Transcript Integrative Medicine - UTMB Health's Complementary and

Integrative Medicine
Using Complementary and Alternative
Therapies in Medical Practice
Victor S. Sierpina, M.D.
Associate Professor
Family Medicine
University of Texas Medical Branch
NUTRICEUTICALS
An Introduction and Overview with
Practical Clinical Applications
Learning Objectives
To learn the definition of nutriceuticals
(nutraceuticals)
 To review the most popularly-used overthe-counter nutriceutical preparations
 To gain understanding of and become
familiar with several dietary programs
 To know the special issues about athletes’
ergogenic and dietary programs

Learning Objectives
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To be familiar with several primary care
applications of nutriceuticals and review
the pertinent supporting literature
To have a useful resource list for
information about nutritional therapy to be
better able to address patient questions in
this area
Nutrition
Finally!
Biochemistry
Again?
Nutriceuticals: Definition and
Usage
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Use of nutritional supplements and food
related constituents therapeutically
Why?

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Dietary deficiencies
Agricultural practices
Environmental toxins
Lifestyle
Micronutrient debate (Goodwin)
Diets

Ornish

Mediterranean

Atkins’

DASH

Zone/Sugar
Busters

Vegetarian

Protein sparing

Macrobiotic
Eat Right for
Your Type

Practice Cardiovascular Exercise
Per Week UTMB Class of 2004
40
35
30
25
20
Percentage
15
10
5
0
None
1-2 Days
3-5 Days
>5 Days
Time of Aerobic Activity per
Session UTMB Class of 2004
30
25
20
15
Percentage
10
5
0
0-15
Mins
20-30
Mins
30-45
Mins
45-60
Mins
>1 Hour
Weight Training Per Week
UTMB Class 2004
50
45
40
35
30
25
20
15
10
5
0
Percentage
None
1-2 Days
3-5 Days
>5 Days
Practice Stretching/Tai Chi/Yoga
Per Week UTMB Class 2004
70
60
50
40
Percentage
30
20
10
0
None
1-2 Days
3-5 Days
>5 Days
Servings of Fruits & Vegetables
Per Day UTMB Class of 2004
70
60
50
40
Percentage
30
20
10
0
None
1-3
4-6
7-9
Health
Habits
to
Change
Dietary Changes
120
105
100
Exercise
87
Sleep
80
Leisure/Sports
60
40
20
Stop Smoking
28
21
10
2
0
Habits to Change
2
Do Nothing
Other
(Meditation/Prayer)
Nutriceuticals---What Are They?
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Amino Acids
Diets
Enzymes
Minerals
Vitamins
Other Pharmacological/Biological Products
Enzymes


Bromelain
CoQ10
Minerals

Magnesium


Manganese
Zinc

Calcium

Potassium

Chromium
Molybdenum

Vitamins

A
B-Complex
B1 (Thiamin)
B2 (Riboflavin)
B3 (Niacin)
B5 (Pantothenic
Acid)
Beta-carotene

B6 (Pyridoxine)
B8 (Folic Acid)
B12 (Cobalamin)
C
D
E
K
Multi
Other Pharmacological/Biological Agents
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Fatty acids—EPO, GLA, flaxseed oil

Glucosamine sulfate, chondroitin, shark
cartilage

Glandulars--thymus, adrenal, thyroid
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Metabolife
Steroids--DHEA

Dr. Andrew Weil’s Anti-Oxidant
Cocktail
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100-250 mg of vitamin C and 25,000 IU of
mixed carotenes at breakfast
400-800 IU of natural vitamin E and 200
mcg of selenium at lunch
100-250 mg of vitamin C at dinner
Dr. Natural
Dr. Victor Sierpina’s Nutritional
Supplement Formula

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
500 mg Vit C in
AM&PM
400 IU Vit E in
AM&PM
High potency Bcomplex with
antioxidants/trace
minerals in AM

