Life is Information at Work
“Information is "a difference that makes a difference.”
–Gregory Bateson (English Anthropologist, Social Scientist, Linguist, Cybernetician and Writer, 1904-1980)
Much of the work in which we’ve been engaged needs us to look very hard at what is life? Is it simply a collection of biochemical reactions glowing in the dark, or is it something more complex, laden in meaning and purpose. This is not an academic exercise: unless and until we can better understand the fundamental processes of life, it is difficult to advance the practice of medicine and the processes of health and wellness.
A fundamental tenet of Healing, Meaning and Purpose is that we live in a non-dual Universe, of which consciousness, information and energy are the primary manifestations and principles. I present a great deal of solid scientific material that you can use immediately. It’s all based on the fundamental concept that illness is caused by degradation in the storehouse of information that sustains the body.
Comprehensive treatment and persistent robust physical, psychological, social, subtle and spiritual health is rooted in clear, harmonious, integrated information. And that is why physical treatments – sometimes including medications – may be an essential component of helping someone get well, but is nonetheless just one piece of the puzzle. It is essential also to ensure that the information and communication between each aspect of a person and his or her environment are also clear, harmonious and integrated. Without those other pieces, we may be doing no more than putting a band aid on a problem.
Valentino Braitenberg the former director at the Max Planck Institute for Biological Cybernetics in Tübingen, Germany, has always had some interesting things to say. He is a truly original thinker who’s also, IMHO, a fine human being.
I recently came across this in his last book, Das Bild der Welt im Kopf: Eine Naturgeschichte des Geistes, published in 2003 by LIT Verlag, Munster:
“Living organisms contain information, are the result of information, pass on information, and information made flesh in the conditions that their environmental niches impose for survival. To read this information is to recognize the very essence of a living organism.”
I think that this is the most succinct summary of what is to be a living organism. Yes, of course, you are made up of atoms and molecules. But the key point is that you are maintained by a constantly flowing river of information. Without it your body, your mind, your relationships and your spiritual essence would cease to flow.
Any treatment worth its salt will always be directed toward correcting and modulating and integrating this flow of information.
Anything less, and we are simply moving around the deckchairs on the Titanic.
“The original root of the word "information" is the Latin word informare, which means to fashion, shape, or create, to give form to. Information is an idea that has been given a form, such as the spoken or written word. It is a means of representing an image or thought so that it can be communicated from one mind to another rather than worrying about all the information afloat in the world, we must ask ourselves what matters to us, what do we want to know. It’s having ideas and learning to deal with issues that is important, not accumulating lots and lots of data.”
–Theodore Roszak (American Social Thinker, Critic and Writer, 1933-)
“Man must go back to nature for information.”
–Thomas Paine (English-born American Political Theorist and Writer, 1737-1809)
Tourette’s Syndrome
No surprise here, but I was just sitting on a plane.
Again.
When I heard people sniggering.
Why? A young man in his thirties was walking along trying to find his seat. As he did so he was constantly grunting, saying partially intelligible words and jerking. As a clinician it was immediately obvious that he almost certainly had Tourette’s syndrome, a developmental disorder of the brain in which people have involuntary, stereotyped, repetitive motor and phonic tics. Some people with the disorder exclaim obscene words or socially inappropriate and derogatory remarks, which together are known as coprolalia.
The illness was originally named for Georges Albert Édouard Brutus Gilles de la Tourette, (1859–1904), a French physician and neurologist, who published an account of nine patients with the now classic clinical features in 1885.
You may not often see someone with this problem, but it is good to know what it is, and that it is an illness that can cause great distress.
We have recently made some interesting discoveries about Tourette’s syndrome.
- It is an illness involving the dopamine systems in the basal ganglia of the brain together with some regions of the midbrain and some very specific linked regions of the cerebral cortex, cerebellum and limbic system.
- In adults with Tourette’s syndrome, the prefrontal cortex is a little smaller than normal, and the corpus callosum linking the hemispheres is larger than expected. These findings correlate with problems in the way in which people transfer information between the hemispheres and modulate attention.
