Making sense of health information can be next to impossible -- it ranges from pure garbage to absolute treasure.
Most of us are able to judge fairly accurately when phony remedies for breast enhancement or unlimited sexual prowess are advertised. But what about when your holistic practitioner swears by grapeseed extract for anything from high blood pressure to cellulite? Or when your doctor dismisses acupuncture as useless for any purpose whatsoever?
Pearls of Wisdom
In medical school, students listen and read for "medical pearls," those tidbits of wisdom that are pure and true (and will help us pass our exams). In this article, Body+Soul has allowed me to share my "pearls" of wisdom for alternative medicine. They have asked me, as a physician in the world of integrative medicine, to present my most reliable alternative clinical practices, the practices I suggest to my patients (and to my family, for that matter) without hesitation.
How do I come to the conclusions that I do? I struggle, just as you do. But I use a variety of methods -- first and foremost, study and interpretation of the medical literature. I also use my clinical judgment -- a combination of experience, intuition, and a sense of what is right.
To present my alternative-medicine pearls, I have developed reference tables, organized by body part. "The Language of Science," will help you interpret the evidence behind my recommendations and, I hope, health information in general.
Keep Exploring Solutions
What if the remedy you swear by isn't listed here? Determine whether it's safe, and if it seems to help, keep using it. I encourage my patients, and I encourage you, to develop your own clinical judgment: Find reliable sources of information, research modalities that resonate with you, communicate with your health care provider, and trust your experience.
The Language of Science
Scientific research is a continuum, with varying levels of evidence that depend and build on one another. The key for the "Evidence" section of the charts in this story, in ascending level of evidence, is as follows:
Evidence that's been compiled from the wisdom and experience of many clinicians. Much of the evidence for herbal medicine and bodywork, for example, is empiric.
Descriptive evidence about an individual or a series of individuals who have had success with a particular therapeutic approach. E.g., the efficacy of homeopathy for infectious diarrhea, now proven by clinical trials, was first reported as a case series.
Studies of large populations that ask, for example, who is healthy and who gets certain illnesses. It determines associations, but does not investigate cause and effect. Epidemiologic evidence first suggested that dietary antioxidants are associated with lower rates of heart disease and cancer.
Randomized Controlled Trials (RCTs)
The "gold standard" of medical research. This type of study is designed to leave little to chance, comparing large enough groups of people receiving the test treatment to a similar size sample receiving some form of placebo.
If the effects of the treatment are positive, it is considered close to unequivocal -- very reliable and fairly safe to recommend. There are, however, loopholes in the gold standard. Sometimes an RCT contradicts a similarly designed trial that came to an opposite conclusion. This may happen, for example, if an RCT did not use a large enough sample size to be considered truly random. Also, many holistic modalities do not lend themselves to RCTs; e.g., what serves as an appropriate placebo for acupuncture or chiropractic?
Meta-Analyses and Review Articles
Evaluations of all existing data on a particular topic to form a consensus regarding what conclusions can be drawn from the scientific literature. A meta-analysis combines information from several studies and statistically quantifies this data. A review of the literature examines the state of all of the science at a given time.
Consensus Statements and National Guidelines
Recommendations from a panel of experts. In 1997, for example, the National Center for Complementary and Alternative Medicine presented a list of conditions for which there was convincing evidence to use acupuncture as a primary treatment (the list ranges from fibromyalgia to stroke rehabilitation).
It's a Woman Thing
If I had to select the main factor that distinguishes women's health from men's, I would say that it's the way our bodies cope with transition. The cycles that we experience tend to be more clear and obvious than those that men experience because of how our bodies change in response to them.
Another important difference is our willingness to talk about our experiences, especially around times of change. This, I'm certain, contributes to the medical labels placed on many of those experiences.
Regardless of whether our symptoms are branded as PMS, PMDD (premenstrual dysphoric disorder), perimenopause, or nothing at all, the important point is that there are things that we can do to feel our best. In addition to living a healthy life full of fruits and vegetables, exercise, and relaxation, you may find it helpful to:
Take calcium, magnesium, vitamin D, and B vitamins (especially B6, B9, and B12). Together these will help mood swings, bloating, weight gain, cramping, breast tenderness, and insomnia; preserve bone strength and prevent bone loss; prevent high blood pressure; and diminish your chances of heart disease, stroke, colon cancer, and osteoarthritis.
