Defining the term
Alternative Healthcare is primarily a function of who is asked
to provide that definition. To most pharmacists and insurers, the
term generally means “anything not FDA-approved, AMA-sanctioned, or
specifically covered by one’s insurance plan,” but that leaves
even off-label uses of approved products in a gray area with which
most physicians would argue. At the other end of the spectrum lie
the practitioners and proponents of alternative therapies, schooled
and competent in their own fields of therapeutic expertise and
confident in the therapeutic benefits to be derived therefrom.
Over the past century,
mainstream America has come to rely on allopathic, or strictly
empirical science-based medicine, as the standard by which to measure
the validity of any other philosophy. This is largely a function of
the progressively strict regulation of the medical field in this
country and of the high-tech, high-dollar nature of the sciences
supported by it. This regulation pressure, so responsible for public
opinion and which continues to escalate, demands that therapies be
proven safe and effective. The idea and the regulations supporting
it have been responsible for the removal of countless examples of
demonstrably counterproductive therapies from the marketplace and the
protection of the public from both charlatanism and blatant ignorance
– hardly an unworthy goal.
In a world where
proving efficacy and safety has become synonymous with tremendous
financial backing, though, this leaves a host of traditional and far
more economical remedies without proof and without financial
incentive to provide such proof. What manufacturer is likely to
invest millions in proving the safety and efficacy of ubiquitous and
inexpensive nutritional products and herbal products that have been
in use for centuries? There is simply no profit in such a venture
compared with the potential of a new high-tech pharmaceutical product
that can be patented for years of profit.
Many of what we have
come to view as alternative medical practices have been proven by
time, if not by science. Many others push the edges of the
credibility envelope, challenging disbelievers with proven success
stories in spite of their dubious likelihood. When judging the
merits of such modalities, we must remind ourselves that if the
Wright brothers had bound themselves by the concepts of what was
considered acceptable and provable in their time, we might never have
flown. Let us not forget that modern medicine is itself an imprecise
science, an exercise in perpetual experimentation. Most proponents
of alternative philosophies are quick to point out that conventional
allopathic medicine in this country tends to concentrate on
bioanalytical, high-tech, high-intervention, and chemical or surgical
treatments for disease states; while most alternative philosophies
place more value on preventive than remedial efforts and concentrate
on the overall (holistic), long-term health of the patient, employing
what are generally less-invasive, more natural remedies, extensive
re-education of the patient, and enlistment of his more enthusiastic
participation in the therapeutic regimen.
The issue is doomed to
polarization, with strong proponents on both sides supporting their
views with intelligent and valid arguments and with fanatics who
refuse to see merit or even possibilities in opposing views. Still,
a growing percentage of respected practitioners on both sides of the
issue are beginning to recognize that both philosophies have their
places. A more moderate stance takes into account the beliefs of the
patient, which can profoundly affect the outcome of any therapeutic
approach. It might suggest that holistic functions of lifestyle
manifested by such things as headache, back pain, colds, digestive or
immune disorders, hypertension, and chronic fatigue be appropriately
addressed by alternative means; while acute life-threatening or
infectious disease, trauma, and major organ failures remain the
bailiwick of conventional medicine. Needless to say, the dividing
lines become increasingly vague as the discussion continues.
In a world where none
of us can possibly know all the facts, and recognizing that healing
is often a function of belief in one’s therapy, every practitioner
and every patient must make his own informed decisions as to where to
place his professional efforts and his personal confidence. Even in
1990, Americans spent fourteen billion dollars on 435 million visits
to alternative practitioners; and the trend was then in its infancy.
Seventy-two percent of these visits went unreported to the patients’
more conventional physicians. Now even insurers are beginning to
recognize an obligation to provide some alternative therapies as well
as the benefits, both therapeutic and financial, to be derived from
them.
