Complementary and Alternative Therapies

When a chronic illness interrupts a person's life — particularly at an age when life is finally starting to make sense — confronting the news and the effects of the disease can seem impossible. It's only natural for even the most pragmatic patients to find themselves hoping for a miracle cure.

This hope has led some people to complementary and alternative therapies when conventional medicine doesn't seem to have the answers they're looking for. Although these therapies have not been proven by scientific research to be safe and effective for certain uses, and are not widely accepted or practiced by the mainstream medical community, their popularity is growing.

What Is Complementary and Alternative Medicine?

Complementary and alternative medicine covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and health care practices not taught widely in medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies.

Complementary medicine refers to therapies that are used in addition to conventional medication. Many people take vitamins, incorporate exercise therapy, or even practice mind-body exercises like yoga or t'ai chi. These are all examples of complementary therapies that work as part of an overall treatment program.

Alternative medicine refers to treatments used instead of conventional medicine. This means that people rely solely on non-prescription therapies such as electromagnetics, bee venom therapy, herbal supplements, or acupuncture, to name a few.

A Word of Caution

You will likely encounter people who swear by alternative treatments, and have personal success stories to claim they work. It's important to remember that for every success story there could be stories from other people who invested money and time away from proven treatments only to be let down.

The growing popularity of complementary and alternative therapies in Canada has produced a huge consumer market. With this increasing interest has come an increase in the number of cases of health care fraud.

The frustrating fact is that living with a chronic disease can make us vulnerable. Because we live with MS on a daily basis, a product or therapy that claims to cure us, or even ease our symptoms, can seem very appealing. In our eagerness to feel better, we may increase our chances of becoming a victim of false hopes. Fraudulent marketers may target these hopes in an effort to make a profit, so it is extremely important to keep an objective outlook when considering therapies and to discuss your options with your health care provider. We'll talk more later about how to be a smart shopper.

Getting the Answers You Need

Never in the history of medicine has a person living with an illness played a more prominent role in working with his or her doctors to choose the best treatment options as we do today. And why shouldn't we? The ultimate responsibility for our health and well being belongs to us as individuals. But what happens when you start to wander away from conventional medicine, into a grayer area where neurologists and primary care physicians are no longer there to offer you advice learned from years of education and practice? Who will be your guide?

For the most part, the answer is you — although there are many available resources to help you along the way. Your doctor is probably familiar with some of the more popular alternative therapies, and should be consulted for advice along the way. In fact, as we learn more about complementary and alternative medicine, certain treatments are making their way into the curricula of medical colleges.

Whether you gather your information from friends, your local MS organization, your local library or the Internet, it's important to be an informed consumer when it comes to alternative treatments. Armed with knowledge, you and your doctor can work to choose the best treatments for you.

If you're interested in the more experimental or controversial alternative treatments, you may find yourself making decisions on your own. To protect yourself — not to mention your checkbook — you'll need to take extra caution and be sure to investigate your options thoroughly. Remember the lesson many have learned the hard way: if it sounds too good to be true, it probably is.

How Alternative Is Alternative?

Alternative medicine has become a catch phrase for a wide variety of treatments and practices. Alternative drugs and dietary supplements may seem the most familiar and closest in similarity to conventional medications.

Herbalists and Oriental medicine advocates offer treatments that have been used for centuries, and are still the treatment of choice among many cultures. There are also mind and body advocates who promote meditation, yoga, t'ai chi, acupuncture, even hypnosis as complementary or alternative forms of treatment for chronic illnesses.

Then there are more controversial treatments, such as bee sting therapy and magnets that continue to show up in and out of the news.

No matter how conservative or how extreme, the question comes back to effectiveness. How do any of these treatments show that they work? They are not held to the same rigorous standards for conventional medicine, so they don't have years of the same type of clinical research to support their claims. Often we don't have clinical records of side effects or potential long-term consequences.

So how do you separate fact from fiction? The best rule is to arm yourself with knowledge. The information below will help you get started.

Truth or Fiction?

True or false: alternative medicines are all natural, but conventional medications are not. While many alternative treatments are promoted as "natural," not all fall into this category. And it may surprise you to learn that many conventional medications are derived from natural sources.