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High fiber, low fat diet,
5-7 servings
fruits/veggies per day,
garlic, red wine, olive oil,
green tea
(Ginkgo biloba 60 mg
AM & PM)
Be thankful for your
food….
My Favorite Therapies—stuff you
can use every day
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Glucosamine
Anti-oxidants Vitamins C (1 gram/d), E
800 IU/d), high intakes (5-7 servings/d) of
fruits and vegetables
Chromium 200-400 mcg/d
My Favorite Therapies—stuff you
can use every day
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Vitamin B6 50-100 mg/d
Zinc 15-45 mg/d
Magnesium 300-500 mg/d
Coenzyme Q10 50-300 mg/d
Concerns
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Standardization
Purity
Potency
Bioavailability
FDA’s role
Remember
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FDA neither establishes nor regularly
enforces any standards of quality for herbs
or other dietary supplements
Nutritional supplements and herbs are
technically unapproved drugs, in an OTC
limbo
Best advice: obtain a standardized extract
marketed by a reputable firm
Nutriceuticals for Common
Problems in Primary Care
Anti-oxidants

Oxidant by-products of normal metabolism
result in extensive damage to DNA, proteins and
lipids, leading to aging and degenerative
diseases including cancer, cardiovascular
disease, immunoincompetence, brain
dysfunction and cataracts.*

Low intakes of fruits and vegetables double the
risk of many types of cancer versus high intakes.
*Proc NY. Acad Sci. 1993; 90: 7915-7922
Vitamins C and E

Pretreatment with vitamin C and E
prevented a fall in vasodilation which
occurred after a high fat meal. No such
fall was noted after a low fat meal.*
*Plotnick GD, Corretti MC. et al. Effect of Antioxidant Vitamins on the
Transient Impairment of Endothelium-Dependent Brachial Artery VasoActivity Following a Single High-Fat Meal. JAMA.1997;278(20):1682-1686.
Vitamin E
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High risk CV pts. had “no apparent effect”
from Vit E (NEJM, 2000;342:154-60). No
significant adverse events
Preventive effect suggested in Stampfer,
Rimm studies (NEJM, 1993; 328)
Intermittent claudication Vit E found useful
(Goodwin, Ann Int Med, Nov 1997)
Coenzyme Q10

CHF - Stroke index at rest and work improved
significantly (p< .05), the pulmonary artery
pressure at rest (p< .05) and work decreased and
the pulmonary capillary wedge pressure at rest
and work decreased (p< .05) with CoQ10 100mg
bid*
*Munkholm H, Hansen HH. Coenzyme Q10 treatment in serious heart failure.
Biofactors. 1999;9(2-4):285-9
Vitamin B6

27/28 patients diagnosed with idiopathic
CTS improved substantially on B6, 100
mg/day vs placebo. ¼ of patients were
noted to be pyridoxine-depleted based on
serum studies.*
*Carpal Tunnel Nutr Rep Int.1986 34(6):1031-40
Osteoarthritis--glucosamine sulfate,
chondroitin sulfate
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Drovanti A, Bignamini AA, Rovati AL.
Therapeutic activity of oral glucosamine sulfate
in osteoarthritis: a placebocontrolled doubleblind
investigation. Clin Ther 1980;3(4):26072
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Morreale P, et al. Comparison of the antiinflammatory efficacy of chondroitin sulfate and
diclofenac sodium in patients with knee
osteoarthritis. J Rheumatol 1996; 23: 1385-91.
Recent studies on Glucosamine

McAlindon, TE, et al. Glucosamine and
chondroitin for treatment of osteoarthritis: a
systematic quality assessment and meta-analysis.
JAMA 283(11): 1483-84. Feb 2000

