January 27, 2001 Research Update

James Bogash, D.C. Mesa, AZ
info@lifecarechiro.com
www.lifecarechiro.com

Patients' Role in the Use of X-Rays for Common Complaints

Many times I see patients in my office who have had X-rays and MRIs taken almost right at the start. And of course, the usual diagnosis is arthritis.

Well, I've got sorry news...ALL of us have arthritis to some degree. This study suggests that patient's perception and wishes have an influence on whether or not radiographs are taken. I firmly believe that if the patient was educated and informed about their condition, then they would understand that X-rays are not needed right away. Remember, in Latin, Doctor translates to Teacher.... Patients' Role in the Use of Radiology Testing for Common Office Practice Complaints http://archinte.ama-assn.org/issues/v161n2/abs/ioi00125.html

Potential Adverse Effects of Alternative Rx 'Growing Exponentially'

There are several ways to look at this article. First, the list of adverse effects (potential, actually...) could keep growing exponentially for many years and still not touch the numbers associated with pharmaceutical drugs. On the other hand, we really do need to come to terms with the power of natural medicine and stop taking it so lightly. There are many, and I would venture to say most, patients using a specific natural medicine based on something their neighbor told them or they read in Reader's Digest. It's not that easy, and almost always, involves some aspect of lifestyle changes to augment the therapy, such as consistent exercise.

(article) The number of known nutrient-to-nutrient and nutrient-to-drug interactions is growing exponentially, panelists said here Monday at a complementary and alternative medicine symposium at the American Society for Parenteral and Enteral nutrition's 25th Clinical Congress. Though herbs and plants have been used to treat medical conditions for thousands of years, "we don't know what effect our culture has on these herbs," warned Georgia M. Decker, a nurse practitioner at Integrative Care in Albany, New York. The speakers emphasized that even benign-sounding herbs can be dangerous in combination with other therapies or if taken by patients with certain diseases. For example, garlic can worsen a hypoglycemic patient's symptoms, and ginger should not be taken by patients with gallbladder disease. Another drawback is that alternative therapies sometimes mask patients' symptoms and thus their underlying diseases. That means patients need to be asked not only what they are taking, but how much, panelists said. "Licorice wafers do help settle the stomach when there's a lot of acidity," Decker explained. "But if somebody is saying to you, 'Oh, I take five, six licorice wafers a day,' then what's the gastrointestinal symptom that would require five or six wafers a day?" The presenters encouraged healthcare professionals to continue to learn what they can from the literature that is available. "We simply cannot say, 'No, you can't take that,' because there aren't several big prospective randomized trials that have come to the same conclusion," said Kathryn K. Hamilton, a registered dietitian and instructor at Columbia University in New York. "In all likelihood, these trials are not going to happen."

Complementary and Alternative Medicine in the Treatment of Cancer

This is always a very touchy subject and recommendations should ONLY be taken from those fully familiar in this field. There are certain chemotherapeutic drugs that work by creating high levels of free radicals, and taking antioxidants would prevent that drug from working the way it was designed. With that said, I know that, should the event transpire that I was diagnosed with cancer, I would not forsake Western medicine's approach. But I would search hard for those few clinics in the country that combine the best of Western medicine and alternative for cancer care. As far as I am concerned, that is the ONLY way to go. That's not to say that antineoplastins, Essiac tea and others are not effective and have not cured "incurable" cancers safely and effectively, but I think more work needs to be done in these areas. Just remember--the true answer lies in prevention.

Oncology Issues 15(6):17-19, 2000 The term "alternative cancer therapy" refers to clinically unproven treatments that are used in place of conventional cancer treatments, while the term "complementary therapy" is attributed to such treatments when they are used as adjuncts to conventional therapy. These treatments may enhance, interfere, or have no interactions with standard cancer therapy. Some complementary and alternative medicine (CAM) treatments may provide symptom control and palliation with minimal or no side effects. However, CAM treatments may have dangerous adverse effects or potentially interfere with standard therapy. In addition, if used alone, they may indirectly harm the patient by delaying clinically proven standard treatments.Complementary cancer therapies have recently received considerable attention in the scientific and medical community. The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) is dedicated to research investigating these therapies. Although CAM therapies have been used for many years, few well-designed, properly conducted clinical studies have investigated their efficacy and adverse effects. Many physicians treating cancer patients have little knowledge of alternative therapies and, therefore, frequently discourage their use by patients. More recently, however, reports of CAM treatments have begun to appear in medical journals, and research programs for CAM therapy have been developed by several comprehensive cancer centers.

