What is aromatherapy?

Aromatherapy is the use of essential oils from plants for healing. Although the word “aroma” makes it sound as if the oils would be inhaled, they can also be massaged into the skin or -- rarely -- taken by mouth. Essential oils should never be taken by mouth without specific instruction from a trained and qualified specialist. Whether inhaled or applied on the skin, essential oils are gaining new attention as an alternative treatment for infections, stress, and other health problems. However, in most cases scientific evidence is still lacking.

What are essential oils?

Essential oils are concentrated extracts taken from the roots, leaves, seeds, or blossoms of plants. Each contains its own mix of active ingredients, and this mix determines what the oil is sued for. Some oils are used to promote physical healing -- for example, to treat swelling or fungal infections. Others are used for their emotional value -- they may enhance relaxation or make a room smell pleasant. Orange blossom oil, for example, contains a large amount of an active ingredient that is thought to be calming.

What is the history of aromatherapy?

Essential oils have been used for therapeutic purposes for nearly 6,000 years. The ancient Chinese, Indians, Egyptians, Greeks, and Romans used them in cosmetics, perfumes, and drugs. Essential oils were also commonly used for spiritual, therapeutic, hygienic, and ritualistic purposes.

More recently, René-Maurice Gattefossé, a French chemist, discovered the healing properties of lavender oil when he applied it to a burn on his hand caused by an explosion in his laboratory. He then started to analyze the chemical properties of essential oils and how they were used to treat burns, skin infections, gangrene, and wounds in soldiers during World War I. In 1928, Gattefossé founded the science of aromatherapy. By the 1950s massage therapists, beauticians, nurses, physiotherapists, doctors, and other health care providers began using aromatherapy.

Aromatherapy did not become popular in the United States until the 1980s. Today, many lotions, candles, and beauty products are sold as "aromatherapy." However, many of these products contain synthetic fragrances that do not have the same properties as essential oils.

How does aromatherapy work?

Researchers are not entirely clear how aromatherapy may work. Some experts believe our sense of smell may play a role. The "smell" receptors in your nose communicate with parts of your brain (the amygdala and hippocampus) that serve as storehouses for emotions and memories. When you breathe in essential oil molecules, some researchers believe that they stimulate these parts of your brain and influence physical, emotional, and mental health. For example, lavender is believed to stimulate the activity of brain cells in the amygdala similar to the way some sedative medications work. Other researchers think that some molecules from essential oils may interact in the blood with hormones or enzymes.

Aromatherapy massage is a popular way of using essential oils because it works in several ways at the same time. Your skin absorbs essential oils and you also breathe them in. Plus, you experience the physical therapy of the massage itself.

What happens during an aromatherapy session?

Professional aromatherapists, nurses, physical therapists, pharmacists, and massage therapists can provide topical or inhaled aromatherapy treatment. Only specially trained professionals can provide treatment that involves taking essential oils by mouth.

At an aromatherapy session, the practitioner will ask about your medical history and symptoms, as well any scents you may like. You may be directed to breathe in essential oils directly from a piece of cloth or indirectly through steam inhalations, vaporizers, or sprays. The practitioner may also apply diluted essential oils to your skin during a massage. In most cases, the practitioner will tell you how to use aromatherapy at home, by mixing essential oils into your bath, for example.

What is aromatherapy good for?

Aromatherapy is used in a wide range of settings -- from health spas to hospitals -- to treat a variety of conditions. In general, it seems to relieve pain, improve mood, and promote a sense of relaxation.

Several clinical studies suggest that when essential oils (particularly rose, lavender, and frankincense) were used by qualified midwives, pregnant women felt less anxiety and fear, had a stronger sense of well-being, and had less need for pain medications during delivery. Many women also report that peppermint oil relieves nausea and vomiting during labor.

Massage therapy with essential oils (combined with medications or therapy) may benefit people with depression. The scents are thought by some to stimulate positive emotions in the area of the brain responsible for memories and emotions, but the benefits seem to be related to relaxation caused by the scents and the massage. A person’s belief that the treatment will help also influences whether it works.

In test tubes, chemical compounds from some essential oils have shown antibacterial and anti-fungal properties. Some evidence also suggests that citrus oils may strengthen the immune system and that peppermint oil may help with digestion. Fennel, aniseed, sage, and clary-sage have estrogen-like compounds, which may help relieve symptoms of premenstrual syndrome and menopause. However, human studies are lacking.

Other conditions for which aromatherapy may be helpful include:

    * Alopecia areata (hair loss)

    * Agitation, possibly including agitation related to dementia

    * Anxiety

    * Constipation (with abdominal massage using aromatherapy)

    * Insomnia

    * Pain: Studies have found that people with rheumatoid arthritis, cancer (using topical chamomile), and headaches (using topical peppermint) require fewer pain medications when they use aromatherapy

    * Itching, a common side effect for those receiving dialysis

    * Psoriasis

Should anyone avoid aromatherapy?

Pregnant women, people with severe asthma, and people with a history of allergies should avoid all essential oils.

Pregnant women and people with a history of seizures should avoid hyssop oil.

People with high blood pressure should avoid stimulating essential oils such as rosemary and spike lavender.

People with estrogen-dependent tumors (such as breast or ovarian cancer) should not use oils with estrogen-like compounds such as fennel, aniseed, sage, and clary-sage.

People receiving chemotherapy should talk to their doctor before trying aromatherapy.

Is there anything I should watch out for?

Most topical and inhaled essential oils are generally considered safe. You should never take essential oils by mouth unless you are under the supervision of a trained professional. Some oils are toxic, and taking them by mouth could be fatal.

Rarely, aromatherapy can induce side effects, such as rash, headache, liver and nerve damage, as well as harm to a fetus.

Oils that are high in phenols, such as cinnamon, can irritate the skin. Add water or a base massage oil (such as almond or sesame oil) to the essential oil before applying to your skin. Avoid using near your eyes.

Essential oils are highly volatile and flammable so they should never be used near an open flame.

Animal studies suggest that active ingredients in certain essential oils may interact with some medications. Researchers don’t know if they have the same effect in humans. Eucalyptus, for example, may cause certain medications, including pentobarbital (used for seizures) and amphetamine (used for narcolepsy and attention-deficit hyperactivity disorder) to be less effective.

How can I find an aromatherapist?

While there are currently no boards that certify or license aromatherapists in the United States, many professionals are members of professional organizations. To locate a qualified aromatherapist in your area, contact www.naha.org. Many aromatherapists are trained in some other form of therapy or healing system, such as massage or chiropractic, and include aromatherapy in their practice.

What is the future of aromatherapy?

Although essential oils have been used for centuries, few studies have looked the safety and effectiveness of aromatherapy in people. Scientific evidence is lacking. And there are some concerns about the safety and quality of certain essential oils. More research is needed before aromatherapy becomes a widely accepted alternative remedy.

References

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Ballard CG, Gauthier S, Cummings JL, Brodaty H, Grossberg GT, Robert P, Lyketsos CG. Management of agitation and aggression associated with Alzheimer disease. Nat Rev Neurol. 2009 May;5(5):245-55. Review.

Bastard J, Tiran D. Aromatherapy and massage for antenatal anxiety: its effect on the fetus.Complement Ther Clin Pract. 2006;12(1):48-54.

Burns E, Zobbi V, Panzeri D, Oskrochi R, Regalia A. Aromatherapy in childbirth: a pilot randomised controlled trial. BJOG. 2007;114(7):838-44.

Dunning T. Applying a quality use of medicines framework to using essential oils in nursing practice. Complement Ther Clin Pract. 2005;11(3):172-81.

Edris AE. Pharmaceutical and therapeutic potentials of essential oils and their individual volatile constituents: a review. Phytother Res. 2007;21(4):308-23.