- Very recent evidence has shown us that there are small hyper-intense lesions in the deep regions of the brain in people with Tourette’s, obsessive-compulsive disorder and attention deficit disorder. These three problems seem to have a number of biological links and two or more may co-exist in the same person. In children and adolescents with Tourette’s, the tics tend to get better over time but obsessive-compulsive disorder symptoms become more severe and persistent as they get older.
- There is important evidence that in some people, Tourette’s is linked to a post-infectious autoimmune disorder, and many have antibodies directed against neurons in the brain.
- There is also a link between Tourette’s and having low iron stores. Low iron stores are common in people with many chronic inflammatory illnesses. Iron is crucially important in the development of key regions of the brain. We do not have any viable evidence that giving people iron supplements will reduce the severity of Tourette’s, but it is something that needs to be examined in a formal study.
People have typically been treated with antipsychotic medicines such as risperidone that block dopamine receptors in the brain, and they can certainly help. A more recent approach is to use medicines like aripiprazole that modulate dopamine activity in the brain. A recent study done by some colleagues in the United Kingdom have confirmed that aripiprazole seems to be very helpful in about half of patients with Tourette’s, though neurological side effects do sometimes occur.
There has recently been a lot of interest in Habit Reversal Therapy: a behavioral treatment for tics. The therapy takes a lot of time and effort, but it is very interesting that behavior therapy can help with a neurological illness.
There is no published data on the use of Integrated Medicine in the treatment of people with Tourette’s, but many experts have reported that some patients have been helped with homeopathy and acupuncture.
That guy in the next seat who is cursing may not just be mean and uncouth. He may be suffering.
But maybe not for much longer.
We are getting very close. Not just to discovering the physical basis of the illness, but perhaps its meaning and purpose as well.
New discoveries are coming thick and fast, and I shall keep posting about those that will help individuals and illuminate the principles of Integrated Medicine.
The Parachute Approach to Evidence
Almost three years ago, one of the British Medical Journal – one of the top rated medical journals in the world – published an amusing article with an extremely serious sting in the tail. The article, entitled “Parachute use to prevent death and major trauma due to gravitational challenge,” highlighted some of the absurdity surrounding the constant demand for scientific validation using only one set of criteria.
The authors pointed out that – as with many interventions intended to prevent ill health – there had been no randomized controlled trials of parachutes in preventing the major trauma that may be caused by gravity!! Yet we would hope that nobody would consider exiting a plane in flight without first equipping himself or herself with a parachute.
Advocates of evidence-based medicine have criticized the adoption of interventions that have only been evaluated by using observational data.
The authors therefore said that, “We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.”
They used the lack of randomized controlled trials in testing parachutes to show that situations still exist where such trials are not only unnecessary, but also dangerous.
Anyone who has spent 30 seconds on this blog knows that I’m firmly committed to the rational analysis of data. But I am just as certain that there are many valid types of evidence.
There is an important article in this week’s issue of the British Medical Journal that lies at the heart of Integrated Medicine, and the research that we’ve been facilitating. The article suggests that waiting for the results of randomized trials of public health interventions can cost hundreds of lives, especially in poor countries with great need and potential to benefit. If the science is good, we should act before the trials are done.
The article argues that the “parachute approach,” where practice and policies are based on good science but without randomized trials, is often more suitable in resource poor settings. They go on to consider three areas of critical importance, in which there are real ethical, moral and logistical problems if we wait for the results of randomized controlled trials.
They use the three examples of:
- Oral rehydration therapy
- Male circumcision to prevent HIV infection
- Misoprostol for postpartum hemorrhage
We have constantly run into the same kinds of problems with alternative, complementary and now Integrated Medicine. In most of theses fields there is precious little in the way of randomized controlled trials, but a wealth of clinical reports and case series. The problem with unorthodox medicine is that much of it does not fulfill one of the criteria for the parachute approach: to be “based on good science.” This is one of the reasons for expending so much energy on finding common ground between conventional and Integrated Medicine, and for investigating several advances in the basic sciences that may help us square the circle.
It is also why we have adopted a second criterion: the potential for a therapy to do harm. Clearly the level of evidence for risk and benefit is quite different for a potentially risky surgical procedure, compared with, say, crystal therapy. The biggest risk with crystal therapy is that it might get used inappropriately in place of a treatment that has been shown to work.