Here's another one for you: natural is better, because natural means safe. Not necessarily. The food chain is natural — but unless you're on top, the fact that it's "natural" doesn't exactly make it safe. Many natural plants and fungi are toxic if consumed by humans — the fact that they are found in nature does not alone guarantee that they are safe.

Another common misconception is that alternative therapies do not have the same side effects as are associated with many conventional medications. The fact is that any product or therapy carries with it a measure of risk. The decision to begin a treatment should be made only when the benefits outweigh any potential risks. In fact, because alternative medicine is not subject to the same extensive testing, some alternative therapies may carry risks of which we are not yet aware.

How to Be a Smart Shopper

Taking care of yourself these days means taking an active role in maintaining your health. We're much more involved in decisions on medications than generations before us. If we don't like how a medication makes us feel or don't think it's working like it should, we can work with our doctors to find other options.

When we begin to look at complementary and alternative therapies, it can feel as though a whole new world has been opened to us. From vendors hawking purported "cures" to herbal remedies promising us more energy, the options can at times seem overwhelming. Mixed in with all this is a hefty serving of some things you may find you're better off without. So just how do you shop for complementary or alternative treatments while protecting your health, safety and budget?

Before considering a complementary or alternative treatment, take an objective step back and see how well they stand up to the following test .

Aren't-they-greats: If you've ever spent a late night in front of the TV, you know that the favorite tool of infomercials is the customer testimonial. No one's going to spend any money telling you their product doesn't work. If they can't come up with any more concrete evidence than a bunch of talking heads, keep your guard up.

Cure-all claims: Any product that claims it can make symptoms go away, stop hair loss, take inches off your waistline and help you look ten years younger with just one tablet per day would make you roll your eyes and walk away. Don't be taken by more cleverly disguised over-promises that claim to be the cure for all different kinds of conditions. They're not hard to spot once you're aware of what you're looking for.

Superhero syndrome: Guard yourself against claims that use a lot of wow-appeal. "Incredible," "amazing," "never before seen" should all really say "watch out." Products using these strong claims should be investigated carefully.

Good guy/bad guy: Watch out for treatments that want you to believe that conventional medicine is about the bad guys who are in it for self-serving reasons while their treatment is sold out of their humanitarian duties. Ask yourself why they are taking this position rather than telling you how their product works or showing you scientific results.

Trust your instincts. Use your knowledge — and seek additional information from your health care provider — to identify safe treatments that may be beneficial for you. And trust your instincts - if something sounds too good to be true, it probably is.

"Scientific information" and "clinical information" may sound alike — and they're meant to — but unless a clinical trial was involved, the two are far from equal in significance.

Types of Complementary and Alternative Therapies

There is no universal way to categorize all the different kinds of complementary and alternative treatments. The list below is not a complete list of all the different therapies, since there are enough to fill a book. Still, this gives us a great place to start:

• Alternative medical systems: acupuncture, Ayurveda, homeopathy, dental amalgam restoration
• Bioelectromagnetics: magnets, pulsing electromagnetic fields
• Biologically based therapies: diet, herbs, vitamins, supplements, bee venom, hyperbaric oxygen
• Biomedical medicine: therapeutic touch
• Lifestyle and disease prevention: exercise
• Manipulative and body-based systems: chiropractic, massage, reflexology
• Mind/body medicine: relaxation methods, hypnosis, biofeedback, t'ai chi, yoga Let's take a closer look at a sample of these complementary or alternative treatments.

Alternative Medical Systems

Acupuncture

Acupuncture is probably one of the first things that comes to mind when people talk about alternative medicine - and for good reason. Traditional Chinese medicine has been around for thousands of years, and is used by nearly a quarter of the world's population, including a growing number of patients in Canada.

Acupuncture is believed to work on the premise that a free flow of energy or "qi" runs throughout a number of pathways, or "meridians" in the body. Disease is believed to result from a disruption in the normal flow of energy throughout these pathways. Small metallic needles are inserted along what are believed to be these pathways in an attempt to redirect the flow of negative energy. One theory for how acupuncture might work is that it may stimulate activity in pain-related regions in the brain. It may also be a placebo effect, or a combination of this and actual physical response. Despite a regular appearance on the list, its use as a complementary therapy to treat pain-related symptoms in MS has not been well studied.

