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Newsfeed display by CaRP Many people use drugs or remedies that are not part of the traditional medical treatment prescribed by their health care provider. Using this type of alternative therapy along with traditional treatments is called complementary medicine.

Alternative Therapies and Their Uses:
One survey found that 42% of Americans used at least one of 16 alternative therapies. Based on this survey, investigators estimated that patients paid $27 billion annually for alternative therapies. This amount is similar to the annual out-of-pocket costs for all physician services in the United States.

Commonly used alternative therapies include the following:
1. Herbal medicines
2. Massage therapy
3. Chiropractic care
4. Large doses of vitamins
5. Self-help groups
6. Folk remedies
7. Energy healing (eg, magnets)
8. Homeopathy
These alternative therapies are used to treat many symptoms or illnesses, including the following:
a. Back or neck pain
b. Headaches
c. Arthritis
d. Fatigue
e. Anxiety
f. Depression
g. Memory problems

Safety and Side Effects:

People often feel more comfortable taking herbal remedies, thinking that because these products are "natural," they are safe. It is important to recognize that many traditional drugs also come from natural sources (eg, digitalis, penicillin, morphine, and aspirin).

Herbal remedies can affect the body just like traditional drugs. This means that they can either add to or work against the effects of traditional drugs prescribed by a doctor. Even when used by themselves, herbal preparations can also be unsafe and cause complications or toxic effects. When people are taking herbal products along with other medications, possible side effects can be difficult to anticipate. This is especially serious for elderly people, because how our organs function changes with age.

Another common misconception is that taking large doses of vitamins or minerals is safe. This is not always the case. For example, large doses of vitamin A can influence bone health. Large doses of vitamin B6 can influence nerves and cause a condition called peripheral neuropathy.

Unfortunately, well over half of the people who use alternative therapies do not tell their primary-care physician. They may be afraid that their health care provider will disapprove or react negatively. However, it is very important to tell your health care provider about all medications you are taking, including any over-the-counter (OTC) remedies and alternative therapies. Again, this is because many OTC products and alternative therapies can interact with or alter the effects of many prescription medications. Some of these interactions or side effects can be serious and even life threatening.

The FDA does not regulate herbal products, which means that they can be sold with no proof of their safety, purity, or even whether they work as claimed. Also, the herbal manufacturing industry in the United States is not uniform or standardized. This means that products with the same name may not have the same amount of ingredients, or even the exact same ingredients! Some companies produce high-quality preparations, but others have poor quality control or unsanitary conditions. Therefore, the dosing and purity of herbal products is not straightforward. This also increases the possibility of side effects.

The herbal preparations listed below are commonly used by elderly people. It is important to remember that research studies of these products are not required as they are for prescription medications, and that study results may not be scientifically accurate.
a. St. John’s wort
b. Kava
c. Valerian
d. Ginkgo
e. Saw palmetto
f. Glucosamine with or without chondroitin

a. St. John’s wort is commonly used for depressed mood. The way it works in unknown. There have been more than 24 studies published on the effectiveness of St. John’s wort, but only 9 of them are considered to be well done by the scientific community. In 4 of these studies, St. John’s wort had similar effects compared with a standard antidepressant therapy, but in the other 5 studies, St. John’s wort improved depression only slightly more than a sugar pill (ie, placebo).

Side Effects: Side effects from St. John’s wort are not common (affecting about 24 of every 1000 people), but can include allergic reactions, stomach upset, dry mouth, sleepiness, and headache. At doses higher than that used for depressed mood (eg, greater than 900 mg), St. John’s wort can increase sensitivity to sun light, resulting in a sunburn type of reaction or rash.

St. John’s wort also influences the effects of many prescription medications, so it is always important to check with your health care provider or pharmacist.

b. Kava is an herbal remedy used for anxiety. The exact way it works is unclear, but the active ingredients (kavapyrones) act to relax muscles, prevent seizures, and decrease emotional responses. Most of the studies on the use of kava are not thought of as quality research by the scientific community. However, in one large study, anxiety was significantly improved after 8 weeks of kava therapy, and this effect continued for the entire 25 weeks of the study.

Side Effects: Side effects from kava included allergic reactions, stomach upset, yellowing or scaling of the skin, and blurred vision.

c. Valerian comes from a plant that is used to improve sleep. Doses of 400-900 mg appear to improve both the ability to fall asleep and the quality of sleep, but it may take 2-4 weeks of use to reach the desired effect.

Side Effects: Side effects are rare but may include stomach upset, headaches, restless sleep, blurry vision, and skin reactions from contact with the product.

d. Ginkgo is an herbal preparation used to prevent and treat memory problems. In most of the studies on ginkgo, it improved memory loss, concentration problems, fatigue, anxiety, and depression. However, many of these studies are not thought of as quality research by the scientific community.

Side Effects: Side effects include headache, stomach upset, allergic skin reactions, and brain hemorrhage (ie, stroke).

e. Saw palmetto is used by men for urinary symptoms caused by an enlarged prostate. The way it works is unknown. An analysis that combined results of several clinical studies on saw palmetto found it to be better than a sugar pill (ie, placebo) and similar to standard drug therapy for improving urinary symptoms.

Side Effects: In the study above, side effects were mild and included stomach upset and impotence/erectile dysfunction. Saw palmetto can also affect the test used to screen for prostate cancer (PSA), so it’s important to let you health care provider know if you are taking it.

f. Glucosamine and chondroitin are often used as a combination for arthritis pain. Most of the past studies reporting benefits from this combination had scientific flaws, but newer studies on the effectiveness of glucosamine by itself are promising. Some research suggests that it may take 4-6 weeks of use before improvement is seen.

Side Effects: Side effects appear to be few.

Where to Go for More Information:
You can ask your health care provider or pharmacist about the safety of combining alternative and prescription medicines. However, keep in mind that some health care providers may not be completely knowledgeable about non-traditional therapies and their pros and cons.

Other resources include the following:
The American Pharmaceutical Association Practical Guide to Natural Medicine.
The Review of Natural Products is a collection of over 300 in-depth summaries of natural products. It provides detailed information on botany, history, chemistry, pharmacology, toxicology, medicinal uses, and drug interactions for health care professionals.


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Submitted: 06/21/06

Description: Many people use drugs or remedies that are not part of the traditional medical treatment prescribed by their health care provider. Using this type of alternative therapy along with traditional treatments is called complementary medicine.

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