But above all else, when we are dealing with sick and suffering people, we have to take action. Safe action, action that has a good chance of helping, and action that is fully explained to the individual. Honestly and straightforwardly, and without false optimism.
“A man’s best friends are his ten fingers.”–Robert Collier (American Writer and Publisher, 1885-1950)
Reversing the Irreversible
When I am analyzing current medical research for you, I focus on findings that are relevant to our underlying theme of Integrated Medicine.
One of the most important of all is the evidence for “spontaneous” remissions of otherwise fatal illnesses, and the reversal of diseases that are usually thought of as irreversible. It is exciting when we can show that arteriosclerosis and some neurological disease may be reversible, though most physicians still do not know that good news.
Two years ago I was asked to comment on a remarkable clinical problem. A 28-year old woman had seen a neurologist about some odd symptoms, which included quite severe visual disturbances. On MRI and electrical she had clear evidence of demyelination, the hallmark of multiple sclerosis. All of which has resolved after just one month of complete withdrawal from her diet of the sweetener aspartame. Multiple sclerosis is a disease that comes and goes, but the point of this case is that there was clear evidence that it went away completely. The neurological lesions in the brain that should have stayed forever, just melted away. I’ve looked at thousands of brain scans and this is extraordinary. And clinically the young woman is just fine.
Cases like this must be very rare: the FDA has determined that aspartame is safe, though on a future occasion I’ll say a bit more about the pros and cons of sweeteners. Discussions about artificial sweeteners usually generate more heat than light, but there is a lot of very helpful data to guide us.
Now let’s look at another condition that is supposed to be irreversible: cirrhosis of the liver. The liver is a remarkable organ. It has almost unique regenerative abilities. I’ve often wondered if the Ancient Greeks somehow knew about that remarkable attribute of our largest solid organ. When Prometheus was chained to a rock, an eagle came every day to eat his liver, which had re-grown by the next day.
The trouble is that if the liver keeps getting damaged and trying to re-grow, it produces a lot of fibrous scarring, the hallmark of cirrhosis. For more than a century, every expert has said that this fibrosis is irreversible. Now some first class research has shown that it isn’t true. An inexpensive medicine can reverse the fibrous changes in the liver.
The medicine is called sulfasalazine (sulphasalazine in the UK) that is normally used for treating inflammatory bowel diseases and some kinds of inflammatory arthritis. A team of scientists lead by Professor Derek Mann has recently moved from Southampton to Newcastle University has made a series of ground breaking discoveries. One of the most exciting is that sulfasalazine can reverse fibrosis in the liver.
The results were published in the journal Gastroenterology. A second and third papers published in Apoptosis, that describe the – then – Southampton group’s collaboration with chemists and oncologists to produce novel and more effective derivatives of sulphasalazine.
The researchers believe that, subject to further research and clinical trials, sulfasalazine could potentially be used to treat types of chronic liver disease – like cirrhosis – that are currently considered untreatable. Sadly because of greater alcohol consumption, especially binge-drinking, and obesity, liver disease is rising dramatically.
And if a simple medicine can reverse something previously believed to be irreversible, the final question that we have to ask is whether other the non-invasive methods may also help? Since most of the non-invasive methods work at deeper and more subtle levels of the organism, the answer to that one is, “Highly likely.” But it is going to have to be tested scientifically, just as every other hypothesis has to be tested.
Vitamin D and Interstitial Cystitis
I think that interstitial cystitis (IC) must be one of the most distressing of conditions to have, and it is certainly one of the most challenging to treat. Outside the United States, it is more often called painful bladder syndrome (PBS).
IC is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from person to person and even in the same individual. It can vary from an experience of mild discomfort, pressure, tenderness, to intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. Both may be severe: I’ve seen people who had to urinate every ten minutes. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation, and some experience pain with vaginal intercourse. There is a good website provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), that is fairly up-to-date.
Because IC varies so much in symptoms and severity, most researchers believe that it is not one, but several diseases. There are clear links between IC and fibromyalgia, irritable bowel syndrome and chronic fatigue, and probably many other illnesses.