Increase dietary sources of soy and omega-3s to help prevent heart disease and reduce menopausal symptoms.
Try evening primrose oil. It can help mood swings, bloating, breast tenderness, and, for some women, the hot flashes of menopause.
Consider trying black cohosh for relief of menopausal symptoms such as irritability, mood swings, hot flashes, and sleep disturbances. It can also help menstrual symptoms such as PMS and pain.
A cautionary note: If you've had breast cancer or have a strong family history, talk to a physician before using black cohosh or increasing soy intake. Both contain phytoestrogens, and while studies have been conflicting, some show that these plant-based estrogens, like synthetic estrogens, may increase breast cancer risk.
Also of note are two trendy remedies that do not have a strong scientific basis and require more research:
Dong quai has long been used in Chinese medicine for cramps, irregular periods, PMS, and menopausal symptoms. However, it has mainly been used in combination with other herbs, not alone.
Despite the popularity of wild yam for menstrual cramps, menopausal symptoms, and morning sickness, there is no scientific proof that it works.
Text by Jacqueline A. Hart, M.D.
Therapy: St. John's wort
Although controversy does exist, many studies suggest that St. John's wort is better than placebo and as effective as antidepressants (tricyclics and SSRIs), with fewer side effects, for mild to moderate depression only. (It is very important to distinguish these forms of depression from major depression, which tends to include a greater number of depressive symptoms and, possibly, thoughts of suicide. For major depression, prescription medications and other therapies are a must.)
Talk with your doctor if you're considering trying St. Johnâ€™s wort; this herb has many potential drug interactions. Also, St. John's wort must not be combined with antidepressant medications. Psychotherapy should always be included in treatment for all forms of depression.
Evidence: Randomized controlled trials, review articles, and meta-analyses. Not all studies have had favorable results.
Therapy: Relaxation techniques, Valerian root
Up to 80 percent of people with insomnia can improve their sleep by learning to relax. Sleep-promoting techniques include progressive relaxation (a process that involves tensing and then releasing each muscle group in your body), meditation, yoga, guided imagery, self-hypnosis, and biofeedback.
Valerian, a mildly sedating botanical, can help you fall asleep faster and improve the quality of your sleep. Valerian combined with lemon balm and hops has yielded positive results as well. It may take one to two weeks to feel the effects. Valerian should not be used with sleeping pills, particularly barbiturates. Limit your use to six weeks or less until long-term safety information is available.
Evidence: Relaxation: Meta-analysis, review articles, and clinical savvy. Relaxation techniques, along with other behavioral changes, are considered first-line therapy for sleeping difficulties. Valerian: Randomized controlled trials. Trials to date have been short-term; there is no scientific information about the safety of using valerian for extended periods of time.
Feverfew may be worth a try for many migraine sufferers, particularly those who have used prescription medications and have either not had success with them or not been able to tolerate the many side effects. Look for feverfew standardized to contain at least 0.2 percent parthenolide, the active component thought to be responsible for reducing migraines and their symptoms. (The potency of feverfew varies tremendously from product to product, depending on where the herb was grown.)
Evidence: Randomized controlled trials and case reports. Several studies comparing feverfew with placebo have shown benefit in reducing the number of migraines over time and the symptoms associated with each headache.
Alcoholism, Smoking, and Other Addictions
Acupuncture for addictions may be most effective when combined with behavioral modification and, at times, medication. Endorphins released during acupuncture treatments may help reduce cravings and withdrawal symptoms. Auricular (ear) acupuncture may be particularly useful for narcotics and cocaine addiction.
Evidence: Consensus statement. Two subsequent review articles, however, concluded that there was no difference between real and sham acupuncture, in which needles are applied randomly. My bottom line: Acupuncture seems effective, and it can't hurt.
Therapy: Ginkgo biloba
Some experts feel that ginkgo is an excellent alternative to medication because it appears to have fewer side effects and costs less. While there are flaws to some of the research and not all trials have reached a positive conclusion, the evidence that ginkgo may improve thinking and memory in people with Alzheimer's has been highly promising.
Ginkgo is best if taken at the early stages of Alzheimer's. It may also be considered as a preventive measure if you have a family history of the disease. Ginkgo should not be used if you take a blood thinner (like warfarin) or a class of antidepressants called monoamine oxidase inhibitors (MAOIs).
