Acupuncture & Integrative Medicine College, Berkeley

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Complementary Medicine: Traditional Chinese

Nearly half the US populations turns to complementary, alternative and integrative practices to maintain or improve their health. Beverly Burns of UCSF's Osher Center for Integrative Medicine explores traditional Chinese medicine including acupuncture, meridians and chi. Series: "UCSF Mini Medical School for the Public"

Experts Offer Tips on Lung Cancer Prevention

(HealthDay News) -- People, especially smokers, should not rely on vitamin and mineral supplements to prevent lung cancer, say members of the American College of Chest Physicians in their second annual guide to lung cancer prevention, care and treatment.

The new evidence-based guidelines also include a strong statement opposing the use of low-dose CT scans for the general screening of lung cancer.

Lung cancer is the leading cause of cancer death in the United States. More people die from lung cancer than from colon, breast, prostate and pancreatic cancer combined.

"Each year, great strides are made in the diagnosis and treatment of lung cancer, allowing patients with the disease to live longer and increase the quality of their lives. However, the real culprit behind lung cancer is tobacco," Dr. Mark J. Rosen, president of the American College of Chest Physicians (ACCP), said in a prepared statement. "Avoiding tobacco is the key to preventing most forms of lung cancer. Until we eliminate tobacco use completely, we will continue to deal with its devastating health consequences."

Published as a supplement to the September issue of the college's journal Chest, the guidelines note there is little evidence to show lung cancerscreening changes the outcome for patients, including those considered to be at high risk.

"Even in high-risk populations, currently available research data do not show that lung cancer screening alters mortality outcomes," Dr. W. Michael Alberts, chairman of the ACCP lung cancer guidelines, said in a prepared statement. "We hope that, one day, we can find a useful and accurate tool for general lung cancer screening but, at this time, the evidence does not support the use of LDCT screening."

This is the second edition of Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines. The guide contains 260 recommendations, including a review of complementary and integrative therapy for the prevention and treatment of lung cancer.

Due to the lack of supporting evidence, the guidelines recommend against the use of LDCT, chest X-rays or single or serial sputum cytologic evaluation for lung cancer screening in the general population, including smokers or others at high risk. The exceptions are for patients in well-designed clinical trials.

"Population screening for lung cancer is not recommended and may, ultimately, put the patient at risk for further complications," Dr. Gene L. Colice, vice chairman of the ACCP lung cancer guidelines, said in a prepared statement. "Nodules are commonly found during screening; however, to determine whether they are cancerous requires additional testing, which is fairly invasive and extensive. This may cause the patient needless risk, both physically and psychologically."

In terms of prevention, the guidelines recommend against the use of several common supplements and medications in at-risk patients or those with a history of lung cancer.

Beta carotene tops the list of supplements that the ACCP recommends against. According to the data, there is a actually a higher incidence of lung cancer in people who use these supplements.

Other supplement recommendations:
Vitamin A, including isotretinoin, has not been shown to decrease the number of second tumors and actually increases the risk of early death for current smokers.

Vitamin E is not recommended for lung cancer prevention, as studies show that there is no difference in the occurrence of lung cancer between people taking vitamin E and those who are not.

Aspirin has been shown in some studies to play a protective role, but the guidelines do not recommend aspirin for preventing lung cancer. Studies show aspirin does not decrease the risk of death or lung cancer incidence.

This is also the first edition of the guidelines to include recommendations on techniques that can help reduce the anxiety, mood disturbances and chronic pain associated with cancer.
Massage therapy is recommended as a way to reduce anxiety and pain.

Acupuncture is recommended for patients experiencing fatigue, dyspnea and chemo-induced neuropathy. Acupuncture is also recommended for people whose nausea, vomiting or pain is poorly controlled.

Electrostimulation wristbands are not recommended for managing chemo-induced nausea or vomiting. Studies show they do little to delay nausea or vomiting.

A multidisciplinary group of 100 pulmonologists, medical oncologists, radiation oncologists, thoracic surgeons and other health professionals reviewed the 260 recommendations.

More information
To learn about lung cancer, visit the U.S. Centers for Disease Control and Prevention.

Researching Alternatives: A Talk With Donald Abrams

By Bob Huff
June 2003
You have a reputation as being a rigorous clinical researcher and tough advocate for making evidence-based treatment decisions.

Yet you've also been very open to studying a number of alternative and complementary therapies that have been used in the HIV patient community. How did all these concerns come together and what are you involved with these days?

I was training in oncology at UC San Francisco just as the first AIDS cases were reported. I helped found the AIDS program there and I've been participating in academic clinical research for over 20 years. More recently I've become an associate fellow of the Program in Integrative Medicine at the University of Arizona that was founded by Andrew Weil.

This is a two-year program, mostly online, that is increasing my training and background in integrative medicine, including things like botanical medicine, manual medicine, and spirituality. It's been a stimulating experience so far and I'm really enjoying it.

I've been interested in complementary medicine since the very beginning of my career, so one of the reasons I'm doing the fellowship is to learn more that I can integrate into my own healthcare discussions with my patients. Of course another impetus is to see what other things we might want to do clinical research on.

My intention is to continue to investigate the complementary and alternative approaches that our patients are using. We want to determine whether or not they may be beneficial, but also determine whether or not they may be harmful, particularly in how they interact with the conventional medications that patients are taking.

In the earliest days of AIDS we didn't have any treatment for this new disease; people were dying and everybody was frightened. Being here in San Francisco, we were near the Linus Pauling Research Institute in Palo Alto, so there were a number of people in the city who were proponents of high doses of Vitamin C.

One of the first responses we saw in the early '80s were storefront clinics opening up where people went to receive intravenous injections of very high doses of Vitamin C.

At that point in time we didn't even know that it was a virus causing the disease. So I used to go around on the lecture circuit with someone who would talk to audiences of concerned people who listened to him while hooked up to intravenous infusions of Vitamin C.

Then I would speak as the academician who cautioned people that we really don't know if this is beneficial and there may be some dangers to being hooked up to intravenous vitamin C, and so on. Ultimately, this led to me to write a grant proposal in collaboration with the Linus Pauling Institute.

It was right about the time we learned that HIV was the cause of AIDS so we wrote a proposal to the NIH to study the in vitro effects of Vitamin C on HIV. That grant didn't get funded.

In San Francisco at that time there were also a number of DNCB proponents. DNCB, dinitroclorobenzene, is actually a photographic chemical used for developing pictures, but it is also a skin sensitizer that had been used to test for delayed hypersensitivity reactions.

There were people who believed that somehow it might be useful in restoring some of the T-cell immunity that patients with this new disease were lacking. So there were people who would paint themselves weekly or so with DNCB until they developed these skin reactions, thinking that the skin reaction was some sort of improved T-cell immune response that would help combat the virus.

And again, seeing that people were using this and seeing that we really didn't have much else happening, I worked with some of the DNCB proponents, as well as some experts from the University of California -- I remember Jay Levy was involved, as was Marcus Conant and others -- and we wrote a protocol that we submitted to the FDA for funding. That also was rejected.

Around the time that AZT first became available in 1986, I went to a conference in Japan where I was introduced to some investigators from the Ueno Fine Chemicals company who told me that they had the cure for this disease. They said it was something that was very commonly used in Japan but they couldn't tell me about it until I signed a confidentiality agreement.

That turned out to be dextran sulfate. Not long after I was going through the process of filing the paperwork to get approval from the FDA to do a phase I study of dextran sulfate in the United States when evidently some people heard about it.

They realized that it was a product that was widely available in Japan -- I believe it was used for lowering cholesterol -- so they started an importation scheme similar to what had happened in earlier days with isoprinosine and ribavirin, which were brought across the Mexican border.

But people had now become more sophisticated in their methods and began to import dextran sulfate from Japan to sell in the underground AIDS therapy market.

I remember that activists stormed the offices of a Japanese drug distributor in New York for refusing to make dextran sulfate more widely available. Ultimately it became such a political issue that, even though my clinical trial here in San Francisco didn't show much benefit, Congress got involved and the AIDS Clinical Trial Group (ACTG) was asked to do a study of dextran sulfate through the NIH-funded mechanism. It turned out the drug was not even absorbed into the blood.

Another Japanese product I worked with was lentinin, which was an intravenously administered extract of shiitake mushroom. In Japan it was felt to be an immune booster for patients with cancer. Although it was being used by mainstream doctors in Japan, it was an alternative therapy here because it was not something that we had ever learned about or used in hospitals in the U.S. That's David Eisenberg's description of what an alternative therapy is -- that it's not taught about in medical schools or widely available in U.S. hospitals -- and certainly shiitake mushroom extracts qualified. Again, that's another study we did that had negative findings;

there was no benefit to the intravenous infusions of lentinin. Since I've learned more about botanicals, it would seem to me that if there were immune enhancing benefits to shiitake mushrooms then they are more likely to be obtained by eating them rather than by injecting an extract intravenously.

