integrative medicine and phitotherapy

8/14/2019 Integrative Medicine and Phitotherapy

1/72

Integrative Medicine

Nutritional Implications


2/72

Complementary and

alternative medicine (CAM): Complementary and alternative

medicine (CAM): alternative,

adjunctive health care practices: notpresently an integral part ofconventional medicine; includes

botanical use, mind-body approaches,musculoskeletal manipulation, energymedicine, nutrition-diet interventions

Thomson in Krause, p. 470


3/72

CAM Therapies Include

Alternative medical systems, such asnaturopathy, traditional Chinese medicine,ayurveda, and homeopathy

Mind-body therapies, such as meditation,prayer, art or music therapy

Biologically based therapies such as herbs,whole foods diets, and supplementation

Manipulative therapies such as massage,chiropractic medicine, osteopathy, yoga

Whole medical systems based on energytherapies such as qi gong, magnetic

therapy, and reiki


4/72

Integrative medicine

Integration of these approaches intoconventional medicine; nutritional care

is a primary therapy in this model Focused on combined use of

conventional and CAM approaches

Evidence-based

Includes wellness and prevention

Thomson in Krause, p. 471


5/72

Complementary and

Alternative Medicine(NCCAM)

Part of the National Institutes of Health

Investigates and evaluates alternative

therapies and their effectiveness


6/72

Theoretical Basis of

Holistic Therapies Health as a vital, dynamic state; more

than the absence of disease

The healing force of nature

Self-healing power of living things;organisms have inherent self-defense

mechanisms against illness

Includes naturopathy, chiropractic,homeopathy, traditional Oriental

medicine, acupuncture, phytotherapy


7/72

Health is more than the absence of disease.

The body can heal itself .

Integrative Therapies

Naturopathy

Homeopathy

Traditional Chinese medicineAcupuncture

Phytotherapy


8/72

Naturopathy

Practitioners diagnose and treat at the primary carelevel

Train in 4-year postgraduate institutions

Most states require licensure

Uses natural methods of healing (light, heat, air,water, and massage)

Training includes pathology, microbiology, physicaland clinical diagnosis, pharmacognosy, hydrotherapy,physical therapy, nutrition,

Treatments include phytomedicines, electrotherapy,physiotherapy, minor surgery, mechanotherapy,nutrition, nutritional supplements, and natural forces


9/72


10/72

Chiropractic Practitioners

Do not prescribe drugs or performsurgery

Licensed and regulated in all 50 statesand 30+ countries

Practitioners must graduate from 4-

year accredited college of chiropracticand pass a nationally-administeredexam


11/72

Chiropractic

The most widely-used of thecomplementary and alternative

treatments, particularly for low backpain, neck pain, and headache

Effectiveness is being studied by the

Consortial Center for ChiropracticResearch, a consortium of chiropracticschools and universities, established

by NCCAM


12/72

Homeopathy

Law of similars: Substances in largedoses that produce symptoms of a

disease in healthy people will cure thesame symptoms when administered invery dilute amounts

Remedies become potentized throughrepeated dilution and succussion(shaking)


13/72

Homeopathy

Results of research on theeffectiveness of homeopathy have

been contradictoryAppears to have more than a placebo

effect, but scientific basis unclear

Generally regarded as safe (manyhomeopathic remedies are so dilutethat the healing substance is

nondetectable by chemical means


14/72

Traditional Chinese

Medicine Based on the concept of body life

force chi (Qi)

Forces that must be balanced

Yin and yang and blood

Invisible energy circuits calledmeridianscarry chi and blood

throughout the body


15/72

Nutrition in Traditional

Chinese Medicine Components: Food as a means of

obtaining nutrition, food as a tonic or

medicine, fasting Foods classified by taste (sour, bitter,

sweet, spicy, salty) and property (cool,

cold, warm, hot and plain) Regulate yin, yang, chi, blood


16/72

Acupuncture and

MoxibustionAcupuncture: Use of thin needles,

inserted into points on the meridians,

stimulating the bodys energy or chi Moxibustion: application of heat along

meridian acupuncture points, affecting

chi and blood, balancing substancesand organs

Treat disharmony in the body


17/72

Acupuncture as

Anesthesia Has been used to produce regional

anesthesia

Appears to act through needle stimulation,triggering the release of opioids

Research has been mixed

Has been shown to be efficacious in adultpostop management, chemotherapy-induced nausea, postoperative dental pain


18/72

Traditional Chinese Herbs

Includes herbs and minerals as well asanimal products

Pharmacopoeias published as early asthe third century BC

Most medicinals include multiple

substances


19/72

Phytotherapy

Science of using plant-derived substances totreat and prevent illness

Botanicals: come as bulk herbs, tinctures,capsules and tablets; includes herbs andother plant materials