Fellowes D, Barnes K, Wilkinson S. Aromatherapy and massage for symptom relief in patients with cancer. Cochrane Database Syst Rev. 2004;(2):CD002287.

Fowler NA. Aromatherapy, used as an integrative tool for crisis management by adolescents in a residential treatment center. J Child Adolesc Psychiatr Nurs. 2006;19(2):69-76.

Goel N, Kim H, Lao RP. An olfactory stimulus modifies nighttime sleep in young men and women. Chronobiol Int. 2005;22(5):889-904.

Hadfield N. The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours. Int J Palliat Nurs. 2001;7(6):279-85.

Herz RS. Aromatherapy facts and fictions: a scientific analysis of olfactory effects on mood, physiology and behavior. Int J Neurosci. 2009;119(2):263-90. Review.

Hongratanaworakit T, Buchbauer G. Relaxing effect of ylang ylang oil on humans after transdermal absorption. Phytother Res. 2006;20(9):758-63.

Hur MH, Oh H, Lee MS, Kim C, Choi AN, Shin GR. Effects of aromatherapy massage on blood pressure and lipid profile in korean climacteric women. Int J Neurosci. 2007;117(9):1281-7.

Kim JT, Wajda M, Cuff G, et al., Evaluation of aromatherapy in treating postoperative pain: pilot study. Pain Pract. 2006;6(4):273-7.

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Review Date: 9/7/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

What is biofeedback?

Biofeedback is a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily, such as heart rate, blood pressure, muscle tension, and skin temperature. Electrodes attached to your skin measure these processes and display them on a monitor. With help from a biofeedback therapist, you can learn to change your heart rate or blood pressure, for example. At first you use the monitor to see your progress, but eventually you will be able to achieve success without the monitor or electrodes. Biofeedback is an effective therapy for many conditions, but it is primarily used to treat high blood pressure, tension headache, migraine headache, chronic pain, and urinary incontinence.

Are there different types of biofeedback?

The three most commonly used forms of biofeedback therapy are:

    * Electromyography (EMG), which measures muscle tension

    * Thermal biofeedback, which measures skin temperature

    * Neurofeedback or electroencephalography (EEG), which measures brain wave activity

How does biofeedback work?

Researchers aren’t sure exactly how or why biofeedback works. However, there does seem to be at least one common thread: most people who benefit from biofeedback have conditions that are brought on or made worse by stress. For this reason, many scientists believe that relaxation is the key to successful biofeedback therapy. When your body is under chronic stress, internal processes like blood pressure become overactive. Guided by a biofeedback therapist, you can learn to lower your blood pressure through relaxation techniques and mental exercises. When you are successful, you see the results on the monitor, which encourages your efforts.

What happens during a biofeedback session?

In a normal biofeedback session, electrodes are attached to your skin. They send information to a small monitoring box that translates the measurements into a tone that varies in pitch, a visual meter that varies in brightness, or a computer screen that shows lines moving across a grid. The biofeedback therapist then leads you in mental exercises. Through trial and error, you can soon learn to identify the mental activities that will bring about the physical changes you want.

What is biofeedback good for?

Biofeedback seems to be effective for a range of health problems. For example, it shows promise for treating urinary incontinence, which is a problems for more than 15 million Americans. Some people choose biofeedback over drugs because of the lack of side effects. Based on findings in clinical studies, the Agency for Health Care Policy and Research has recommended biofeedback therapy as a treatment for urinary incontinence. It may also help people with fecal incontinence.

Research also suggests that thermal biofeedback may ease symptoms of Raynaud's disease (a condition that causes reduced blood flow to fingers, toes, nose or ears) while EMG biofeedback has been shown to reduce pain, morning stiffness, and the number of tender points in people with fibromyalgia. A review of scientific clinical studies found that biofeedback may help people with insomnia fall asleep.

Biofeedback can also be used effectively in children. For example, EEG neurofeedback (especially when combined with cognitive therapy) has been reported to improve behavior and intelligence scores in children with attention deficit/hyperactivity disorder (ADHD). Biofeedback, combined with fiber in the diet, may help relieve abdominal pain in children. Thermal biofeedback helps relieve migraine and chronic tension headaches among children and teens as well.

Biofeedback may also be useful for the following health problems:

    * Anorexia nervosa

    * Anxiety

    * Asthma

    * Autism

    * Back pain

    * Bed wetting

    * Chronic pain

    * Constipation

    * Depression

    * Diabetes

    * Epilepsy and related seizure disorders

    * Head injuries

    * High blood pressure

    * Learning disabilities

    * Motion sickness

    * Muscle spasms

    * Sexual disorders, including pain with intercourse

    * Spinal cord injuries

How many sessions will I need?

Each session generally lasts less than 1 hour. The number of sessions required depends on the condition being treated. Many people start to see results within 8 - 10 sessions. Treatment of headache, incontinence, and Raynaud's disease requires at least 10 weekly sessions and some follow-up sessions as health improves. Conditions like high blood pressure, however, usually require 20 weekly biofeedback sessions before you see improvement. You will also be taught mental exercises and relaxation techniques that you can do at home for at least 5 - 10 minutes every day.

Are there any risks associated with biofeedback?

Biofeedback is considered safe. No negative side effects have been reported.

How can I find a qualified practitioner?

Specialists who provide biofeedback training range from psychiatrists and psychologists to nurses, dentists, and physicians. The Association for Applied Psychology and Biofeedback (www.aapb.org) is a good resource for finding qualified biofeedback practitioners in your area.

References

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Burgio KL, Goode PS, Urban DA, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175(1):196-201; discussion 201.

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Chiarioni G, Whitehead WE, Pezza V, et al. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657-64.

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Review Date: 9/7/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

What is chiropractic?

Chiropractic concentrates on manipulating the spine and other joints to treat illnesses. It is based on the belief that because the nervous system controls the body, correcting the spine can treat a variety of illness. Daniel David Palmer founded chiropractic in 1895. Palmer was a self-taught healer who was studying spinal structure and manipulative techniques when he reportedly restored the hearing of a deaf man by realigning a displaced vertebra in his back. Palmer believed that most diseases were a result of abnormal nerve signals caused by "vertebral subluxation" (misalignment of the spine). Although today most chiropractors use other therapies as well, spinal manipulation remains at the center of chiropractic. There are more than 60,000 active chiropractic licenses in the United States. According to a study in 2002, about 7.4% of the population in the U.S. used chiropractic care -- a higher percentage than yoga, massage, acupuncture or other diet-based therapies.

What happens during a visit to a chiropractor?

The first visit usually lasts about an hour. The chiropractor takes a complete health history, including information on past injuries and illnesses, current conditions and medications, lifestyle, diet, sleep habits, exercise, mental stresses, and use of alcohol, drugs, or tobacco. During a physical exam, the chiropractor evaluates your spine and joints and may perform diagnostic tests, such as blood pressure and x-rays, to rule out other conditions. Treatment usually starts at either the first or second visit. Patients are typically asked to lie on a specially designed table, where the chiropractor does the spinal manipulations. The most common is manual manipulation, where the chiropractor moves a joint to the end of its range, then applies a low-force thrust. The chiropractor may also use other treatments, including massage and heat and ice therapies. You should not feel any pain from the manipulation. Some people have minor aches, stiffness, and tiredness for a few days after the manipulation while their body adjusts to the new alignment.

How many treatments will be required?

A typical course of treatment lasts several weeks. The chiropractor may suggest two or three sessions a week (lasting about 10 - 20 minutes), then weekly sessions once you improve. Together, you and the chiropractor will set goals for your treatment and evaluate how effective treatment is as you go along.

What conditions are treated effectively with chiropractic?

Chiropractic has been shown to be effective for acute and chronic low back pain, neck pain, and headaches. Preliminary evidence suggests it may also help treat frozen shoulder, tennis elbow and other sports injuries, carpal tunnel syndrome, otitis media (ear infection), digestive problems, menstrual and premenstrual pain, and asthma. Many people also use chiropractic to treat headaches, fatigue, and other health issues.

