Timothy McCall. Vegetarian Times. Oak Park: Oct 2007. , Iss. 353; pg. 27, 2 pgs
[Headnote]
What can Ayurveda teach us about diet and health?
Ayurveda is the traditional system of medicine in India. It developed alongside yoga thousands of years ago, and both systems offer us an interesting perspective on how to eat well to maximize health and well-being.
A personalized diet is the centerpiece of the Ayurvedic approach to disease. Dietary changes are thought to be so beneficial and safe that Ayurvedic physicians typically start there and only add other treatments, like herbs and massages with medicated oils, if dietary measures aren't likely to be sufficient.
KNOW YOUR DOSHA
Ayurveda teaches that each of us is made up of a balance of three basic constitutional types, called doshas. The three doshas are vata, pitta, and kapha, and each person is said to have all three in different measure. In many people, one dosha dominates, and such people are described by the dominant dosha. In other people, two or more doshas may be fairly evenly balanced, as in vata-pittas.
Each dosha is associated with certain body types, personality styles, predilections to specific diseases, and dietary needs. Vata, the dosha associated with "air," is linked to people who are thin, energetic, creative, and often a bit scattered. According to Ayurveda, vatas are at risk for insomnia, anxiety, constipation, and diseases of the nervous system. Ayurvedic doctors recommend that vata types choose warm, well-cooked foods, and eat them at regular intervals,
Left to their own devices, however, many vatas will choose granola and salads, which while nutritious, could put their vata even more out of balance. This is not to say vatas should never eat these foods, but moderation is recommended.
The 6 Tastes of ayurveda
Pitta is the "fire" dosha, and people of this type tend to be passionate, intelligent, and hardworking, though they often have a problem with anger. Pittas are usually medium in build, strong, and predisposed to heartburn, headaches, and inflammatory conditions such as heart disease. Overly spicy or oily rood may not be best for them. Instead pitta types are encouraged to emphasize "cooling" foods, including watery fruits and vegetables such as zucchini, pears, and pomegranates.
The kapha dosha is associated with "inertia" and "water." Kaphas tend to be strong and sturdy, and are the most likely to live a long life, but they also have a tendency to be lazy. They are at risk of overweight and obesity, respiratory infections, and type 2 diabetes. While they may enjoy rich desserts and fatty or starchy main courses, Ayurveda suggests they try to eat lightly, favoring greens and spicy dishes.
ENERGY, TASTE, BALANCE
Ayurvcdic philosophy favors food that is fresh, and whenever possible, organic and locally grown. Food that has been overly processed, canned, or even refrigerated and then reheated is said to lose prana, or life force. Even fresh vegetables that sit around for days lose life force. This may sound superstitious, but it's something you can see and taste, and studies have shown that vitamin levels also decline over time.
Rather than evaluating foods based on their levels of various nutrients the way Western science does, Ayrirveda categorizes foods according to six basic tastes. Sweet tastes, for example, are said to be beneficial for vatas and pittas, but too many sweet foods may be less good for those with a predominance of kapha. (Note that when Ayurvedic doctors speak of sweet they mean naturally sweet foods like fruit, not roods high in refined sugars.) Choosing the proper diet according to Ayurveda can be a bit involved and it's not always simple to determine your constitutional type, so if you're interested in learning more, you're best off consulting a qualified practitioner. (To take a quick online dosha quiz, visit store.chopra.com/dosha-survey.asp.)
If you are naturally introspective or have developed a strong awareness of your body through the practice of yoga or another discipline, the rules of thumb outlined above may be trumped by your actual experience. If you eat a particular food that's generally considered healthful, hut find yourself feeling sluggish, congested or agitated afterward, the food in question may not be for you. If you have any doubts about a particular food, try eliminating it from your diet for a couple of weeks, then see how you feel when you reintroduce U. Such an experiment can be a valuable complement to what scientists learn from their studies, and help you make better choices.
[Author Affiliation]
Timothy McCall, MD, is a board-certified specialist in internal medicine, the medical editor of Yoga Journal, and the author of Yoga as Medicine: The Yogic Prescription for Health and Healing. He can be found on the Web at drmccall.com.