Sometimes the active ingredient has been

identified; sometimes not

Have a long history of research and use inEurope


20/72

Botanical Formulations

Teas: weak concentration prepared bysteeping fresh/dried herbs for a few

minutes in water Infusions: more concentrated than

teas; steeped for 15 minutes

Decoction: Most concentrated ofbeverages; botanical is boiled for 30-60 minutes


21/72


Extracts: herbs are extracted with anorganic solvent to dissolve the active

components; concentrated form Tincture: extract in which solvent is

alcohol

Glycerite: extract in which the solvent is

glycerol or mixture of glycerol, propyleneglycol, and water; more suitable forchildren


22/72


Capsules: Herbal material enclosed in a hard shellmade from gelatin or cellulose

Tablets: herbal material is mixed with filler to formthe hard tablet; may be coated or uncoated

Lozenges (troches): active components arereleased in the mouth when chewed or sucked

Soft gels: used to encase liquid extracts, such asomega-3 fatty acids or vitamin E

Essential oils: fragrant, volatile plant oils used foraromatherapy, bathing; not to be used internallyunless specifically directed


23/72

American Herbal Products AssocBotanical Safety Rating System

Class 1: herbs that can be safely consumedwhen used appropriately

Class 2: herbs for which restrictions apply,e.g. for external use only, not to be usedduring pregnancy, nursing, etc

Class 3: herbs labeled To be used only

under the supervision of an expert qualifiedin the appropriate use of this substance.

Class 4: insufficient data for classification


24/72

Dietary Supplement Health andEducation Act of 1994 (DSHEA)

Defined dietary supplements as a productintended to supplement the diet that bearsor contains one or more of the following

dietary ingredients: a vitamin, a mineral, anherb or other botanical, an amino acid, adietary substance for use by man tosupplement the diet by increasing the totaldaily intake, or a concentrate, metabolite,

constituent, extract, or combinations ofthese incredients

Reclassified botanicals as dietarysupplements, distinct from food or drugs

Di t S l t


25/72

Dietary SupplementHealth and Education Act

of 1994 (DSHEA) Plant extracts, enzymes, vitamins, minerals,

hormonal products available withoutprescription may carry structure-function

claims Cannot claim to prevent or cure specific

conditions Must display disclaimer, This statement has

not been evaluated by the Food and DrugAdministration. This product is not intendedto diagnose, treat, cure or prevent anydisease.


26/72

Required Labeling of DietarySupplements under DSHEA Name (echinacea, for example)

Ingredient information

Disclaimer: "This statement has not beenevaluated by the Food and Drug

Administration. This product is not intendedto diagnose, treat, cure or prevent any

disease." Supplement Facts panel, which includes

serving size, amount and active ingredient.

Name and address of manufacturer, packeror distributor.


27/72

Supplement Facts Panel


28/72

Dietary Supplement

Claims Health claim: describes the relationship

between a substance and a disease

condition; FDA does not approve, but mustbe notified

Qualified health claim: based on emergingscientific evidence; must be approved by

FDA Structure-function claim: most common;

does not claim to prevent disease, but aphysiological effect is noted, e.g. increasesblood flow to the heart.


29/72

Labeling Under DSHEA

Allowed

This product helps toincrease blood flow tothe heart.

This product promotesurinary tract health

This product improvesabsent-mindedness.

This product reducesstress and frustration

Not Allowed

This product preventsheart disease

This product preventsurinary tract infections.

This product reducesrisk of AlzheimersDisease.

This product improvesdepression.


30/72

Regulation of Dietary

Supplements Dietary supplements are not subject to the

same standards as prescription or over-the-

counter drugs Manufacturers do not have to prove their

products are safe or effective before theyput them on the market

FDA can pull supplements proven to bedangerous, but only after the fact; it is up tothe FDA to make its case


31/72

Regulation of Dietary

Supplements: Medwatch The FDAs Medwatch system can be

used to report possible adverse

reactions to dietary supplementshttp://www.fda.gov/medwatch/report/hcp.htm
http://www.fda.gov/medwatch/report/hcp.htmhttp://www.fda.gov/medwatch/report/hcp.htm


32/72

Examples of FDA Warnings

January, 2004: FDA warns consumers not tofeed their babies Better than Formula Ultra

Infant Immune Booster 117" being soldover the internet as a dietary supplement

February, 2002: Consumers warned to stopusing the products PC SPES and SPES

capsules because they contain undeclaredprescription drug ingredients that couldcause serious health effects


33/72


34/72


35/72


36/72

Cautions Regarding

Dietary Supplements There may be a discrepancy between

the ingredients on the label and whats

inside This is especially true of herb

mixtures, such as Chinese herbs

The dosage of the active ingredientin herbals can vary widely dependingon the variety of plant, where its

grown, climate, etc.


37/72

Read the Dietary SupplementLabel and Verify.