This is clearly an
issue that will remain unresolved; so we, as professionals in
pursuit of optimal outcomes, must learn to deal with the controversy
and to recognize the validity of what actually works best for a given
patient. It’s a posture that requires an open mind, a willingness
to learn, and often a suspension of disbelief. Toward those ends,
here is a cursory look at a few alternative therapies for which
scientific evidence continues to grow.
Some Websites Worth Checking Out Not surprisingly, many
of the most informative sources of information on herbal therapies
are associated with herbal product sales. Unfortunately, they tend
to expound loquaciously on the benefits of herbal products and
conveniently skirt the issues of contraindications and side effects,
leaving them to the imagination. Nonetheless, these sites are what
your patients have access to; and they can provide quick insight
into the uses of myriad herbal remedies. Be assured that most of
these sites have a convenient link to How To Order.
http://www.mothernature.com/herb.htm Mother
Nature’s General Store provides an index of many herbal products,
their uses, ready availability and prices.
http://www.realtime.net/anr/herbs.html
is a Reference Guide for HERBS, providing very short descriptions
and uses for looking these things up quickly.
The public is reading
more about “smart drugs”, products touted to improve memory,
concentration, mental acuity, and even intelligence, and herbal
remedies are a major focus of that interest. Check out this detailed
compendium on smart drugs of all kinds.
http://www.uta.fi/~samu/SMARTS2.html
Holistic philosophies
focus on the whole person for promotion of overall long-term health.
Though it concentrates on prevention, it must address interventions
for a number of disease states and disorders. This site is a guide
to holistic treatments for such problems.
http://www.geocities.com/HotSprings/Spa/3477/
Chiropractic is often a
great source for a holistic approach to healthcare. Learn more about
the profession and its focus on Chiropractic Online Today.
http://198.6.71.25/~tonto1/dcaol.html
SOME POPULAR HERBAL THERAPIES
Answers to the
question, “What other medications are you taking?” are becoming
increasingly complex. As herbal remedies become more popular and
sold in greater quantities to greater portions of the population –
even in pharmacies – it becomes more important for the pharmacist
to be educated in the basics of herbal therapy. Here is important
information on some of the herbal remedies about which your patients
are likely to be reading. Bear in mind that claims made of
therapeutic benefit are largely unsubstantiated by clinical studies,
but rather are the collective opinions of what herbal healers have
learned through generations of trial and error. From the literature
disseminated, some of these products are so universally beneficial,
with so many “proven” therapeutic benefits that one might
feel better just by reading about them. That, of course,
depends on symptoms.
It must also be
recognized that herbal products suffer from a general lack of
standardization. Different brands of the same product, and even
different batches of the same brand, claiming the same strength or
concentration of various active ingredients can differ dramatically
in actual content of ingredients that may confer side effects as well
as therapeutic benefit. Most inevitably contain a vast array of
chemical compounds with unquantified if at all identified
pharmacological effects. The current trend is toward
standardization, but the industry as a whole still has considerable
distance to cover toward achieving that goal to the satisfaction of
the pharmaceutical industry.
Echinacea (Echinacea
angustifolio) is more commonly known as the purple
coneflower that grows wild on roadsides in the central plains of the
United States, thriving on poor soil, sun or shade, and warmer
climates. American Indians used it to treat snakebite, insect
stings, wounds, toothaches, sore throats, smallpox, measles, and
mumps. They called it snake root because of its thick black roots,
which when dried are the source in most of the herbal products. It
is also commonly available in juice and liquid extract.
Typical samples will
contain tannins, proteins, fatty acids, copper, iron, vitamin A,
vitamin C, vitamin E, essential oils, polysaccharides,
polyacetylenes, glycosides, betain, sesquiterpenes, and caryophylene.
Some of the larger polysaccharides, particularly inulin, are touted
to stimulate the immune system by increasing T-cell production and
killer cell activity; while lipid-soluble alkylamides and caffeic
acid glycoside (echinacoside) enhance immune activity by facilitating
migration of inflammatory cells, and stimulating interferon
production. Interestingly, it is also used for its anti-inflammatory
effects in psoriasis, eczema, and arthritis. The compound is touted
to have direct antiviral and antibacterial properties that make it
popular in treating and preventing colds, flu, herpes, and Staph and
Strep infections.