Evidence: More than 40 randomized controlled trials -- even some comparing ginkgo with standard medications -- and several review articles.
Therapy: Acupuncture, chiropractic
There are many nonpharmaceutical options to lessen the frequency and severity of throbbing head pain, whether it starts in your temples or your neck. Acupuncture and chiropractic are my preferred treatments for prevention. An acupuncturist will test your energy, looking for imbalances, to determine the best course of action for your headaches. Chiropractic tends to work best if your headaches begin at the base of your skull, or the top of your neck, and travel forward to other parts of your head.
Evidence: Acupuncture -- Consensus statement, some randomized controlled trials (RCTs), some review articles, and empiric knowledge. Not all studies have shown positive results.
Chiropractic -- RCTs and review articles. Several studies have compared this technique with medications and found chiropractic more effective for prevention.
Eyes, ears, nose and throat
Carotenoids and flavonoids can help prevent and treat macular degeneration. Lutein and zeaxanthin, both carotenoids, seem to be especially beneficial. For prevention, load up on orange and yellow squash, dark, leafy greens, and berries. For people who have macular degeneration, supplementing with mixed carotenoids (25,000 to 50,000 IU daily) and adding some extra lutein (5 mg daily) may help stop its progression. Vitamins C and E, zinc, and selenium can also help.
Evidence: Epidemiologic, randomized controlled trials (RCTs), and review articles. More RCTs investigating carotenoids and other antioxidant supplements for macular degeneration are currently under way; there are no definitive conclusions yet.
Homeopathy can be an excellent treatment, particularly for children. Talk with your doctor about ways to care for ear infections without antibiotics, about when antibiotics are truly necessary (children under age 2, for instance, should generally use antibiotics), and about your desire to try homeopathy.
Evidence: Empiric knowledge and randomized controlled trials.
Zinc lozenges or nasal gel (but not spray) have been shown to improve symptoms and reduce the length of time that a cold lingers. Evidence for vitamin C and echinacea is less convincing; surveys suggest, however, that many people experience better relief with these remedies than the science would lead you to believe.
Evidence: Randomized controlled trials, review articles, and surveys.
Acupuncture works especially well for the headache often associated with sinusitis. Many acupuncturists will also use moxibustion, which involves burning a stick containing the herb mugwort and holding the heat from the smoldering flame over acupuncture points.
Evidence: Empiric knowledge. Surveys show that more people tend to try over-the-counter herbs (like stinging nettles) or chiropractic for ongoing sinus symptoms, but my patients seem to get the best results from acupuncture.
Therapy: Omega-3 fatty acids
Early studies suggest that taking fish oil or alpha-linolenic acid may help ease asthma symptoms and improve lung function. I recommend dietary sources of omega-3s: eat fish, walnuts, and flaxseed while decreasing foods rich in omega-6s (e.g., meat, egg yolks, and certain oils) and trans-fatty acids. Use dietary measures as part of a comprehensive plan, including medication and breathing exercises.
Evidence: Epidemiologic, small randomized controlled trials, and review articles.
High Blood Pressure
Research shows that regular meditation practice can help lower blood pressure and keep it down. Biofeedback, qi gong, massage, and self-hypnosis have also been shown to help treat high blood pressure. Be sure to eat foods rich in calcium, magnesium, and potassium as well.
Evidence: Randomized controlled trials and meta-analyses. Many (but not all) studies have shown positive results.
Therapy: Soy, fiber
Both soy and soluble fiber are essential for lowering cholesterol. The American Heart Association recommends consuming at least 25 grams of soy protein per day (if you have a high risk of breast cancer, talk with your doctor first). Aim for at least 25-30 grams of fiber per day and eat plenty of fruits, vegetables, whole grains, and nuts.
Evidence: Review articles, meta-analyses, and national guidelines.
Therapy: Milk thistle
Several studies suggest that taking milk thistle can stop or slow the progression of liver damage from chronic drinking. In patients with hepatitis C or the chronic active form of hepatitis B, the use of milk thistle to prevent progression of liver disease has not been proven.
If you are interested in trying milk thistle for hepatitis, talk with your hepatologist. Until more is known about interactions with the drugs used to treat hepatitis, some feel it is best to reserve use of milk thistle for those who either do not see improvement from the available prescription medications or who cannot tolerate the many side effects.