Complete botanical name of the product(make sure it is the right botanical)

The part of the plant used to make theproduct; it should be the part that containsthe active components

The concentration of the botanical and if it

is appropriate, neither too weak or twostrong

Debusk, RM. A practical guide to herbal supplements for

nutrition practitioners. Top Clin Nutr 16:53, 2001


38/72

Read the Dietary SupplementLabel and Verify. The daily dosage needed to obtain the

desired effect

The list of ingredients used to identify fillers,

potential allergens

Lot number

Expiration date

Recognized seal of approval (GoodHousekeeping, USP, Consumerlab)

Compare prices: prices vary widely

Debusk, RM. A practical guide to herbal supplements fornutrition ractitioners. To Clin Nutr 16:53, 2001


39/72

Evaluating Dietary

Supplements Obtain unbiased evaluative information from

resources like Supplement Watch and

Consumer Lab www.consumerlab.com Encourage patients to purchase supplements

from well-known manufacturers


40/72

ConsumerLab Study of 20

MultivitaminsVitamins that failed: The Vitamin Shoppe Multivitamins Especially for

women: Contaminated with lead

Hero Nutritionals Yummi Bears: Had twice thelabeled amount of vitamin A Nature's Plus Especially Yours for Women: Took

twice as long as allowed to disintegrate AARP Maturity Formula: Took nearly twice as long

as allowed to disintegrate Eniva VIBE: Only 54 percent of claimed vitamin A Pet-Tabs Complete Daily Vitamin-Mineral

Supplement for Dogs: Contained lead Accessed at MSNBC http://www.msnbc.msn.com/id/16655168/ Released 1/2007
http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/


41/72

ConsumerLab Study of 20

MultivitaminsVitamins that passed:

Centrum Silver

Member's Mark Complete Multi

One A Day Women's

Flintstones Complete http://www.msnbc.msn.com/id/16655168/

January, 2007
http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/


42/72

Tips for Picking a

Multivitamin from CSPI Choose well-known mainstream brands by companies

that have a lot at stake. Buy from large, trusted retailers, not unknown sellers

on the Internet. Look on the bottle for a stamp from USP, NSF or

ConsumerLab.com. While the stamp doesn't guaranteethe product is safe and effective, it does indicate thatthe manufacturer has submitted the product fortesting to show that it contains what is stated on the

label. Dont spend a fortune on vitamins. Pricey products

toting all sorts of "extras" aren't necessary and maybe trouble.

Center for Science in the Public Interest accessed athttp://www.msnbc.msn.com/id/16655168/ 1/07
http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/http://www.msnbc.msn.com/id/16655168/


43/72

Evaluating Dietary

SupplementsUnited States Pharmacopeial Convention

(USP) Dietary Supplement Verification

Program (DSVP) Certification mark (USP)indicates that

the product contains the dietary supplementlisted on the label in the stated amount and

that the product is manufactured properly Does not speak to the safety or efficacy of

the ingredients, only to good manufacturingpractices


44/72

CAM Providers: MDs/DOs

Over 1/3 of medical schools offerinstruction in alternative medicine

More than half of family physicians inthe US regularly prescribe alternativetreatments or have used themselves


45/72

CAM Providers: RDs

Nutrition in Complementary Care DPG, asubunit of the American Dietetic Association

http://www.complementarynutrition.org/ Some RDs are incorporating counseling

about CAM into their practices


46/72

CAM Providers: Other

RNs

RPh

ND: naturopath provider DC: chiropractor

OMD: oriental medical doctor

Accupuncturist Massage Therapist

Hypnotherapist

Herbalist


47/72

Tips for Patients:Evaluating CAM Providers

Check for licensing, education,accreditation of provider

Check for complaints (BBB, Board ofHealth, Attorney Generals office,patient support groups)

Speak with the practitioner in person,evaluate facilities and neighbors


48/72


49/72


50/72


51/72


52/72


53/72

Trends in Use of CAM byUS Adults 1997-2002 The number of Americans using CAM

remained stable at 72 million

50% in use of herbal supplements,from 12.1% in 1997 to 18.6% (38million).

Yoga increased 40%, from 3.7% to5.1% (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 andMedicine; 1; 1: 2005.