Are there conditions that should not be treated with chiropractic?

If you have a broken bone, tumors, an arthritis flare, bone or joint infections, or advanced osteoporosis, you should not have a manipulation in the affected area. Be sure to tell your chiropractor about any physical disabilities you have, or if you experience numbness, tingling, weakness, or other neurological problems. In extremely rare cases, manipulation of the neck has damaged blood vessels or caused strokes. The screening process, however, is designed to detect people at high risk.

How can a qualified practitioner be located?

All 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands recognize chiropractic as a health care profession. A chiropractic degree requires about the same number of educational hours as a medical degree. The chiropractic program includes clinical experience, basic sciences, and standard as well as structural (spinal) and functional (nervous system) diagnoses. At least one chiropractic organization serves each state in the U.S. The largest association is the American Chiropractic Association (ACA). The ACA (www.amerchiro.org

) can provide a list of licensed chiropractors in your area.

Does medical insurance cover chiropractic treatments?

Medicare, Medicaid, and worker's compensation cover chiropractic care. Most health care plans offered by employers cover at least part of the cost of chiropractic.

Glossary

    * Hard tissue manipulation -- manipulation of bone and cartilage, including joints.

    * High velocity thrust -- manual manipulation that involves movement of the selected joint to its end range of voluntary motion, followed by a quick manual thrust.

    * Interferential therapy -- a form of electronic stimulation.

    * Ischemic compression (Travell-Simons trigger point therapy) -- a technique in which progressively strong pressure is applied to a pressure point, trigger point, or tight muscle.

    * Joint mobilization -- slower or gentler manual techniques in which the joint remains within its passive range of movement.

    * Low amplitude thrust -- amplitude refers to the depth of, or distance traveled by, the practitioner's thrust. Most adjustment/manipulation is of low amplitude, minimizing total force applied to the patient.

    * Manipulation-- manual techniques that move a joint beyond the end point of its passive range of motion.

    * Soft tissue manipulation -- manual manipulation of muscle, tendon, and ligament.

    * Spinal manipulation -- manipulation of the vertebrae.

    * Subluxation -- where alignment, movement integrity, and physiologic function are altered although contact between the joint surfaces remains intact.

    * Thrust -- the therapeutic maneuver delivered by the practitioner during high-velocity adjustment and manipulation.

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Review Date: 9/29/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

What is herbal medicine?

Herbal medicine -- also called botanical medicine or phytomedicine -- refers to using a plant's seeds, berries, roots, leaves, bark, or flowers for medicinal purposes. Herbalism has a long tradition of use outside of conventional medicine. It is becoming more mainstream as improvements in analysis and quality control along with advances in clinical research show the value of herbal medicine in the treating and preventing disease.

What is the history of herbal medicine?

Plants had been used for medicinal purposes long before recorded history. Ancient Chinese and Egyptian papyrus writings describe medicinal uses for plants. Indigenous cultures (such as African and Native American) used herbs in their healing rituals, while others developed traditional medical systems (such as Ayurveda and Traditional Chinese Medicine) in which herbal therapies were used. Researchers found that people in different parts of the world tended to use the same or similar plants for the same purposes.

In the early 19th century, when chemical analysis first became available, scientists began to extract and modify the active ingredients from plants. Later, chemists began making their own version of plant compounds, and over time, the use of herbal medicines declined in favor of drugs.

Recently, the World Health Organization estimated that 80% of people worldwide rely on herbal medicines for some part of their primary health care. In Germany, about 600 - 700 plant-based medicines are available and are prescribed by some 70% of German physicians. In the last 20 years in the United States, public dissatisfaction with the cost of prescription medications, combined with an interest in returning to natural or organic remedies, has led to an increase in herbal medicine use.

How do herbs work?

In many cases, scientists aren’t sure what specific ingredient in a particular herb works to treat a condition or illness. Whole herbs contain many ingredients, and they may work together to produce a beneficial effect. Many factors determine how effective an herb will be. For example, the type of environment (climate, bugs, soil quality) in which a plant grew will affect it, as will how and when it was harvested and processed.

How are herbs used?

The use of herbal supplements has increased dramatically over the past 30 years. Herbal supplements are classified as dietary supplements by the U.S. Dietary Supplement Health and Education Act (DSHEA) of 1994. That means herbal supplements -- unlike prescription drugs -- can be sold without being tested to prove that they are safe and effective. However, herbal supplements must be made according to good manufacturing practices.

The most commonly used herbal supplements in the U.S. include echinacea (Echinacea purpurea and related species), St. John's wort (Hypericum perforatum), ginkgo (Ginkgo biloba), garlic (Allium sativum), saw palmetto (Serenoa repens), ginseng (Panax ginseng, or Asian ginseng; and Panax quinquefolius, or American ginseng), goldenseal (Hydrastis canadensis), valerian (Valeriana officinalis), chamomile (Matricaria recutita), feverfew (Tanacetum parthenium), ginger (Zingiber officinale), evening primrose (Oenothera biennis), and milk thistle (Silybum marianum).

Often, herbs may be used together because the combination is more effective and may have fewer side effects. Health care providers must take many factors into account when recommending herbs, including the species and variety of the plant, the plant's habitat, how it was stored and processed, and whether or not there are contaminants (including heavy metals and pesticides).

What is herbal medicine good for?

Herbal medicine is used to treat many conditions, such as asthma, eczema, premenstrual syndrome, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, and irritable bowel syndrome, among others. Herbal supplements are best taken under the guidance of a trained health care provider. Be sure to consult with your doctor or pharmacist before taking any herbs. Some common herbs and their uses are discussed below.

    * Ginkgo (Ginkgo biloba) has been used in traditional medicine to treat circulatory disorders and enhance memory. Although not all studies agree, ginkgo may be especially effective in treating dementia (including Alzheimer's disease) and intermittent claudication (poor circulation in the legs). It also shows promise for enhancing memory in older adults. Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets. By the same token, this means ginkgo may also increase the effect of some blood-thinning medications, including aspirin. People taking blood-thinning medications should ask their doctor before using ginkgo.

    * Kava kava (Piper methysticum) is said to elevate mood, well-being, and contentment, and produce a feeling of relaxation. Several studies have found that kava may be useful in the treatment of anxiety, insomnia, and related nervous disorders. However, there is serious concern that kava may cause liver damage. It's not clear whether the kava itself caused liver damage in a few people or whether it was taking kava in combination with other drugs or herbs. It's also not clear whether kava is dangerous at previously recommended doses, or only at higher doses. Some countries have taken kava off the market. It remains available in the United States, but the Food and Drug Administration (FDA) issued a consumer advisory in March of 2002 regarding the "rare" but potential risk of liver failure associated with kava-containing products.

    * Saw palmetto (Serenoa repens) is used by more than 2 million men in the United States for the treatment of benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate gland. A number of studies suggest that the herb is effective for treating symptoms, including too-frequent urination, having trouble starting or maintaining urination, and needing to urinate during the night. But a well-conducted study published in the February 9, 2006 edition of the New England Journal of Medicine found that saw palmetto was no better than placebo in relieving the signs and symptoms of BPH.

    * St. John's wort (Hypericum perforatum) is well known for its antidepressant effects. In general, most studies have shown that St. John's wort may be an effective treatment for mild to moderate depression, and has fewer side effects than most other prescription antidepressants. But the herb interacts with a wide variety of medications, including birth control pills, so it is important to take it only under the guidance of a health care provider.

    * Valerian (Valeriana officinalis) is a popular alternative to commonly prescribed medications for sleep problems because it is considered to be both safe and gentle. Some studies bear this out, although not all have found valerian to be effective. Unlike many prescription sleeping pills, valerian may have fewer side effects such as morning drowsiness.

