not hampered and do not use use continuallycontinually
GarlicGarlic
Source: Source: Garlic plantGarlic plant Indication: Indication: Lower serum cholesterol Lower serum cholesterol
and and triglyceridestriglycerides Action: Action: Chewing or crushing Chewing or crushing
activates several sulfur-activates several sulfur-containing compoundscontaining compounds
Cautions: Cautions: Allergies, GI symptoms, Allergies, GI symptoms, interaction with interaction with
anticoagulant anticoagulant drugsdrugs
GingerGinger Source: Source: Root of ginger plantRoot of ginger plant Indication: Indication: For nausea and For nausea and
vomiting of vomiting of pregnancy and motion pregnancy and motion sickness; anti-sickness; anti-
inflammatoryinflammatory Action: Action: Volatile oils in the Volatile oils in the
rhizome, rhizome, called gingerols; may act called gingerols; may act on on serotonin receptors in serotonin receptors in the the ileumileum
Cautions: Cautions: Interaction with anti-Interaction with anti-coagulant, antihypertensive, coagulant, antihypertensive, glucose-loweringglucose-lowering drugsdrugs
Gingko BilobaGingko Biloba Source: Source: Gingko treeGingko tree Indication: Indication: Improved blood Improved blood
circulation; circulation; used to treat age-related used to treat age-related mental function decline r/t mental function decline r/t cerebrovascular insufficiency cerebrovascular insufficiency
Action: Action: Flavone glycosides have Flavone glycosides have antioxidant effect, inhibit antioxidant effect, inhibit platelet platelet aggregationaggregation
Cautions: Cautions: Class 2d botanical; may Class 2d botanical; may potentiate MAO inhibitors; GI potentiate MAO inhibitors; GI complaints, headache, allergycomplaints, headache, allergy
GinsengGinseng
Source: Source: Ginseng plant (radish-like Ginseng plant (radish-like herb) rootherb) root
Indication: Indication: General improvement General improvement from from the steroidlike the steroidlike componentscomponents
Action: Action: Ginsenosides, enhanced Ginsenosides, enhanced immune function; studies immune function; studies mixedmixed
Cautions: Cautions: Class 2d botanicals; Class 2d botanicals; contraindicated in persons contraindicated in persons with with hypertension; hypertension; overstimulation, GI overstimulation, GI distressdistress
HawthornHawthorn
Source: Source: Native European tree; Native European tree; leaves, blossoms, fruitleaves, blossoms, fruit
Indication: Indication: Improve blood flow in Improve blood flow in circulatory disorderscirculatory disorders
Action: Action: Dilates coronary Dilates coronary vessels; vessels; strengthens heart strengthens heart contractions and ratecontractions and rate
Cautions: Cautions: Class 1 botanicalClass 1 botanical
Saw PalmettoSaw Palmetto
Source: Source: Palm tree Palm tree Indication: Indication: Reduce incidence of BPHReduce incidence of BPH Action: Action: Action unclear; research Action unclear; research
results mixedresults mixed Cautions: Cautions: Contains Contains
phytoestrogens, phytoestrogens, could interfere could interfere with estrogen with estrogen therapy, oral therapy, oral contraceptives, contraceptives, other other phytohormone-phytohormone- containing herbscontaining herbs
St. John’s WortSt. John’s Wort
Source: Source: Perennial herbPerennial herb Indication: Indication: Mild to moderate depressionMild to moderate depression Action: Action: Hypericin and hyperforin in Hypericin and hyperforin in
flowering tops; reuptake of flowering tops; reuptake of neurotransmittersneurotransmitters
Cautions: Cautions: Rated as 2d botanical; may Rated as 2d botanical; may potentiate pharmaceutical potentiate pharmaceutical MAOIs; interact with other MAOIs; interact with other antidepressives; antidepressives;
photosensitivityphotosensitivity
ValerianValerian
Source: Source: Perennial herb; active Perennial herb; active element element in roots and rhizomesin roots and rhizomes
Indication: Indication: Minor tranquilizer and Minor tranquilizer and sleep sleep aid; fewer side effects aid; fewer side effects than than medicationsmedications
Action: Action: Volatile oils (bornyl Volatile oils (bornyl acetate acetate and valerenic acid) and valerenic acid) mode of mode of action GABA bindingaction GABA binding
Cautions: Cautions: Class 1 botanical; abrupt Class 1 botanical; abrupt withdrawal may withdrawal may
precipitate precipitate symptomssymptoms
Milk ThistleMilk Thistle
Source: Source: Herb in daisy family; seeds Herb in daisy family; seeds are highest in silymarinare highest in silymarin
Indication: Indication: Hepatoprotective; used to Hepatoprotective; used to treat liver damage in treat liver damage in
cirrhosis, cirrhosis, hepatitis, fatty infiltrationhepatitis, fatty infiltration Action: Action: Silymarin stimulates protein Silymarin stimulates protein
synthesis, antioxidant; synthesis, antioxidant; shown shown to be moderately effectiveto be moderately effective
Cautions: Cautions: Class 1 botanical; mild Class 1 botanical; mild laxative effect; allergieslaxative effect; allergies
Working with Clients Working with Clients who Use CAMwho Use CAM Most clients will not tell their allopathic Most clients will not tell their allopathic
(mainstream medicine) providers (mainstream medicine) providers about CAM use, unless askedabout CAM use, unless asked
Establish a rapport with clientsEstablish a rapport with clients Be non-judgemental; assume role of Be non-judgemental; assume role of
coachcoach Ask clients to bring all prescription, Ask clients to bring all prescription,
OTC, and dietary supplements with OTC, and dietary supplements with them to their visitthem to their visit
Debusk RM. Integrative medicine and phytotherapy. In Krause, p. 491-492.