54/72

Trends in Use of CAM byUS Adults 1997-2002

Use of CAM therapies includingacupuncture, biofeedback, energy healing,hypnosis remained essentially unchanged

Use of homeopathy, high-dose vitamins,chiropractic, and massage therapy declinedslightly

Increased use of herbal medicinepractitioners among those who use herbs(5% to 15%)


55/72

Commonly UsedBotanicals

Echinacea

Garlic

Ginger Gingko biloba

Ginseng

Hawthorn

Milk thistle

Saw palmetto St. Johns wort

Valerian


56/72

Echinacea

Source: Purple cornflower

Indication: Stop or moderate colds

or fluAction: Macrophages and their

secretions

Cautions: Avoid if immune system ishampered and do not usecontinually


57/72

Garlic

Source: Garlic plant

Indication: Lower serum cholesterol and

triglyceridesAction: Chewing or crushing

activates several sulfur-containing compounds

Cautions: Allergies, GI symptoms,interaction with anticoagulantdrugs


58/72

Ginger

Source: Root of ginger plant

Indication: For nausea and vomiting ofpregnancy and motion

sickness; anti-inflammatoryAction: Volatile oils in the rhizome,

called gingerols; may act onserotonin receptors in the

ileum Cautions: Interaction with anti-

coagulant, antihypertensive,glucose-lowering drugs


59/72

Gingko Biloba

Source: Gingko tree

Indication: Improved blood circulation;used to treat age-related

mental function decline r/tcerebrovascular insufficiency

Action: Flavone glycosides have

antioxidant effect, inhibitplatelet aggregation

Cautions: Class 2d botanical; maypotentiate MAO inhibitors; GI

complaints, headache, allergy


60/72


61/72

Hawthorn

Source: Native European tree;leaves, blossoms, fruit

Indication: Improve blood flow incirculatory disorders

Action: Dilates coronary vessels;

strengthens heartcontractions and rate

Cautions: Class 1 botanical


62/72


63/72

St. Johns Wort

Source: Perennial herb

Indication: Mild to moderate depression

Action: Hypericin and hyperforin inflowering tops; reuptake ofneurotransmitters

Cautions: Rated as 2d botanical; maypotentiate pharmaceuticalMAOIs; interact with otherantidepressives;

photosensitivity


64/72

Valerian

Source: Perennial herb; active elementin roots and rhizomes

Indication: Minor tranquilizer and sleep

aid; fewer side effects thanmedicationsAction: Volatile oils (bornyl acetate

and valerenic acid) mode of

action GABA binding Cautions: Class 1 botanical; abrupt

withdrawal may precipitatesymptoms


65/72

W ki ith Cli t h


66/72

Working with Clients whoUse CAM

Most clients will not tell their allopathic(mainstream medicine) providers about CAMuse, unless asked

Establish a rapport with clients

Be non-judgemental; assume role of coach

Ask clients to bring all prescription, OTC,

and dietary supplements with them to theirvisit

Debusk RM. Integrative medicine and phytotherapy. In

Krause, p. 491-492.


67/72

For Each Supplement

Ask client what he/she hopes to achieve bytaking it

Discuss whether the formulation is

appropriate to achieve the clients healthgoals Discuss whether dosage taken has been

found to be safe and effective in clinicaltrials

Review quality of the particular preparationand how to evaluate


Krause, p. 491-492.


68/72

For Each Supplement

Discuss any known safety orcontraindication concerns

Review potential or known interactions

between each supplement and prescriptionor OTC preparations, other dietarysupplements, and foods

Instruct client to use dosage commonlyrecommended and instructions for where toobtain credible information


Krause, . 491-492.


69/72

For Each Supplement

Recommend a low starting dosage,even lower than that commonly

recommended and evaluate response Use this as an opportunity to teach

consumers analytical skills that will be

useful in managing their own health.


Krause, p. 491-492.

W ki ith Cli t Wh


70/72

Working with Clients WhoUse CAM

It is the responsibility of healthprofessionals to ask clients about use

of CAM and to be familiar withcommonly-used therapies

Nutrition professionals can take the

same evidence-based approach toCAM as to any other therapy ormedical intervention

Li k f I t ti


71/72

Links for IntegrativeMedicine Information

Intellihealth Index of Herbal Medicines andSupplementshttp://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html

Herb Med: An interactive electronic herb database.http://www.herbmed.org/

Rosenthal Center Botanical Medicine InformationResources (Columbia University)http://www.rosenthal.hs.columbia.edu/Botanicals.ht

ml National Institutes of Health National Center for

Complementary and Alternative Therapyhttp://nccam.nih.gov/
http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.htmlhttp://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.htmlhttp://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.htmlhttp://www.herbmed.org/http://www.herbmed.org/http://www.rosenthal.hs.columbia.edu/Botanicals.htmlhttp://www.rosenthal.hs.columbia.edu/Botanicals.htmlhttp://www.rosenthal.hs.columbia.edu/Botanicals.htmlhttp://nccam.nih.gov/http://nccam.nih.gov/http://nccam.nih.gov/http://www.rosenthal.hs.columbia.edu/Botanicals.htmlhttp://www.rosenthal.hs.columbia.edu/Botanicals.htmlhttp://www.herbmed.org/http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.htmlhttp://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html


72/72

Summary

Identify use of herbs and botanicals.

Monitor for side effects.

Document for records.

Discuss with physician.

integrative medicine and phitotherapy

Documents