JustCare

Tag: Complementary medicine

  • Do not take supplements on blind faith

    Do not take supplements on blind faith

    As a primary care doctor, I come across several interesting situations, challenges and experiences. Some are inspirational and some are eye opening. As I have become increasingly aware of the potential dangers of supplements, I have started asking my patients if they are taking any. Many of my patients are taking supplements on blind faith, assuming that they are helpful to them, when they may be harming themselves.

    Some of my patients tell me that they are taking supplements because they can get a good deal on them.  Some tell me that they are encouraged to take supplements by their family members and friends who work in stores that sell supplements. Some mistakenly believe that supplements will help them live longer.

    But, most of the supplements you take have not been checked for drug interactions and are probably not safe for people older than 65. Moreover, places and companies who sell supplements don’t know what prescription medications you are taking and cannot warn you about harmful drug interactions.

    According to the National Center for Complementary and Integrative Health (NIH),  the “natural” label on supplements does not always mean “safe.” Be aware that an herbal supplement may contain dozens of compounds and that all of its ingredients may not be known. The regulations for dietary supplements are not the same as those for prescription or over-the-counter drugs.

    For example, the Centers for Disease Control and Prevention (CDC) reports that castor oil is a stimulant laxative that may cause thorough evacuation of the bowels within 2-6 hours of ingestion; this strong result of taking castor oil also can cause dehydration and electrolyte imbalance. Long-term use of castor oil may reduce your ability to absorb nutrients.

    Curcumin (turmeric) is among the most popular supplements. It is  believed to be an antioxidant, anti-inflammatory and anti- carcinogenic. But, a recent multicenter, randomized double blind, placebo-controlled study by Lang et al. reported that the combination of mesalamine and curcumin may have a beneficial effect in mild to moderately active ulcerative colitis. It may cause liver toxicity and stomach upset specifically in larger doses for longer duration.

    Curcumin can also lower blood glucose levels so diabetics should be cautious taking this supplement. Last but not least, curcumin does interfere with blood-thinners such as aspirin, Coumadin and Plavix. I had one patient who developed worsening of acid reflux symptoms with curcumin. And, it is reported that curcumin interferes with antacids like ranitidine which is available over the counter.

    My advice is to talk to your doctor before buying any over-the-counter medications or supplements. Do not waste your money on something that you don’t know for sure will be beneficial for your health. With the tsunami of social network, comes the chaos of information which can confuse us all. This is where your primary doctor can guide you in making smart choices.

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  • Beware of medical advice from the mainstream media

    Beware of medical advice from the mainstream media

    Kevin Lomangino of Health News Review explains how you and the rest of America may end up duped by medical advice from the mainstream media. Even the medical correspondents in the big media outlets are often not delivering evidence-based advice. And, while they may be spinning an interesting story based on a study of one sort or another, question what you learn before taking action.

    Medical studies abound to support the value of all kinds of treatments. And, it seems worthwhile to let people know when a study shows that a treatment works. What’s the downside, especially when the treatment sounds benign. Unfortunately, if the sample of people studied is small, the length of the study is short, or the design of the study is flawed, the value of the study is questionable. And, in some cases, the proposed treatment may have harmful side effects.

    At Just Care, where possible, before reporting on a study, in addition to speaking with medical experts, we check with Cochrane, an independent non-profit that does meta-studies, before we offer health advice. Cochrane’s meta-studies dig deep into as much of the research as possible to determine whether a particular finding can be trusted; and, if so, to what degree. But, Cochrane does not always have an answer, so what to do?

    If the proposed treatment is based on independent peer-reviewed evidence and there is no harm in trying it–such as “exercise” or “eat green leafy vegetables”–there are likely only benefits to trying it. And, Just Care might write about it as we did with one study on exercise and memory. It could be another reason to take a brisk walk or eat a Mediterranean diet or not eat foods with processed sugar.

    But, if the proposed treatment is any type of supplement or complementary medicine, it is potentially unsafe. And, you should likely avoid it. You certainly should not take it without first consulting with your doctor. Much like new drugs and medical devices approved by the FDA, the treatment may not be worth the risks, as less in known about it.

    Health News Review reports, for example, that ABC News’ Good Morning America’s medical correspondent advised viewers to take “complementary natural” remedies for the flu without any compelling evidence that they work. Without evidence on benefits and toxicities, the ABC News medical correspondent has no business recommending to viewers a cocktail of supplements to treat the flu and how to take them. The medical correspondent even acknowledges that there is no evidence that these “remedies” work and no data on their toxicity. What is she and ABC’s Good Morning America thinking?

    Similarly, Sharon Begley at StatNews writes about a rash of media reports on the value of aerobics and other exercise to help the brain. But, as Begley explains, experts disagree on the value of the studies underlying these reports. Even when advice is evidence-based, there is generally more to the story.

    The American College of Neurology recently began recommending aerobics to patients with mild cognitive impairments as a way to help their memory, thinking and judgment and to prevent dementia as they age. And, there is evidence to support this recommendation. But, the National Academy of Sciences (NAS) has completed a meta-study of 262 studies, and it did not find a link between exercise and dementia prevention.

