CAM for kidney care, heatstroke

Renal and urology news weighs in with information about CAM therapies for kidney care, the "skeptic" fights on, and someone offers household herbal remedies.

From the July 2008 Issue of Renal And Urology News:

DESPITE INTENSIVE dietary intervention, malnutrition remains prevalent in stage 5 CKD, affecting 20%-70% of all patients. Malnutrition, as evidenced by hypoalbuminemia, is strongly associated with increased morbidity and mortality in this patient population. Both nutritional and non-nutritional factors have been identified as contributing to malnutrition in CKD and include poor appetite and intake, inflammation, GI problems, and other comorbidities. Because traditional dietary strategies have had limited success, it may be helpful to examine alternative approaches as an adjunct to improving nutrition outcomes in CKD.

Use of complementary and alternative medicine (CAM) has increased in recent years, prompting the need to examine the safety and efficacy of these therapies in an evidence-based manner. Toward this end, the National Center for Complementary and Alternative Medicine (NCCAM) was created in 2002 by the National Institutes of Health. With the growing use of dietary and herbal supplements in the general population, there are special health concerns for people with impaired renal function. Among these are the risk of acute and chronic kidney injury and potential herb-drug interactions with commonly prescribed medications. In a survey of 452 hemodialysis patients, presented as a poster by my colleagues and me at the National Kidney Foundation (NKF) Spring Clinical Meetings in 2000, (Blair et al, J Ren Nutr. 2000; 10:111, abstract), more than 30% of subjects reported either current use (16%) or past use (16%) of nutraceuticals, including vitamins other than a prescribed renal multivitamin.

Lack of federal oversight of products classified as dietary supplements, inadequate product standardization, and scarcity of controlled trials have been cause for concern among renal health professionals. To improve "current good manufacturing practice" of dietary supplements, a final rule promoting the safe use of diet-ary supplements was enacted by the FDA in 2007 as a "critical com-ponent of the Dietary Supplement Health and Education Act of 1994 (DSHEA)." (See www.fda.gov/consumers/updates/dietarysupps 062207.pdf.) With serious issues remaining as to the use of dietary and herbal supplements in CKD, other areas of complementary and alternative medicine may provide safer options. This review will explore the safety and efficacy of non-herbal CAM therapies, specifically acupuncture and acupressure, in addressing factors contributing to malnutrition in CKD patients.

Acupuncture

Inflammation is a major cause of hypoalbuminemia in dialysis patients. Studies have demonstrated a reduction in proinflammatory cytokines, specifically interleukin (IL)-6 as a result of acupuncture therapy (Garcia et al, Adv Chr Kidney Dis. 2005;12:282-291). In addition to nutritional effects, inflammation also negatively impacts cardiovascular health, the leading cause of morbidity in CKD. The World Health Organization has identified more than 40 health conditions that could be helped by acupuncture, and those relevant to nutrition include nausea and vomiting, weight control, dental pain, acute and chronic colitis (without organic components), hiccups, pharyngitis, and esophageal spasms. Research is in progress regarding use of acupuncture as an adjunct treatment for hypertension,hypercholesterolemia, and diabetes.

Acupuncture has been recognized as a complementary treatment for depression and anxiety, which is widespread in the dialysis population. A study by Kalender et al (Nephron Clin Pract. 2005;102[3-4]:115-121), noted an association of depression with markers of nutrition and inflammation in CKD and end-stage renal disease (ESRD). Depression can impact appetite and food intake, so successful treatment may result in nutritional benefit. Considerations with regard to acupuncture as a treatment option include choosing a qualified provider, and use of disposable needles. Acupuncture may be contraindicated for patients with pacemakers or for those who bruise easily.

