Integrative Health: An overview

Transcription

1 Integrative Health: An overview Maya Romani, MD Health and Wellness Center Director Department of Family Medicine American University of Beirut May 12, 2017

2 Objectives At the end of this presentation you will be able to: 1 Define Complementary, Alternative and Integrative Medicine 2 Become familiar with the principles p of integrative medicine 3 Identify various categories of integrative medicine 4 Recognize the health effects of some herbal products and supplements based on evidence based research 5 Introduced to our AUB Health and Wellness Center and Nature Conservation center

3 Definitions iti Allopathic Complementary Alternative Folk Integrative

4 Allopathic The system of medical practice which treats disease by the use of remedies which produce effects different from those produced by the disease under treatment. Medical Doctors practice allopathic medicine. i

5 Folk Folk medicine refers to therapies that are provided by family or group members as part of a family or cultural tradition: Part of culture Uses native remedies

6 Complementary Versus Alternativeti Complementary generally refers to using a nonmainstream approach together with conventional medicine. Alternative ti refers to using a non mainstream approach in place of conventional medicine. health

7 The move: Integrative medicine "combines mainstream medicaltherapies and CAM therapies for which there is some high quality scientific evidence of safety and effectiveness. NCCAM to NCCIH health

8 Integrative medicine and health Reaffirms the importance of the relationship between practitioner and patient. Focuses on the whole person. Informed by evidence. Makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing. Addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a person s health. Academic Consortium for Integrative Medicine & Health is integrative medicine/ g /

9 A move or back to basics? Emphasizes the WHO definition dfiiti of health : Health is a state of complete physical mental and social Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.

10 Integrative medicine is about patients and not diseases It is more important to know what person has the disease than what disease the person has. Sir William Osler

11 Why we should care? Documented Growth: Centers providing CIH Health schools teaching CIH Research studying CIH Spending Number of patients seeking CIH

12 Centers and medical schools 60% of US Med Schools offer some form of CAM education. 165 Integrative Health Centers in US today University Hospitals Independent Centers

13 34,525 Adults Children Practices and Products The 2012 National Health Interview Survey

14 Pti Patient t Conditions with highest h clinical i l Practice Demographics success Models *

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16 CAM use in Lebanon* Vitamin and Mineral Supplements (3.8%) Folk Foods (13.2%) Natural Health Folk Herbs Products (75%) (31.7%) * Naja F et al, The Use of Complementary and Alternative Medicine among Lebanese Adults: Results from a National Survey. Evidence Based Complementary and Alternative Medicine Volume 2015 (2015), Article ID , 9 pages

17 NIH-NCCAMNCCAM Backed up by the Department of Health and Human Services in United States, t congress established the Office of Alternative ti Medicine i in 1992 and the NCCAM in NCCAM, which belongs to the NIH, has a mission to fund and carry on rigorous scientific research in the field of CAM. The budget allocated to this center was of 2 million dollars when it was founded, and became 50 millions in 1999, and close to 130 million dollars in 2012.

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19 Research

20 Is it cost effective? Several RCT s conducted over ten years on people with severe CHD. (JAMA, The Lancet) Interventions included yoga, meditation, low-fat Veg. Diet, smoking cessation, moderate exercise and social support. Disease stopped or reversed without use of drugs or surgery. Effectiveness of comprehensive lifestyle changes Meta-analysis of 107 studies looking at stress reduction and blood pressure: Transcendental Meditation program alone able to reduce both systolic and diastolic blood pressure in significant number of patients. NIH funded trials on TM reduction in HTN, Atherosclerosis and insulin resistance.

21 Cancer More recent work in prostate cancer demonstrated lifestyle changes can affect gene expression. Nutrition, stress management, walking and psychosocial support. Changed expression of > 500 genes. Oncogenes (breast and prostate ca) + genes causing heart disease, oxidative stress and inflammation Downregulated or Turned off. Protective genes Upregulated or Turned on. Related study published in The Lancet Oncology: Telomerase increased ~ 30% in three months. Lifestyle changes not only reverse disease but also extend lifespan

22 CIH in Cancer Examples of treatment complexity IM center at MD Anderson Cancer Center in Houston, Texas. Cancer patients present with a variety of health issues: Pain; acupuncture*, massage, music therapy. Fatigue; exercise, nutrition, acupuncture*. GI disorders; acupuncture* for nausea, massage for constipation, mind-body therapy for general discomfort. Depression; Psychiatry and meds, mind-body therapies.