    * Echinacea preparations (from Echinacea purpurea and other Echinacea species) may improve the body's natural immunity. Echinacea is one of the most commonly used herbal products, but studies are mixed as to whether it can help prevent or treat colds. A meta-analysis of 14 clinical studies examining the effect of echinacea on the incidence and duration of the common cold found that echinacea supplements decreased the odds of getting a cold by 58%. It also shortened the duration of a cold by 1.4 days.

Buying standardized herbal supplements helps ensure you will get the right dose and the effects similar to human clinical trials. Ask your doctor or pharmacist about which herbal supplements are the best choice for your health concerns.

Is there anything I should watch out for?

Used correctly, herbs can help treat a variety of conditions and in some cases may have fewer side effects than some conventional medications. But because they are unregulated, herbal products are often mislabeled and may contain additives and contaminants that aren’t listed on the label. Some herbs may cause allergic reactions or interact with conventional drugs, and some are toxic if used improperly or at high doses. Taking herbs on your own increases your risk, so it is important to consult your doctor or pharmacist before taking herbal medicines. Some examples of adverse reactions from certain popular herbs are described below.

    * St. John's wort can cause your skin to be more sensitive to the sun's ultraviolet rays, and may cause an allergic reaction, stomach upset, fatigue, and restlessness. Clinical studies have found that St. John's wort also interferes with the effectiveness of many drugs, including the blood thinner warfarin (Couamdin), protease inhibitors for HIV, birth control pills, certain asthma drugs, and many other medications. In addition, St. John's wort should not be taken with prescribed antidepressant medication. The FDA has issued a public health advisory concerning many of these interactions.

    * Kava kava has been linked to liver toxicity. Kava has been taken off the market in several countries because of liver toxicity.

    * Valerian may cause sleepiness, and in some people it may even have the unexpected effect of overstimulating instead of sedating.

    * Garlic, ginkgo, feverfew, and ginger, among other herbs, may increase the risk of bleeding.

    * Evening primrose (Oenothera biennis) may increase the risk of seizures in people who have seizure disorders.

Some herbal supplements, especially those imported from Asian countries, may contain high levels of heavy metals, including lead, mercury, and cadmium. It is important to purchase herbal supplements from reputable manufacturers to ensure quality. Talk to your health care provider for more information.

Who is using herbal medicine?

Nearly one-third of Americans use herbs. Unfortunately, a study in the New England Journal of Medicine found that nearly 70% of people taking herbal medicines (most of whom were well educated and had a higher-than-average income) were reluctant tell their doctors that they used complementary and alternative medicine. Many herbs can interact with prescription medications and cause unwanted or dangerous reactions. Be sure to consult your doctor before trying any herbal products.

How is herbal medicine sold in stores?

The herbs available in most stores come in several different forms: teas, syrups, oils, liquid extracts, tinctures, and dry extracts (pills or capsules). Teas can be made from dried herbs left to soak for a few minutes in hot water, or by boiling herbs in water and then straining the liquid. Syrups, made from concentrated extracts and added to sweet-tasting preparations, are often used for sore throats and coughs. Oils are extracted from plants and often used as rubs for massage, either by themselves or as part of an ointment or cream. Tinctures and liquid extracts are made of active herbal ingredients dissolved in a liquid (usually water, alcohol, or glycerol). Tinctures are typically a 1:5 or 1:10 concentration, meaning that one part of the herb is prepared with five to ten parts (by weight) of the liquid. Liquid extracts are more concentrated than tinctures and are typically a 1:1 concentration. A dry extract form is the most concentrated form of an herbal product (typically 2:1 - 8:1) and is sold as a tablet, capsule, or lozenge.

Currently, no organization or agency regulates the manufacture or certifies the labeling of herbal preparations. This means you can't be sure that the amount of the herb contained in the bottle, or even from dose to dose, is the same as what is stated on the label. Some herbal preparations are standardized, meaning that the preparation is guaranteed to contain a specific amount of the active ingredients of the herb. However, it is still important to ask companies making standardized herbal products about their product's guarantee. It is important to talk to your doctor or an expert in herbal medicine about the recommended doses of any herbal products.

Are there experts in herbal medicine?

Herbalists, chiropractors, naturopathic physicians, pharmacists, medical doctors, and practitioners of Traditional Chinese Medicine all may use herbs to treat illness. Naturopathic physicians believe that the body is continually striving for balance and that natural therapies can support this process. They are trained in 4-year, postgraduate institutions that combine courses in conventional medical science (such as pathology, microbiology, pharmacology, and surgery) with clinical training in herbal medicine, homeopathy, nutrition, and lifestyle counseling.

How can I find a qualified herbalist in my area?

For additional information, or to locate an experienced herbalist in your area, contact the American Herbalists Guild (AHG) at site at www.americanherbalistsguild.com/

. To locate a licensed naturopath in your area, call the American Association of Naturopathic Physicians (AANP) at www.naturopathic.org

.

What is the future of herbal medicine?

In some countries in Europe -- unlike the U.S. -- herbs are classified as drugs and are regulated. The German Commission E, an expert medical panel, actively researches their safety and effectiveness.

While still not widely accepted, herbal medicine is being taught more in medical schools and pharmacy schools. More health care providers are learning about the positive and potentially negative effects of using herbal medicines to help treat health conditions. Some health care providers, including doctors and pharmacists, are trained in herbal medicine. They can help people create treatment plans that use herbs, conventional medications and lifestyle changes to promote health.

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Review Date: 9/27/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

What is homeopathy?

The main idea behind homeopathy is the Law of Similars, which is sometimes explained as “like cures like.” In the late 18th century, a German physician named Samuel Hahnemann read that quinine-containing Peruvian bark (chinchona) cured malaria. Hahnemann swallowed a dose of Peruvian bark and began to feel feverish, drowsy, extremely thirsty, and agitated -- all symptoms of malaria. Hahnemann started to experiment more and formed his theory that like cures like, or the Law of Similars: that when a substance in large doses causes certain symptoms, in small doses it can cure these same symptoms.

Herbs and other plants, minerals, venom from snakes and other substances can be used to make homeopathic remedies. They are diluted again and again and “succussed” or shaken vigorously between each dilution. The process of sequential dilution and succussion is called potentization .

How does homeopathy work?

Homeopathic remedies start with substances such as herbs, minerals, or animal products. These substances are first crushed and dissolved in a liquid -- usually grain alcohol or lactose -- mechanically shaken, then stored. This is the "mother tincture." Homeopaths then dilute tinctures more with alcohol or lactose, either 1 part to 10 (written as "x") or 1 part to 100 (written as "c"). These tinctures are shaken, yielding a 1x or 1c dilution. Homeopaths can further dilute these tinctures two times (2x or 2c), three times (3x or 3c), and so forth. Many times professional homeopaths will use much higher dilutions, because the more diluted the substance, the more potent its healing powers are thought to be.

Homeopathic remedies aim to stimulate the body's own healing mechanisms. Homeopaths believe that any physical disease has a mental and emotional component. So a homeopathic diagnosis includes physical symptoms (such as feverishness), current emotional and psychological state (such as anxiety and restlessness), and the person’s constitution. A person’s constitution includes qualities related to creativity, initiative, persistence, concentration, physical sensitivities, and stamina). The right remedy for a condition will take all of these aspects into account, so each diagnosis and remedy is individualized. That means three people with hay fever could need three very different prescriptions.

Health-food stores and some pharmacies sell homeopathic remedies for a variety of problems. Remedies are usually taken for no more than 2 - 3 days, although some people may need only 1 - 2 doses before starting to feel better. In some cases daily dosing may be prescribed.

What happens during a visit to the homeopath?

Your first visit to the homeopath can take from 1 - 2½ hours. Because homeopaths treat the person rather than the illness, the homeopath will interview you at length, asking many questions and observing personality traits as well as unusual behavioral and physical symptoms. A physical examination and possibly laboratory work is also done.

