Alternative Healthcare

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Alternative Healthcare

• An Overview for Educators of
• Dietetic Interns
• March 2003

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Objectives

• Discuss the rationale for learning about CAM
• Describe incidence and prevalence of CAM
• Discuss reasons for increased use of CAM
• List the categories of CAM and give an example of
  each
• Identify resources for interns

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Self-Care Movement
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The Self Care Movement

• Healthy foods
• Vitamins, Supplements, Natural products and
  herbals
• Self-care devices
• OTC items
• Pharmacy
• (Seeking CAM)

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Using CAM

• 1/3 using
• Few have health professional counseling in
  decision
• Safety, efficacy and toxicity unknown with many
  CAM
• Billions are being spent out of pocket
• Professional and ethical issues

6
Using CAM

• Serious side effects of medical treatment
• Felt conventional treatments did not help
• Complimentary therapies thought to be safe
• Mistrust of WM
• Want to do everything to help self
• Longer lasting and better relationship with CAM
  practitioners
• Critical attitude towards healthcare
• CAM usually used for chronic disorders
• CAM pts. want to share in decision making

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Predictors of using CAM

• lower age
• higher pain
• higher disability

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Alternative Healthcare

• Definition a group of diverse medical and
  health care systems, practices, and products that
  are not presently considered to be part of
  conventional medicine (NCCAM)

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Definitions (NCCAM)

• Complementary medicine is used together with
  conventional medicine
• Alternative medicine is used in place of
  conventional medicine
• Integrative medicine combines mainstream medical
  therapies and CAM therapies for which there is
  some high-quality scientific evidence of safety
  and effectiveness

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Alternative Healthcare The Big Picture (NCCAM)

• Alternative Medical Practices
• Mind/Body Interventions
• Manual Healing Methods
• Energy Therapies
• Biologically Based Therapies
• Lifestyle Changes

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Classification Resources

• http//www.mdadvice.com/topics/alternative/info/cl
  assify.html
• http//nccam.nih.gov/

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1. Alternative Medical Systems
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Alternative Medical Systems

• Traditional Oriental Medicine
• Homeopathic Medicine (vs. allopathic)
• Community Based Practices

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Traditional Oriental Medicine

• Chinese
• Macrobiotics
• Acupuncture
• Indian
• Aryuveda
• Yoga

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Traditional Chinese Medicine

• According to Chinese philosophy, the universe and
  the body can be described by two separate but
  complementary principles, that of yin and yang
• allow the two to balance each other and exist
  harmoniously together

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Traditional Chinese Medicine

• Chi is the fundamental life energy of the
  universe
• invisible and is found in the environment in the
  air, water, food and sunlight
• we get acquired chi from the food we eat and the
  air we breathe
• Chi travels through the body along channels
  called meridians

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Traditional Chinese Medicine

• world and body are made up of five main elements
• wood, fire, earth, metal, and water
• interconnected
• each organ is associated with one of the five
  elements

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Acupuncture

• believed to adjust and alter the body's energy
  flow into healthier patterns
• Insertion of needles into specific body points
• practiced in all 50 states by over 9,000
  practitioners, with over 4,000 MDs including it
  in their practices

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Eastern Philosophy Diets

• Macrobiotics
• Based on balancing 2 forces opposite forces
• Yin and yang
• Acid and base
• Contractive and expansive

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Macrobiotics

• Macrobiotics
• Yin Energy or movement that has a centrifugal or
  outward direction, and results in expansion
• Diffusion
• Dispersion
• Separation
• Yang Energy or movement that has a centripetal
  or inward direction and results in contraction
• Organization

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Macrobiotics
Yin (cooling)

• Soft, juicy fruits
• Drier, harder fruits
• Vegetables
• Roots and tubers
• Grains
• Seeds
• Nuts
• Legumes
• Dairy, eggs
• Animal foods