During that time I was also involved with studies of conventional therapies. Even in the days of early AZT monotherapy, which I was not a big supporter of, I was involved in trying to put some evidence behind the claims of the proponents for these various agents. And since that time, I've had a constant history of investigating conventional therapies through the federally-funded CPCRA (Community Programs for Clinical Research on AIDS), and more recently through the ESPRIT study of interleukin 2, as well as in other, sometimes pharmaceutical industry-sponsored trials. But always ongoing with those studies, I've been involved with clinical trials of complementary and alternative interventions.

When we first became aware of immune thrombocytopenic purpora (ITP) in AIDS, I worked with a nurse who was very interested in therapeutic touch and we studied men with low platelet counts to see if therapeutic touch could decrease their stress and increase their platelet counts. That was another study that turned out to be fairly negative.

I then became interested in traditional Chinese medicine (TCM) and, in fact, one of the colleges of TCM here in San Francisco sent me to China in 1989 just to learn about Qigong (Chi Kung) -- that exercise that's felt to improve the immune system -- to see if it was something that I wanted to study here. Although I never studied Qigong I collaborated with Misha Cohen from the Quan Yin Healing Arts Center here in San Francisco. We did three studies of traditional Chinese herbal interventions for, first, symptomatic HIV, then for patients with diarrhea without a pathogenic source, and then another study for patients with anemia.

The last two were hindered by the fact of being initiated about the time that HAART became available, so patients with diarrhea as well as anemia became scarce. There were also a lot of pills that needed to be taken in these Chinese herbal investigations and patients at that time were taking huge amounts of pills with their antiretroviral regimens, so the studies weren't very attractive. None of these studies had spectacular results and the anemia study was terminated for poor enrollment.

Have "soft endpoints" such as life satisfaction created a problem for designing and conducting credible studies?

The TCM herbal study that we published in 1996 investigated herbs versus placebo in symptomatic HIV infection. At the time of the study in 1993, we had patients with about 14 symptoms on average and we found that there was a significant decrease of symptoms in the herb-treated group -- they decreased from 14 to 12 -- whereas the other group still had 14 symptoms. We also found that they had improved "life satisfaction" which improved by a factor of +0.86 or thereabouts.

Yet, if you look at the rest of the results, the Chinese herbal patients actually lost weight over 12 weeks compared to the placebo group, and their CD4 counts also dropped -- not statistically significant, but it was a trend. So that was an example of where their symptoms improved and their life satisfaction increased, but the parameters that we would normally look at to see if a patient is doing well (i.e., weight and CD4 count) went in the wrong direction. So, although I was also first author on a study that showed that epoetin alfa improves quality of life in HIV patients who are anemic, I'd have to say that a study whose main endpoint is quality of life is something I would find difficult to interpret.

The CPCRA actually did a large study of acupuncture for patients with HIV-related peripheral neuropathy that was published in JAMA. That was a landmark, having the NIH support an acupuncture study, although, again, it turned out to have negative results; acupuncture didn't appear to be effective in treating peripheral neuropathy.

About this time I began trying to study another botanical, which has consumed my efforts for the past decade, and that would be cannabis, or marijuana. Starting in 1992 I began proposing and developing clinical trials to investigate first the effectiveness -- but then I realized that that wasn't going to happen -- so subsequently, the safety of smoked marijuana in patients with HIV.

We finally completed a study in the year 2000, that we hope will soon be published, that looked at the safety of marijuana in patients taking protease inhibitor regimens. And since that time we have obtained funding from the State of California that allows us now to conduct clinical trials to look at the potential effectiveness of smoked marijuana in patients with various syndromes. We have also just completed a pilot study in patients with HIV peripheral neuropathy, which allowed us to ascertain that there was some effectiveness of marijuana. But an open-label pilot study is not going to prove that, so we're now in the process of continuing on with a randomized, placebo controlled, double-blind trial in patients with HIV-related peripheral neuropathy. We're also doing marijuana studies in patients with cancer who have pain who are on opioid analgesics, and another study to look at the effect of smoked marijuana in patients who have delayed nausea and vomiting from breast cancer chemotherapy.

It was working with marijuana and all the problems that are inherent in studying a plant as a therapy that has led me to a broader interest in botanicals and the use of substances that come from nature as medicinal agents. Certainly, for thousands of years, people have depended primarily on these things. Whether or not they worked is unclear, but as an oncologist I know that many of my most potent chemotherapeutic agents were derived from plants. So right now we are waiting to hear if a protocol we submitted to the National Center for Complementary and Alternative Medicine (NCCAM) to investigate the lipid lowering effects of oyster mushrooms in patients on Kaletra is being funded. There's good evidence that mushrooms, including oyster mushrooms in particular, have some activity for lowering blood lipids and cholesterol.

We're also just finishing a three-year NCCAM grant studying the effects of DHEA, dehydroepiandrosterone, which is an over-the-counter adrenal steroid that people are taking for many reasons. We received a grant to investigate it as an antiviral and to see what impact it has on the immune system. Hopefully that data will be available by the end of the year and we will know if DHEA had any impact, positively or negatively, in our patients.

The goal, ultimately, would be to submit a center grant to the NCCAM, to allow us to establish a center here for the study of botanicals in HIV because there are still a number of herbal preparations and mushroom extracts that warrant further investigation for their potential benefit -- and to make sure that they're not harmful in our patients.

Safety keeps coming up again and again as one of the inarguable justifications for doing this research.

There's not a huge amount that we know about some of these botanical products and how they're metabolized, but there's probably more than people think. There are a number of textbooks available that talk about herb-drug interactions. That was the question in our marijuana study: is there an interaction between cannabinoids and protease inhibitors, which are both metabolized by cytochrome P450 enzymes in the liver, that may alter the activity of the protease inhibitors such that patients lose their viral suppression when they mix cannabis with their treatments?

And in fact, in our article that was already published in AIDS, we saw no such effect. We've all heard about garlic and St. John's Wort and their interactions, and I think there are many other agents that we would like to study to make sure that they are not having significant interactions with protease inhibitors. We don't want people to either lose control of their viremia (through underdosing) or experience toxicity (through overdosing) because of antiretroviral concentrations that have been affected by herb-drug interactions.

You had to be enormously persistent to accomplish your marijuana study. In the current political climate, is it going to be more difficult to do marijuana studies?

I think we're blessed to live in the State of California, which is somewhat of a freestanding republic in and of itself. In 1996, the people of California voted to allow physicians to talk to their patients about the medicinal use of cannabis. Then, through the work of Senator John Vasconcellos, one of our state senators, appropriations were made to the University of California that established the Center for Medicinal Cannabis Research (http://www.cmcr.ucsd.edu/). And that Center has had funds for the past three years that allows it to support clinical trials to investigate the use of marijuana for medicinal purposes.

Whereas the NIH and NIDA, via their congressional mandate, could only give marijuana to clinical trials that show that it was harmful (they are the National Institute on Drug Abuse, not for Drug Abuse, as NIDA's director Alan Leshner always reminded me), they were not really able to provide us with marijuana to study the benefits. But now, they have modified their system so they can provide marijuana for peer reviewed clinical trials that will look at its effectiveness as a therapeutic agent -- as long as they are not funding it. So they have now created this ability for us to obtain government marijuana.

Is there a need to increase provider knowledge about these issues?

I think a part of the problem is a lack of communication from both sides. Patients don't really perceive that these substances are something that they need to tell their doctor about -- in fact many studies show they don't want to tell their doctor because they're afraid they're going to be reprimanded or told that they're wasting their money. And many physicians never even think about asking about these things as potential confounders or as things that are causing clinical symptoms.

There also may be a variable of where in the country you are. I know many surveys show that we in the West have the highest percentage of people in the population who are using complementary and alternative interventions. So many of my colleagues here might be more familiar with how to ask the question and what to be looking for.

I remember once seeing a patient at our drop-in clinic who clearly had a drug rash. I looked through his chart -- this was when we had paper charts -- and he had a high CD4 count and a low viral load but he wasn't taking any medications.

So I said to the guy, "You're not taking any medications, huh?" And he said, "No."
"Are you taking any vitamins?" And he said, "Yeah."

So I asked him what he took and he listed about four or five vitamin preparations. Then I asked, "Do you take any herbs?" And he said, "Sure."

And so I listed the three or four herbal substances th
at he took.
"Do you take any minerals?" And he said, "Yeah."
By the time I finished I had a list of 12 different things he was taking.
So I asked, "Well, how come everybody else wrote down that you don't take anything?" And he said, "Well, nobody ever asked me before."


more info at:
http://www.dreddyclinic.com/integrated_med/integrated_med.htm

Acupuncture, Turmeric May Help Ease Arthritis

(HealthDay News) -- Acupuncture and an extract of turmeric -- the spice that gives curry its kick -- may both offer significant pain relief to some arthritis patients, two new studies suggest.
Reporting in the November issue of Arthritis & Rheumatism, a German team says a combination of acupuncture and conventional medicine can boost quality of life for patients suffering from osteoarthritis.