Feverfew
(Chrysanthemum parthenium) is also known as
bachelor’s buttons and featherfew. Originally from southwestern
Europe, it is cultivated in Europe, Africa, and Japan, producing
prolific blossoms in sun or partial shade on average, well-drained
soil. The flowers and leaves of the plant are used to make the
extract and powder for capsules.
Samples contain
mixtures of essential oils, flavinoid glycosides, costic acid, pinene
derivatives, and sesquiterpene lactones. Parthenolide, one
sesquiterpene lactone, is reputed to inhibit release of serotonin,
histamine and prostaglandins to make it effective in both treatment
and prevention of migraine, especially with regular use. It is
commonly used in the place of aspirin and is viewed by many as more
effective than the NSAIDS for pain and fever reduction with less
stomach irritation. It also confers bonuses like blood pressure
reduction, appetite stimulation, improved digestion and kidney
function, and mood elevation. It is also used to treat dermatitis,
coughs, asthma, sluggish menstruation, tinnitus, dizziness, and
worms. No pharmacy should be without a good migraine remedy that
also treats worms.
Ginseng (Panax
ginseng) has been used in medicine for seven thousand
years and grows all over the world, though it is difficult to grow
and requires four to six years to attain adequate root size for
harvesting. The root is powdered and used in teas and capsules.
The word panax is
derived from the Greek word for panacea, and it is used as such, as
an adaptogen that treats whatever ailment it is called upon to treat.
For example, it is used for both hypertension and hypotension.
Samples contain zinc, vitamin B6, and vitamin A in addition to
saponin triterpenoid glycosides (ginsenosides), “steroid-like”
compounds that have been “proven” effective at just about
anything imaginable: Stress reduction, performance and stamina
improvement, energy and memory enhancement, immune stimulation, tumor
dissolution, reduction of the effects of aging, prevention of adrenal
hypertrophy and excess steroid production in response to stress or
trauma, neurotransmitter production and release, resistance against
viral infection and environmental toxins, functional enhancement of
the nervous system, liver, lungs, and circulatory system, reduction
of triglyceride and cholesterol levels, enhancement of male sexual
performance and estrogen levels in women, prevention and treatment of
diabetes and colds, protection from side effects of radiation and
chemotherapy, and sleep induction.
St. John’s Wort
(Hyperieum) grows wild in Colorado, Oregon,
and northern California as well as many places in Europe. The bushy
perennial is a prolific producer of yellow flowers which are used
along with the herb tops to make tea, extract, oil and powder for
tablets and capsules. Named for John the Baptist by early Christians
who gathered it on St. John’s day for making “The Blood of
Christ”, a red anointing oil. Since the Middle Ages, it has been
used to protect from evil with its magical powers. With a reputation as a
“potent antiviral and antibacterial”, it has attracted the
attention of those who treat HIV; and it’s antidepressant
properties have spurred studies to evaluate its role as a monoamine
oxidase inhibitor. Over the past 2400 years it has been used in
pulmonary complaints, incontinence, dysentery, worms, diarrhea,
hysteria, nervous depression, hemorrhage, and jaundice, tumors, caked
breasts, ecchymosis, etc.
Aloe (Aloe
vera), “the medicine plant”, “lily of the
desert”, “the plant of immortality”, was used as early as 1500
B.C. by the Egyptians to treat parasites, burns, and infections. Its
five hundred varieties grow worldwide in all sorts of climates in
sandy soil in partial sun or full shade. The extract comes from
pulverized whole leaves, while the juice is from the inner leaf.