Eat
Yang (warming)
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Aryuveda

• Aryuveda medicine strives to maintain or
  reestablish harmony between the mind, body and
  the forces of nature using
• Diet
• Herbs
• intestinal cleansing
• Yoga
• Mediation
• breathing exercises
• Aromatherapy
• massage or bodywork

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Aryuveda

• Based on balancing 3 forces or energies
• Tridosha System
• Dosha An energy system
• Vata
• Pitta
• Kapha

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Aryuveda Vata dosha

• Cold
• hands and feet
• dislikes cold climate
• Quick
• to remember and forget
• Dry
• Skin and hair only moderate sweating
• Rough
• Rough skin coarse hair

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Aryuveda Pitta dosha

• Warm
• Flushed skin
• Overactive metabolism
• Sharp
• In mind and speech
• Moist
• Profuse perspiration
• Sour
• Breath and body odor if unattended

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Aryuveda Kapha dosha

• Heavy
• overweight
• Oppressive characteristics such as depression
• Sweet
• Weight gain
• Tendency for diabetes
• Steady
• Self contained body processes do not swing to
  extremes
• Soft
• Hair, skin, eyes
• Slow
• Movement
• Deliberate thinking

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Tridoshas

• Vata
• People who are creative, quick-witted and
  resourceful. They like being on the move. Seldom
  very good at managing money. Vatas good can be
  quite soft-hearted and romantic. Thrive in warm,
  coastal climates.
• Pitta
• People who are fiery, determined, strong- willed
  and passionate. They are tough minded,
  clearheaded, enthusiastic and ambitious and can
  be quite successful. Work well under pressure.
  Can be fad followers. Cool climates where seasons
  change visibly are best for Pitta
• Kapha
• People who are sensuous, strong, clam,
  soft-spoken and forgiving. Tend to develop
  well-developed bodies with big bones. Energy
  dominates in winter and early spring

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Balancing Vata

• Keep warm
• Eat warm foods and spices
• Keep calm
• Keep a regular routine
• Avoid cold, frozen or raw foods
• Get plenty of rest
• Avoid extreme cold  

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Balancing Pitta

• Avoid excessive heat
• Eat cooling, non-spicy foods
• Avoid excessive oil
• Exercise during the cooler part of the day
• Avoid excessive steam  
• Limit salt intake  

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Balancing Kapha

• Get plenty of exercise
• Vary your routine
• Avoid heavy foods
• Avoid fatty, oily foods
• Keep active Eat light, dry food
• Avoid dairy
• No daytime naps
• Avoid iced food or drinks

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Yoga
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Yoga
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Homeopathic Medicine

• based on the notion that a medicine capable of
  curing a disease will mimic or imitate its
  symptoms
• restoration of the body to homeostasis, or
  healthy balance, which is considered its natural
  state
• symptoms of a disease are regarded as the body's
  own defensive attempt to correct its imbalance
• Complicated approach

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Community Based Practices

• May be spiritually based
• Scientific based faiths
• May be communal
• Macrobiotic
• May be more allopathic
• Patch Adams

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2. Mind Body Intervention

• The body affects the mind and the mind affects
  autonomic, immune and nervous systems

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Mind Body Intervention

• Art Therapy
• Biofeedback
• Dance Therapy
• Guided Imagery
• Hakomi Method
• Humor
• Hypnotherapy
• Meditation

• Music Therapy
• Prayer Therapy
• Psychotherapy
• Rebirthing
• Relaxation
• Support Groups
• Yoga

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Biofeedback

• provides people with continuous information about
  physiological processes of which they are
  normally unaware
• learn strategies that enable them to achieve
  voluntary control over the processes involved

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Humor

• the recognition by physicians, nurses, and other
  health care practitioners of the value of mixing
  humor and laughter with medication and treatment
• http//www.goodnewsnetwork.org/

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Hakomi Method

• Body Centered Psychotherapy
• Change core material
• Develop Mindfulness
• Inward focus of attention