Evidence: Empiric evidence, animal studies, and review articles. Human studies have generally been too small to draw definitive conclusions. A national study under way should resolve outstanding questions.
Urinary Tract Infection
Several randomized controlled trials have confirmed this century-old remedy. Cranberry tablets appear to be more effective than cranberry juice. Excess cranberry may increase your risk of kidney stones; consult your doctor if you have a personal or family history of kidney stones.
Evidence: Randomized controlled trials and review articles.
Therapy: Abdominal massage, biofeedback
Along with drinking plenty of water, exercising regularly, and eating a high-fiber diet, abdominal massage and biofeedback can help relieve constipation for both children and adults. Reflexology and acupuncture also have some convincing, albeit early, scientific evidence for effectiveness.
Evidence: Review articles and clinical trials; some trials have been randomized while others have not.
Several studies have shown that homeopathy can shorten the duration of infectious diarrhea in children placed on an individualized remedy. In adults, and for other forms of diarrhea, there is a lot of empiric evidence but few studies. Speak with your doctor and find a reputable homeopath if you have ongoing or periodic diarrhea.
Additionally, there is preliminary scientific evidence for probiotics and herbs: Lactobacillus, especially for antibiotic-related diarrhea; berberine extract for infectious diarrhea (if your doctor also prescribes antibiotics, be sure to take both); and Boswellia serrata, an Ayurvedic remedy, for chronic colitis.
Evidence: Randomized controlled trials in children and one meta-analysis looking at the value of the data from three trials; the sample size from each study to date has been small.
Irritable Bowel Syndrome
Therapy: Relaxation techniques
Ongoing practice of a relaxation technique of your choice, such as meditation or hypnotherapy, is key for continued regulation of bowel habits and reduction of pain. If you choose hypnotherapy, it is important to see a qualified hypnotherapist who teaches you self-hypnosis methods. No time or too costly to see a hypnotherapist? Try an audiotape to learn self-hypnosis.
It is very important to include fiber in your diet. And try peppermint-oil capsules for symptom relief. (Be sure to buy the enteric-coated version; uncoated peppermint oil is likely to give you heartburn and indigestion in exchange for easing your IBS symptoms.)
Evidence: Randomized controlled trials.
Lower Back Pain
Some reviews suggest that chiropractic offers only marginally better treatment for low back pain over conventional medical care, educational materials, or time and patience. However, when surveyed, people who see chiropractors are much more satisfied with their care, especially with the end result. Greater satisfaction with care can translate into motivation to take the necessary steps to keep your back in shape.
Evidence: Review articles, randomized controlled trials, and empiric knowledge.
Therapy: Glucosamine and chondroitin, tai chi
Although it may take several months for pain relief to begin, glucosamine tends to have three advantages over conventional nonsteroidal anti-inflammatory drugs: longer-lasting pain control, fewer side effects, and improved range of motion.
Chondroitin is another option, though the evidence is weaker. Taking the two supplements together seems to add little benefit. For diabetics, however, chondroitin is a better choice; glucosamine may interfere with the way your body uses insulin. If you have asthma, talk to your doctor before using either one. Tai chi can help strength, flexibility, and balance and diminish the chances of falling.
Evidence: Glucosamine and chondroitin: Meta-analyses, review articles, and randomized controlled trials. Evidence is positive, though individual trials have been fairly small. A large study is currently under way looking at both supplements; results are due out in 2005. Tai chi: Empiric knowledge and randomized controlled trials.
Massage reduces overall muscle tension, helping you feel and sleep better. You will likely still need some combination of medication, physical therapy, heat therapy, acupuncture, magnesium, biofeedback, and practices for relaxation such as yoga or meditation.
Evidence: Randomized controlled trials and empiric knowledge.
Psoriasis and Eczema
Therapy: Essential fatty acids
Those with eczema tend to have high levels of an omega-6 fatty acid called linoleic acid, which promotes inflammation. One theory suggests thatâ€™s because they lack the ability to convert linoleic acid to a useful omega-6 essential fatty acid called gamma-linolenic acid, or GLA. Borage, black currant, or evening primrose oils can provide GLA directly. For psoriasis, fish-oil supplements may prove beneficial. Try foods high in omega-3 fatty acids, e.g., fatty fish, walnuts, and flaxseed.
Evidence: Randomized controlled trials and review articles.
Text by Jacqueline A. Hart, M.D.