23 IH Categories Natural products Herbs, vitamins and minerals, and probiotics Mind body interventions Yoga, chiropracticand and osteopathic manipulation, meditation, massage, acupuncture, relaxation techniques(breathing exercises, guided imagery, and progressive muscle relaxation), tai chi, qi gong, and hypnotherapy Other complementary health approaches Other complementary health approaches Ayurvedic medicine, and homeopathy

24 Naturopathy th Natural Products Herbs Vitamins and minerals Probiotics Often sold as dietary supplements

25 Co enzyme Q10 Also called ubiquinon Antioxidant found in high concentrations in the heart A 2013 meta analysis: CoQ10 increased net cardiac ejection fraction by 3.7% 2014 multicenter RCT:CoQ10 added to standard therapy was safe and well tolerated, improved symptoms, and reduced major cardiovascular events in patients with heart failure No evidence on performance enhancement, retardation of the aging process, immune system enhancement, diabetes mellitus, hypertension, or cancer (G D) Am J Clin Nutr. 2013;97(2): JACC Heart Fail. 2014;2(6):

26 Effects of Omega-3 3FAonCVD Previous data: Conflicting evidence The omega 3 fatty acids found in fish oil lowers high triglyceride levels Dosage of 4 g per day decreases triglyceride levels by 25% to 30% Fish consumption 2 4 times per week is associated with lower cardiovascular mortality in cohort studies Real fish or fish oil? Expert Opin Pharmacother. 2015;16(1): Cardiol Rev. 2010;18(5): (5) Heart Lung Circ. 2015;24(8): Public Health Nutr. 2012;15(4):

27 Cranberry Early studies: Prevention of recurrent UTI Recent data: Cranberry Juice Is No better than placebo at preventing recurrent UTIs or treating acute UTI Preliminary evidence: antioxidant properties and may also be able to reduce dental plaque and the ability of H. pylori bacteria to live in the stomach and cause ulcers Clinical Infectious Diseases. 2011; 52(1):23 30 NCCIH

28 Ecchinacea Has immune stimulating effects No evidence on treating or preventing common cold (Grade 1B) for preventing and treating the common cold

29 Garlic supplements e Short term (1 3 m) benefits on blood cholesterol llevelsl NCCIH study showed no benefit Population based: the higher the amount of garlic consumed, the lower the risk of stomach and colorectal cancer Journal of Nutrition 2001; 131(3s):1032S 1040S International Journal of Cancer 2006; 118(10):

30 Ginger Effective: Pregnancy related nausea and vomiting. Conflicting data: Nausea caused by motion, chemotherapy, or surgery It is unclear whether ginger is effective in treating rheumatoid arthritis, osteoarthritis, th or joint and musclepain of herbal medicine and dietarysupplements?source=search_result&search=ginger&selectedtitle=1%7e40

31 Gingko Biloba A meta analysis of 7 RCTs including 2,684 patients with Alzheimer or vascular type dementia: standard measures of overall cognition and ADL improved on 240mg ginkgo extract(industry funded) easu es o oea cog t o a d poedo 0 g g goe t act( dust y u ded) Ineffective Against High Blood Pressure Does not reduce the risk ikof cancer Interacts with anticoagulation Effect of Ginkgo biloba on blood pressure and incidence of hypertension in elderly men and women. American Journal of Hypertension.2010

32 St. John s wort and depression Hypericum perforatum 2008 Cochrane review:, St. John s wort more effective than placebo for the treatment of mild major depression with minimal side effects Extracts standardized to 0.3% hypericin ebmh.bmj.com Archive Volume 12, Issue 3

33 Melatonin Effective in Jet lag and shiftwork disorder Not effective in treating most primary sleep disorders May be effective in tinnitus Evidence suggests that melatonin is safe with short term use.