Sunday, October 5, 2008
Complementary Therapies (Aromatherapy & Herbal Medicine): Clinician Information
Zachary Munn. Evidence Summaries - Joanna Briggs Institute. Adelaide: Nov 2, 2007. 1 pgs
QUESTION
What is the evidence regarding complimentary therapies such as aromatherapy and herbal medicine?
CLINICAL BOTTOM LINE
Complementary therapies are those which are used in addition to traditional medical methods to assist in a person's treatment and have been gaining in popularity in recent times1,2.
Aromatherapy and herbal medicine are both types of complementary therapy. Exploration and research into the effects of complementary therapies has been encouraged by some authors as to align its principles with holistic care, as not all complementary therapies are well accepted by health professionals3. A major criticism of complementary therapies is that many are not based on scientific evidence1,2,4. Complementary therapies aim to treat the whole person and not just the symptoms of the disease. 4
* Complementary therapies for cancer patients have been described as an extension of supportive care services, such as individual and group counselling, social work assistance and nutritional guidance, which all aim at relieving symptoms, enhancing well being and increasing quality of life. 5(Level IV)
* As complimentary therapies are increasingly being used with some claiming to be able to completely heal (rather than cure) a person, it is important to thoroughly test the efficacy of these treatments. 4(Level I)
* Music is an example of complimentary therapy. A systematic review assessed music as an intervention in the hospital setting. The results displayed that playing music to patients while they are resting in a bed or chair reduces their anxiety and improves their mood. Further research is required to evaluate the impact of music on outcomes such as pain, sedation and analgesic effect. 6(Level I)
AROMATHERAPY
The main principle of aromatherapy focuses on utilising the scents of plants and flowers to alter moods, influence psychological and spiritual states, and influence the physical state through the mind-body connection. 1(Level IV)
* Aromatherapy may be of most benefit when utilised for conditions associated with high stress and anxiety. 3(Level IV)
* Aromatherapy has been shown to enhance therapeutic massage and promote beneficial effects. 3(Level IV)
* Aromatherapy has been used in pre-operative patients, with authors citing its cost-effective sedatory and antiemetic effects. 3(Level IV)
* Educating nurses regarding aromatherapy use has been advocated to justify and encourage pre-operative use. 3(Level IV)
* It has been noted that aroma therapy is susceptible to criticism due to the lack of rigorous research conducted focusing on its effects. The standards for practice or products used for aromatherapy are not reliable at this time. 7(Level IV)
* A systematic review of aromatherapy found that aromatherapy massage could be helpful for anxiety reduction for short periods. There was no support, however, for aromatherapy massage use in the health care setting. The report concluded that there were no long lasting effects of aromatherapy massage of benefit or detriment to the patient. 8(Level I)
* A systematic review assessed aromatherapy in patients with dementia. The results from one trial demonstrated a significantly favourable effect in favour of the intervention (10% Lemon Balm and base solution applied topically to arms and face twice daily for 1-2 minutes for four weeks). The results must be interpreted with caution as they are only from one trial, with most studies on aromatherapy in dementia being of qualitative nature or small scale, low methodological quality. 2(Level I)
* A systematic review assessing the use of aromatherapy and massage for symptom relief in cancer found massage (alone or in conjunction with aromatherapy) may reduce anxiety in cancer patients in the short term although there was insufficient evidence to draw firm conclusions. 9(Level I)
* A systematic review assessed the use of aromatherapy for the treatment of patients with psychiatric conditions. They found that the use of Kava and St John's Wort were effective as psychotropic medicines. The authors recommended herbal medicine use as an adjunct to conventional techniques. 10(Level I)
HERBAL MEDICINE
There is an abundance of literature referring to the effectiveness of herbal products. The reliability and knowledge of Germany's Institute for Drugs and Medical Devices, who base their opinion on clinical trials, case reports and expert opinion, cites the safety of many herbs. 11 (Level IV)
* The US Food and Drug administration has not endorsed herbs as therapeutic drugs because of the lack of rigorous testing. Systematic investigation of herbal remedies is needed. 12(Level IV)