What illnesses and conditions respond well?

Scientific evidence is mixed. In some clinical trials, homeopathy appeared to be no better than placebo. In other clinical studies, researchers believed they saw benefits from homeopathy. More controlled clinical research is needed.

Preliminary evidence shows that homeopathy may be helpful in treating childhood diarrhea, otitis media (ear infection), asthma, fibromyalgia, chronic fatigue syndrome, symptoms of menopause such as hot flashes, pain, allergies, sore muscles, and colds and flu. Some professional homeopaths specialize in treating serious illnesses, such as cancer, mental illness, and autoimmune diseases. You should not treat a life-threatening illness with homeopathy alone. Always make sure that all your health care providers know about all the different therapies you are using.

Homeopathic medicines, because they are diluted, generally don’t have side effects. However, some people report feeling worse briefly after starting homeopathic remedies. Homeopaths interpret this as the body temporarily stimulating symptoms while it makes an effort to restore health. Homeopathic medicines are not known to interfere with conventional drugs. However, if you are considering using homeopathic remedies, you should discuss this with your doctor.

Is homeopathy regulated?

The U.S. Congress passed a law in 1938 declaring that homeopathic remedies are to be regulated by the U.S. Food and Drug Administration (FDA) in the same manner as nonprescription, over-the-counter (OTC) drugs. This means that homeopathic medicines can be purchased without a doctor’s prescription. Unlike conventional prescription drugs and new OTC drugs, which must undergo thorough testing and review by the FDA for safety and effectiveness before they can be sold, homeopathic remedies don’t have to undergo clinical trials. They do have to meet certain legal standards for strength, quality, purity, and packaging. In 1988, the FDA required that all homeopathic medicines list on the label the medical problems these remedies can treat. The FDA also requires the label to list ingredients, dilutions, and instructions for safe use.

The guidelines for homeopathic medicines are found in an official guide, the Homeopathic Pharmacopoeia of the United States, which is written by a nongovernmental, nonprofit organization of industry representatives and homeopathic experts. The Pharmacopoeia also includes provisions for testing new remedies and verifying their clinical effectiveness.

How can I find a qualified practitioner?

There are homeopathic schools and training programs, although no diploma or certificate from any school provides a license to practice. Many homeopaths are also medical doctors (MDs), although homeopaths are licensed in almost every health-profession category, including veterinarians. In most states, practitioners of homeopathy must be licensed health care providers. Several respected certification agencies exist. The American Board of Homeotherapeutics certifies medical doctors and doctors of osteopathic medicine (DOs) who have specialized in homeopathy (DHt indicates a doctor of homeopathy). Naturopathic doctors study homeopathy extensively as part of their medical training and some are certified by the Homeopathic Academy of Naturopathic Physicians (DHANP). All homeopathic practitioners, including chiropractors, nurse practitioners, and acupuncturists, can apply for Certification in Classical Homeopathy (CCH).

To find a homeopathic provider in your area, contact:

    * The Council for Homeopathic Certification: www.homeopathicdirectory.com

    * The National Center for Homeopathy: http://nationalcenterforhomeopathy.org

    * The American Association of Naturopathic Physicians: www.naturopathic.org

    * The North American Society of Homeopaths: www.homeopathy.org

    * Homeopathic Educational Services in Berkeley, California: www.homeopathic.com

Does my medical insurance usually cover homeopathy?

Insurance companies are more likely to cover homeopathy when the person providing the service is a licensed health care professional, such as an MD or DO who also practices homeopathy.

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Thompson EA, Montgomery A, Douglas D, Reilly D. A pilot, randomized, double-blinded, placebo-controlled trial of individualized homeopathy for symptoms of estrogen withdrawal in breast-cancer survivors. J Altern Complement Med. 2005;11(1):13-20.

Vickers AJ, Smith C. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Cochrane Database Syst Rev. 2006;3:CD001957.

Witt CM, Lüdtke R, Willich SN. Homeopathic treatment of patients with psoriasis--a prospective observational study with 2 years follow-up. J Eur Acad Dermatol Venereol. 2009 May;23(5):538-43.

Review Date: 9/7/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

What is massage?

Massage is a "hands-on" treatment in which a therapist manipulates muscles and other soft tissues of the body to improve health and well-being. Varieties of massage range from gentle stroking and kneading of muscles and other soft tissues to deeper manual techniques. Massage has been practiced as a healing therapy for centuries in nearly every culture around the world. It helps relieve muscle tension, reduce stress, and evoke feelings of calmness. Although massage affects the body as a whole, it particularly influences the activity of the musculoskeletal, circulatory, lymphatic, and nervous systems.

What is the history of massage?

The use of massage for healing purposes dates back 4,000 years in Chinese medical literature and continues to be an important part of Traditional Chinese Medicine (TCM). A contemporary form of massage, known as Swedish massage, was introduced to the United States in the 1850s. By the end of the 19th century, a significant number of American doctors were practicing this manual technique, and the nation's first massage therapy clinic had opened its doors to the public.

In the early 20th century, the rise of technology and prescription drugs began to overshadow massage therapy. For the next several decades, massage remained dormant, with only a few therapists continuing to practice the "ancient" technique. During the 1970s, however, both the general public and the medical profession began to take notice of alternative medicine and mind-body therapies, including massage therapy. Today, more than 125,000 massage therapists practice in the United States. Their numbers are growing rapidly to keep up with the more than 80 million massage therapy appointments people make every year.

Are there many types of massage?

There are nearly 100 different massage and body work techniques. Each technique is uniquely designed to achieve a specific goal. The most common types practiced in the United States include:

    * Aromatherapy massage: Essential oils from plants are massaged into the skin to enhance the healing and relaxing effects of massage. Essential oils are believed to have a powerful effect on mood by stimulating two structures deep in the brain known to store emotions and memory. (See also: Aromatherapy

      .)

    * Craniosacral massage: Gentle pressure is applied to the head and spine to correct imbalances and restore the flow of cerebrospinal fluid in these areas.

    * Lymphatic massage: Light, rhythmic strokes are used to improve the flow of lymph (colorless fluid that helps fight infection and disease) throughout the body. One of the most popular forms of lymphatic massage, manual lymphatic drainage (MLD), focuses on draining excess lymph. MLD is commonly used after surgery (such as a mastectomy for breast cancer) to reduce swelling.

    * Myofascial release: Gentle pressure and body positioning are used to relax and stretch the muscles, fascia (connective tissue), and related structures. Trained physical therapists and massage therapists use this technique.

    * On-site/chair massage: On-site massage therapists use a portable chair to deliver brief, upper body massages to fully-clothed people in offices and other public places.

    * Polarity therapy: A form of energy healing, polarity therapy stimulates and balances the flow of energy within the body to enhance health and well-being.

    * Reflexology: Specialized thumb and finger techniques are applied to the hands and feet. Reflexologists believe that these areas contain "reflex points," or direct connections to specific organs and structures, throughout the body.

    * Rolfing: Pressure is applied to the fascia (connective tissue) to stretch it, lengthen it, and make it more flexible. The goal of this technique is to realign the body so that it conserves energy, releases tension, and functions better.

    * Shiatsu: Gentle finger and hand pressure are applied to specific points on the body to relieve pain and enhance the flow of energy (known as qi) through the body's energy pathways (called meridians). Shiatsu is widely used in TCM.

    * Sports massage: Often used on professional athletes and other active individuals, sports massage can enhance performance and prevent and treat sports-related injuries.

    * Swedish massage: A variety of strokes and pressure techniques are used to enhance the flow of blood to the heart, remove waste products from the tissues, stretch ligaments and tendons, and ease physical and emotional tension.

    * Trigger point massage: Pressure is applied to "trigger points" (tender areas where the muscles have been damaged) to alleviate muscle spasms and pain.