34 Honey Cough: Effective more than diphenhydramine Wounds: 1. High quality evidence that honey heals partial thickness burns around 4 to 5 days more quickly than conventional dressings 2. Moderate quality evidence that honey is more effective than antiseptic followed by gauze for healing wounds infected after surgical operations. as a topical treatment for acute and chronic wounds Pediatrics. 2012;130(3):

35 Zinc and common cold Treatment: Zinc > 75 mg daily administered within 24 hours daily cold duration and symptoms Prevention Children: Systematic ti R(2RCT):zinc sulfate, tk taken for > 5 months, the rate of colds Adults: Cochrane: No firm recommendation can be made because of insufficient data 1 Cochrane Database Syst Rev 2013; 6:CD001364/ 2 Open Respir Med J 2011; 5:51/ 3 CMAJ 2012; 184:E551.

36 Vitamin C Mt Meta Analysis: No effect on preventing or treating ti common cold Cochrane Database Syst Rev 2013; 1:CD000980

37 Probiotics Probiotics Prevent Pediatric and adult upper respiratory tract infection A recent systematic review pooling data from 63 RCTs on 11,811 participants found a 0.58 RR of antibiotic associated diarrhea among participants who supplemented with probiotics(nnt of 13.35) Additional research is needed to determine which strains are most effective for specific indications. Peds 2009; 124: e172 e179 Cochrane databases systematic reviews 2011 September 7;9 PMID

38 Multivitamin after 70 Multivitamin/mineral it i i lsupplement use may prevent cancer in individuals with poor or suboptimal nutritional status No benefit in preventing cardiovascular disease or cataract, and may prevent advanced age related macular degeneration only in high risk individuals

39 Miscellaneous Glucosamine/chondroitin :Beneficial together in OA Hawthorn: Significant benefit in symptom control as an adjunctive treatment for chronic heart failure Low evidence: tea tree oil, and bee venom may reduce total skin lesions in acne vulgaris Artichoke leaves extracts has potential effect in lowering cholesterol levels Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily

40 The challenges Variability of preparations Variability in the quality and purity of available products limits the ability of effective research The lack of adequate regulation of herbs and supplements by the U.S. Food and Drug Administration makes it difficult for consumers and physicians i to be assured of the quality and safety of a specific supplement

41 Body based Chiropractic or osteopathic manipulation Massage Yoga Meditation Acupuncture Relaxation techniques(breathing exercises, guided imagery, and progressive muscle relaxation) Tai chi Qi gong Hypnotherapy

42 Chiropractic Osteopathic manipulation A health care profession concerned with the diagnosis, treatment and prevention of disorders of the neuromusculoskeletal system There is an emphasis on manual techniques, including joint adjustment and/or manipulation with a particular focus on subluxations. Effective in back pain, neck pain and headaches h World Health Organization, Guidelines on Chiropractic, 2005

43 Massage and evidence Children and adolescents: i. Anxiety and depression ii. Reduce the severity of asthma in school age children hld iii. Enhance the growth rate of premature infants Adults: i. Back pain ii. Decreases stress hormone iii. Enhances serotonin Effectiveness of massage therapy for chronic, non malignant pain: a review. Evid Based Complement Alternat Med 2007; 4:165. Paediatr Anaesth 2008; 18:884 Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence 1998; 33:103

44 Exercise and anxiety Review of 37 meta analyses of RCTs (42,264 participants): exercise had positive effect on reducing anxiety Helps patients t with chronic illness even without t having psychiatric disorder More studies needed regarding the dose, type, and frequency of exercise

45 Tai Chi: definition and evidence 12 month Tai Chi program is effective for improving health fitness of the elderly Rheumatoid arthritis: Statistically significant benefits on lower extremity range of motion Favorable effects upon the occurrence of falls in elderly Promising effect on as a complement therapy for chronic heart failure Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD DOI: / CD Tai chi exercise in patients with chronic heart failure: a randomized controlled trial.. Archives of Internal Medicine ;171(8): month Tai Chi training in the elderly: its effect on health fitness. Medicine and Science in Sports and Exercise [1998, 30(3): Journal of the American Geriatrics Society [1996, 44(5): ]

46 Meditation ti Mindfulness: Particular way to deepen self awareness and increase one s ability to stay present in the moment, nonjudgmentally Goals :To become more aware of one s own mental processes, listen more attentively, become flexible, and recognize bias and judgments, and thereby act with principles and compassion Jon Kabat Zin. Mindfulness for Beginners: Reclaiming the Present Moment and Your Life. Sounds True. Boulder, CO, Ronald M. Epstein, MD, Mindful Practice, Journal of the American Medical Association, September 1, 1999, Volume 282, No. 9