Acupressure

Acupressure, also known as acupoints massage, follows the same principles as acupuncture except that pressure rather than needles is used on specific points of the body. Although this noninvasive procedure is usually provided by practitioners, some acupressure techniques can be taught to patients for independent use. Risk factors for poor nutrition in which acupressure has been used successfully include depression, fatigue, and sleep disturbances, all common in stage 5 CKD patients. In a study by Tsay et al (J Adv Nursing. 2003;42:134-142), 98 ESRD patients with sleep disturbances were randomized to acupressure, sham acupressure, or control, with intervention provided during thrice weekly dialysis sessions. At the end of the four-week study, improvements in sleep as well as quality of life were reported in the treatment group. In addition to impacting quality of life, poor sleep and depression in ESRD patients have been associated with increased levels of inflammatory cytokines and C-reactive protein, as well as de-creased serum albumin.

The potential for improved nutrition outcomes in CKD through integration of CAM and traditional medicine is intriguing. Although there are concerns regarding safety and efficacy of CAM therapies, establishing an open dialogue with patients is important. To integrate CAM into evidence-based practice, it is necessary to have standardization of therapeutic methods, training and licensure of practitioners, and well-designed studies to examine outcome measures and confirm treatment benefit.

From a website on herbal household remedies:

While the use of natural medicine is on the rise, many misconceptions still exist surrounding the use and benefits of these therapies. Here are two common myths and facts about Complementary and Alternative Medicine (CAM) and its role in the future of health care:

Myth: You must choose either natural medicine or conventional medicine.

Fact: People no longer think they have to choose, realizing that both natural and conventional approaches can play a role in meeting their health care needs. According to a study conducted in 2005 by the Institute of Medicine at the National Academy of Sciences, more than a third of American adults use some form of Complementary and Alternative Medicine, including herbal remedies and acupuncture, with total visits to CAM providers each year now exceeding those to primary care providers. As health care consumers demand more options, the medical establishment is responding. Surveys show that 60 percent of conventional medical schools teach some form of complementary medicine. The number of accredited naturopathic medical schools in the country also is growing -- as are their enrollment numbers.

Myth: Herbal remedies are safe and nontoxic, so I can self-prescribe them.

Fact: It is important to realize that "natural" doesn't necessarily mean "safe." Although the vast majority of herbs are safe when used properly, they also are powerful. They can cause adverse effects and can interact negatively with conventional medicines. Seek advice from someone trained in herbal and natural medicines and buy products from a reputable source to ensure quality and purity.

Always tell your conventional health care provider about any CAM therapies you use, because it will give him or her a better understanding of your whole health care picture. For more information on which CAM therapies may benefit you, consult a licensed naturopathic physician.

- Jane Guiltinan, ND, core faculty member in the School of Naturopathic Medicine at Bastyr University

Good heavens, we've been "infiltrated!" (We -- good medicine -- that is). Enjoy the war metaphors in this "skeptical" perspective:

1. ... advocates of unscientific medicine have cleverly coopted the very language of science and medicine, turning it against those who would resist the infiltration of pseudoscience, leading to Wally's lament over how accepting we as the medical profession have become towards pseudoscience. What once was "quackery" or "pseudoscience" is now merely "unconventional" or "complementary," and extreme lack of scientific plausibility for a treatment modality seems no longer to be a barrier to clinical trials. 2. Through the passage of the DSHEA of 1994, the federal government has hobbled the FDA and in essence given free rein to supplement manufacturers to make almost any dubious health claim they wish, as long as the claim is sufficiently vague. Meanwhile legislators such as Dan Burton and Ron Paul lobby aggressively for "health freedom" laws that would in essence inoculate quackery from prosecution and allow quacks to operate without any pesky interference from the FDA or FTC. 3. Due to high profile cases where state child welfare agencies have attempted to strip parents of custody of children with cancer to prevent them from choosing quackery over scientific medicine for their child, ill-advised laws, such as "Abraham's Law" in Virginia, have been passed that in effect strip protections against quackery from teens and older children unfortunate enough to have parents who believe in unscientific medicine. 4. As I and others have pointed out, quackery has infiltrated academic medicine to such an extent that not only are many of our major academic medical centers dedicating divisions, centers, or departments to what Dr. R. W. Donnell has termed "quackademic medicine," but at least one has required it as part of the mandatory medical school curriculum from day one, bringing a whole new meaning to the term "integrative" medicine, as it integrates scientific medicine with pseudoscientific quackery. 5. Meanwhile, Dr. Andrew Weil has succeeded in "integrating" pseudoscience into the eight family practice residencies, with more virtually guaranteed to follow, and Dr. David Katz at Yale has constructed the foundation for an academic empire of woo based on a more "fluid" concept of evidence. 6. The Bravewell Collaborative has many millions of dollars to spend promoting unscientific medicine to any medical school or academic medical center willing to receive its largesse. 7. NCCAM has a budget of over $120 million a year and has spent over $1 billion so far researching, but also promoting CAM. Worse, it is funding trials that are not only scientifically dubious but arguably downright unethical; for example, the TACT trial of chelation therapy for atherosclerotic coronary artery disease, the trial of the "Gonzalez regimen" for pancreatic cancer, and the proposed trial of chelation therapy for autism. Adding an approximately equal money to the pot of CAM funding is the National Cancer Institute, which funds over $120 million a year worth of CAM research related to cancer. 8. Legislatures are passing laws that not only recognize unscientific "healing" traditions as legitimate professions but some states have even mandated that health insurance plans pay for such "treatments." 9. Anti-vaccine activists are sowing fear and distrust over vaccines, even going so far as to march on Washington. As a result, in the U.K. measles, once thought conquered, has become endemic again, and in the U.S. measles outbreaks are increasingly common. 10. Our government is making deals with China to study "traditional Chinese medicine," possibly as a quid pro quo for the Chinese granting the FDA inspection stations in Chinese cities, possibly as an attempt to control adulteration of Chinese herbal medicines.

Suggestions from a fitness coach on CAM therapies for heatstroke:

omplementary and Alternative Therapies Nutrition and Supplements Health care providers may recommend drinking fluids that contain electrolytes (see Prevention section for more details). Endurance athletes may want to take mineral supplements including: Calcium Magnesium Potassium Foods high in these nutrients include dark leafy greens, nuts, seeds, whole grains, sea vegetables, blackstrap molasses, and bananas. Herbs The most important treatment for heat exhaustion is replacing lost fluids by drinking water or a sports drink. Some herbs may help reduce body temperature, but if you have symptoms of heat exhaustion you should talk to your health care provider before taking anything. Although no studies have examined using herbs to treat heat exhaustion specifically, herbs traditionally used to reduce fever or lower body temperature include: Chinese skullcap ( Scutellaria baicalensis ) -- used in traditional Chinese medicine to reduce temperature by dilating blood vessels near the surface of the skin, which helps the body get rid of heat Elder flower ( Sambucus nigra) -- used to treat fever, sometimes combined with peppermint leaf ( Mentha x piperita ) Willow bark ( Salix spp. ) -- used to treat fever. Do not take willow bark if you are allergic to aspirin, and do not give it to children under 16 because of risk of developing Reyes syndrome, a serious illness. Yarrow (Achillea millefolium ) -- used to treat fever Cayenne pepper (Capsicum spp. ) -- contains capsaicin, which may lower body temperature by stimulating sweat glands

Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of fevers based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
Belladonna -- often used for fever, particularly if flushed with bright red skin and dulled mentation. The person for whom this treatment is appropriate does not usually feel thirsty even though his or her mouth and skin are dry
Glonoinum -- used for fever if the person is flushed and sweaty. The person for whom this is appropriate may complain of a hot face but cold extremities, as well as irritability, headache, and confusion. It is often used for ailments brought on by overexposure to the sun.

A fun disclaimer:

I'm not a doctor, and I don't give medical advice. Mention of any medical device, treatment, drug, or food supplement is for educational purposes only. Consult your physician before undertaking any treatment or the use of any drug, food supplement, or medical device. HerbalHouseholdRemedies.com is not responsible for the use or misuse of any product mentioned.

It's nice to see the legal disclaimer use the first person.

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