    * Integrative touch: A gentle form of massage therapy that uses gentle, noncirculatory techniques. It is designed to meet the needs of patients who are hospitalized or in hospice care.

    * Compassionate touch: Combines one-on-one focused attention, intentional touch, and sensitive massage with communication to enhance the quality of life for elderly, ill, or dying patients.

How does massage work?

For centuries, human touch has been shown to be emotionally and physically healing. Particular massage techniques may either stimulate or calm the body's muscles and tissues to create a desired effect. When a practitioner massages soft tissue, electrical signals are transmitted both to the local area and throughout the body. These signals, in combination with the healing properties of touch, help heal damaged muscle, stimulate circulation, clear waste products via the lymphatic system, boost the activity of the immune system, reduce pain and tension, and induce a calming effect. Massage may also enhance well-being by stimulating the release of endorphins (natural painkillers and mood elevators) and reducing levels of certain stress hormones.

What happens during a massage therapy session?

At your first massage therapy session, the practitioner will ask you about any symptoms you may have (like low back pain) and will also ask questions about your medical history. The practitioner may also initiate a discussion about what you expect to achieve from the massage session.

The therapist leaves the room while you undress and lie down on the massage table. A sheet is draped over your body during the session and moved only to expose the part of the body being worked on at any given time. Massage oil or lotion is often used to reduce friction between the practitioner's hands and your skin. The room is kept warm and free of distractions. The therapist will ask whether they are applying too much or too little pressure. Soft music may be playing in the background.

The manner in which a practitioner massages your body depends on the problem being treated. A massage session can last from 15 - 90 minutes and may include a schedule of follow-up visits, depending on the severity of your situation.

What is massage good for?

In general, massage is believed to support healing, boost energy, reduce recovery time after an injury, ease pain, and enhance relaxation, mood, and well-being. It is useful for many musculoskeletal problems, such as low back pain, osteoarthritis, fibromyalgia, and sprains and strains. Massage may also relieve depression in people with chronic fatigue syndrome, ease chronic constipation (when the technique is performed in the abdominal area), decrease swelling after a mastectomy (removal of the breast), alleviate sleep disorders, and improve self-image. In the workplace, massage has been shown to melt away stress and enhance mental alertness. One study found that deep tissue massage reduced blood pressure levels (an average reduction of 10.4 mm Hg in systolic pressure and a diastolic pressure reduction of 5.3 mm Hg). Other studies show that massage may have immediate beneficial effects on pain and mood among patients with advanced cancer.

Clinical studies show that massage relieves chronic back pain more effectively than other treatments (including acupuncture and conventional medical care for this condition with education via books and videos) and, in many cases, costs less than other treatments. Mothers and newborns also appear to benefit from massage. Mothers trained to massage their infants often feel less depressed and have a better emotional bond with their babies. Newborns who receive massage from their mothers also tend to cry less, and are more active, alert, and sociable. Premature babies who receive massage therapy have been shown to gain weight faster than preemies who do not receive this type of therapy. Infants who receive massage regularly may also sleep better, be less gassy or colicky, and have better body awareness as well as more regular digestion.

Clinical studies also show that massage may be an effective treatment for young children and adolescents with a wide range of health problems, including:

    * Autism: Autistic children, who usually don't like being touched, show less autistic behavior and are more social and attentive after receiving massage therapy from their parents.

    * Atopic dermatitis/eczema: Children with this scaly, itchy skin problem seem to experience less redness, scaling, and other symptoms if receiving massage between flares. Massage should not be used when this skin condition is actively inflamed.

    * Attention deficit hyperactivity disorder (ADHD): Massage may improve mood in children with ADHD and help them feel less fidgety and hyperactive.

    * Bulimia: Studies show that adolescents with this eating disorder feel less depressed and anxious after receiving massage therapy.

    * Cystic fibrosis: Massage may reduce anxiety and improve respiration in children with this lung condition.

    * Diabetes: Massage may help regulate blood sugar levels and reduce anxiety and depression in children with diabetes.

    * Rheumatoid arthritis: Children with juvenile rheumatoid arthritis (JRA) have been shown to experience less pain, morning stiffness, and anxiety as a result of massage therapy.

Are there any risks associated with massage?

In general, massage is considered relatively safe. Pain or other rare negative side effects are generally caused by an extremely vigorous massage technique.

Women should be very cautious about receiving massages during pregnancy. If you are pregnant, be sure to find a therapist specifically trained to perform massages on pregnant women.

Even though massage is a useful technique to help regulate blood sugar over time, if you have diabetes you should check your blood sugar after receiving a massage because it may be too low. Plus, if you have diabetes and you are receiving massage on a regular basis, you should check your blood sugar frequently to evaluate changes over time.

Should anyone avoid massage?

People with these conditions should avoid massage:

    * Heart failure

    * Kidney failure

    * Infection of the superficial veins (called phlebitis) or soft tissue (called cellulitis) in the legs or elsewhere

    * Blood clots in the legs

    * Bleeding disorders

    * Contagious skin conditions

If you have cancer, check with your doctor before considering massage because massage can damage tissue that is fragile from chemotherapy or radiation treatments. People with rheumatoid arthritis, goiter (a thyroid disorder characterized by an enlarged thyroid), eczema, and other skin lesions should not receive massage therapy during flare-ups. Experts also advise that people with osteoporosis, high fever, few platelets or white blood cells, and mental impairment, as well as those recovering from surgery, should avoid massage. Check with your doctor.

Tell your massage therapist about any medications you are taking, as massage may influence absorption or activity of both oral and topical medications.

What is the future of massage?

More research is needed to determine how effective massage therapy is, which health problems improve the most from this technique, and whether it is more cost-effective than other types of treatment. Although massage is usually offered in the community by private practitioners, it is slowly being integrated into a variety of health care settings, such as hospice care facilities and hospitals.

How can I find a practitioner?

Certified massage therapists complete a training program of 500 or more hours, take national board exams, and are licensed or registered in many states. To find a massage therapist in your area, visit the American Massage Therapy Association (AMTA) web site at www.amtamassage.org

Although the AMTA has a listing of massage therapists who specialize in a variety of techniques, you may also use different resources to locate practitioners who specialize in the following techniques:

    * Lymphatic massage: Massage therapists and physical therapists with at least 500 hours of massage or physical-therapy training can become certified in lymphatic massage by taking a 4-week training program. To find a therapist who practices lymphatic massage, visit the web stie of the North American Vodder Association of Lymphedema Therapists (NAVALT), at www.navalt.org

    * Reflexology: The American Reflexology Certification Board (ARCB) certifies reflexologists who undergo 100 hours of training and pass an exam. To find a qualified reflexologist, visit the ARCB web site, at www.arcb.net

    * Rolfing: Visit the Rolf Institute of Structural Integration web site, at www.rolf.org

    * Shiatsu: Visit the American Oriental Bodywork Therapy Association web site, at www.aobta.org

References

Anderson PG, Cutshall SM. Massage therapy: a comfort intervention for cardiac surgery patients. Clin Nurse Spec. 2007;21(3):161-5; quiz 166-7.

Barlow A, Clarke R, Johnson N, Seabourne B, Thomas D, Gal J. Effect of massage of the hamstring muscles on selected electromyographic characteristics of biceps femoris during sub-maximal isometric contraction. Int J Sports Med. 2007;28(3):253-6.

Beider S, Mahrer N, Gold J. Pediatric Massage Therapy: An Overview for Clinicians. Pediatric Clinics of North America. 2007;54(6).

Bernas M, Witte M, Kriederman B, Summers P, Witte C. Massage therapy in the treatment of lymphedema. Rationale, results, and applications. IEEE Eng Med Biol Mag. 2005;24(2):58-68.

Billhult A, Bergbom I, Stener-Victorin E. Massage relieves nausea in women with breast cancer who are undergoing chemotherapy. J Altern Complement Med. 2007;13(1):53-7.