    Interestingly, the studies showing a link between exercise and dementia prevention were randomized-controlled studies that were peer-reviewed. But, the NAS found that many of them were flawed in one way or another.

    Of course, lots of us want to learn about ways to stave off the flu, forestall dementia and live longer healthier lives. So, we are sure to continue to read and hear about new findings as to what we can do. If the recommendations are exercise and good nutrition, following them will most likely help you. But before buying and taking a pill, an oil or some complementary medicine remedy, look deeper into the research and talk to your doctor.

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  • The value of integrative care

    The value of integrative care

    As much as we may believe that different health conditions from which we suffer can be treated independently of one another, there is ample evidence to suggest that they tend to be interconnected and often should be treated as such. Katherine Gergen Barnett, M.D. explains in a Health Affairs post the value of integrative care, doctors who look at the whole patient when providing treatment, not discrete conditions.

    In short, Barnett explains that a good doctor treats the person–understands the range of personal, social, medical and emotional issues his or her patient is facing–in order to heal the patient. Put differently, as Hippocrates is believed to have said, “It is more important to know what sort of person has a disease than to know what sort of disease that person has.” In turn, it’s generally helpful for the millions of people who suffer from chronic conditions to have peer support as well as lifestyle support, in addition to medical support, to promote better health.

    Dr. Barnett, along with her colleagues at the Boston Medical Center, have created an integrative medicine group to better treat patients with multiple conditions. Their patients, all of whom suffer from chronic pain–as do some 100 million Americans–benefit from group medical visits, the principles of mindfulness-based stress reduction (MBSR), and evidenced-based complementary medicine.

    • Group medical visits: In this care model, as many as 12 patients with a shared condition–e.g., diabetes, back pain, high blood pressure, arthritis–see the doctor at the same time. These visits allow for peer-to-peer support–a type of buddy system–as well as more time for the medical visit. The social aspect of the visit also can promote better health.  The research suggests that these group visits can improve quality of life for patients.
    • Mindfulness-based stress reduction (MBSR): Research further shows that mindful meditation and purpose promote better health. They can ease stress, improve mental health and reduce pain.
    • Integrative medicine: With integrative medicine, doctors see and understand the whole person requiring treatment and recognize that treatment can include help with lifestyle changes. Patients may be offered evidence-based complementary medicine, such as tai chi to improve balance, yoga to promote calm, or acupuncture, all of which can help reduce pain.

    Integrative care is still a relatively new concept. To see if it’s available in your community, contact your local hospital. And, if it is, and you’re suffering from pain and other chronic conditions, you might consider learning more about it. You might also want to learn more about good incremental care, another evidence-based approach to alleviating pain that treats the whole person.

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  • Millions of Americans spend billions on alternative treatments or “complementary medicine”

    Millions of Americans spend billions on alternative treatments or “complementary medicine”

    There’s endless talk about the $2.8 trillion dollars Americans spend each year on health care. Believe it or not, that’s not all we spend on care. Millions of Americans, about a third of all adults, spend billions on alternative treatments or “complementary medicine.” What kind of care are we buying, what are we spending and what are the risks and benefits?

    A June 2016 National Health Statistics Reports paper finds that 59 million people spent over $30 billion dollars out of pocket on complementary medicine in 2012. Complementary medicine comes in many flavors, including chelation therapy, acupuncture, Ayurveda, biofeedback, chiropractic manipulation, hypnosis, energy healing therapy, meditation, yoga and massage therapy. Supplements are another form of complementary medicine, with fish oil, which has no proven benefits, the most often used product.

    Complementary medicine only represents about 1.1 percent of total health care spending. But, it constitutes a healthy portion of our out-of-pocket costs (9.2 percent) relative to what we spend for conventional physician treatments and prescription drugs.

    We spent $12.8 billion out of pocket on natural product supplements, about one fourth (24 percent) of what we spend on prescription drugs. And, there’s no compelling evidence these products provide benefits. Moreover, herbal supplements may not be what you think they are.

    We spent $14.7 billion out of pocket on complementary practitioners, almost 30 percent of what we spend out of pocket on traditional physicians.The average out-of-pocket expense per person for visiting a complementary practitioner was $433.  That’s more than the average out-of-pocket expense for purchases of natural product supplements, $368, or for self-care, $257. Of note, adults spent about as much as children on natural product supplements and self-care but far more on visits to complementary practitioners.

    If you have a chronic condition and are using complementary alternative medicines, be sure to let your doctor know. According to a study in the British Journal of Cancer, the use of alternative medicines, particularly herbal remedies and supplements, may cause serious problems. Some, such as St. John’s Wort, garlic and cod liver oil, can have adverse interactions with conventional treatments.

    If you want an alternative health care treatment, check with your insurer to see what kinds of treatments are covered. Ask about which practitioners or products you can use, whether pre-authorization is required, whether there is a limit to the number of treatments you can get, as well as your out-of-pocket costs.

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