And in a second study in the same issue, American researchers say the ingestion of a special turmeric extract could help prevent or curb both acute and chronic rheumatoid arthritis.
The findings should be heartening to the roughly 40 percent of arthritis patients in the United States who say they've turned to some form of alternative medicine.

"If I had arthritis, I would be very excited about this," said Dr. Janet L. Funk, the lead author of the turmeric study and an assistant professor of physiological sciences at the University of Arizona in Tucson.

According to the Arthritis Foundation, nearly one in five Americans (46 million) suffers from one of the more than 100 various joint diseases that constitute arthritis. An additional 23 million have chronic joint pain that has yet to be formally diagnosed.

Osteoarthritis is caused by a progressive degeneration of bone cartilage and is the most common type of arthritis in the United States. Rheumatoid arthritis is an immunological disorder characterized by a painful inflammation of the lining of the joints.

In her study, Funk built on earlier research she had conducted with rats. Those efforts suggested that turmeric might prevent joint inflammation.

In her current work, she first broke down the specific contents of commonly sold turmeric dietary supplements.

In the lab, she and her colleagues then isolated a turmeric extract that was free of essential oils and structurally similar to that found in commercial varieties. The extract was based largely on curcuminoids -- a compound they believed to be most protective against arthritic inflammation.
Funk's group administered the extract to female rats both before and after the onset of rheumatoid arthritis. They then tracked changes in the rodents' bone density and integrity.

The turmeric extract appeared to block inflammatory pathways associated with rheumatoid arthritis in rats at a particularly early point in the development of the disease. The extract had a beneficial impact if given three days after arthritis set in, but not if given eight days after disease onset.

Investigations in the laboratory revealed that turmeric stops a particular protein from launching an inflammatory "chain reaction" linked to swelling and pain. The expression of hundreds of genes normally involved in instigating bone destruction and swelling was also altered by the turmeric.

Funk stressed, however, that the findings are preliminary, and the extract needs to be tested in people.

"I feel an obligation to make clear that people should not run out to buy and consume turmeric powder," she cautioned. "First of all, a very small percent of the ground-up root that we buy in the grocery store is the protective part of the root, so it's not going to get you anywhere." In fact, the compound used in the study probably makes up only about 3 percent of the weight of current store-bought turmeric supplements, Funk said.

"That means that if this pans out in further studies, patients will be taking a purified extract, and this is all really exciting," she said. "But we still need conclusive proof that this extract is safe and efficacious."

In the second study, researchers led by Dr. Claudia M. Witt of Charite University Medical Center in Berlin spent three years tracking the treatment results of 3,500 male and female osteoarthritis patients suffering from either knee or hip pain.

For six months, all the participants were permitted to continue whatever conventional western medical treatments they had been undergoing prior to the onset of the treatment trials.
However, in addition, over 3,200 of the patients also received up to 15 sessions of needle-stimulation acupuncture during the first three months of the study. The remaining 310 patients received no acupuncture in the first three months. They were offered such treatment in the final three months of the study period, however.

All acupuncture sessions were administered by physicians who had received a minimum of 140 hours of certified training.

Symptom and pain questionnaires were completed at the onset of the study and at three months and six months of therapy.

Patients with chronic osteoarthritis pain who underwent a combination of routine medical care plus acupuncture demonstrated significant quality of life improvements, the researchers found. This included increased mobility and pain reduction above and beyond that experienced by patients who did not receive acupuncture.

For those who began their acupuncture treatments immediately, osteoarthritis improvement held steady three months after cessation of the sessions. For those patients who had begun acupuncture three months into the study period, comparable improvements occurred by the time they ended their sessions at the six-month mark.

The authors said acupuncture appeared to be a safe medical intervention with minor side effects observed in just over 5 percent of patients.

The study, one of the largest of its kind, demonstrated that acupuncture was a viable therapeutic option for people suffering from osteoarthritis, the German team said.

"I'm not surprised that people can be treated with acupuncture and get better," said Marshall H. Sager, a Bala Cynwyd, Pa.-based doctor of osteopathic medicine, acupuncturist, and past president of the American Academy of Medical Acupuncture.

"Using acupuncture adjunctively with western medicine is very common, because if you can do both approaches, you're way ahead of the game," he said. "Some people are not amenable to medication, either because of allergenic effects or because they just don't want to consume artificial things. And so, this is a way to start the healing process by engaging and stimulating the body's own inherent ability to heal itself."

However, Sager cautioned that American patients who consider this alternative route should choose carefully when they seek out acupuncture care.

" 'Medical acupuncture' is acupuncture as practiced by a physician, which is much different than acupuncture as practiced by non-physicians in the east, such as in China," he noted. "And I would most definitely recommend that patients in the west deal with a physician that's properly trained and a member of the American Academy of Medical Acupuncture," Sager said.

More information
Find out more about arthritis at the Arthritis Foundation.

Aromatherapy: The Scent of Dispute

(HealthDay News) -- Aromatherapy is an affordable, accessible natural path to relief for a variety of health problems, ranging from arthritis pain to nausea to drowsiness, supporters insist.

But skeptics dismiss any claims that the use of essential oils from flowers, herbs and trees can promote health in any way.

And both sides are unlikely to relinquish their positions anytime soon.

Aromatherapy "works for so many different things, it is amazing," said Kelly Holland Azzaro, a registered aromatherapist in Banner Elk, N.C., and vice president of the National Association for Holistic Aromatherapy (NAHA), an industry trade group. "You can experience aromatherapy by inhalation by putting one drop of an essential oil on a tissue and inhaling," she said.

According to the NAHA, aromatherapy is the "art and science of utilizing naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit." These essences are then distilled into "essential oils" -- highly concentrated aromatic extracts -- that are derived from a "variety of aromatic plant material, including grasses, leaves, flowers, needles and twigs, peels of fruit, wood and roots."

Among the most popular essential oils, which are widely sold at health-food stores and over the Internet, are eucalyptus, geranium, lavender, lemon, peppermint, rosemary, and tea tree, and according to the NAHA.

"Uplifting scents such as citrus can keep you awake at work," Azarro said. "To help increase alertness, use rosemary and lemon." And to combat nausea, try essence of peppermint, ginger and orange, she added.

While research into aromatherapy's benefits is limited, there are some studies that suggest certain treatments can help ease some symptoms.

For instance, in a 2005 study published in the journal Chronobiology International, researchers reported that lavender aromatherapy helped all 31 men and women feel more "vigor" the next morning, compared to the night they breathed in distilled water, an exercise that served as the control setting.

A study in the March-April 2006 issue of the Journal of Midwifery & Women's Health said that aromatherapy, combined with massage, helped new mothers feel less "blue" and anxious, compared to mothers of newborns who didn't get the treatment.

And a review published in Holistic Nurse Practitioner found that patients with postoperative nausea and vomiting can be helped by aromatherapy as well as acupressure and acupuncture.
But critics find little of value with scent therapy -- or even label it as therapy.

"It's not a therapy, it's a set of products with odors," said Dr. Stephen Barrett, board chairman of Quackwatch Inc., an Allentown, Pa.-based organization that says it fights health fraud and quackery.

"If people like the odors and want to pay for them, I would have no objection," Barrett said. However, he added, don't expect much. "There is no evidence that aromatherapy can alter the course of any disease. There is no logical reason to believe that any such evidence will ever be found," he said.

As for potential risks, Barrett said: "Some people find certain odors irritating. People who use aromatherapy with the hope that it will cure what ails them will waste money."
Azzaro said that, currently, aromatherapy is unregulated in the United States. "And that's part of the issue," she said. People don't understand exactly what it is, either. "People think it's potpourri or a smelly candle."

There's also no state licensing for aromatherapists in the United States. Most practitioners incorporate their training with another profession, such as licensed acupuncturist or registered nurse, according to the NAHA.

If you're interested in pursuing aromatherapy, Azzaro said it's best to ask a practitioner about his or her specific training. "And when you purchase oil, such as from a health-food store, hopefully some educational materials are with the product," she said.

Be aware, too, there can be the possibility of allergic reactions to some treatments.

More information
To learn more about aromatherapy, visit the National Association for Holistic Aromatherapy.

Children's Health

Children's Health
In this section many common questions related to children’s health are explored.

Contrary to popular belief, children are not "little adults," and the approaches to their health conditions are often markedly different than those used for grown-ups.

The rapid changes that occur during growth and development require special consideration in choosing both treatments and medications.

In some cases, specific treatments have not been well studied in children, but the majority of childhood health concerns are those that parents have been asking about for many generations, and the solutions are tried and true. Information on other childhood conditions can be found in the QA archives.