Billhult A, Stener-Victorin E, Bergbom I. The experience of massage during chemotherapy treatment in breast cancer patients. Clin Nurs Res. 2007;16(2):85-99; discussion 100-2.

Buckle S. Aromatherapy and massage: the evidence. Paediatr Nurs. 2003;15(6):24-7.

Button C, Anderson N, Bradford C, Cotter JD, Ainslie PN. The effect of multidirectional mechanical vibration on peripheral circulation of humans. Clin Physiol Funct Imaging. 2007;27(4):211-6.

Cambron JA, Dexheimer J, Coe P. Changes in blood pressure after various forms of therapeutic massage: a preliminary study. J Altern Complement Med. 2006;12(1):65-70.

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Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;(4):CD001929.

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Kaye AD, Kaye AJ, Swinford J, Baluch A, Bawcom BA, Lambert TJ, Hoover JM. The effect of deep-tissue massage therapy on blood pressure and heart rate. J Altern Complement Med. 2008;14(2):125-8.

Kutner JS, Smith MC, Corbin L, Hemphill L, Benton K, Mellis BK, Beaty B, Felton S, Yamashita TE, Bryant LL, Fairclough DL. Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: a randomized trial. Ann Intern Med. 2008;149(6):369-79.

Maa SH, Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self-administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings. J Clin Nurs. 2007;16(4):794-804.

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McNeill JA, Alderdice FA, McMurray F. A retrospective cohort study exploring the relationship between antenatal reflexology and intranatal outcomes. Complement Ther Clin Pract. 2006;12(2):119-25.

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Rakel B, Barr JO. Physical modalities in chronic pain management. Nurs Clin North Am. 2003;38(3):477-94.

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Review Date: 8/24/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

 Nutrition

What is clinical nutrition?

Clinical nutrition is the study of the relationship between food and a healthy body. More specifically, it is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated by the body. Besides studying how food works in the body, nutritionists are interested in how the environment affects the quality and safety of foods, and what influence these factors have on health and disease.

What are nutrients?

Nutrients are substances that the body needs to live and grow. The body requires more than 45 nutrients, and the ways they are used are as different as the molecules, cells, and tissues they help to create. Carbohydrates, proteins, and fats -- called macronutrients -- are broken down (metabolized) to provide energy. Vitamins and minerals -- called micronutrients -- are not used for energy themselves, but are needed to help macronutrients be used for energy.

What is the history of clinical nutrition?

The study of nutrition dates back to the 18th century, when the French chemist Lavoisier discovered that there was a relationship between our metabolism of food and the process of breathing. By the early 20th century, scientists had found that diseases -- such as beri-beri, rickets, scurvy, and pellagra -- were associated with certain diets. By 1912, the Polish chemist Casimir Funk had found a substance (vitamin B1) that actually prevented beri-beri, and he named it "vitamine." Later it was found that these diseases were caused by the lack of specific nutrients -- vitamin B1 (thiamine), vitamin D, vitamin C, and vitamin B3 (niacin) respectively.

In the early 1940s, the National Research Council set Recommended Dietary Allowances (RDAs). The RDAs set the minimum amount of a nutrient needed to prevent diseases like beri-beri and rickets.

Researchers and scientists continue to find out more about how individual nutrients can help in the prevention and treatment of disease. But they are also learning how whole foods may allow many nutrients to work together. For example, antioxidants like beta-carotene, selenium, vitamin E, and vitamin C, when consumed in foods, appear to protect against the development of heart disease, cancer, and other chronic degenerative diseases.

The old RDAs have been replaced by Dietary Reference Intakes (DRIs), which show how much of a nutrient we need every day to maximize health and lower the risk of chronic disease (in contrast to RDAs, which listed the minimum amount needed to prevent a deficiency). The field of clinical nutrition is now increasingly incorporated into mainstream medical treatment.

What are nutritional supplements?

The term "nutritional supplement" refers to vitamins, minerals, and other nutrients that are used to support good health and treat illness. For example, plant compounds known as phytochemicals (found in tomatoes and soybeans) have powerful disease-fighting properties. While it's always best to get nutrients through the foods you eat, sometimes taking a supplement can help. For example, taking zinc supplements has been reported to shorten the duration of the common cold and lower the incidence of acute diarrhea in children.

How do vitamins and minerals work?

Vitamins and minerals play an essential role in the body's normal metabolism, growth, and development. For example, while a vitamin is not a source of energy by itself, it can provide the key the body needs to unlock energy stored in food. Some vitamins and minerals work together, such as the mineral zinc and vitamin A. Zinc enables the body to use vitamin A to promote good vision. Not getting enough vitamin A may lead to night blindness, a condition in which the eyes have trouble adjusting to darkness. Zinc supplementation may help prevent this condition by helping the body use vitamin A. Another example is calcium and vitamin D. Calcium, which is very important in bone and heart health, is more readily absorbed if vitamin D is also present.

Taking supplements, however, is not the answer to long-term good health. Combining a healthy diet with regular exercise and a positive mental attitude has been shown to be the best bet for a healthy lifestyle.

What constitutes a healthful diet?

The United States Department of Agriculture (USDA) food pyramid suggests that we use fat "sparingly," and that our daily diet include 2 - 3 servings of dairy products; 2 - 3 servings of meat, poultry, fish, eggs, beans, or nuts; 3 - 5 servings of vegetables; 2 - 4 servings of fruit; and 6 - 11 servings of bread, cereal, rice, or pasta. But the numbers alone don't tell the whole story. Our food needs are influenced by many factors, including age, gender, body size, pregnancy, and health. A clinical nutritionist or nutritionally oriented doctor can help you determine what type of diet is best for you. No matter what, you can improve your diet by adding more fruits and vegetables and cutting back on saturated fat and sugar.

What happens during a visit to a clinical nutritionist?

At first, the clinical nutritionist will ask you questions about your medical history, family history, and personal lifestyle. The medical history might include questions about your diet, digestion, history of weight loss or gain, sleep and exercise patterns, and relaxation habits. Some clinical nutritionists will ask you to bring a 3-day food diary and list of any herbs, supplements, or medicines that you take regularly. Laboratory tests might be used to find out if you are low in any nutrients and to test your organ function. This way, a nutritionist will get a full picture of your nutritional lifestyle.

During the second part of the visit, the nutritionist will suggest ways that you can fill the gaps and reduce the nutritional "overloads" in your diet. For example, your nutritionist may suggest that you eat your meals at different times or cut down on the amount of carbohydrates that you eat. The nutritionist will also offer advice on specific nutritional supplements if necessary (see below). The nutritionist will then schedule follow-up visits to monitor your health.

What is clinical nutrition good for?

Studies show that eating habits play a major role in the development of certain chronic diseases, including heart disease, obesity, cancer, and diabetes. Making changes to your diet can help to both prevent and treat these conditions. For example, lowering certain fats and cholesterol and adding whole grains to your diet can help prevent atherosclerosis (plaque build up in the arteries), which can lead to heart disease or stroke. Eat fewer calories will help you lose weight. Cutting down on simple sugars (glucose, sucrose, fructose, and lactose) can help prevent diabetes, and diets high in fiber (especially soluble fiber) can help control diabetes.

Scientists have found many other connections between diet and disease. In a clinical study of 20,000 men, for example, eating one fish meal per week was linked to a 52% reduction in the risk of sudden death from a heart attack. Fish is high in omega-3 fatty acids, which can protect the heart from fatal arrhythmias (abnormal heart rhythm).

In another clinical study of more than 42,000 women, those who ate lots of fruits, vegetables, whole grains, low-fat dairy, and only lean meats lived longer. High intake of fruits, vegetables, and legumes is associated with a lower risk of developing heart disease.