For Each SupplementFor Each Supplement
Ask client what he/she hopes to Ask client what he/she hopes to achieve by taking itachieve by taking it
Discuss whether the formulation is Discuss whether the formulation is appropriate to achieve the client’s appropriate to achieve the client’s health goalshealth goals
Discuss whether dosage taken has Discuss whether dosage taken has been found to be safe and effective in been found to be safe and effective in clinical trialsclinical trials
Review quality of the particular Review quality of the particular preparation and how to evaluate preparation and how to evaluate
Debusk RM. Integrative medicine and phytotherapy. In Krause, p. 491-492.
For Each SupplementFor Each Supplement Discuss any known safety or Discuss any known safety or
contraindication concernscontraindication concerns Review potential or known interactions Review potential or known interactions
between each supplement and between each supplement and prescription or OTC preparations, other prescription or OTC preparations, other dietary supplements, and foodsdietary supplements, and foods
Instruct client to use dosage commonly Instruct client to use dosage commonly recommended and instructions for recommended and instructions for where to obtain credible informationwhere to obtain credible information
Debusk RM. Integrative medicine and phytotherapy. In Krause, p. 491-492.
For Each SupplementFor Each Supplement
Recommend a low starting Recommend a low starting dosage, even lower than that dosage, even lower than that commonly recommended and commonly recommended and evaluate responseevaluate response
Use this as an opportunity to Use this as an opportunity to teach consumers analytical skills teach consumers analytical skills that will be useful in managing that will be useful in managing their own health.their own health.
Debusk RM. Integrative medicine and phytotherapy. In Krause, p. 491-492.
Working with Clients Working with Clients Who Use CAMWho Use CAM It is the responsibility of health It is the responsibility of health
professionals to ask clients about professionals to ask clients about use of CAM and to be familiar with use of CAM and to be familiar with commonly-used therapiescommonly-used therapies
Nutrition professionals can take Nutrition professionals can take the same evidence-based the same evidence-based approach to CAM as to any other approach to CAM as to any other therapy or medical interventiontherapy or medical intervention
Links for Integrative Links for Integrative Medicine InformationMedicine Information Intellihealth Index of Herbal Medicines and Intellihealth Index of Herbal Medicines and
SupplementsSupplementshttp://www.intelihealth.com/IH/ihtIH/WSIHW0http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html00/8513/31402.html
Herb Med: An interactive electronic herb Herb Med: An interactive electronic herb database. database. http://http://www.herbmed.orgwww.herbmed.org//
Rosenthal Center Botanical Medicine Rosenthal Center Botanical Medicine Information Resources (Columbia University)Information Resources (Columbia University)http://http://www.rosenthal.hs.columbia.edu/Botanicals.htwww.rosenthal.hs.columbia.edu/Botanicals.htmlml
National Institutes of Health National Center National Institutes of Health National Center for Complementary and Alternative Therapyfor Complementary and Alternative Therapyhttp://http://nccam.nih.govnccam.nih.gov//
SummarySummary
Identify use of herbs and Identify use of herbs and botanicals.botanicals.
Monitor for side effects.Monitor for side effects. Document for records.Document for records. Discuss with physician.Discuss with physician.