* As they are natural, herbs have been perceived to be harmless, when the truth is that little is known about the safety of herbal remedies. It has been suggested that herbal remedies may cause liver and kidney damage, have been advocated for illnesses they do not cure, and may be highly contaminated. There is evidence that herbs have caused adverse reactions such as allergic and toxic reactions, possible mutagenic effects and drug interactions. 12(Level IV)
* A systematic review was performed to assess the effectiveness of kava extract. The results showed that kava appeared to be an effective symptomatic treatment option for anxiety, and that it is relatively safe for short term treatment (1-24 weeks). However, the authors concluded more information was required. 13(Level I)
* A systematic review was performed assessing the use of herbal medicines for treating low back pain. Some evidence was found supporting the use of herbal medicine. Harpagophytum Procumbens (Devil's Claw) was found to be better than placebo for short term improvement. Harpagophytum Procumbens was found to be equivalent to rofecxib. Salix alba (White Willow bark) was suggested to be better than placebo, whilst three low quality trials deemed Capsicum Frutescens (Cayenne) superior to placebo. The quality of many of the trials was poor. 14(Level I)
* It has been advocated that herbal products undergo the same quality control procedures as other drugs, such as post-marketing surveillance and other mechanisms to detect safety problems. 12(Level IV)
* It should be known that the safety of herbal remedies relies on advice given by practitioners, vendors or books on the subject. Herbal remedies may hinder access to other effective therapies if recommended without due consideration of the persons clinical presentation. 12(Level IV)
BEST PRACTICE RECOMMENDATIONS
Herbal remedies may have potential benefit in treating a variety of conditions, although caution must be taken when recommending these products due to possible complications and the lack of evidence surrounding them. (Grade B)
* Aromatherapy in conjunction with massage may assist in short term anxiety relief in patients. (Grade B)
QUESTION
What is the evidence regarding complimentary therapies such as aromatherapy and herbal medicine?
CLINICAL BOTTOM LINE
Complementary therapies are those which are used in addition to traditional medical methods to assist in a person's treatment and have been gaining in popularity in recent times1,2.
Aromatherapy and herbal medicine are both types of complementary therapy. Exploration and research into the effects of complementary therapies has been encouraged by some authors as to align its principles with holistic care, as not all complementary therapies are well accepted by health professionals3. A major criticism of complementary therapies is that many are not based on scientific evidence1,2,4. Complementary therapies aim to treat the whole person and not just the symptoms of the disease. 4
* Complementary therapies for cancer patients have been described as an extension of supportive care services, such as individual and group counselling, social work assistance and nutritional guidance, which all aim at relieving symptoms, enhancing well being and increasing quality of life. 5(Level IV)
* As complimentary therapies are increasingly being used with some claiming to be able to completely heal (rather than cure) a person, it is important to thoroughly test the efficacy of these treatments. 4(Level I)
* Music is an example of complimentary therapy. A systematic review assessed music as an intervention in the hospital setting. The results displayed that playing music to patients while they are resting in a bed or chair reduces their anxiety and improves their mood. Further research is required to evaluate the impact of music on outcomes such as pain, sedation and analgesic effect. 6(Level I)
AROMATHERAPY
The main principle of aromatherapy focuses on utilising the scents of plants and flowers to alter moods, influence psychological and spiritual states, and influence the physical state through the mind-body connection. 1(Level IV)
* Aromatherapy may be of most benefit when utilised for conditions associated with high stress and anxiety. 3(Level IV)
* Aromatherapy has been shown to enhance therapeutic massage and promote beneficial effects. 3(Level IV)
* Aromatherapy has been used in pre-operative patients, with authors citing its cost-effective sedatory and antiemetic effects. 3(Level IV)
* Educating nurses regarding aromatherapy use has been advocated to justify and encourage pre-operative use. 3(Level IV)
