Complementary and Alternative Medicine, Dietary Supplements, and Medications

1. Complementary and Alternative Medicine, Dietary Supplements, and Medications

2. CAM- every where you look

3. Complementary and Alternative Medicine (CAM) • Complementary and alternative medicine • A group of diverse medical and health care systems, practices, and products • Not considered part of conventional medicine • Some scientific evidence exists regarding CAM therapies • For most, questions of safety and efficacy persist • Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.

4. Integrative or Holistic Medicine • Integrative combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. • “Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” http://nccam.nih.gov/health/whatiscam/ http://www.integrativemedicine.arizona.edu/about2.html

5. Major Classes of CAM Enhance the mind’s capacity to affect bodily function and symptoms • Chiropractice • Osteopathy • Massage Alternative medical systems Mind-body interventions Biologically -based therapies Manipulative & body-based methods Energy therapies • Homeopathic • Naturopathic • Traditional Chinese and Ayurvedic treatments • Dietary supp • Herbs • Foods • Vitamins • Natural • substances • Biofield therapy • Bioelectro- • magnetic • therapy http://nccam.nih.gov/

7. Effectiveness uncertain Acupuncture for asthma Acupuncture for hay fever Acupuncture for rheumatoid arthritis Chromium for diabetes Echinacea for common cold preventionor treatment Evening primrosefor eczema Effectiveness unlikely Acupuncture for body weight reduction Acupuncture for smoking cessation Flower remediesfor anxiety Homeopathy for anxiety Spinal manipulation for asthma Spinal manipulation for infantile colic CAM TreatmentsCommonly Thought Effective in Pediatrics

8. Biologically Based Practices Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods Dietary supplements are a subset of biologically based practices

9. Energy Medicine Veritable - energy that can be measured Includes sound, visible light, magnetism Putative – energy that has yet to be measured human beings are infused with a subtle form of energy Includes qi (ki in Japanese); doshas; prana, homeopathic resonance

10. Energy Medicine - Acupuncture Few complications Scientific evidence? post chemotherapy management of nausea pain relief NIH Consensus Statement (1997)

11. Manipulative and Body-Based Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems Includes chiropractic manipulation, massage therapy, reflexology, rolfing, Alexander technique,Feldenkrais method

12. Mind-Body Medicine Interactions among the brain, mind, body, and behavior The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health Includes relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, group support, and spirituality

13. Other CAM Therapies Aromatherapy Colonic Irrigation Therapeutic Touch EDTA Chelation Cupping Primordial Sound Meditation

15. Dietary Supplements RUN THE WHOLE GAMUT!!! vitamins- C, E. minerals- Ca, Se amino acids-lysine fats- fish oil hormones- DHEA herbs- ginseng phytochemicals-garlic etc

16. FDA Regulations Protect Consumers • FDA regulates: Drugs are highly regulated by FDA • Vitamins & minerals regulated as foods • Supplements are considered safe until demonstrated to be hazardous by FDA • Herbals & botanicals totally unregulated

17. Who Benefits?Those at risk for developing nutritional deficiencies only! • People with vit, mineral deficiency • Vegans- vit D, B12 • Pregnant women- folate • Elderly persons- B12/folate • People at risk of osteoporosis- Ca, vit D • People at risk of losing blood- Fe • People on restricted diets- vit, minerals

18. Hormones • HGH • EPO • BHCG • Steroids

19. Human Growth Hormone • Normally secreted by the pituitary • Normal function of GH is growth and development of every body system, including bone and muscle • Can be stimulated by propanolol, vasopressin, clonidine, and levodopa • Synthetic growth hormone

20. Side Effects: • Acromegaly (may be irreversible) • Peripheral Neuropathy • Coronary Artery Disease • Cardiomyopathy • Diabetes, Hypothyroidism, arthritis • No available urine test available, but banned by NCAA and IOC

21. Erythropoietin • Hormone released by the kidneys in response to low Hct • Stimulates RBC production from bone marrow • Has recently been manufactured by recombinant DNA technique • Can increase Hct in renal patients by up to 35%, lasting up to 7 months • Used most by cyclists

22. Blood Doping • Induced Erythrocythemia: An increase in Hb following reinfusion of an athlete’s blood • Goal: to increase the oxygen-carrying capacity of Hb • Has been used as far back as 1947 • 1984: seven US Olympic cyclists guilty • Banned by IOC in 1985

24. Anabolic Steroids • The ultimate ergogenic aid aka “Juice” • Creates the Superhuman Athlete • Testosterone derivatives (cholesterol) • Produced in the adrenal/ testes

25. Anabolic/Androgenic Steroids • Anabolism - Constructive • Catabolism - Destructive • Anabolic effects : inc. skeletal mm mass • anticatabolism • Androgenic effects: secondary sexual characteristics - pubic hair, genital size • No Pure Anabolic Steroids

26. Desired Effects: • Increase in strength • Increase in weight • Increase in aggressiveness • Increased capability of sustaining repetitive, high intensity workouts • Enhanced performance

28. Specific Side Effects • Women (Virilzation): • Clitoril enlargement, Deepening of voice, Male pattern baldness, dec. breast size, libido • Children: • premature closure of growth plate in long bones & thus short stature

30. “Prohormones” • Androstenedione • DHEA • Androstenediol • Norandrostenedione • Norandrostendiol

31. Effects: • Benefits: Same as Testosterone • Increased energy • Enhanced recovery and growth from exercise • heightened sexual arousal and function • greater sense of well-being • Plasma levels of testosterone increased from 140% to 330% of normal levels after 50mg and 100mg doses • SE’s : Same as Testosterone • Banned by IOC, NCAA, NFL

32. Stimulants • Caffeine • Amphetamines • Cocaine • Ephedrine

33. Amino Acids • Creatine • L-Carnitine • Choline • Inosine • HMB (B-OH-B-Methylbutyrate)

34. Amino Acids • Essential amino acids: found in a balanced diet • Recommended protein intake: 0.8 g /kg/day • Athletes may benefit from up to 1.4 -2.4 g/kg/day • Most beneficial for athletes on a poor diet, or vegetarians • In endurance athletes, up to 10% of energy expenditure is from protein breakdown

36. Creatine • Methylguanidine-acetic acid - made from glycine, arginine & methionine • Estimated Daily requirement: 2gms • Available in meats and fish (1/2 EDR) • Sold as Creatine Monohydrate • Stored in Skeletal MM • 2000 NCAA banned distribution in training rooms

37. Antioxidants • Vitamins E & C • potential damage from free oxygen radicals produced by lipid peroxidation in exercise • exercise performance is not improved

38. Herbs • Ginseng • Yohimbe • Tribulus Terresteris • Ma haung