There is good evidence that inflammation in one pelvic organ can cause pain in other organs that share some of the same nerve supply. Inflammation of the colon may make some nerves coming from the spinal cord hyper-excitable, which in turn makes nerves running to the bladder hypersensitive. Because the same nerve plexus connects with the ovaries and uterus, it is no surprise to learn that phases of the menstrual cycle impact the way in which inflammation in one pelvic organ can cause inflammation in another.
IC appears to be becoming more common, although that is always a risky comment, because it was undoubtedly not often recognized in the past. The old teaching was that it was only something that occurred in menopausal women, but it is now being diagnosed in men as well as women, and in people as young as their late teens.
The cause of IC remains unknown, though there have been many theories: infections, allergy, autoimmunity, neurological and genetic. There have been recent claims of the discovery of responsible genes, but hey would most likely be susceptibility genes, rather than causative. Otherwise why should the rates of IC genuinely seem to be increasing? What seems clear is that the normal mucus lining of the bladder wall is damaged.
Multiple types of treatment have been tried, from medication to pelvic floor exercise, to neurological implants and homeopathy and acupuncture. The report of anything new that may help is always welcome.
So I was interested to see a report from investigators in Milan on the efficacy using a molecule that has been attracting a lot of interest recently: vitamin D. The active form of vitamin D is known as calcitriol or 1,25-dihydroxycholecalciferol (1,25(OH)2D3) that is manufactured in the kidney. Its in vivo biological effects include regulation of bone metabolism, control and modulation of the proliferation of cells and some aspects of the immune response. These characteristics have already led to therapeutic applications in osteoporosis, secondary hyperparathyroidism, and psoriasis. Many reports show beneficial effects of vitamin D in animal models of diabetes, organ graft rejection, experimental allergic encephalomyelitis, lupus nephritis, and in asthma. Despite what you may have seen in some advertisements, just taking extra vitamin D does not help, and may make matters worse: they key is to have the right form of vitamin D, that can reach and affect the right areas of the body.
The Milan team used a vitamin D3 analogue (BXL628) in a mouse model of chronic cystitis. What they found was that a specific inflammatory marker in the blood went down with treatment, and at the same time histological analysis showed a decrease in edema and white blood cell (leukocyte) infiltration in the bladder wall. This and some other biochemical evidence of what is known as “mast cell degranulation,” is very encouraging and strongly supports the potential therapeutic use of BXL628 in diseases such as human interstitial cystitis.
This is the kind of mechanism-based research that holds out enormous promise for everyone’s welfare and will help us in our goal of using science to inform the development of the next generation of treatment, health and wellness.
Medicine and the Transformation of Illness
Something important has been happening in the medical field over the last century. And like most important concepts, once I mention it, everyone says, “Oh, that’s obvious.” Yet I have seen little discussion of it except in an occasional book or speculative paper.
The concept is this: modern medicine has been transforming the nature of illness in far-reaching ways. There are many illnesses that once were fatal, and which have now been transformed into chronic problems. Yet most conventional health care providers are still wedded to the short-term resolution of symptoms.
Let me give you three examples:
- The first is diabetes mellitus. There are two main types, and at least ten subtypes. Type 1 diabetes is what used to be known as juvenile onset diabetes or insulin-dependent diabetes. It usually comes on in childhood or adolescence, is associated with severe damage to the beta cells in the pancreas that produce insulin. People with this problem usually become very sick very quickly and need insulin to keep them alive. Until 1922, when the first patient was treated with insulin derived from cows, the illness was usually fatal. Insulin transformed it into a chronic illness. People were kept alive, but now we saw the emergence of diabetic eye disease (cataracts and retinopathy), disease of the blood vessels supplying the limbs, heart and kidneys, kidney failure, infections and many other chronic problems. In 1935 Sir Harold Himsworth, the father of a friend of mine, identified a second type of diabetes. He published a classic paper on his discovery of insulin resistance in 1936. This is what is now known as Type 2 diabetes, and used to be called maturity onset diabetes. This is a more chronic illness, but carries many of the same complications. The point about these two types of diabetes is not just that they have disturbances of glucose and lipid metabolism. That on its own matters little. It is the long-term consequences of the elevated glucose and lipids that causes all the problems.
