Alternative Remedies in the Mainstream

According to Massachusetts General Hospital's (MGH) Department of Psychiatry, complementary and alternative medicine (CAM) therapies are gaining ground in widespread use. A 2003 continuing education seminar, Natural Remedies for Psychiatric Disorders: Considering the Alternatives, covered treatments from natural (herbal) to homeopathic remedies, naturopathic to chiropractic care, and so-called lifestyle practices from yoga to body work, and meditation to magnets. An estimated $27 billion was spent out-of-pocket on CAM therapies in 2002. Such therapies are particularly growing in popularity for the kinds of stress-related disorders that conventional Western medicine, even beyond psychiatry, has failed to treat effectively.

While some "natural remedies"-or agents derived from plants-may be no safer without close monitoring than standard pharmaceuticals, most are nonetheless only loosely regulated. One of the main attractions to these therapies, besides a frustration with ineffective or nonexistent conventional treatments, appears to be a focus on the whole person-including emotional and spiritual well-being-that CAM practitioners and treatments are believed to provide.

Of those alternative remedies most studied, acupuncture has shown degrees of efficacy in the treatment of anxiety, pain, substance abuse, stress, depression and obesity. With acupuncture widely employed in Eastern countries, especially for pain, it is notable that "in 65,000 [Western] clinical cases, not a single major adverse event was reported," say Randy L. Gollub, MD, PhD, and Albert Yeung, MD, who presented on acupuncture and pain management at the MGH seminar.

Increasing amounts of data also show the following agents can be effective in the treatment of chronic stress and its attendant disorders of insomnia, hypertension, anxiety, depression and sexual dysfunction: valerian, kava kava, St. John's wort, Melissa, Passifora, Gotu kola, rhodiola, Gingko biloba, ginseng, L-tryptophan, melatonin, Omega-3 fatty acids, folate (folic acid, vitamin B9), B12 and relaxation training (including hypnotherapy, meditation, and body-based systems from Rolfing to Reiki).

Foods That Help
While the above nutrients are available as dietary supplements, fish is a good source of Omega-3s (for overall health, mood dysfunctions, Crohn's disease and ulcerative colitis), which are prevalent in Atlantic cod, haddock, sea scallops, tuna, Pacific oysters, rainbow trout and pink salmon; and beef, turkey and crab are rich in vitamin B12 (for stress-related fatigue). L-tryptophan, a mild relaxant, is available in Canada, though not in the U.S. except through natural sources like turkey and warmed milk. Leafy green vegetables (like spinach and turnip greens), citrus fruits and juices, dried beans and peas, and certain fortified cereals are rich in folate, or B9, an "anti-stress" vitamin.

Weight gain is considered best regulated by a balance of appropriate nutrition and exercise, by CAM practitioners and MDs alike, but there is some evidence that hunger can be controlled and metabolism regulated by the careful use of pyruvate (a calcium supplement), green tea, oolong tea, glucomannan (a dietary fiber) or red pepper. Supporting data, however, are thin. Green tea extract, the equivalent of drinking hundreds of cups of tea, should probably be avoided.

Contraindications
Be aware that the chemistry of foods and supplements can interact with both alternative remedies and prescription drugs in unexpected ways. For example, because grapefruit juice inhibits the isoenzyme CYP 3A4-one of several cytochromes in the P450 class of genes that metabolize drugs-there is an increased risk of toxicity due to high drug levels, so care should be taken when taking anything with grapefruit juice. On the other hand, cruciferous vegetables such as broccoli and Brussels sprouts, as well as St. John's wort, induce another enzyme in this class of genes, which speeds drug metabolism, increasing the risk of rendering a pharmaceutical treatment inadequate.

As with any agent that is ingested, it is always a good idea to consult and utilize a professional for specific treatments and dosages. A word- of-mouth referral from a trusted friend or healthcare practitioner is the best place to start if you are looking for such a professional. Lacking that, a visit to your local whole foods market or holistic healthcare store could be the next best bet.

For more information on specific supplements, visit the National Center for Complementary and Alternative Medicine at https://nccam.nih.gov.

Resources

• Konjac Foods. Konjac glucomannan-The most viscosity-soluble fiber. www.konjacfoods.com. Accessed March 14, 2005.
• Kruidering M, Masters S. Pharmacokinetics III: Drug metabolism (lecture), 2005. University of San Francisco Biophysics and Biochemistry Department. https://biochemistry.ucsf.edu/~fulton/PTF/syllabus/Drugmetab.pdf. Accessed March 14, 2005.
• Massachusetts General Hospital, Department of Psychiatry. Natural remedies for psychiatric disorders: Considering the alternatives. Postgraduate Education Newsletter. June 2003. www.massgeneral.org/allpsych/ced/boston/Newsletter_PDFS/123299_Natural_NL603.pdf. Accessed March 10, 2005.
• National Institutes of Health, Office of Dietary Supplements. Dietary supplement fact sheets. https://ods.od.nih.gov/Health_Information/Information_About_Individual_Dietary_Supplements.aspx. Accessed March 14, 2005.

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