RPC study showed reduction in cartilage loss and
symptoms of OA over a 3 yr period in 106 pts
(Reginster, Jan 2001 Lancet)
Meta-Analysis of Glucosamine and
Chondroitin for Treatment of Osteoarthritis,
McAlindon, et al. JAMA.2000;283:14691475
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Moderate to large effect size in 15
studies reviewed
Product quality issues?
Publication bias?
Efficacy “appears probable”
Studies under way
Cholesterol--inositol
hexaniacinate, Vit C and E.
 Murray M. Lipid-lowering drugs vs. Inositol
hexaniacinate. Am J Natural Med 1995;2:9-12 (review).
 Belcher JD, Balla J, Balla G, et al. Vitamin E, LDL, and
endothelium: Brief oral vitamin supplementation prevents
oxidized LDL-mediated vascular injury in vitro.
Arterioscler Thromb 1993;13:1779-89.
 Frei B. Ascorbic acid protects lipids in human plasma and
low-density lipoprotein against oxidative damage. Am J
Clin Nutr 1991;54:1113S-8S.
Obesity--Ornish, vegetarian diet,
chromium
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Gould KL, Ornish D, et al. Improved stenosis
geometry by quantitative coronary arteriography
after vigorous risk factor modification. Am J
Cardio 1992, 69:845-53
Ornish D, et al. Effects of stress management
training and dietary changes in treating ischemic
heart disease. JAMA, 1983, 249:54-59
McCarty MF. The case for supplemental
chromium and a survey of clinical studies with
chromium picolinate. J Appl Nutr 1991;43:59-66.
Integrating Nutritional Therapy
Into Your Practice
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Standard of care
Patient preference
Safety vs efficacy
Alternatives/options
Integrative care/adds value
Ask the Unasked Questions
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“What, if any, alternative therapies have
you tried for this problem?”
“Considered?”
“Have questions about?”
“Besides these prescriptions, are you taking
any over the counter products,
supplements, or herbs?”
UTMB’s Alternative
and Integrative Health
Care Program Website
http://atc.utmb.edu/altmed
UTMB Licensed Data Bases
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HealthNotes Online
A data base for
nutritional and herbal
material on UTMB
Alternative and
Integrative website
http://atc.utmb.edu/alt
med
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Scientific Basis for
Holistic Medicine
A data base of
abstracted article
summaries of natural
product use in health
and illness
http://library.utmb.ed
u/holistic
Integrative Healthcare:
Complementary and
Alternative Therapies for
the Whole Person
By: Victor S. Sierpina, MD
FA Davis Philadelphia, 2001
www.B&N.com
www.amazon.com
Other Useful References

Novey DW. 2000. Clinician’s Complete
Reference to Complementary/Alternative
Medicine. St. Louis: Mosby

Dossey, L. 1999. Reinventing Medicine—Beyond
Mind-Body to a New Era of Healing. San
Francisco:Harper Collins
References
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Murray M, Pizzorno J. 1998. Encyclopedia of
Natural Medicine. Rocklin, CA: Prima.
PDR for Herbal Medicines. 2000. Montvale, NJ:
Medical Economics Co.
Jonas WB, Levin JS (eds). 1999. Essentials of
Complementary and Alternative Medicine. Philadelphia:
Lippincott, Williams & Williams
References
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Rosenfeld I. 1996. Dr. Rosenfeld’s Guide to
Alternative Medicine—What Works, What
Doesn’t—And What’s Right For You. New York:
Random House.
Pressman AH, Buff S. 1999. The Complete
Idiot’s Guide to Alternative Medicine. New York:
Alpha Books.
Dillard J, Ziporyn T. 1998. Alternative Medicine
for Dummies. Foster City, CA: IDG Books
Worldwide, Inc.
References
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
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Wirth S (ed) 1999. Integrative Medicine—A
Balanced Account of the Data. Ukiah, CA:
Boitumelo Publishing Inc.
Kemper KJ. 1996.The Holistic Pediatrician. New
York: Harper Collins
Alternative Therapies in Health and Medicine.
Published by the Innovision Communications,
101 Aliso Viejo, CA 92656 800-899-1712;
bimonthly peer reviewed journal.
UTMB’s Alternative
and Integrative Health
Care Program Website
http://atc.utmb.edu/altmed