* It has been noted that aroma therapy is susceptible to criticism due to the lack of rigorous research conducted focusing on its effects. The standards for practice or products used for aromatherapy are not reliable at this time. 7(Level IV)
* A systematic review of aromatherapy found that aromatherapy massage could be helpful for anxiety reduction for short periods. There was no support, however, for aromatherapy massage use in the health care setting. The report concluded that there were no long lasting effects of aromatherapy massage of benefit or detriment to the patient. 8(Level I)
* A systematic review assessed aromatherapy in patients with dementia. The results from one trial demonstrated a significantly favourable effect in favour of the intervention (10% Lemon Balm and base solution applied topically to arms and face twice daily for 1-2 minutes for four weeks). The results must be interpreted with caution as they are only from one trial, with most studies on aromatherapy in dementia being of qualitative nature or small scale, low methodological quality. 2(Level I)
* A systematic review assessing the use of aromatherapy and massage for symptom relief in cancer found massage (alone or in conjunction with aromatherapy) may reduce anxiety in cancer patients in the short term although there was insufficient evidence to draw firm conclusions. 9(Level I)
* A systematic review assessed the use of aromatherapy for the treatment of patients with psychiatric conditions. They found that the use of Kava and St John's Wort were effective as psychotropic medicines. The authors recommended herbal medicine use as an adjunct to conventional techniques. 10(Level I)
HERBAL MEDICINE
There is an abundance of literature referring to the effectiveness of herbal products. The reliability and knowledge of Germany's Institute for Drugs and Medical Devices, who base their opinion on clinical trials, case reports and expert opinion, cites the safety of many herbs. 11 (Level IV)
* The US Food and Drug administration has not endorsed herbs as therapeutic drugs because of the lack of rigorous testing. Systematic investigation of herbal remedies is needed. 12(Level IV)
* As they are natural, herbs have been perceived to be harmless, when the truth is that little is known about the safety of herbal remedies. It has been suggested that herbal remedies may cause liver and kidney damage, have been advocated for illnesses they do not cure, and may be highly contaminated. There is evidence that herbs have caused adverse reactions such as allergic and toxic reactions, possible mutagenic effects and drug interactions. 12(Level IV)
* A systematic review was performed to assess the effectiveness of kava extract. The results showed that kava appeared to be an effective symptomatic treatment option for anxiety, and that it is relatively safe for short term treatment (1-24 weeks). However, the authors concluded more information was required. 13(Level I)
* A systematic review was performed assessing the use of herbal medicines for treating low back pain. Some evidence was found supporting the use of herbal medicine. Harpagophytum Procumbens (Devil's Claw) was found to be better than placebo for short term improvement. Harpagophytum Procumbens was found to be equivalent to rofecxib. Salix alba (White Willow bark) was suggested to be better than placebo, whilst three low quality trials deemed Capsicum Frutescens (Cayenne) superior to placebo. The quality of many of the trials was poor. 14(Level I)
* It has been advocated that herbal products undergo the same quality control procedures as other drugs, such as post-marketing surveillance and other mechanisms to detect safety problems. 12(Level IV)
* It should be known that the safety of herbal remedies relies on advice given by practitioners, vendors or books on the subject. Herbal remedies may hinder access to other effective therapies if recommended without due consideration of the persons clinical presentation. 12(Level IV)
BEST PRACTICE RECOMMENDATIONS
Herbal remedies may have potential benefit in treating a variety of conditions, although caution must be taken when recommending these products due to possible complications and the lack of evidence surrounding them. (Grade B)
* Aromatherapy in conjunction with massage may assist in short term anxiety relief in patients. (Grade B)
The definition of chiropractic
Timothy J Feuling. Chiropractic Journal. Chandler: Aug 2001. Vol. 15, Iss. 11; pg. 4, 1 pgs
For many doctors of chiropractic, the definition of chiropractic is simple: The health care field dedicated to the detection and correction of vertebral subluxation in order to eliminate nerve interference that can adversely affect health. To this, we can add that chiropractic is drugfree, non-invasive and respectful of the body's own innate striving for health.