• Acupuncture
• Attention Deficit Disorder
• Asthma from Exercise
• Bedwetting
• Broken Bones
• Carsickness
• Colicky Babies
• Constipation
• Ear Infections
• Early Puberty
• Fluoride
• Food Coloring
• Head Lice
• Overweight Kids
• Sore Throat
• Teething
• Toy Safety
• Vitamins

Acupuncture
In the United States, acupuncture hasn’t often been used to treat children, mainly because youngsters tend to be afraid of needles.

But several recent studies have suggested that this fear can be overcome and that children can benefit from acupuncture treatment for certain conditions.

The latest study on this subject was conducted at the Harvard-affiliated Children’s Hospital in Boston by Yuan-Chi Lin, MD, an anesthesiologist who specializes in pain management in children. Dr. Lin’s study included 243 youngsters ranging in age from six months to 18 years who were being treated for headaches, stomachaches, back pain and other chronic complaints that often caused them to miss school.

When the study began, the young patients rated their pain as an "8" on a scale of 1 to 10. (One of Dr. Lin’s methods of demonstrating to the kids that the needles won’t hurt is by inserting them first in the children’s parents.)

When the year-long study was over, the average pain rating among the youngsters was a "3." The kids also reported missing less school, sleeping better, and being more able to participate in extracurricular activities as a result of treatment.

In an earlier study at the same hospital, 70 percent of the 47 youngsters participating reported that acupuncture helped relieve their pain and 59 percent of their parents agreed.

The conditions for which these patients were treated included migraines, endometriosis in teenage girls, and reflex sympathetic dystrophy (a syndrome in which pain becomes chronic after an injury).

In this study, 15 children were age 12 or under while 32 were between 13 and 20 years old. Other studies have looked at acupuncture as a treatment for attention deficit hyperactivity disorder and cerebral palsy in children.

While not many acupuncturists specialize in treating children, Dr. Lin estimates that about a third of pediatric pain centers nationwide now offer acupuncture to their young patients.

Acupuncture is best used for pain reduction as part of comprehensive treatment that includes relaxation techniques, clinical hypnosis and various forms of bodywork.

Attention Deficit Disorder
Ritalin, a stimulant, remains the most common treatment for Attention Deficit Disorder (ADD), also called Attention Deficit Hyperactivity Disorder (ADHD). Paradoxically, with ADHD the drug has a calming effect, apparently because it stimulates parts of the brain that regulate activity and attention.

While it can have excellent results in some cases, it is greatly over-prescribed.
There currently is no herbal treatment for ADHD, except possibly coffee, which may work like Ritalin for some patients.

Pediatrician Sandy Newmark, M.D., of Tucson, Ariz., confirms that no herbs have been found effective for treating the main or "core" symptoms of ADHD — that is, lack of focused attention that often leads to poor school performance. And he doesn’t think coffee is a good long-term solution. However, Dr. Newmark notes that herbs can help with some of the associated symptoms. For example, valerian tea can help youngsters with sleeping problems and St. John's wort can help relieve depression. For children under 12, use half the adult dosage.

Dr. Newmark does recommend a dietary supplement, omega-3 fatty acids, for all children with ADHD because levels of omega-3s in the plasma and red blood cells of children with ADHD are lower than in normal children. He also recommends that youngsters with ADHD take a quality multivitamin as well as a good probiotic, a product that contains "friendly" bacteria that can stabilize the digestive tract. You can find milk-free brands in health-food stores.

Make certain that the underlying cause of your child’s disruptive behavior really is ADHD, and that he or she isn’t acting out difficulties at home or expressing frustration with a learning disability. Be sure to rule out hearing or vision problems, allergies, depression or even boredom in a gifted child.

As far as foods are concerned, while there’s no evidence that a dietary approach helps in all cases, a 1993 Cornell University study found that eliminating dairy products, wheat, corn, yeast, soy, citrus, eggs, chocolate, peanuts, artificial colors and preservatives seemed to decrease ADHD symptoms. An even earlier study showed that a low-allergen diet supplemented with calcium, magnesium, zinc and vitamins produced favorable results.

Asthma from Exercise
Exercise can trigger asthma symptoms in children and adults – even those who don't otherwise suffer from the condition - and can aggravate the problem in up to 80 percent of those who do have asthma.

The symptoms – coughing, wheezing, shortness of breath or tightness in the chest – usually come on after exercise, although they can occur soon after exercise has begun. It can be treated with medication and by taking precautions to prevent or minimize symptoms. Here’s a rundown of medication options, provided by pediatrician John Mark, MD, an assistant professor of pediatrics at the University of Arizona who treats asthma in both adults and children.

Albuterol – A short-acting bronchodilator that’s inhaled 15 to 20 minutes prior to exercise and that protects against symptoms for about four to six hours.

Salmeterol – A long-acting bronchodilator that’s inhaled twice a day which offers protection for up to 12 hours. You can also use salmeterol as a preventive before you work out.

Montelukast (Singulair) – A drug that blocks the action of leukotrienes in the lungs, resulting in less constriction of bronchial tissue and less inflammation. Leukotrienes are one of several classes of chemical messengers produced in the body that can trigger bronchial constriction and inflammation. Montelukast is available in pill form and is taken the night before you exercise.

Cromolyn (Intal) – An anti-inflammatory drug inhaled 15 to 20 minutes before exercising that prevents the release of histamines and leukotrienes. It’s most useful in asthma when an allergic component is present.

In addition to medication, the following approaches can help prevent or minimize symptoms:
A very slow warmup. Even to the point that your child reports the beginning feelings of the "tightness" associated with exercise-induced asthma.

Then your child should stop and stretch, or slow down if exercising vigorously. By taking this break, the development of asthmatic symptoms can often be blocked and a normal pace can be resumed. This may take some getting used to, but can sometimes eliminate the need for medication.

Try breath work. The most effective approaches are pranayama techniques – breath control exercises taught in some yoga classes for adults. You can have your child do these after the initial warm-up, again, when the symptoms are almost felt. For most children, you can start with Dr. Weil’s technique for "The Relaxing Breath."

Find a form of physical activity that minimizes exercise-induced symptoms. Sports or activities that have intermittent rest periods (such as tennis, softball and golf) can allow your child to regain control of his or her breathing. Swimming may be better than running outdoors in cold weather, but no type of exercise is off-limits with proper treatment. In fact, some of the world’s top athletes have exercise-induced asthma, and they’re still able to compete successfully in Olympic-level events.

Bedwetting
Although by age 8 most youngsters have outgrown bedwetting, a sizeable minority still haven’t. As a matter of fact, 5 to 10 percent of boys still have enuresis (the medical term for bedwetting) by age 10. Enuresis tends to run in families and, when this is the case, children usually outgrow it at the same age as the parent, sibling or other relative who had the problem did.

No one knows what causes bedwetting, although it is sometimes associated with constipation. If so, simple dietary changes such as eating more fruits and vegetables and drinking more water early in the day can help resolve matters. Pediatrician Sandy Newmark, MD, of Tucson, Ariz., suggests making sure that children aren’t drinking any beverages that contain caffeine (such as some sodas) and trying to limit (within reason) the amount of fluids they drink in the evening.

Dr. Newmark explains that an "enuresis alarm" is the most simple and effective intervention for youngsters. This device is a wristwatch with a sensor that is attached to pajamas so that the alarm sounds at the first sign of wetness.

This system eventually conditions a child to wake when the bladder is full. Dr. Newmark says that the alarms work in about 70 to 80 percent of children. They are available at most drugstores and cost about $50. Be patient with this system since it can take weeks, and sometimes months, to see results.

If the alarm doesn’t help, Dr. Newmark suggests trying hypnosis as a safe and effective treatment. While some pediatricians prescribe drugs for children who wet the bed, using medication is controversial and should be viewed as a last resort. Homeopathic remedies also may be effective; consult a homeopathic practitioner if you want to try this approach.

Broken Bones
Results of a recent study at the Mayo Clinic in Rochester, Minn., suggest that the rate of wrist and forearm fractures among young girls has increased dramatically in the last 30 years. The study results, published in the Sept. 17, 2003, issue of the Journal of the American Medical Association showed that the fracture rate for young girls increased 56 percent from 1969-1971 and 1999-2001.

Boys still suffer more fractures, but the rate of increase among young boys was only 32 percent. Overall, the Mayo Clinic researchers found that the fracture rate among young people had increased 42 percent over three decades.

The researchers had no answers for why this is happening. It is unlikely that youngsters are breaking more bones because they’ve become more physically active. One possibility is that kids may not be getting enough calcium during a period when their bones are growing rapidly.

If so, their bones may never become as dense as they should, which raises the possibility that affected youngsters may be more vulnerable later in life to osteoporosis and hip and vertebral fractures.