- The second is hypertension. Again, this often used to be a fatal illness. Until the invention of the sphygmomanometer most people did not know that they had high blood pressure, and most often would die of strokes. Hypertension is now also a chronic illness. The problem is not the blood pressure itself, but the long-term consequences of an elevated blood pressure. That is why most physicians are now trying to prevent the damage to the heart, eyes and kidneys, instead of just focusing on the blood pressure numbers themselves.
- The third is Lyme disease. This is a bacterial illness that is acquired by being bitten by a tick. It is said to be the fastest growing infectious disease in the United States, primarily because we are spending more time venturing into the wilderness, and the deer population – a major carrier of the tick – is increasing in most Eastern states. Lyme disease can make people very ill. We identify acute and chronic types. The acute can usually be treated if identified quickly and if the correct treatment is given. But sometimes identification can be very difficult, and inadequate or even inappropriate treatment may lead to the chronic form. We have even seen people who have been treated exactly as the experts say, but have still developed the chronic form of Lyme disease. The biggest problem with Lyme disease is that it is a great masquerader: it can look like so many other illnesses, from multiple sclerosis and rheumatoid arthritis to chronic fatigue syndrome and syphilis.
We could pick out other examples. I have mentioned some of the problems of thinking that attention deficit disorder is just a problem with getting good grades in school. When in reality the problem is that inadequately treated ADD is associated with a range of long-term problems that occur outside of school hours.
For many years now some practitioners have been warning about the long-term consequences of symptomatic treatment alone. One of the most eloquent critics of this way of treating people is the Greek homeopath and teacher George Vithoulkas. I like and respect George, but he takes a militant view, saying that conventional treatment simply suppresses illnesses, rather than treating them. His solution is to use homeopathy for everything. He is a genius and also a natural healer, so he can probably get away with that. Most of us cannot.
So the fundamental tenets of Integrated Medicine include medical treatment to deal with the acute problem, but a combination of approaches to prevent the problem from becoming chronic. Or if it has become chronic, then how to change its course over time.
As I’ve said before: Combinations are Key. Not randomly giving an antibiotic as well as a homepoathic remedy, but precisely tailoring the combination to the individual.
True Integrated Medicine
“Our body is a machine for living. It is organized for that, it is its nature. Let life go on in it unhindered and let it defend itself, it will do more than if you paralyze it by encumbering it with remedies.”
–Count Leo Tolstoy (Russian Writer and Philosopher, 1828-1910)
“The cure of the part should not be attempted without treatment of the whole.”
–Plato (Athenian Philosopher, 428-348 B.C.E.)
Have you ever woken up in the morning with a feeling that something’s not quite right, but you couldn’t quite put your finger on it? That is the feeling that we get if something is out of place. Our minds and our brains have evolved with a remarkable ability to pinpoint things in external space: it was once an important survival mechanism. As we became more complex, those same systems began to be able to tell when things were out of place in our internal environment as well as in our relationships. We are social animals and most of the cognitive systems of the brain are designed to aid and abet our social interactions.
The key to health is to have all of our systems working in harmony. It is absolutely true that 70% of human illness is a result behavior born of bad choices. We make those bad choices when we stop listening to our bodies and heeding our hearts.
People love to place us in categories. I am constantly being asked why all my work contains three parts: cutting edge conventional medicine, natural medicine and self-help. I’ve had people in the publishing business say, “Well, is it health OR self-help?” For me, the answer to that is yes!
We cannot attain health and wellness unless we have done some work on ourselves; we cannot heal ourselves and others unless we have something with which to do the healing. If we are fearful, and moving haphazardly through life with little self-control, it is hard to pay attention to your body, mind, relationships, subtle systems or spirituality. A physician too distracted to focus on and respect another person is unlikely to help him or her get better. A therapist without a strong sense of self would find it hard to help a troubled mind, and a spiritual teacher who had no personal experience of the Higher Realms of existence and no clear moral compass, could devastate the spiritual well being of a disciple.
When we talk about Integrated Medicine, people usually assume that we are only talking about integrating different types of treatment. Yet that is only part of it. We are also aiming to integrate the individual: to enable every aspect of the person to be acting in harmony. When all of our systems are in harmony, pulling together in the same direction, when they are listening to each other and communicating with each other, there is a free flow of energy and we achieve a state of coherence.