Samples contain a
wealth of active ingredients: Essential oils, vitamins, minerals,
enzymes, amino acids, glycoproteins, and 96% water. Three of the
fatty acids are thought to have anti-inflammatory action; and
acemannan is suspected of stimulating the action of T-lymphocytes. The juice is used as a food supplement to treat colitis, ulcers, and
other digestive tract irritations. It is said to improve the
functions of not only the digestive system, but kidneys, liver, gall
bladder, and circulatory and lymphatic systems. Applied topically,
it treats dry skin, irritations, infections, burns, bites, stings,
eczema, acne, cuts, abrasions, and itching. But not worms.
Bee Pollen, not
surprisingly, is harvested from bees by brushes placed at the
entrance of the hive that dislodge pollen grains from the legs of the
insects as they enter the hive. The granules contain male gametes of
plants – grains or dust pellets on the stamen of flowers frequented
by the bees on their rounds. Viewed as the perfect food, these
grains contain amino acids, enzymes, trace elements, minerals,
vitamins, carbohydrates, and digestive enzymes from the bees.
Much like ginseng, bee
pollen seems good for just about everything, again from hypertension
to hypotension. It reportedly enhances sexual function and hormone
levels, alleviates allergy symptoms, “strengthens the respiratory
system”, “relieves brain fatigue”, enhances concentration,
stamina and strength, reduces recovery time from exercise, relieves
stress, enhances the immune system, treats nausea, sleep disorders,
urinary and rectal disorders, and enhances recovery from exposure to
radiation.
DHEA
(dehydroepiandrosterone) is a natural precursor of testosterone
and estrogen and is produced by the adrenals in decreasing amounts
after the age of twenty. In addition to helping to maintain levels
of both testosterone and estrogen, and thereby minimizing the effects
of aging, DHEA is also touted to increase one’s ability to burn
calories. This is accomplished by blocking
glucose-6-phosphate-dehydrogenase (G6PD), an enzyme necessary for fat
deposition and growth of cancer cells. Remarkably, at the same time,
it counteracts the catabolic effects of cortisol (the “stress
hormone”) to help prevent aging. It is commonly used to treat an
amazing list of maladies: Osteoporisis, depression, immune
dysfunction, Alzheimer’s, Parkinson’s, multiple sclerosis,
cardiovascular disease, hyperlipidemia, obesity, and diabetes. Those
who take DHEA report an almost immediate improvement of mood and a
sense of physical wellbeing.
Goldenseal
(Hydrastis canadenis),
also known as yellowroot, ground
raspberry, eye-balm, yellow paint, wild turmeric,
and yelloweye, is a perennial with a bright yellow rhizome and has
been harvested from the wild throughout the Appalachian region for
generations. Unrestricted harvest has seriously diminished wild
supplies, but the plant is easily cultivated in shaded, rich soil.
The alkaloids hydrastine and berberine, usually present in
concentrations of 2-4% in samples, are thought responsible for the
herb’s therapeutic effects.
The Cherokee employed
it as an antiseptic, a general health tonic, and to treat snakebite;
while the Iroquois treated whooping cough, pneumonia, and digestive
disorders with it. The American pioneers used it primarily as an
eyewash and to treat mouth sores. Today it is used for nasal
congestion, mouth sores, eye infections, ringworm, hemorrhoids, acne,
as a topical antiseptic, and to enhance the immune system. It is
reputed to mask illegal drugs from urinalysis.
Pycnogenol
(proanthocyanidin) is a bioflavinoid from the bark of Pinus
maritima, the European coastal pine, and a powerful antioxidant
reputed to be twenty times as potent as vitamin C in that role. The
pine grows on the sandy coast of France, south of Bordeaux. Samples
contain some 40 natural agents, including roanthocyanidins, organic
acids and other biologically active components, of which lycuogenoft
is one suspected major contributor to antioxidant activity. It is
used like vitamins A, E, and C and beta-carotene as an antioxidant to
eliminate free radicals and minimize their negative impact on the
system.
In its antioxidant
role, it inhibits collagenase and elastase, proteolytic enzymes that
degrade connective tissue in the normal aging process. It improves
peripheral circulation and shortens recovery time from exercise and
stress.