Ayurveda

Ayurveda, which means "knowledge (or science) of life" in Sanskrit, is believed to be the oldest system of medicine still in use. This ancient practice advocates a harmony among mind, body and spirit. Developed in India thousands of years ago, this method of treatment primarily involves meditation, yoga and breathing exercises, but may also include diet, massage, aroma therapy, enemas, and, in some parts of the world, vomiting and bloodletting (by way of leeches).

Ayurveda tonics can include lead or mercury that may be toxic when ingested, and cause serious side effects. There is reason to believe that Ayurvedic supplements affect the immune system, but not in the same way as immune therapy. In fact, this immune-stimulating activity may prove to be more harmful than beneficial. This is a case where the lack of clinical trials to answer these questions may leave much to chance.

Bee Venom Therapy

Bee venom therapy, or apitherapy, has received much press in recent years. However, the use of bee venom in therapy is not new. Ancient Egyptians used it to treat conditions such as arthritis.

In the 1930s Charles Mraz (alias "The Bee Man"), perhaps this therapy's greatest advocate, promoted its use as a possible catalyst to activate the immune system. Mraz believed that the sting would cause inflammation, and the body would generate a natural anti-inflammatory response, theoretically bringing down inflammation at the site and throughout the body. The pain and swelling following a sting may also cause the body to release natural pain-relieving chemicals.

It is important to remember that a number of people are allergic to bee stings — sometimes severely. Studies from experimental models of MS indicate it is possible that bee venom therapy may actually make MS worse.

Dental Amalgam Removal

Amalgam is a metal-based substance that has been used for nearly 150 years as fillings in cavities. One of the metals contained in amalgam is mercury, which - at high doses - is known to be harmful to humans. Some people believe that mercury from fillings is released into the body over a period of time, and causes damage to the immune or nervous systems. This damage has been implied as a possible cause of MS, cancer, heart disease and other immunologic and neurologic conditions.

Removal of mercury-containing fillings, therefore, has been recommended by some as a possible therapy. However, the Canadian Dental Association asserts that the levels of mercury contained in amalgam are safe. In fact, it is believed that a person would have to have between 200 - 300 dental fillings before even a minimal toxic effect could be measured. Mercury is far more likely to be ingested through foods (especially fish), paints, disinfectants or exposure to pollution.

While the side effects may be minimal, it is possible that disturbing the fillings may actually increase mercury levels in the body for a period of time. Based on what we know as of today, there is no good indication that this expensive treatment has any beneficial effect on multiple sclerosis.

Manipulative and Body-Based Systems

Chiropractor

When you think of chiropractic medicine you probably think of one thing: your back. So how does this make sense as an alternative treatment for an autoimmune disease? In chiropractic medicine, spinal manipulation is believed to promote the body's natural healing process.

Long scrutinized by the traditional medical field, chiropractic medicine has not had a golden road. Still, chiropractic therapy is very popular and some people chose this as a complementary or alternative therapy to help reduce back pain and symptoms. There are no well-documented studies that indicate chiropractic medicine can improve the course of MS.

Cooling Therapy

With the introduction of cooling suits and vests, cooling therapy received much media attention in the past decade, and is still widely talked about today. In fact, a number of people with MS have added some sort of cooling method to their treatment program, from the simple to the complex.

Heat is a well-known antagonist when it comes to fatigue in MS and can exacerbate an attack. Cooling - whether by exposure to colder air, water, or other methods - can sometimes be effective in calming MS-related symptoms, and has been shown in a 1997 study to significantly improve motor function. The biological reason for this is that nerve signals are transmitted more effectively in myelin -damaged nerve cells at cooler temperatures.

Cooling can be as simple as taking a cool shower, using an ice pack or pulling up a chair in front of an air conditioner. It may also be a little more elaborate, like a cooling suit or the cooling collars that are becoming more common. In fact, depending on your health insurance, some of these devices may be covered.

Herbs

Despite the current popularity and long history of use, few clinical trials have been performed on different herbs. What science does know is that, unlike traditional medications that mostly consist of a single chemical compound, herbs may contain a number of different chemicals. How these chemicals act, and interact, in the body is a matter that requires further investigation.

Since January 2004, herbal remedies on the Canadian market today are subject to regulation by the Natural Health Products Directorate (NHPD), a branch of Health Canada. Natural health products that are reviewed and approved by NHPD are assigned a Natural Product Number (NPN), in the same fashion as approved drugs are assigned a Drug Identification Number (DIN). NHPD has estimated that the implementation of these new regulations will be complete in six years.