Is Wine "Healthier" Than Other Drinks?

The idea of wine being healthy has been debated heavily. First, a clarification--red wine is the wine usually studied. Second, I firmly believe it is not the alcohol content, but rather, the bioflavanoids such as resveratrol from the red grapes (also found in peanuts) that offer the protective benefits. Considering that alcohol does increase your risk of certain types of cancer, skip the wine, eat lots of grapes and you'll also get many other healthy substances and antioxidants.

Ann Intern Med. 2000;133:411-419 Wine may have protective effects beyond those associated with light alcohol consumption, according to findings of a pooled cohort study involving more than 24,000 subjects. The study is published in a recent issue of the Annals of Internal Medicine. The investigation included 13,064 men and 11,459 women, 20 to 98 years of age, who were participants in the Copenhagen City Heart Study, the Copenhagen Male Study, and studies from the Copenhagen County Centre of Preventive Medicine. Subjects reported their average weekly intake of wine, beer, and spirits. The researchers also took into account participants' smoking status, education level, physical activity level, and body mass index. Compared with nondrinkers (whose relative risk was set at 1.0), light drinkers (those who consumed one to seven alcoholic drinks per week) had a relative risk of death from all causes of 0.82, but those who drank more than 35 drinks per week had a relative risk of 1.1. In general, alcohol consumption was associated with a reduced risk of death from coronary heart disease but an increased risk of death from cancer (especially in subjects who drank more than 21 drinks per week).Wine consumption at all levels -- light, moderate, and heavy -- was associated with a lower mortality rate in all three categories (all causes, cancer, and heart disease). Subjects who drank eight to 21 glasses of wine per week had a relative all-cause mortality risk of 0.76; from cancer, 0.78, and from heart disease, 0.64. Furthermore, compared with light drinkers who did not drink wine, light drinkers for whom wine made up 30% or more of their total alcohol intake had a 0.67 relative risk of all-cause mortality.Study authors Grønbæk et al speculate that "Wine may contain one or several substances that add to the beneficial effect of intake of a small amount of ethanol."

Long-term effects of glucosamine sulphate on osteoarthritis progression

Not that these results are Earth-shattering, but it's nice to see them published in one of the major medical journals. Glucosamine and chondrotin sulfate have been used for a long time now with natural practioners. It is very effective, very inexpensive (when compared with almost any NSAID and especially the new COX-2 inhibitors) and has little incidence of side effects. There has been some concern with GS affecting insulin sensitivity, but the evidence is not strong to date. Combine GS or CS with manipulative therapy, an exercise routine, an anti-inflammatory diet and avoidance of food allergies to round out a natural approach to osteoarthritis.

Lancet 2001; 357: 251-56 Treatment of osteoarthritis is usually limited to short-term symptom control. We assessed the effects of the specific drug glucosamine sulphate on the long-term progression of osteoarthritis joint structure changes and symptoms. We did a randomised, double-blind placebo controlled trial, in which 212 patients with knee osteoarthritis were randomly assigned 1500 mg sulphate oral glucosamine or placebo once daily for 3 years. weightbearing, anteroposterior radiographs of each knee in full extension were taken at enrolment and after 1 and 3 years. Mean joint-space width of the medial compartment of the tibiofemoral joint was assessed by digital image analysis, whereas minimum joint-space width--ie, at the narrowest point--was measured by visual inspection with a magnifying lens. Symptoms were scored by the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. The 106 patients on placebo had a progressive joint-space narrowing, with a mean joint-space loss after 3 years of -0·31 mm (95% CI -0·48 to -0·13). There was no significant joint-space loss in the 106 patients on glucosamine sulphate: -0·06 mm (-0·22 to 0·09). Similar results were reported with minimum joint-space narrowing. As assessed by WOMAC scores, symptoms worsened slightly in patients on placebo compared with the improvement observed after treatment with glucosamine sulphate. There were no differences in safety or reasons for early withdrawal between the treatment and placebo groups. The long-term combined structure-modifying and symptom-modifying effects of gluosamine sulphate suggest that it could be a disease modifying agent in osteoarthritis.