• Core Material
• Memories
• Beliefs
• Neural patterns
• Emotional dispositions

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Rebirthing

• a body-centered therapy that uses a gentle yet
  powerful breathing technique to help activate and
  release stored stress, pain, and emotional trauma
  of all degrees
• also includes identifying limiting beliefs that
  are formed before, during, and after birth

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3. Manual Healing
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Alternative Healthcare

• The most sought out treatments
• Relaxation
• Chiropractic
• Massage

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Manual Healing

• Acupressure
• Jin Shin Do
• Shiatsu
• Alexander technique
• Chiropractics
• Craniosacral therapy
• Feldenkrais method
• Massage

• Osteopathy
• Reflexology
• Rolfing
• Trager method

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Acupressure

• same points on the body are used as in
  acupuncture
• stimulated with finger pressure instead of with
  the insertion of needles

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NAET

• Nambudripad's Allergy Elimination Techniques
• a non-invasive, drug free, natural solution to
  eliminate allergies of all types and intensities
  using a blend of selective energy balancing,
  testing and treatment procedures from
  acupuncture/acupressure, allopathy, chiropractic,
  nutritional, and kinesiological disciplines of
  medicine

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NAET

• When contact is made with an allergen, it causes
  blockages in the energy pathways called meridians
  
• allergens are cleared (treated) one at a time, in
  a specific order
• Acupressure is primary treatment
• Also used chiropractics
• Kinesiology for assessment

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Jin Shin Do

• combines deep finger pressure with a
  mental-focusing technique based on Taoist yogic
  breathing
• as the energy flows freely, the body will heal
  itself from everyday stress
• providing relief from things like neck and back
  pain, insomnia, PMS, immune system problems,
  headaches, PMS and depression

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• Combination
• Acupressure
• Stretching
• Western massage

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Alexander Technique
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Alexander Technique

• adjusting and correcting habitual misaligned body
  posture
• efficient physical movements that can improve
  posture, balance, and coordination
• a process of reeducation

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Chiropractics

• focuses on the relationship of the spinal column
  to the nervous circulatory systems
• Misalignments, or what he called "subluxations,"
  interfere with the normal transmission of nerve
  impulses from the brain to the body's organs and
  tissues and can affect health

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Craniosacral Therapy

• hands-on technique
• gentle manipulation of the bones of the skull
• underlying meningeal membranes
• and the nerve endings in the scalp

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Feldenkrais Method

• uses movement to enhance the communication
  between the brain and the body
• become aware of faulty patterns or habits
• guided by teachers through a series of slow,
  gentle sequences of movements designed to replace
  old, negative habits with new, positive ones

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Massage

• Massage therapy is the scientific manipulation of
  the soft tissues of the body for the purpose of
  normalizing those tissues and consists of manual
  techniques that include applying fixed or movable
  pressure, holding, and/or causing movement of or
  to the body

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Osteopathy

• emphasis on the musculoskeletal system
• places greater emphasis on the relationship
  between the organs and the musculoskeletal system
  
• treating the whole individual rather than just
  the disease
• Osteopaths, chiropractors, and physical
  therapists are the experts in manipulations

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Reflexology

• Based on the premise that there are reflex points
  in the hands and especially the feet that
  correspond to every part of the body, reflexology
  is the practice of applying pressure to these
  points in order to stimulate the body's natural
  healing powers

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Rolfing

• the manipulation or deep tissue massage of the
  body's connective tissue and muscles, in order to
  realign and balance the body's structure

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Trager Method

• Hawaiian Physician
• Rocking shaking movements to loosen joints
  release patterns of chronic tension

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4. Energy Therapies
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Energy Therapies

• Biofield therapies
• Energy fields that surround and penetrate
• Qi gong
• Reiki
• Therapeutic Touch
• Polarity Therapy
• Bioelectromagnetic-based therapies
• Unconventional fields
• Pulsed fields
• Magnetic fields
• Direct current fields