Because there is little scientific information about herbal medicine and MS, it is wise to proceed with caution, and always discuss options with your health care provider before beginning a new treatment.

Herb Smarts

Remember these important facts about herbal supplements:

• An herb is not just an herb. Some herbal medications on the market have additives that may interfere with other medications or cause unwanted side effects. Shop around, and get the advice of a physician or pharmacist before choosing a brand.
• Don't buy it and shelve it. The amount of money spent on herbal and vitamin supplements is staggering - and many of these end up parked in a kitchen cabinet until they expire. Don't get caught in an impulse buy.
• Keep it short. Herbs are not typically intended for long, extended periods of time.
• Moms beware. Most herbs are not recommended for use while pregnant or nursing. Check with your doctor or pharmacist first.
• More is not necessarily better. In the case of herbal medicine, it's possible to have too much of a good thing. Don't assume that the product with the highest amount of an ingredient is the best without first talking with a health care professional.

Homeopathy

Homeopathy, though relatively popular worldwide, is one of the most controversial forms of alternative medicine. Homeopathy is a system of medicine developed in the 1800s and still widely used around the world today, particularly in parts of Europe and India. It is based on the principle that "like cures like," so that if large doses of a substance produce a set of symptoms, small doses will cure the symptoms.

One of the most common homeopathic remedies is the use of St. John's wort to treat depression, headache, and more. Another is the use of arsenic in the treatment of nervousness, restlessness and anxiety.

No well-controlled studies are available to support any sort of benefit in MS. Homeopathic medicines have been regulated by the Natural Health Products Directorate since January 2004.

Hypnosis

According to the Canadian Society of Clinical Hypnosis, hypnosis is a state of heightened and focused attention. In practice hypnosis is used to treat numerous psychological and physical problems.

Although there are a handful of studies indicating that hypnosis may help in symptom management for some people with multiple sclerosis, these studies involved very few patients (in some cases only one patient) and no study indicates an effect on the disease process. There are other studies, though, that support hypnosis as a therapy for relieving symptoms associated with MS, like anxiety, pain and depression.

T'ai Chi

Because of its mental, physical and social benefits, t'ai chi has grown in popularity over the past decade. For people with multiple sclerosis, t'ai chi classes offer a low-impact exercise option that can improve flexibility and coordination.¹⁸ Additionally, t'ai chi exercises can be adapted to be done from a seated position.

T'ai chi was originally developed as a component of Chinese medicine. Nearly anyone can participate, even if they lead a mostly sedentary lifestyle. The practice consists of a series of slow, deliberate movements, focusing attention on the motions of the body.

Many local chapters of the Multiple Sclerosis Society of Canada sponsor t'ai chi classes or can provide additional information on local resources.

Magnets and Electromagnetic Therapy

Magnets and electricity have been used in ancient Chinese medicine for thousands of years, and are used to this day in both conventional and unconventional forms of medicine.

In conventional medicine, particularly MS treatment, magnets are used in magnetic resonance imaging (MRI) to help produce dimensional images of parts of the body. Electric therapy is also being studied for the reduction of tremors in patients with MS, Parkinson's and other conditions.

Proponents of unconventional magnet therapy (also referred to as biomagnetic therapy, electro-biomagnetics or magnetic field therapy) claim that it brings balance to a person's disrupted natural energy field, thus promoting healing and wellness. You've probably noticed the recent resurgence in the popularity of this form of therapy. From magnetic insoles for work shoes to magnetic bracelets, many people are looking at magnetic therapy as a low-cost, low-risk complement to other therapies.

There have been several promising studies on the use of pulsing electromagnetic therapy as a complementary treatment for symptom management in MS. Researchers continue to investigate potential uses of this therapy, and early results of some studies are encouraging.

Knowledge Is Power

If you're ready to start looking for more information, remember that your doctor is your best resource. He or she knows your personal health history and can help find therapies suitable for you. Your local MS organization is likely to have additional information as well. An excellent resource is Dr. Allen Bowling's new book Alternative Medicine and Multiple Sclerosis.

The most important lesson to be learned from this chapter is to approach complementary and alternative therapies with care. Remember that the treatments and therapies covered in this chapter are generally not subject to testing or regulation by federal agencies. While there may be options you'd like to try, talk with your health care provider before beginning any new therapy.