Ginko Biloba (Ginkgo
Biloba Leaf) is a tree originally grown in China and
taken to Europe in the Eighteenth Century, thriving in full sun and
average soil. The dried leaf containing flavinoids and terpene
lactones (bilobalide, quercetin, kaempferol, and ginkgoloides A, B,
and C) is used for a host of medical applications centered around
enhancement of circulation. It is thought to facilitate blood flow
by inhibiting Platelet Activity Factor (PAF), elevated by stress and
poor dietary habits.
In its vascular role, the herb is used for
enhancement of memory, mental clarity, and reaction time, treating
disorders like Alzheimer’s cerebral insufficiency, confusion,
lethargy, depression, anxiety, diabetic peripheral vascular disease,
Raynaud’s syndrome, varicose veins, hemorrhoids, stroke, head
injuries, dizziness, headache, and tinnitus. Ginkgo is considered
particularly effective in restoring blood flow to the retina. It is
also reported to have significant antioxidant activity and to
interfere with atherosclerotic plaque formation.
Gotu Kola (Centella
asiatica and Hydrocotyle asiatica) is
an Ayurvedic herb, a creeping, marsh-loving plant originally used in
India, China, and the South Pacific about two thousand years ago. In
India, it was used for skin irritations and for diuresis; but it has
long been revered as the “herb of enlightenment”, refining the
nervous system to promote awareness of the whole being. In China, it
has been used to treat fevers, colds, and congestion as well as
depression and other emotional problems that may have a physical
base. It also promotes longevity.
Today, its list of uses
is no less impressive: Enhancement of blood flow and capillary
health, treatment of phlebitis, leg cramps, edema and heaviness or
tingling in the legs, hypertension, senility, and aging. It is
thought to reduce the effects of stress, to improve reflexes,
increase mental and physical power, and to protect against toxins.
Saw Palmetto (Sabal
serrulata), a small palm found primarily on sand dunes
along the Atlantic and Caribbean coast of North America, thrives on
ample sunlight. The berries from the tree are harvested in autumn,
dried, and used in capsules, tinctures, or extracts. Active
ingredients include steroidal saponin, tannins, volatile oils, and
polysaccharides. It is primarily recommended for men suffering from
benign prostatic hypertrophy (BPH), as it prevents conversion of
testosterone to dihydrotestosterone, which is thought to precipitate
prostatic hyperplasia. Its diuretic effect and improvement of urine
flow contribute to its effectiveness in this application, acting to
tone the bladder, relieve strain, decrease urinary frequency, and
reduce inflammation.
Other uses include:
Inhibition of androgen and estrogen receptor activity to restore
hormonal balance, improvement of thyroid function, appetite
stimulation, improvement of digestion, breast enlargement, libido
stimulation, treatment of ovarian and uterine irritability, treatment
of congestion, cough, bronchitis, and asthma.
Yohimbe Bark
comes from the African yohimbe tree, and the bark is used as powder,
for tablets and capsules, and as an extract. It has been used orally
for centuries by natives as an aphrodisiac and to enhance sexual
prowess and smoked for its hallucinogenic effects. Yohimbine, the
indole alkaloid primary active ingredient is an alpha-2-adrenergic
blocking agent used to treat both organic and psychogenic male
erectile dysfunction with some success. This remains the primary use
for the bark products.
The bark and extract
provide sympathomimetic activity (release of both epinephrine and
norepinephrine) as well as short-term monoamine oxidase inhibition.
As an MAOI, the product bears the same liabilities as other MAOI’s:
Dietary restrictions to avoid tyramine (see the section on MAOI’s
in last month’s PowerGraph) and numerous drug interactions
that can precipitate potentially-lethal hypertensive crisis. Side
effects include nausea, hyperacidity, tachycardia, irritability,
headache, urinary frequency, sweating, and dizziness.
Contraindications include kidney disease, heart disease, glaucoma,
and history of gastrointestinal ulcer.
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