Yet, there is a great deal of confusion about chiropractic since that definition has been disputed, re-interpreted, mis-stated, and distorted through the years. Even within the profession, there are disagreements about the very nature of chiropractic and its purpose.
Webster's "Medical Desk Dictionary, for instance, says that chiropractic is "a system of therapy which holds that disease results from a lack of normal nerve function and which employs manipulation and specific adjustments of body structures (as the spinal column)."
Of-course, each state has its own "definition" of chiropractic for statutory purposes.
Massachusetts, for instance, says, chiropractic is defined as "the science of locating and removing interference with the transmission or expression of nerve force in the human body, by the correction of misalignments or subluxations of the bony articulations and adjacent structures, more especially those of the vertebra column and pelvis, for the purpose of restoring and maintaining health. X-ray and analytical instruments may be used for the purposes of chiropractic examinations."
Even chiropractic organizations have different ideas about the definition of chiropractic. The World Chiropractic Alliance and Chiropractic Benefit Services hold that chiropractic is:
"A primary health care profession in which professional responsibility and authority are focused on the anatomy of the spine and immediate articulation, and the condition of nerv interference .... The professional practice objective of chiropractic is to correct nerve interference caused by vertebral subluxations. The correction is not considered to be a specific cure for any particular symptom or disease. It is applicable to any patient who exhibits nerve interference regardless of the presence or absence of symptoms or disease."
However, some organizations fail even to mention subluxations or adjustments. American Chiropractic Association (ACA) Board Chairman Edward Maurer, D.C., on behalf of ACA's Board of Governors, submitted the following definition of chiropractic to Dorland's Dictionary: "Chiropractic: A health profession concerned with the diagnosis, treatment and prevention of functional disorders of the neuromusculoskeletal system, and the effects these disorders have on the function of the nervous system and general health. Treatment emphasis is on spinal manipulation or adjustments and other manual therapies."
In March 2001, at the request of the World Chiropractic Alliance, a resolution - formally known as Concurrent Resolution 46 - was introduced into the House of Representatives by Rep. Donald Manzullo (R-Ill.). Although not technically a "definition" of chiropractic, the resolution states that: "Chiropractic care includes diagnosis, correction, and management of either vertebral subluxations or neuromusculoskeletal conditions performed by a licensed doctor of chiropractic, and should not include the use of drugs or surgery."
Finally, there is the definition of chiropractic found in the Association of Chiropractic Colleges' Position Paper No. 1, signed and agreed upon by the presidents of all North American chiropractic colleges. It says: "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." This definition has also been endorsed by most chiropractic organizations.
While there are many variations, certain common threads run through most of these definitions. The result is a clear understanding that chiropractic:
is drug-free and non-invasive
involves the location and correction of subluxations through adjustments
is directed toward the restoration of nerve function for the optimization of health and wellness
Since malpractice claims often hinge on whether a D.C. provided proper and adequate chiropractic care, it's important for doctors of chiropractic to fully understand the legal definitions of chiropractic, as well as the definitions held by various organizations and entities.
It is also important that each doctor of chiropractic make a conscious decision about the definition of chiropractic to be adopted in his or her own office. By adopting a definition that delineates chiropractic as the detection and correction of vertebral subluxation, for instance, doctors can carefully formulate and implement policies and procedures that are in keeping with that definition. In so doing, they are helping to protect themselves from misunderstandings and potential lawsuits.
[Author Affiliation]
(Timothy J Feuling is vice president of Chiropractic Benefit Services (CBS) and the World Chiropractic Alliance. He assists doctors in maximizing their practices through the proper choice of insurance and related services. Doctors may contact him with questions, comments, and requests for insurance quotes at 2950 N. Dobson Rd. Ste. 1, Chandler AZ 85224, by phone at 800-347-1011 or by e-mail: feuling@cbsmalpractice.com).
For many doctors of chiropractic, the definition of chiropractic is simple: The health care field dedicated to the detection and correction of vertebral subluxation in order to eliminate nerve interference that can adversely affect health. To this, we can add that chiropractic is drugfree, non-invasive and respectful of the body's own innate striving for health.
