Ch 31 - Complementary and Alternative Medicine

Chemical agents that increase rates of genetic mutation by interfering with function of nucleic acids.

mutagens

Many herbs listed for use as herbal supplements are also listed on the FDA's Poisonous Plant Database! These include herbs such as:

• aloe • black cohosh • chamomile • feverfew • ginkgo • milk thistle • rose hips • St. John's wort • valerian

Identify the alternative systems of complementary and alternative medicine (CAM) therapies.

Alternative therapies focus on treating each person individually, considering the health of the whole person. They emphasize integration of mind and body, promoting disease prevention, self-care, self-healing and spirituality as part of health and healing. Research is ongoing about whether CAM therapies are totally or partially effective, or not at all effective. Some therapies have proven effectiveness, but others do not. Therapies include: • specific diets • homeopathy • chiropractic • acupuncture • massage • exercise • relaxation techniques • hypnotherapy • biofeedback • prayer • counseling • detoxification therapies The value of CAM therapies lies in an ability to reduce the need for medications. When drug doses are reduced, this leads to fewer potential adverse effects.

Describe the indications for black cohosh, echinacea, and St. John's wort.

Black cohosh (Actaea racemosa) is a popular supplement, derived from a flowering plant that grows in the forests of eastern North America. It is used for menopausal symptoms such as hot flashes. Its pharmacologic actions show some amount of hormonal activity, and it is described as a selective estrogen receptor modulator (SERM). Echinacea is a group of herbaceous flowering plants of the daisy family. They are found only in eastern and central North America. Echinacea supplements are commonly used to prevent or treat the common cold, but also for urinary tract infections, upper respiratory tract infections, herpes, and other infections. It is believed that echinacea stimulates and improves immune system function. However, various studies have shown that echinacea is not effective in preventing the common cold. It has only a slightly higher effect than placebo on treating a cold at onset. St. John's wort (Hypericum perforatum) is a flowering plant in the family Hypericaceae. It is used to treat depression, and there have been a variety of studies for this use, as well as for obsessive-compulsive disorder, menopausal symptoms, smoking cessation, and various psychological disorders. For its antidepressant effects, St. John's wort may utilize reuptake of serotonin, dopamine, and norepinephrine. Its effectiveness has been documented, and it may be very close to the effects of standard antidepressants. St. John's wort has been shown to be two to six times more effective than placebo for patients with various levels of depression, except for major depression. Overall, most clinicians agree that St. John's wort is effective for mild to moderate depression, but not for severe depression.

What is the difference between complementary alternative and integrative medicine?

Complementary medicine is used together with mainstream medical care. An example is using acupuncture to help with side effects of cancer treatment. When health care providers and facilities offer both types of care, it is called integrative medicine. Alternative medicine is used instead of mainstream medical care.

Identify the indications for Ginkgo biloba, garcinia, and dong quai.

Ginkgo biloba is also commonly known as ginkgo, as well as the maidenhair tree. It is native to China and was first recorded as being used as a medicine in the late 15th century. Today, it is used for memory problems, dementia such as Alzheimer's disease, and other central nervous system disorders. Many studies have been conducted on this supplement, with results showing it to be only slightly more effective than placebo. The conclusion is that there is no strong evidence to show that ginkgo biloba improves dementia or cognitive impairment. Garcinia cambogia, a tropical fruit also known as the Malabar tamarind, is a popular weight-loss supplement. People say it blocks your body's ability to make fat and it puts the brakes on your appetite. The active ingredient in the fruit's rind, hydroxycitric acid, or HCA, appears to block an enzyme called citrate lyase, which your body uses to make fat. It also raises levels of the brain chemical serotonin, which may make you feel less hungry. But actual weight loss results aren't impressive. Dong quai is a plant. The root is used to make medicine. Dong quai is commonly taken by mouth for menopausal symptoms, menstrual cycle conditions such as migraines and many other conditions, but there is no good scientific evidence to support these uses. Dong quai root has been shown to affect estrogen and other hormones in animals. It is not known if these same effects happen in humans.

Explain the sources and indications for glucosamine and chondroitin.