The researchers noted that government surveys have shown a decrease in milk consumption among older girls and an increase in consumption of carbonated drinks. The phosphates in carbonated beverages interfere with calcium absorption.

The RDA for calcium is 1,300 mg for young people age 9 to 18. This translates to 4-5 servings of dairy per day, but kids don’t have to drink milk to get their calcium. Other good sources include yogurt, cheese, sea vegetables, collard and mustard greens, kale, bok choy, broccoli, canned salmon and sardines, tofu that has been coagulated with a calcium compound, calcium-fortified soy milk, fruit juice and blackstrap molasses.

Other experts have noted instances of vitamin D deficiency that could contribute to weakened bones. Our bodies make vitamin D with exposure to sunlight, and youngsters who spend too much time indoors may not produce optimal amounts of vitamin D. Spending 10 minutes in the sun without sunscreen a few days each week will do the trick, but it is not a bad idea for kids 12 and older to take a multivitamin supplement that includes 400 IU of vitamin D.

Carsickness
Carsickness, like all types of motion sickness, occurs when the brain receives conflicting signals from the inner ears, eyes, and other parts of the body that sense motion. A child sitting in the back seat of a car may sense movement – her inner ear perceives the motion – but she may not be able to see out the window to see that she is moving. At the same time, her perception is that her body isn’t moving at all. In some children, these conflicting messages can result in very distressing nausea.

One effective remedy for motion sickness comes from an old Chinese fisherman’s remedy of stimulating the acupressure points that control nausea. The updated version of this treatment is done with wristbands equipped with a plastic peg that presses on acupressure points on the inner surfaces of the wrists. The wristbands are available at most drug and health-food stores. Follow package directions carefully – proper placement of the wristbands is critical.

Motion sickness can also be prevented (and treated) with ginger. Mix a half teaspoon of ginger powder in a glass of water and give it to your child 20 minutes before you get in the car. Or give your child two capsules of powdered ginger.

This remedy has proved more effective than Dramamine – with none of the drowsiness that can occur as a side effect of the drug. Ginger snaps, ginger ale and candied ginger can all help with mild nausea, so keep some in the car should someone develop symptoms during the trip. You also could explore homeopathic remedies – and possibly hypnosis – as a long-term solution.

The American Academy of Pediatrics suggests trying to deal with carsickness in children by focusing youngsters’ attention away from their queasiness. Listen to the radio or tapes, sing or talk. Also, direct their attention at things outside the car, not at books or games. Make sure that they look out the front windows, where apparent motion of objects is less.

Colicky Babies
First, exclude other reasons for the baby’s crying. Make sure the infant isn’t running a fever, isn’t lethargic, is eating normally and isn’t having any trouble breathing. Your pediatrician will also want to exclude GERD (gastroesophageal reflux disease), which can occur among babies (although it is much more common among adults).

The good news about colic is that what you see is what you get – a fussy, crying but otherwise perfectly healthy baby. Some doctors think that this irritating phase may be part of normal development. Between 5 and 28 percent of infants develop colic between when they are two to six weeks old, and usually outgrow it by the time they’re three to four months old.

Here are Dr. Russell Greenfield’s suggestions for dealing with colic – and with the frustration it can breed among parents:

• Try massage therapy, a great way to enhance bonding between parent and child at a time when colic may be interfering with the bonding process.
• Rock your baby rhythmically.
• Turn on music or try the clothes dryer or vacuum cleaner. Sometimes the white noise they produce helps.
• Try cranial osteopathy or homeopathy; both may help and are safe forms of treatment.
• Try herbal remedies such as cooled chamomile or fennel tea. You can get tea bags at the health food store and give the baby one to two ounces at a time, no more than three to four ounces per day.
• Switch to a cow’s milk-free formula, or, if breast feeding, change the mother’s diet to affect what is entering her breast milk (in some cases, a food sensitivity may play a role).
  Swaddle your baby – it provides a nice snug feeling.
• Chill – find a way to relax; try breathing exercises or other relaxation techniques to lower your frustration level.

By the way, the latest international report on colic comes from a Canadian study that found that mothers don’t appear to sustain any lasting psychological effects as a result of dealing with a colicky infant.

Constipation
Constipation is a common problem for children and usually is temporary. Strictly speaking, a child is constipated if he or she has fewer than three bowel movements per week or if the stools are hard, dry, and unusually large or difficult to pass. Because constipation can make bowel movements painful, youngsters may try to avoid having them. (In addition, about 60 percent of constipated children experience recurrent abdominal pain, a common stress-related condition in youngsters.)

The causes of constipation in kids usually are simple and relatively easy to correct: not enough fiber in their diets, not drinking enough liquids or not getting enough exercise. Then, too, constipation can occur when youngsters ignore the urge to have a bowel movement, which they can do for reasons ranging from not wanting to take a break from playing to embarrassment at using a public bathroom or because a parent isn’t around to help when the urge occurs.

Medication can also be a factor. Those that can cause constipation include aspirin and codeine, vitamins with high doses of iron, the bismuth in Pepto-Bismol, as well as some chemotherapy agents (vincristine) and some psychiatric drugs (imipramine).

Sandy Newmark, MD, a pediatrician at the University of Arizona Program in Integrative Medicine, recommends the best ways to deal with constipation in young children, listed here:
Decrease dairy products: They can be constipating. Provide your child with an alternative source of calcium such as soy milk fortified with calcium or a calcium-fortified breakfast cereal.
Increase fluids: Encourage your child to drink lots of water.

Increase fiber: Give your child lots of high-fiber fruits and vegetables as well as high-fiber cereals, whole-grain breads and beans.

Although these measures probably will do the trick, if a child’s episodes of constipation last longer than three weeks and prevent him or her from participating in normal activities, you might want to consult a pediatrician. Don’t be tempted to administer the over-the-counter laxatives designed for children. They can be dangerous to youngsters and should be given only under the direction of a pediatrician.

Ear Infections
Recurrent ear infections can be troublesome during early childhood. Here are two strategies:
Eliminate milk and milk products from your child’s diet for at least two months. This means avoiding all dairy products as well as other foods containing milk in any form. Soy, rice, and nut milks such as almond milk are all right. The protein in milk, casein, is often associated with recurrent ear infections in early life as well as with sinus conditions, eczema, chronic bronchitis, and asthma.

Try cranial osteopathy. It is another good treatment for recurrent ear infections. When performed by a skilled practitioner, this technique can often end cycles of ear infections, sometimes with a single treatment.

The late Bob Fulford, D.O., a leading practitioner of cranial osteopathy, had great success curing recurring infections in young children. He believed that fluid stagnation in the middle ear – caused by restricted breathing – was at the root of the trouble.

Gentle manual manipulation (and sometimes application of a vibrating instrument known as a percussion hammer) opens up breathing, which in turn helps fluid drain from the middle ear. To find a practitioner of cranial osteopathy, send a self-addressed stamped envelope to the Cranial Academy, 8202 Clearvista Parkway, #9D, Indianapolis IN 46256. At the University of Arizona, researchers are now concluding a study funded by the National Institutes of Health's National Center for Complementary and Alternative Medicine on the use of both cranial therapy and Echinacea to break cycles of recurrent childhood ear infections.

Early Puberty
In the United States, there's a virtual epidemic of precocious puberty these days – the onset of puberty at very young ages in both boys and girls. Among Caucasian girls today, 1 in 7 starts to develop breasts or pubic hair before she is 8 years old. Among African-American girls, the number is 1 out of 2! Unfortunately, no one knows why this is happening, although there's plenty of speculation. Precocious puberty can be triggered by tumors in the pituitary gland, hypothalamus, ovaries, or testicles, but these cases are rare. Environmental factors are more likely to blame for the upsurge in cases today. The theory with the most scientific support is that obesity is responsible. I think this may be true, since we've long known that overweight girls mature physically earlier than thin ones.

Research also has suggested that environmental pollution may play a small role. In the spring of 2000, results of a study reported in the Journal of Pediatrics showed that boys exposed to DDE (a breakdown product of DDT) were heavier than their peers, while girls exposed to PCBs were heavier than their peers and tended to reach puberty a bit sooner, even though the actual numbers involved in the study were not deemed statistically significant. (Both DDT and PCBs are chemicals that appear to interfere with the body's own hormones.) Researchers are also looking at other environmental chemicals – among them Bisphenol A (BPA), used in manufacturing plastic – but so far haven't found a definitive link.

Unfortunately, there's not a lot to offer in terms of treatment and no natural remedy that I can suggest. Since it's occurring so often these days, some physicians believe that precocious puberty in girls between the ages of 6 and 8 should be seen as normal and not treated at all. (We do know that the risk of breast cancer later in life increases with an earlier onset of puberty.) The only approved allopathic treatments are two drugs: Gonadotropin-Releasing Hormone, GnRH, and Luteinizing Hormone-Releasing Hormone, LHRH, both given by daily injections or at intervals of every three to four weeks. These drugs interfere with the hormonal changes responsible for precocious puberty, in effect putting them on "hold" until the child reaches a more appropriate age (typically between the ages of 11 and 13 in girls). The drugs may also reverse the changes that already have taken place.