Yet, there is a great deal of confusion about chiropractic since that definition has been disputed, re-interpreted, mis-stated, and distorted through the years. Even within the profession, there are disagreements about the very nature of chiropractic and its purpose.
Webster's "Medical Desk Dictionary, for instance, says that chiropractic is "a system of therapy which holds that disease results from a lack of normal nerve function and which employs manipulation and specific adjustments of body structures (as the spinal column)."
Of-course, each state has its own "definition" of chiropractic for statutory purposes.
Massachusetts, for instance, says, chiropractic is defined as "the science of locating and removing interference with the transmission or expression of nerve force in the human body, by the correction of misalignments or subluxations of the bony articulations and adjacent structures, more especially those of the vertebra column and pelvis, for the purpose of restoring and maintaining health. X-ray and analytical instruments may be used for the purposes of chiropractic examinations."
Even chiropractic organizations have different ideas about the definition of chiropractic. The World Chiropractic Alliance and Chiropractic Benefit Services hold that chiropractic is:
"A primary health care profession in which professional responsibility and authority are focused on the anatomy of the spine and immediate articulation, and the condition of nerv interference .... The professional practice objective of chiropractic is to correct nerve interference caused by vertebral subluxations. The correction is not considered to be a specific cure for any particular symptom or disease. It is applicable to any patient who exhibits nerve interference regardless of the presence or absence of symptoms or disease."
However, some organizations fail even to mention subluxations or adjustments. American Chiropractic Association (ACA) Board Chairman Edward Maurer, D.C., on behalf of ACA's Board of Governors, submitted the following definition of chiropractic to Dorland's Dictionary: "Chiropractic: A health profession concerned with the diagnosis, treatment and prevention of functional disorders of the neuromusculoskeletal system, and the effects these disorders have on the function of the nervous system and general health. Treatment emphasis is on spinal manipulation or adjustments and other manual therapies."
In March 2001, at the request of the World Chiropractic Alliance, a resolution - formally known as Concurrent Resolution 46 - was introduced into the House of Representatives by Rep. Donald Manzullo (R-Ill.). Although not technically a "definition" of chiropractic, the resolution states that: "Chiropractic care includes diagnosis, correction, and management of either vertebral subluxations or neuromusculoskeletal conditions performed by a licensed doctor of chiropractic, and should not include the use of drugs or surgery."
Finally, there is the definition of chiropractic found in the Association of Chiropractic Colleges' Position Paper No. 1, signed and agreed upon by the presidents of all North American chiropractic colleges. It says: "Chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on the subluxation. A subluxation is a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system function and general health." This definition has also been endorsed by most chiropractic organizations.
While there are many variations, certain common threads run through most of these definitions. The result is a clear understanding that chiropractic:
is drug-free and non-invasive
involves the location and correction of subluxations through adjustments
is directed toward the restoration of nerve function for the optimization of health and wellness
Since malpractice claims often hinge on whether a D.C. provided proper and adequate chiropractic care, it's important for doctors of chiropractic to fully understand the legal definitions of chiropractic, as well as the definitions held by various organizations and entities.
It is also important that each doctor of chiropractic make a conscious decision about the definition of chiropractic to be adopted in his or her own office. By adopting a definition that delineates chiropractic as the detection and correction of vertebral subluxation, for instance, doctors can carefully formulate and implement policies and procedures that are in keeping with that definition. In so doing, they are helping to protect themselves from misunderstandings and potential lawsuits.
[Author Affiliation]
(Timothy J Feuling is vice president of Chiropractic Benefit Services (CBS) and the World Chiropractic Alliance. He assists doctors in maximizing their practices through the proper choice of insurance and related services. Doctors may contact him with questions, comments, and requests for insurance quotes at 2950 N. Dobson Rd. Ste. 1, Chandler AZ 85224, by phone at 800-347-1011 or by e-mail: feuling@cbsmalpractice.com).
Thursday, September 4, 2008
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