And it is this coherence that underlies our sense of health and well being.
For coherence is the key to resilience.
“The patient must combat the disease along with the physician.”
–Hippocrates (Greek Physician, c.460 B.C.E.- c.377 B.C.E.)
“Those whose consciousness is unified abandon all attachment to the results of action and attain supreme peace. But those whose desires are fragmented, who are selfishly attached to the results of their work, are bound in everything they do.”
–Bhagavad Gita
Shock Waves and Diabetes
A psychiatrist friend once called me to say that he knew that he had to change his job. He was in the second year of his Freudian training analysis, and as he was driving to work he experienced a severe pain in the back. He told me that it felt as if someone had put a knife in his back. This, he told me, was a psychosomatic reflection of the mean back stabbing environment in which he was working. “Tell me more about the pain,” I said. “Just like a knife,” he said, “it’s the most obvious example of my body telling me what’s going on here.” I suggested that he should come over for me to give him a physical check up, but he was having none of it.
The following day he passed a large kidney stone.
It’s important to listen to your body, and to try and understand its message. It’s also important to respect every aspect of your being: physical, psychological, social, subtle and spiritual. A physical pain may be telling you about something in your environment or it may just be telling you that there’s something wrong with your body. Sigmund Freud once famously remarked that “Sometimes a cigar is just a cigar.”
I was reminded of this story as I was reviewing a new report about an association between the use of sound waves – lithotripsy – to shatter kidney stones and the eventual development of diabetes. Approximately 10 percent of men and 5 percent of women under the age of 70 will experience a kidney stone.
Surgery for kidney stones used to be horribly traumatic. As a very young student and junior doctor I assisted in more than one operation to remove them. The invention of the lithotripter – a device that uses ultrasound to break up stones, so that they can be passed out of the body – was a big advance. Though the treatment itself is far from being painless, it is much better than major surgery, It is a shame to learn that the treatment is not as innocuous as we thought. This is important, because about 1 million people in the United States have had shock wave lithotripsy (SWL).
In a study published in the May issue of the Journal of Urology, researchers at the Mayo Clinic followed up on a group of 630 patients who had been treated with SWL in 1985. The Mayo was one of the first centers to use the technique, the hospital keeps wonderful records, and so it was one of the few places in the world where it was possible to follow people 19 years after treatment.
Almost 60 percent of the patients responded to a questionnaire and were matched to an equal number of patients whose kidney stones had been treated by some other method. Among the SWL group, 16.8 percent had developed diabetes, compared with 6.7 percent of the control group, and 36.4 percent had high blood pressure compared with 27.9 percent of the control group. According to the study, the development of hypertension was related to the treatment of stones in both kidneys, while the onset of diabetes bore a relationship to the number of shocks administered and the intensity of the treatment.
This makes sense: the kidneys are key controllers of blood pressure, and it has long been known that stones, inflammation, infection or vascular disease in the kidneys can cause elevated blood pressure. Perhaps the treatment scars the kidneys. And it is not surprising that sound waves powerful enough to shatter a stone might also cause damage to the tissues through which they are passing; which include the pancreas.
These findings will need to be replicated, particularly with newer model lithotripters. But even before that, I’m sure that the criteria for gets the treatment will be modified, and it will also be necessary to re-think how the treatment is done. As an example, instead of shooting one powerful burst of sound waves at the stone, it may be necessary to fire several low intensity burst from different directions that all crisscross in the vicinity of the stone.
For now, if you are one of the unlucky ones who gets a kidney stone, discuss this new research with your doctor before having lithotripsy. And if you have access to a good acupuncturist, naturopath or homeopath, ask them if they have had any success in treating kidney stones, and if “Yes,” whether they would be prepared to work with your physician to help you.
A Very Useful Demonstration of Thought Field Therapy
I have written several times about the tapping therapies: primarily thought field therapy (TFT) and its child: emotional freedom technique (EFT). They also play a central role in the combination of techniques that I discuss in Healing, Meaning and Purpose, and my forthcoming book, Sacred Cycles.
Andy Hunt in the UK has a very nice blog, and I found a reference to another website for the Center for Integrative Psychotherapy. This one contains a very nicely done short video demonstrating TFT.