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Biofield Therapies

• not a clearly defined view
• mixes concepts physics and metaphysics, or
  ancient and modern wisdoms
• Rigorous research has been hindered by the belief
  that a placebo effect is the operative factor,
  affecting funding, publishing, and status of
  researchers

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Qi Gong

• The practice of oriental medicine that enhances
  the flow of qi energy, thus, improving
  circulation and immune functioning
• Movement
• Meditation
• Regulation of breathing

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Reiki

• A Japanese therapy to channel spiritual energy
  through the practitioner for healing

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Therapeutic Touch

• A procedure also called "laying-on of hands" in
  which the clinician passes their hands over the
  patient to identify energy imbalances to promote
  healing

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Polarity Therapy

• Integrates bodywork with
• Diet
• Yoga-based exercise
• Physical touch and manipulation
• Self-awareness techniques to release energy
  blockages in the patient's body, mind, or
  feelings
• Purpose is to free up and balance the patient's
  flow of life energy on the physical, emotional,
  and spiritual levels

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Polarity Therapy

• Divides the body into three horizontal and four
  vertical zones (right, left, front, and back)
• each having a positive, negative, or neutral
  charge
• Energy currents in the zones are correlated with
  five energy centers in the body corresponding to
  the five elements (ether, air, fire, water, and
  earth) of Aryuvedic medicine
• Rocking the patient's body and holding his or her
  head

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BIO-ENERGETIC TESTING

• view of the physical body as an energy system
  composed of wave forms or oscillation at various
  frequencies
• EEG,EKG,EMG,and MRI employ the principles of
  energy medicine
• various electromagnetic measurements over certain
  body points much like an electrocardiogram
  registers electrical current in the heart

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BIO-ENERGETIC TESTING

• Determines the energy level of each and every
  organ in the body and how it is functioning
• Evaluates the digestive system, endocrine,
  lymphatic, and immune systems
• indicates any vitamin, mineral, or amino acid
  imbalances
• Identifies food allergies and sensitivities
• Points out environmental allergies to various
  substances, and chemicals, as well as allergies
  to yeasts and molds
• Identifies the presence of heavy metals

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BIO-ENERGETIC TESTING

• Use with food sensitivity testing

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Magnetic Therapy

• the use of magnets to relieve pain in various
  areas of the body speed healing
• produce a slight electrical current
• nerves in that area are stimulated
• releasing the body's natural painkillers
• the cells in that area react to
• increase blood circulation heat production
• ion exchange
• oxygen flow to the area. Magnetic fields attract
  and repel charged particles in the bloodstream,
  increasing blood flow and producing heat

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Pulsed Fields for Food Preservation

• High-voltage PEF as a low-temperature food
  processing method and application of this
  technology in food preservation
• New technology used to inactivate microorganisms
  and enzymes with only a small increase in food
  temperature
• Enzyme inactivation kinetics

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5. Biologically Based Therapies
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Biologically Based Therapies

• Vitamins
• Minerals
• Non-vitamin, Non-mineral (NVNM)
• Herbals
• Hormones
• Enzymes
• Antioxidants
• Amino Acids
• Food concentrates

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Chelation Therapy

• EDTA ethylene diamine tetra-acetic acid
• Intravenous administration
• Chelates heavy metals
• Lead
• Iron
• Copper
• Calcium
• Arsenic
• Urinary excretion

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Chelation Therapy

• FDA approved for lead poisoning or other heavy
  metal toxicity
• Can be recommended for CHD
• Mechanism unclear
• Possible binding to Ca in artery plaques
• NIH study TACT
• 30 million 5 year trial to assess safety and
  effectiveness starting 3/2003

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Alternatives to HRT

• Long term use of HRT for disease prevention is
  inappropriate
• Short term use for the relief of menopausal
  symptoms and osteoporosis prevention can be
  discussed with the doctor