The physical changes are only one aspect of what girls must contend with as a result of precocious puberty. Because they look like young women, they're often treated as if they were much older than they are by boys (or men who should know better) and may also be teased by friends and at school. If you are a parent with a child in the midst of precocious puberty, you must keep the parent-child lines of communication open. Make sure that your child understands that despite the change in her appearance, he or she is still a child.

Fluoride
The only children who need fluoride supplements of any type are those who live in communities without fluoridated water supplies or in homes with water purifiers that remove minerals. The easiest, most efficient and most cost-effective means of making sure that children have adequate fluoride to protect against tooth decay is to support fluoridation of your area's water supply.

If your community's water is not fluoridated, your child will need dietary fluoride supplements which are available only by prescription from your dentist or physician. To protect against tooth decay, children need fluoride on a daily basis from the age of 6 months to 16 years. (Pregnant women take fluoride supplements beginning in the sixth month of gestation to ensure strong tooth development in the fetus – check with your obstetrician about this.) The correct dosage for your child must be calculated on the basis of the natural fluoride concentration of your local drinking water as well as your child's age, and the extent of his or her exposure (if any) to other sources of fluoride, such as toothpaste or commercial products.

Some fluoride is present in all water sources, but according to the American Dental Association, most bottled waters don't contain enough to prevent tooth decay. Fluoridation of community water supplies involves adjusting the fluoride content to the optimal level for dental health, 0.7 to 1.2 parts fluoride per million parts water. Too much fluoride can be bad for children's teeth, just as too little is bad. An excess of fluoride can lead to mottled, chalky, white spots on the teeth. Other health risks include weight loss, brittle bones, anemia and weakness. Be aware that there are conflicting reports that continue to fuel the controversy over fluoridation. Yet at proper levels, fluoride is of immeasurable benefit to the teeth – during childhood and throughout life.

Food Coloring
We are seeing more and more strangely colored foods and snacks, but as a precaution, keep children – and adults – away from foods with artificial colorings. The danger is that the chemicals used to create color are energetic molecules, many of which are capable of interacting with and damaging DNA. Anything that damages DNA can injure the immune system, accelerate aging, and increase the risk of cancer. Indeed, many synthetic food dyes once considered safe have turned out to be carcinogenic. Some approved for use in Europe are considered unsafe in the United States, and vice versa.

Dyes are added to foods for the convenience of the manufacturer, not for the health of the consumer. Luckily, these are among the easiest types of food additives to avoid. Try to convey to your children that garishly colored snack foods are weird and unhealthy – rather than attractive – and make it a rule not to buy them. Watch out for labels that list any of the following terms: "color added," "artificial color added," "U.S.-certified color added," or "FD&C red No. 3" (or green or blue or yellow followed by any number; these are FDA-approved food drug and cosmetic dyes).

There is nothing wrong with foods dyed with natural colors obtained from plants. The most common, annatto, is from the reddish seed of a tropical tree. It is widely used in Latin American cooking to make yellow rice and breads, and is also commonly added to butter and cheese to make them yellow or orange. Other safe food colorings are a red pigment obtained from beets, a green one from chlorella (freshwater algae), caramel, and carotene from carrots.
Definitely keep your kids away from bright green ketchup, a product designed specifically to appeal to youngsters.

Head Lice
Head lice are a common nuisance of childhood. Kids pick them up from someone who already has them by wearing each other’s hats, scarves, hair ribbons and other clothes; sharing combs, brushes or towels; or lying on a bed, couch, pillow or even cuddling a stuffed animal that belongs to a child who has lice. Try to discourage this kind of sharing, particularly if you hear that there’s an infestation at school, at a day care center, or wherever your children spend time.

The conventional treatment is one-percent lindane, sold as Kwell lotion. Yet lindane is a cousin of DDT and can harm the nervous system. Natural and safer alternatives include one-percent permethrin cream rinse, sold as Nix and Neem, which is derived from a tree in India. Lice can develop resistance to permethrin products, and they can aggravate asthma in some children, but both are relatively nontoxic. (Neem is sold in garden shops.)

Some California school systems are using a new product called Lice B Gone, a non-toxic, multi-enzyme shampoo made from plant sources that seems to get rid of lice in a single application. It works by softening the glue that holds the nits (lice eggs) to the hair shaft and also dissolves the exoskeletons of adult lice. Since it contains no pesticides, Lice B Gone is considered safe for pregnant women, nursing mothers, young children and people with asthma.

Overweight Kids
You'll probably be happy to hear that not all children who are heavy grow up to be overweight adults. However, we do have an epidemic of childhood obesity in the U.S., and all parents should be aware that for every year that a child remains overweight, his or her chances of growing into an overweight adult increase.

Aside from eliminating sodas or junk food at home, look to physical activity as a way to help your child lose weight. Try for at least half an hour of physical activity each day. Unfortunately, only 25 percent of school-aged children now take physical education classes. If your child doesn't get any exercise at school, it's up to you to make sure he or she does some type of physical activity at home.

Here are some approaches to add exercise to your child's life as well as foods that will help control his or her weight:
Curb screen time. Limit the time your child spends watching television, sitting at the computer or playing video games.
Set a good example. Studies have found that children are more likely to be physically active if their parents and siblings are active, and if they're encouraged to take part in physical activities. Take family walks, hikes or bike rides on a daily basis, if possible.
Emphasize nutritious foods. Don't limit the amount your child eats, but make sure the foods he does eat are low in fat and high in fiber. When making these changes, say that you're doing it for the entire family to avoid drawing attention to your child's need to lose weight.
Eat meals together. Family breakfasts and dinners give you more control over what your child eats and allow you to make sure that everyone gets at least two nutritious meals per day.
Think about drinks. Cut back on fruit juices, sodas and whole milk. Drinks can provide a surprisingly large number of calories per day.
Teach a relaxation technique. If your child eats in response to stress, you might show him how a relaxation technique such as deep breathing can help to calm him.

Sore Throat
The most important thing parents can do when children develop sore throats is to make sure that the problem isn’t strep, a bacterial infection that requires antibiotic treatment. Strep is diagnosed via a throat culture. (Or a rapid strep test, which takes only 10 minutes but is not as accurate.) While the results may not be available for a few days, a doctor often can tell on the basis of observation whether strep is the likely problem and begin immediate treatment with penicillin. The sore throat usually eases in 24 to 48 hours.
Besides a very sore throat, symptoms of strep often include fever, swollen and tender lymph glands under the jaw, and a swollen and marked redness at the back of the throat that may have white dots. Those symptoms don’t always mean strep, but they often do. (Another clue: suspect strep when there are none of the typical symptoms of a viral infection such as a cough, runny nose, hoarseness and eye irritation.)
It is very important to treat strep throat with antibiotics as soon as possible, because in rare cases it can lead to an autoimmune reaction – rheumatic fever – that can affect the joints, heart and kidneys.
To reduce your child’s susceptibility to sore throat, try to build up his or her immune system by administering a course of the Chinese herb astragalus (Astragalus membranaceous) during cold and flu season. You can get astragalus in tincture form or in capsules at the health-food store. Administer one half the adult dose. This herb is safe for regular use.
If your child can gargle, give her a mixture of half hot water and half hydrogen peroxide to use several times a day. Gargling with warm salt water (one-quarter teaspoon salt to one cup of warm water) is also soothing.

Teething
In many infants, the process of teething is painless, causing only some increased drooling and a desire to chew. However, some infants develop tender, swollen gums, may not sleep or eat well, and may run a low fever (under 100 degrees). A fever above 100 degrees or diarrhea suggests problems unrelated to teething.
Here are some recommendations to keep a teething baby comfortable:
Wipe the drool off your baby’s face with a soft cloth (to prevent rashes).
Rub the baby’s gums with a clean finger.
Let your baby chew on a wet washcloth that has been placed in the freezer for 30 minutes (wash it after each use). Alternatively, use a cool spoon or rubber teething ring (take it out of the freezer before it gets so hard that it bruises the tender gums).
Never tie a teething ring around a baby’s neck – it could get caught on something and strangle the child.
Homeopathic teething tablets are a good option. Many parents tell me they have used them successfully to relieve the minor discomforts of teething in their babies.