There are many ongoing studies regarding clinical nutrition. Some interesting results show that:

    Diets high in folate (found in leafy greens, dry beans and peas, fortified cereals and grain products, and some fruits and vegetables) may lower risk of stroke and heart disease.

    Eating small amounts of fish when pregnant may protect against early delivery and low birth weight infants. Some fish may contain higher amounts of mercury, and should only be eaten in moderation. Ask your obstetrician which types of fish are best for you when pregnant. Taking iron supplements improves aerobic training ability in iron-depleted women.

    Lutein and zeaxanthin (carotenoids) in the diet may reduce risk of cataracts.

    Lutein from dietary sources (such as kale and spinach) may protect against colon cancer.

    Flavonoids (found in apples, blueberries, broccoli, cabbage, carrots, citrus fruits, onions, and teas) may protect against cancer.

    Omega-3 fatty acids found in cold water fish (such as herring, tuna, and salmon) help reduce inflammation and help prevent certain chronic diseases, such as heart disease, cancer, and arthritis.

    Vitamin E (in the diet from fruits and vegetables) may reduce the risk of angina (chest pain) and heart attack in people with atherosclerosis.

In hospitals, nutrition is used to improve the overall health of patients with a wide range of conditions. Examples of these conditions are AIDS, cancer, osteoporosis, lung disease, obesity, burns, metabolic disorders, and kidney, liver, and pancreatic disorders. Patients who need surgery are also supported with clinical nutrition.

Is there anything I should watch out for?

Some nutritional supplements can interact with medications; it is very important to tell your doctor about any dietary supplements you are considering taking. Always take supplements according to label directions unless otherwise directed by a qualified health care practitioner.

There is little scientific information about the effect of so-called functional foods -- foods to which vitamins, minerals, herbs, or other dietary substances are added -- despite their growing popularity in the marketplace. Examples include calcium-fortified orange juice or snacks containing Echinacea.

Some common foods, including nuts, wheat gluten, dairy products, fish, shrimp, soy, bananas and eggs, may trigger allergic reactions. Your doctor can test for such possible allergies if he suspects you have them.

How can I find a certified clinical nutritionist?

To find a clinical nutritionist in your area, contact:

    The American Board of Nutrition: www.acbn.org

    The American College of Nutrition: www.amcollnutr.org

    The Clinical Nutrition Certification Board: www.cncb.org

    The American Dietetic Association: www.eatright.org

Specialists in many alternative health systems (including Traditional Chinese Medicine, Ayurveda, and naturopathy) also consider food a vital part of preventing and treating illness.

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Review Date: 9/27/2009

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

Relaxation techniques

What are relaxation techniques?

Our fast paced society can cause people to push their minds and bodies to the limit, often at the expense of physical and mental well being. According to the Mind/Body Medical Institute at Harvard University, 60 - 90% of all medical office visits in the United States are for stress related disorders. Such stress has damaging effects on health and the immune system. Relaxation techniques are helpful tools for coping with stress and promoting long term health by slowing down the body and quieting the mind. Such techniques generally entail: refocusing attention (for example, noticing areas of tension); increasing body awareness; and exercises (such as meditation) to connect the body and mind together. Used daily, these practices can lead to a healthier perspective on stressful circumstances. In fact, more than 3,000 studies show the beneficial effects of relaxation on health and well being.

What are the types of relaxation techniques?

There are three major types of relaxation techniques:

    Autogenic training . This technique uses both visual imagery and body awareness to move a person into a deep state of relaxation. The person imagines a peaceful place and then focuses on different physical sensations, moving from the feet to the head. For example, one might focus on warmth and heaviness in the limbs, easy, natural breathing, or a calm heartbeat.

    Breathing. In breathing techniques, you place one hand on your chest and the other on your belly. Take a slow, deep breath, sucking in as much air as you can. As you're doing this, your belly should push against your hand. Hold your breath and then slowly exhale.

    Progressive muscle relaxation . This technique involves slowly tensing and then releasing each muscle group individually, starting with the muscles in the toes and finishing with those in the head.

    Meditation . The two most popular forms of meditation in the U.S. include Transcendental Meditation (students repeat a mantra -- a single word or phrase) and mindfulness meditation (students focus their attention on their thoughts and sensations).

How do relaxation techniques work?

When we become stressed, our bodies engage in something called the "fight or flight response." The fight or flight response refers to changes that occur in the body when it prepares to either fight or run. These changes include increased heart rate, blood pressure, and rate of breathing, and a 300 - 400% increase in the amount of blood being pumped to the muscles. Over time, these reactions raise cholesterol levels, disturb intestinal activities, and depress the immune system. In general, they leave us feeling "stressed out."

However, we also possess the opposite of the fight or flight response -- the "relaxation response." This term, first coined in the mid-1970s by a Harvard cardiologist named Herbert Benson, refers to changes that occur in the body when it is in a deep state of relaxation. These changes include decreased blood pressure, heart rate, muscle tension, and rate of breathing, as well as feelings of being calm and in control. Learning the relaxation response helps to counter ill effects of the fight or flight response and, over time, allows the development of a greater state of alertness. The relaxation response can be developed through a number of techniques, including meditation and progressive muscle relaxation. It is now a recommended treatment for many stress related disorders.

What are relaxation techniques good for?

Research suggests that meditation can help improve a person's quality of life and reduce stress hormone levels.

Clinical studies also show that relaxation techniques reduce the perception of pain. One clinical study found that among patients undergoing colorectal surgery, those who listened to guided imagery tapes before, during, and after the operation had less pain and needed fewer pain medications than those who did not.

Meditation has also been used as part of the treatment for post-traumatic stress disorder in Vietnam veterans and to break substance abuse patterns in drug and alcohol abusers. Relaxation techniques can also enhance coping skills in migraine sufferers and reduce stress as well as improve mood in those with cancer.

In general, studies show that with consistent practice, relaxation techniques can potentially reduce symptoms or improve outcomes in the following conditions:

    Premenstrual syndrome

    Pain

    Irritable bowel syndrome

    Anxiety

    Infertility

    High blood pressure

    High cholesterol

    Diabetes

    Panic disorders

    Chronic tension headaches

    Fibromyalgia

    Insomnia

    Psoriasis

    Arthritis

    Hyperactivity in children, as in attention deficit hyperactivity disorder (ADHD)

It is extremely important that usual medical care and advice be followed for these conditions as well. Relaxation techniques are meant to complement usual medical care.

Is there anything I should watch out for?

Relaxation techniques are considered to be very safe. There have been unusual cases where people become more, rather than less, anxious when using the techniques because of a heightened awareness of body sensations. Even more rare are reports of pain, heart palpitations, muscle twitching, and crying spells associated with the use of relaxation techniques. When this happens, it is often related to the process of relaxing and reflecting inward such that emotions become very poignant.

Experts advise people with schizophrenia and other forms of psychosis (thought disorders that distort reality) to avoid relaxation techniques.

Can I learn relaxation techniques by myself?

If you want to generally reduce stress and enhance well being, you can teach yourself some relaxation techniques. Look for videotapes and audiobooks on popular techniques, such as guided imagery and meditation, and check for community classes in your area. If you have a specific medical or psychological disorder or concern, however, it is best to see a health care professional, such as a clinical psychologist, social worker, or guided imagery therapist who teaches relaxation techniques as part of their therapeutic practice. Your health care professional will help you decide what relaxation method is best for you.

Where can I find a qualified practitioner?

Numerous clinics and hospitals around the country have integrated relaxation techniques into various health care programs. The following resources can help you learn more about relaxation techniques and locate health care facilities that include them as part of their practice:

    The American Holistic Medical Association, www.holisticmedicine.org

    The American Holistic Health Association, www.ahha.org

    The National Institute for Clinical Applications of Behavioral Medicine, www.nicabm.com

    The Center for Mind-Body Medicine, www.cmbm.org

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Review Date: 9/28/2009

Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.