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Alternatives to HRT

• vitamin E
• evening primrose oil
• soy isoflavones
• dong quai
• red clover
• Ginseng
• yam cream
• Chinese medicinal herbs

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Alternatives to HRT

• Might work, but data unavailable
• black cohosh
• vitex

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Alternatives to HRT

• Soy Isoflavones
• Genistein and daidzein have estrogen-like effects
  on select tissues but very minor effects in
  comparison to placebo
• Long-term effects of soy phytoestrogens on
  estrogen-sensitive tissues are unknown
• Soy components stimulate breast tumors in mice

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Alternatives to HRT

• Phytoestrogens
• Consist of more than 20 compounds in over 300
  plants
• Retrospective studies suggest that phytoestrogens
  are associated with a reduction in certain
  chronic diseases
• their effects in any woman will vary for many
  reasons
• product concentration
• woman's estrogen status
• flora in her digestive tract

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Probiotics
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Probiotics

• Therapeutic dose given for 10 days
• Maintenance dose
• Enteric coated
• Multiple cultures
• Proper storage

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Probiotics

• Improves digestion
• secretion of enzymes
• Improving integrity of gut lining
• Boosts immunity
• Communication with white cells across mucosal
  border
• Balances Candida
• Counters harmful microbes

84
Probiotics

• Allergies
• Digestive disorders
• Immune dysfunction
• Diarrhea
• Yeast overgrowth
• Cholesterol

85
Omega-3 Fatty Acids

• Inflammatory diseases
• CAD
• Colitis
• Autoimmune diseases
• Fibromyalgia
• Rheumatoid arthritis
• Mental diseases
• Depression

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Omega-3 Fatty Acids

• Plant sources (ALA)
• Walnuts, flaxseed, olive oil, canola oil, leafy
  greens
• Enriched foods (eggs)
• Animal sources (EPA DHA)
• Fatty fish

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Omega-3 Fatty Acids

• Treatment
• Preventive or Medicinal?
• Dietary sources vs. supplements?
• 0.5g-3g fish oil capsules
• 1-3 Tbs. ground flaxseed

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Enzyme Therapy

• Plant enzymes
• Papain
• Bromelain
• Bean-o
• Animal enzymes
• Ox bile
• Pancreatin

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Enzyme Therapy

• Digestive disorders
• Mucous accumulation
• Food allergies

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6. Lifestyle Changes
91
Food/Health Connection

• 58 feel you can greatly reduce the risk of
  certain diseases
• 50 bought a food product because of health
  benefit
• 25 told by a doctor to change eating habits

92
What Type of Whole Health Products are They
Buying?

• OTCs - 86
• Fortified foods - - 78
• Vitamins and minerals - 74
• Prescription medications - 68
• Organic foods - 37

93
Demand for reliable sources of health
information

• Health food stores nutrition centers

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Information is KEY!
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Lifestyle Changes

• Diets
• Low-fat (Pritikin, Ornish, Macrobiotics)
• Low-carb (Atkins, Zone, Sugar Busters)
• Low-calorie (Slim Fast, Cabbage Soup)
• Exclusion diets (Atkins, Gluten Free, Low
  Allergen)
• Fasting
• Physical Activity
• Endurance
• Strength
• Flexibility
• Relaxation

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Fasting

• Used in ancient cultures
• Spiritual healing components
• Used by many alternative systems
• Macrobiotics
• Yoga
• Treatment of build up diseases
• Cancer (tumors)
• CAD
• Obesity

97
Fasting Theory

• Gives the digestive system a rest
• Rids body of toxins and wastes
• Stimulates the metabolism
• Promotes healing by strengthening the immune
  system

98
Fasting

• Different Levels
• Fruits vegetables
• Juices, broths, teas (liquids)
• Juices
• Water
• Different Lengths
• 24 hours
• 3 day
• Week
• Month