47 Meditation Affects positively the brain morphology Help cancer patients relieve anxiety, stress, fatigue, and general mood and sleep disturbances, thus improving their quality of life. Reduces symptoms of anxiety and depression, as well as menopausal symptoms HTN: A 2013 review and scientific statement from AHA : The overall evidence supports that Transcendental Meditation (TM) modestly lowers blood pressure. ADHD: Few studies, beneficial More studies are needed

48 Yoga The various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation. Popular Yoga Practice May Improve Pain Tolerance and Alter Brain Anatomy Yoga practitioners have more gray matter in multiple brain regions compared with individually matched people who did not practice yoga Possible evidence on Asthma Villemure C, Čeko M, Cotton VA, Bushnell C. Insular cortex mediates increased pain tolerance in yoga practitioners. Cerebral Cortex. May 21, 2013

49 Hypnotherapy Clinical hypnosis resulted in significant reductions in hot flashes compared with controls, in postmenopausal women 2015 Systematic review: good evidence on insomnia aafp.org/afp/2015/1101/p807.html f /2015/1101/ Elkins GR, Fisher WI, Johnson AK, et al. Clinical hypnosis in the treatment of postmenopausal hot flashes: a randomized controlled trial. Menopause: The Journal of the North American Menopause Society. October 22, 2012.

50 Acupuncture Acupuncture is based upon the theory of a vital energy that circulatesthrough through thebody in channels called meridians Disease occurs when the flow of vital energy is disrupted or blocked. Acupuncture restores the flow of vital energy through stimulation of specific points along the energy meridians Safe and well tolerated Strong evidence on pain management (back, neck, shoulder, headache) Moderate evidence: functional GI sx, GU sx Little evidence: stress management and addiction New evidence: IVF Arch Intern Med. 2012;172(19): Evid Based Complement Alternat Med. 2015;2015:

51 Non-categorized Ayurvedic medicine Aromatherapy Homeopathy

52 Aromatherapy Aromatherapy is the use of essential oils from plants to support and bl balance the mind, body, and spirit ii Aromatherapy May Make Good Scents, But Does It Work? Lemon appeared to enhance mood, while lavender (thought (h h to be a relaxant) had no effect on mood Psychoneuroendocrinology ; 33(3):

53 Homeopathy 2 unconventional theories: like cures like :A disease can be cured by a substance that produces similar symptoms in healthy people; and law of minimum dose : the lower the dose of the medication, the greater its effectiveness. little to no evidence to support homeopathy as an effective treatment for any specific condition FDA regulated, however, FDA does not evaluate the remedies for safety or effectiveness Sehttps://nccih.nih.gov/health/homeopathy

54 Research challenges Methodological Funding Publishing

55 Methodological l challenges CAM and IM researchers: RCT is problematic due to differences in diagnosis,treatment and assessment Financial support: government and private funding organizations NCRS is not supporting herbal research anymore

56 AUB Health and Wellness Center Providesa platform for both wellnessand integrative health services: 1. Wellness Services 2. AUB Wellness Program 3. Academic and Research

57 Agenda of Activities

58 Our Team Family medicine physicians Nurses Dietitian Acupuncture specialists Certified yoga teacher and certified life coach and stress management specialist Community health nurse Coordinator

59 Our services: Clinical Services General Health Checkup Executive Health lhcheckup Travel Health Smoking Cessation Employee Health Services Acupuncture Nutrition Stress management workshops

60 Our services: Integrative Health Services Life Coaching Yoga Meditation Hypnotherapy

61 Our services: Consultancy Services Schools Corporations Banks NGOs Wellness Packages offered: Stress Management package Ergonomics package Flu season package Nutrition package Smoking Cessation package Golden Wellness package

62 Research funding opportunities Smoking cessation Herbal preparations and IBS, functional dyspepsia/bloating Acupuncture and functional disorders

63 Contact t us: wellness@aub.edu.lb Phone: 01/ Ext: 3000/3002

64 Thank you

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