Toy Safety
Look over the toys you have at home to see if they are age-appropriate for your children. In general, this means making sure they aren't too advanced for the youngest child, but sufficiently sophisticated for the older ones. Homes with infants or toddlers should make sure all toys (and their removable parts) are large enough so they can't be put into a child's mouth and become a choking hazard. (An easy test: A child can choke on any object that fits inside the tube from a roll of toilet paper.)
Parents or grandparents should also be aware that over the last two years toy manufacturers have recalled teethers, rattles, and other products that contain a cancer-causing chemical called diisononyl phthalate (DINP) from the market. Phthalates are used to soften plastics, but high doses have been linked to cancer in mice and rats. The U.S. Consumer Product Safety Commission has said the amounts that might have been ingested by small children are not high enough to pose a risk, but it does make sense to toss any soft plastic rattles and teethers that you’ve had more than a year – that's when most toy manufacturers agreed to phase out use of the additive.
The following guidelines for toy safety are from the American Academy of Pediatrics and the Consumer Products Safety Commission:
Check the surface and edges of wooden toys. Sandpaper sharp corners and splinters.
Don't give hobby kits, such as chemistry sets, to children younger than 12.
Don't permit children to play with adult darts or other hobby or sporting equipment that have sharp points.
Examine all outdoor toys regularly for rust or weak parts that could become hazardous.
Discard all plastic wrappings on toys before they become deadly playthings.
New toys intended for children under age 8 should be free of glass and metal edges.
Toys with long strings or cords may be dangerous around infants and very young children. Never hang toys with long strings, cords, loops, or ribbons in cribs or playpens where children can become entangled.
Keep toys designed for older children out of the hands of little ones.

Vitamins
Yes, children should take vitamins, mostly because so many kids don’t eat enough fruits and vegetables, and because their diets are often full of processed and refined foods. However, vitamin supplements shouldn’t be substitutes for whole foods, especially fruits and vegetables.
Teach children of any age to enjoy healthy food by involving them in its preparation, even if they’re only in the kitchen to observe. In "The Healthy Kitchen," Rosie Daley and I give a number of ideas for recipes and snacks that kids will like. Also, try to discourage your children from eating too much fast food, processed food, sugar and caffeine (in cola and other soft drinks). There’s no harm in the occasional ice cream, pizza or candy bar in the context of a well-balanced diet, but try to encourage snacking on healthier foods – fresh or dried fruit; a small handful of raw, unsalted nuts such as cashews and walnuts; a piece of flavorful, natural cheese; or a piece of dark chocolate.
As far as supplements are concerned, give children a complete antioxidant formula as well as multiminerals. Be sure to keep the vitamins out of the reach of young children – some supplements for kids taste and look like candy and there is a danger of overdosing, especially when supplements contain iron.

Andrew Weil, M.D.–Author of:
Eight Weeks to Optimum Health
Spontaneous Healing
The Natural Mind
The Marriage of the Sun and Moon
Health and Healing
Natural Health, Natural Medicine
From Chocolate to Morphine (with Winifred Rosen)

Acupressure Eases Low Back Pain

(HealthDay News) -- Acupresssure -- pushing with the fingertips at the same body points used in acupuncture -- gave patients better, long-lasting relief for low back pain than conventional physical therapy, Taiwanese researchers report.

"Acupressure was effective in reducing low back pain in terms of disability, pain scores and functional status," doctors at the National Taiwan University reported in the current issue of the British Medical Journal. "The benefit was sustained for six months."

The researchers recruited 129 people with chronic low back pain from a specialist orthopedic clinic. All of them filled out a standard disability questionnaire before being assigned to one of two different treatment regimens, with 64 people receiving six sessions of acupressure and 65 receiving standard physical therapy.

"Acupressure conferred an 89 percent reduction in physical disability compared with physical therapy," the researchers reported. The people who got acupressure also scored better on measures of pain and had fewer days taken off from work or school, the researchers said.

However, they cautioned that the effectiveness of any manipulative therapy such as acupressure "is highly dependent on the therapist's technique and experience." All the people in this study received treatment from the same therapist, to eliminate any difference in the treatment given.

"We hope that this technique can be imparted to other therapists now that its efficacy has been shown in our study, so that acupressure can be used in other populations," they wrote. "How acupressure can be generalized to patients with low back pain is the subject of ongoing research."

Dr. Marcos Hsu is an acupuncture specialist at the University of Maryland Center for Integrative Medicine who got his training in acupuncture and acupressure at the Maryland Institute of Traditional Chinese Medicine. He called the Taiwan report "quite amazing," because the benefits persisted for so long. But he added that he would like more information on the causes of back pain in the people treated in the study.

Hsu said he routinely uses acupressure supplemented with acupuncture to treat low back pain. "I have seen good responses similar to those in the paper, but some people do not respond to it," he said. The response generally is good for musculoskeletal problems such as sprains, Hsu said, but when the pain is caused by problems with structural bones and tissues, as in arthritis, the treatment "may take longer to take effect."

Hsu's patients usually receive painkillers, as well, because "most people who come to us are on painkillers, so it is not advisable to stop," he said. Patients can have anywhere from five to 15 treatments, with pressure applied "by our thumbs, hands, wrists, knuckles, elbows, every joint we can use," Hsu said.

People seeking acupressure or acupuncture treatment for low back pain should be cautious whenever they seek out help, Hsu recommended. "Check their credentials first," he advised.
The Taiwan study does have some flaws, added Richard E. Harris, a research investigator in the rheumatology division of the University of Michigan Medical School, who has also done work on acupressure.

Harris said he'd like a more detailed account of the treatment given -- which acupressure points were pressed, for example. And he noted that the participants weren't blinded to the treatment they were given. Patients who got acupressure knew they were getting it, which might have influenced their response, Harris said.

Nonetheless, the report that acupressure seems to be better than physical therapy for back pain is significant and deserves follow-up, he said.

More information
For the lowdown on low back pain, head to the U.S. National Library of Medicine.

What You Should Know About Complementary and Alternative Medicine

(HealthDay News) -- If you've ever taken herbal products, seen a chiropractor or tried megavitamin therapy, you've ventured outside the boundaries of conventional medicine.
There's a term for those therapies -- "complementary and alternative medicine," or CAM -- and it describes the wide range of health systems, practices and products that fall outside the mainstream. The National Center for Complementary and Alternative Medicine (NCCAM) catalogues dozens of them -- from acupuncture to zinc supplementation.

• detoxification

The list of CAM therapies continually changes, as the ones proven safe and effective become well integrated into conventional medicine and new therapies are introduced.
There are also important distinctions between complementary and alternative medicine. Complementary medicine is something that is used in conjunction with conventional medicine, while alternative medicine is used in place of conventional treatment.

"You can have conventional cancer therapy along with, say, some music therapy or something that's soothing but relatively innocuous. It isn't going to affect your conventional treatment," explained Jackie Wootton, president of the Alternative Medicine Foundation in Potomac, Md.
"On the other hand," she added, "alternative medicine, such as coffee enemas, can be used as an alternative to conventional treatment."

In the United States, 36 percent of adults are using some form of complementary or alternative medicine, according to a 2004 study by NCCAM and the National Center for Health Statistics. The number rises to 62 percent when the definition of CAM includes megavitamin therapy and prayer specifically for health reasons.
According to the survey, prayer is the most commonly used CAM therapy. It is considered a type of "mind-body" therapy.

About one-fifth of people surveyed used natural products, such as Echinacea, ginseng, ginkgo biloba, garlic supplements and glucosamine.
Recognizing CAM's possible potential to prevent disease and promote wellness, some health care providers practice what is known as "integrative medicine," which combines conventional treatment with CAM therapies for which there is some evidence of safety and effectiveness.
But if, like many Americans, you see a conventional physician and use complementary or alternative medicine on the side, play it safe and tell your doctor what you are doing.

People shouldn't be afraid to broach the subject, Wootton urged. Physicians are much more accepting of CAM these days, and it's vital that they know what you are doing, she said, especially if you are ingesting something, such as herbal supplements.
Experts say one reason to share this information is the pittance of scientific evidence demonstrating the results of various therapeutic combinations.

"We know very little about the herb-drug interactions or the herb-herb interactions or vitamin-drug interactions," said Fredi Kronenberg, director of the Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine at Columbia University in New York City.
You want your doctor to be in the loop because a particular supplement you are taking may interact either positively or negatively with a drug you are taking.

"It could interact negatively if you're taking a blood thinner and now you're taking a supplement that's a blood thinner, and now you get too much of a good thing," Kronenberg explained.
On the other hand, she added, "You could have a supplement that synergizes the effect of a drug -- that makes a drug work better -- and therefore you might need less of that drug."
Conventional doctors may not be CAM experts. But they are aware of some of the benefits and problems of CAM, Kronenberg pointed out. "And they're aware mostly that their patients are using these things, and they need to know about it if only because their patients are using them," she said.

More information
The National Center for Complementary and Alternative Medicine has developed a tip sheet for people who are considering using CAM.

• detoxification

Overcoming Addictions?