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Fasting Side Effects

• Fatigue
• Dizziness
• Kidney stones
• Gall stones
• Electrolyte imbalance

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Fasting Contraindications

• Pregnant
• Breast feeding
• Diabetes
• Kidney problems
• Liver problems
• Eating disorder
• Asthma
• Tuberculosis

101
Food Combining

• as each food is eaten, it forms a layer in the
  stomach, and each layer is then sequentially
  digested
• the dominant nutrient in a food determines the
  type of digestive enzymes that will be secreted

102
Low Carb Plans

• Atkins theory
• Delays and lessens insulin release
• Protein fat establish satiety
• Decreases caloric intake
• Atkins drawbacks
• Low vitamin-mineral
• Form of elimination
• Ketosis
• Fat protein quality
• Water loss associated with glycogen depletion
• Rough on kidneys

103
Low Carb Plans

• Atkins advantages
• May jump start severely obese
• Alternative to gastric bypass
• Improved maintenance plan
• Phases are adjusted for loss maintenance

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Reduced Carb Plans

• Zone
• Goal is to control insulin in a Zone, not too
  high not too low, throughout the day
• Starchy, sugary carbohydrate sources in
  moderation, like condiments
• Must consume a minimum of 3 meals and 2 snacks
  per day

105
Reduced Carb Plans

• Sugar Busters
• reduce the sugar in your daily menu
• steers you away from foods such as potatoes and
  pasta, white bread and white rice, carrots and
  corn
• Insulin causes you to convert and store excess
  sugar as fat and also store excess fat as fat

106
Candida Elimination

• Candida albicans is related to many chronic
  health disorders
• PMS
• Sexual dysfunction
• Asthma
• Psoriasis
• Digestive and urinary problems
• Multiple sclerosis
• Muscle pain
• Chronic fatigue
• Gluten intolerance

107
Candida Elimination

• Probiotic course
• Elimination of all sugars
• Elimination of yeast

108
Gluten Free

• Celiac sprue is most common genetic abnormality
  among European decent
• 1150 may be positive
• Gluten sensitivity not limited to bowel skin
  manifestations
• Depression
• Brain Fog
• Polycystic ovary disease
• Diabetes
• Fibromylagia
• Chronic Fatigue

109
Pilates

• Movement focusing on
• Lengthening
• Balancing
• Strengthening
• Flexibility

110
Strength Training

• Inexpensive dumbbells
• Household objects
• Rubberbands
• Isometric exercises

111
Endurance
112
Relaxation

• Meditation
• Breathing exercises
• Yoga
• Massage

113
Resources for Interns
114
Informational Resources Healthnotes Online
115
Internet Resources

• NCCAM
• By treatment http//nccam.nih.gov/health/bytreatm
  ent.htm
• By disease http//nccam.nih.gov/health/bydisease.
  htm
• Health World Online
• http//www.healthy.net/clinic/therapy/index.html
• National Library of Medicine
• http//www.nnlm.nlm.nih.gov/nnlm/online/
• Web MD
• http//www.webmd.com/
• Comprehensive List of Resources
• http//www.pitt.edu/cbw/gov.html

116
Books

• Alternative Medicine Expanding Medical Horizons.
  U.S. Govt Printing Office
• Micozzi M. Fundamentals of Complimentary and
  Alternative Medicine NY Churchill Livingston
• Fugh-Berman A. Alternative Medicine What Works.
  Tuscon Odonian Press

117
Journals

• Alternative Therapies in Health and Medicine
• Alternative Health Practitioner

118
Comments

• Suggestion Practitioners should include
  nonjudgmental inquiries about patients use of
  alternative medicine because of their extensive
  use.
• Suggestion unconventional treatments often seem
  to make people feel more comfortable, even when
  their accompanying theories are silly.
• Ask Has this helped you? Respect the placebo
  effect.