I’ve had a lot of experience with these therapies, and despite a paucity of research, they really do seem to work with a great many people. This video is a wonderful service: it shows you what to expect from treatment.
Thank you Andy for alerting me to the site, and thank you to Mary Sise for making the video and for making it available for free.
Peripheral Neuropathy and Integrated Medicine
We have already discussed some of the causes and conventional treatments for peripheral neuropathy.
Unfortunately many people are not much helped, and it is good to know what else may assist them. And also what may not: sadly people suffering from chronic illnesses often become the victims of people selling treatments that may have scant chance of success.
There is not much research to support most of these approaches, which we use in tandem with conventional medicine. However, I’ve used all of these approaches and found that each has helped some people. The problem, as with most of conventional medicine, is in knowing who will respond to what. Often the key is to use several approaches in combination. That is where you need a specialist in Integrated Medicine who can put together the right “package” of treatment for the individual. What we don’t want to do is use a kind of “blunderbuss approach,” where we hit people with everything at once.
- Diet and exercise may help, particularly in diabetic neuropathy, where improved metabolic control will reduce – but not abolish – the risk of neuropathy, and may improve pre-existing neuropathic pain.
- Some naturopaths in Europe recommend using parsley, celery and carrot juices. Not something that I’ve seen work, but some people tell me that they’ve found them helpful.
- There has been a lot of research on the use of alpha lipoic acid and vitamins B and E, particularly in diabetic neuropathy: some positive and some negative. Each has sometimes helped in clinical practice, though you have to be a little careful with vitamin E: it can impair the clotting system, and cause diarrhea and transient elevations in blood pressure.
- Acupuncture – traditional Chinese, “Western Medical,” and electro-acupuncture – have been used a lot in peripheral neuropathy. There have been some positive studies in painful diabetic, HIV-associated and chemotherapy-induced neuropathy. None of the studies has been perfect, but they tend to support the clinical impression that man people are helped – some greatly – but few are cured with acupuncture. There have also been negative studies. There are also some positive studies from China, but only a few have been translated in their entirety. There are often two big problems with research done in China: many Chinese investigators feel that it’s unethical to include a control group, and their studies tend to use endpoints like “cured” or “partially cured,” rather than objective rating scales. I have used it in peripheral neuropathy, but it’s extremely important to use scrupulous technique, since people with neuropathy are at increased risk of getting skin breakdown and ulcers, especially if they also have any vascular compromise. Many of us have also found that it can be helpful in compression neuropathies, like carpal tunnel syndrome. There’s recently been some fascinating research using brain imaging in acupuncture treated carpal tunnel syndrome.
- Herbal remedies are used by about a fifth of people with neuropathy, but I’ve never had much luck with them. Some herbalists tell me that they have good results with an array of different herbs, though there is little objective evidence that they work.
- There have been clinical reports and at least one research study on the use of magnet therapy in neuropathy. Earlier this year there was an article in the British Medical Journal that was critical about magnet therapy in general. The article provoked one of the most vigorous debates that I’ve seen in along time. I’ve not seen it help, but there are some people who swear by it. And other who swear at it!
- There have been many attempts to use electrical fields to help neuropathy, from the conventional transcutaneous electrical nerve stimulation (TENS) boxes, to yet more variations on electro-acupuncture. Some people are helped, and these are good extra tools.
- Many homeopathic remedies have been used in neuropathy. Homeopathy is a highly individualized form of therapy: no two patients will get the same remedies. But some of the most commonly used remedies are Agaricus, Alumina, Arsenicum album, Natrum muriaticum, Phosphorus and Plumbum. If you live somewhere that there are good homeopaths, homeopathy is an option to consider, despite the dearth of good research into its use in neuropathy.
- It is important not to neglect the psychological aspects of neuropathy: people can become profoundly depressed by the intractable pain, and sometimes psychotherapy and antidepressants can be a helpful.
- Finally, ask yourself what the neuropathy is trying to teach you. There is no problem that comes out of a clear blue sky, and it is always valuable to look beyond the physical problem itself to its meaning and purpose.
If you are not having success from conventional medicine alone, or if you don’t care for conventional medicine, then discuss these options with a professional, use your intuition to guide you, and let us know if you have success.