Q: I am addicted to alcohol and caffeine and am ready to go cold turkey off of both. Can you suggest any natural supplements that would help with cravings/withdrawal?-- Carola Gregg

A: Congratulations on your determination to overcome your addictions. We all know about the addictive potential and side effects of drinking too much alcohol, but few people realize the negative effects of dependence on caffeine. Over-stimulation from caffeine, especially coffee, provokes anxiety, interferes with restful sleep, and significantly irritates the urinary, gastrointestinal, and other systems of the body. So again, I applaud your efforts.

I would recommend withdrawing from caffeine first. Compared to alcohol – and tobacco – caffeine is a much easier habit to break. But to succeed, you should plan ahead. Give yourself three days to do it. Arrange to keep yourself distracted and comfortable and anticipate that you probably won’t have much energy for the duration. You’re also liable to develop a distinctive throbbing headache. You can take aspirin for it, but avoid Excedrin and other pain relievers that contain caffeine.

Giving up alcohol can be much more difficult depending on how much you drink. "Too much" usually means more than two drinks per day for men and more than one drink per day for women (twelve fluid ounces of regular beer or five ounces of wine or 1.5 ounces of 80-proof distilled spirits) or any habitual use that disrupts your life and routines. Withdrawal symptoms usually begin within 12 hours after you stop drinking and peak 48 to 72 hours later.

Since some of the symptoms - both physical and psychological - can be quite severe, I wouldn’t recommend going cold turkey on your own. At best, you’re likely to be nervous, shaky, anxious and may have trouble thinking clearly. Physical symptoms may include headache, nausea, vomiting, insomnia, rapid heart rate and tremor. At worst, withdrawal can lead to delirium tremens (a combination of confusion and visual hallucination), convulsions, and blackouts, all of which require emergency medical treatment. Severe alcohol withdrawal can be fatal.

If you think your withdrawal is unlikely to lead to severe symptoms, you might use the herb valerian as well as breathing exercises to cope with anxiety. Both acupuncture and hypnosis may help you deal with cravings down the line. And take one B-100 B-complex a day to make up for the B-vitamin deficiency alcoholism can cause. I also recommend the herb milk thistle for liver protection and regeneration. Buy a standardized product and follow the dosage directions on the label. (Everyone who drinks alcohol regularly should be on milk thistle, whether or not they plan to withdraw.)

Before you begin the withdrawal process, discuss your plans with your physician. He or she may recommend a drug rehab facility to get you through it. You also could look for one via SAMHSA, the federally sponsored Substance Abuse and Mental Health Facility Locator (http://findtreatment.samhsa.gov/). I also encourage you to join Alcoholics Anonymous or some other support group. Congratulations and good luck!

Andrew Weil, M.D.

–Author of:

• Eight Weeks to Optimum Health
• Spontaneous Healing
• The Natural Mind
• The Marriage of the Sun and Moon
• Health and Healing
• Natural Health, Natural Medicine
• From Chocolate to Morphine (with Winifred Rosen)

Acceptance of Alternative Medicine on a (Slow) Upgrade.

By Jane Schwanke
WebMD Medical News

Dec. 28, 1999 (Minneapolis) -- Like children trying to gain acceptance, complementary and alternative therapies have meekly but steadily gained approval this year with a few bumps and bruises along the way. Now, optimistically poised on the edge of the new millennium, alternative methods of therapy are positioned to enter 2000 on a positive note.

Complementary and alternative medicine (CAM) includes a broad range of healing philosophies and approaches. Generally speaking, a therapy is called complementary when it is used in addition to conventional treatment and alternative when used instead of conventional medicines. Data about just how many people use CAM varies from 9% to 42%. But like it or not, CAMs have exploded onto the American scene. While cost issues swirled and health plans debated who should pay for complementary therapies, Americans managed to spend more than $22 billion on CAMs in 1997 -- mostly out of pocket.

During 1999, debate about the safety and efficacy of CAMs has boosted as well as hindered the credibility and acceptance of alternative medicine, which includes herbs, amino acids, botanical extracts, and pseudo vitamins, to name a few. Though CAMs were reeling from negative publicity in 1998 after home-run slugger Mark McGwire's admitted use of the steroid hormone androstenedione, this year researchers were making strides in the lab with the development of new supplements.

One such success was glucosamine -- a supplement that has shown amazing decreases in the symptoms of knee osteoarthritis, or wear-and-tear arthritis. In one of the first well-designed medical studies, 22% of patients who took 1,500 mg oral glucosamine sulfate daily had X-ray evidence of joint structure deterioration, compared with 38% of those who took placebo.

But whether the media attention was positive or negative this year, policy heads kept right on turning toward complementary therapies. In March, congressional supporters of the multibillion-dollar dietary supplement industry went head-to-head with the FDA about whether the agency undermined supplement makers' ability to deem their products beneficial. In May, President Clinton's drug policy adviser urged the federal government to investigate the health effects of androstenedione.

Factors propelling alternative medicine toward a more respected status this year included a number of high-ranking institutions that launched complimentary medicine or 'healing' clinics. Endorsements by universities and medical centers that had previously shunned alternative medicine signal changes that are creating ripple effects from coast to coast.

Earlier this year, Memorial Sloan-Kettering Cancer Center unveiled plans to open an Integrative Medicine Service in the department of medicine to recognize "the unique emotional and psychological needs of cancer patients." In a statement released to WebMD, center President Paul A. Marks, MD, says "Memorial Sloan-Kettering physicians and staff pioneered the field of psycho-oncology by recognizing the unique emotional and psychological needs of cancer patients. [This] program is an extension of that tradition." The service includes art and music therapy, meditation, massage, acupuncture, and hypnosis.

"The whole [alternative therapy] movement is about patient choice -- choice of approaches, techniques, and interventions that fit best with a person's lifestyle and view," Gregory A. Plotnikoff, MD, tells WebMD. He warns that self-diagnosis and self-treatment can put consumers at risk for error, and encourages people to "partner with an informed health professional." In the past, there was a don't-ask-don't-tell mentality, he says, but today, clinicians are becoming more aware that patients are using alternative medicines and are more willing to talk about it. Plotnikoff is medical director of the Center for Spirituality and Healing at the University of Minnesota.

The National Cancer Institute maintains that while "conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process, often less is known about the safety and effectiveness of complementary and alternative methods." Yet, they say, many therapies once considered unorthodox, "are finding a place in cancer treatment -- not as cures, but as complementary therapies that may help patients feel better and recover faster."

Still, alternative medicine took some hard knocks this year. In January, a dietary supplement known as GBL or Blue Nitro was found to be the cause of one death and severe reactions in others. The chemical was touted for building bigger muscles, enhancing sexual performance, and inducing sleep. In May, the FDA was asked to consider a recall of the chemical.

In June, a study in The New England Journal of Medicine found that women with breast cancer who began to use alternative therapies actually reported worse quality of life.

This summer, the Cancer Advisory Panel on Complementary and Alternative Medicine, which offers high-level advice to the National Institutes of Health on how to invest research dollars in this area, met to help separate the inferior CAMs from those worth further research. Two NCI-sponsored trials -- one of oral shark cartilage, the other on pancreatic enzymes -- have garnered more than $1 million in government support. While it's still too early to tell which treatments will work, the panel is looking more seriously at them, says Michael Hawkins, MD, a panel co-chairman and oncologist at the Washington Hospital Center.

"There's a need for physicians to be aware of the fact that people are using [alternative] medicines, [and] for patients to be aware that they should tell their physicians," says Bruce Bacon, MD, a professor of internal medicine at St. Louis University School of Medicine. "

There really isn't all that much known about whether or not what [patients] are taking is effective or potentially harmful."

It's not only patients who are turning to alternative medicines to complement their medical regime. William Fair, MD, of Memorial Sloan-Kettering Cancer Center, himself a recovering cancer patient, is a convert to alternative treatment, saying, "You can't just say 'we don't believe this stuff.' Let's look at the data."

So where are CAMs headed in the new millennium? According to Stephen E. Straus, MD, director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health, "Several therapeutic and preventative modalities currently deemed elements of CAM will have proven effective, and the term 'complementary and alternative medicine' will be superseded by the concept of 'integrative medicine'" by the year 2020.

In their optimistic projection, NCCAM maintains that the biological and pharmacological basis for effectiveness of selected herbal and nutritional supplements will be clarified, leading to their standardization.

"The field of integrative medicine will be seen as providing novel insights and tools for human health," Straus says in a statement issued to WebMD, "and not as a source of intellectual and philosophical tension that insinuates itself between and among practitioners of the healing arts and their patients."

Whether the talk was positive or negative this year, there's no doubt that most of us were paying attention. And according to Mary Ann Richardson, DrPH, director of the University of Texas Center for Alternative Medicine Research, "This is just the beginning. [Alternative medicine] is not going away. It has infiltrated every aspect of health care. Research needs to take place, more programs need to be integrated ... and [physician-patient] communication needs to increase."

Well, hold on. Indications are that it's going to be a bumpy ride.