Glucosamine and chondroitin are dietary supplements taken together or separately, usually for osteoarthritis. Glucosamine is an amino sugar that is a precursor for biochemical synthesis of glycosylated proteins and lipids. Glucosamine may help rebuild cartilage lost in joints of patients who have osteoarthritis, but this is not proven. Unlike the nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine is not believed to inhibit cyclooxygenase enzymes. Chondroitin sulfate is a glycosaminoglycan made up of a chain of alternating sugars. It is an important structural component of cartilage that provides much of its resistance to compression. It may work against osteoarthritis by preventing cartilage from being degraded within the joints. For supplements, chondroitin is obtained from animal cartilage.

Explain manufacturer recordkeeping practices for dietary supplements.

It required manufacturers to include contact information on labels for consumers, so that they can report adverse effects of the products. If a manufacturer is alerted to such an event, it must inform the FDA within 15 days after receiving a consumer complaint. Manufacturers must keep records of such events for at least six years, subject to FDA inspection. The FDA requires manufacturers to evaluate the identity, potency, purity, and composition of all products, with labels accurately reflecting this information.

Explain reasons why the FDA has issued warnings about dietary supplements.

Since the FDA does not regulate these supplements, there is no independent verification method concerning their quality and effectiveness, or the quantity of their ingredients. Some herbs contain substances that are toxic to all body systems or, usually, to the liver. Others are carcinogens, mutagens, or teratogens. lack of sufficient testing means that proof of actual effectiveness is not well documented.

Describe herbal supplements and their classification by the FDA.

The law defines dietary supplements in part as products taken by mouth that contain a "dietary ingredient." Dietary ingredients include vitamins, minerals, amino acids, and herbs or botanicals, as well as other substances that can be used to supplement the diet. They are labeled as dietary supplements and include among others • vitamin and mineral products • "botanical" or herbal products— These come in many forms and may include plant materials, algae, macroscopic fungi, or a combination of these materials. • amino acid products—Amino acids are known as the building blocks of proteins and play a role in metabolism. • enzyme supplements—Enzymes are complex proteins that speed up biochemical reactions.

Explain the terms "herb" and "botanical."

The terms herb and botanical have been used historically for plant products that may contain healing, flavor-enhancing, or food enhancement properties. Herbs have been used for many centuries. The term herb is defined as a botanical product without stems or bark. Botanicals have been used for thousands of years to treat many different conditions.

Identify the three types of claims allowed concerning dietary supplements.

Under the law, there are three types of claims that are allowed: • Health claims—when there is a reduced risk of acquiring a disease with intake of a particular substance; for example, a product that contains calcium may state that a high-calcium diet will reduce risks for osteoporosis • Nutrient content claims—allow manufacturers to describe levels of ingredient contents; for example, "low sodium" or "high fiber" • Structure/function claims—describing how a substance affects normal structure or function, or how it may be helpful for deficiency, along with health maintenance, or affecting normal aging; for example, a supplement containing vitamin A may state that it "promotes better vision". note: these types of claims must include the phrase: "This statement has not been evaluated by the FDA. This produce is not intended to diagnose, treat, cure, or prevent any disease."

Describe the effects of the Dietary Supplement Health and Education Act (DSHEA) of 1994.

attempted to regulate herbal supplements as part of its description of dietary supplements. These supplements are intended to enhance or supplement the diet. They include botanicals, herbs, vitamins, minerals, amino acids, enzymes, organ tissues, and extracts or metabolites not approved as drugs by the FDA. There have been many reports of contamination, impurities, and inconsistent amounts of ingredients.

Chemical compounds capable of causing cancer and other malignant tumors.

carcinogens

A large, diverse set of systems of diagnosis, treatment, and prevention based on philosophies and techniques outside those of conventional Western medicine.

complementary and alternative medicine (CAM)

Products containing one or more vitamins, herbs, enzymes, amino acids, or other ingredients, taken orally to supplement the diet, as by providing missing nutrients.

dietary supplements

A dietary supplement that contains medicinal herbs.

herbal supplement

Agents that cause physical effects in developing embryos; substances that may result in birth defects.

teratogens