Acupressure for Sleepiness
I’ve been using and teaching about the use of acupressure for boosting energy for a very long time. Since the early 1980s I’ve used pressure and tapping of some specific acupuncture points to give myself a quick jolt of energy. I’ve also had some success in helping patients with chronic fatigue by giving them some acupressure methods to use on a daily basis.
So I was very interested to see the publication of a small study involving 39 students in the Journal of Alternative and Complementary Medicine. The students were participating in three days of all-day lecture classes. They were taught to apply acupressure – either tapping or massaging – either five stimulating or five relaxing points. The students were not told the intended effects of the different points.
Acupressure stimulation points were:
1. The top of the head
2. The top of the back of the neck on both sides
3. On the back of the hands in between the thumb and forefinger
4. Just below both knees
5. On the bottom of the feet — at the center just below the balls of the feet
Acupressure relaxation points were:
1. Between the eyebrows
2. Just behind the earlobes
3. On the front of the wrists
4. On the lower legs above the ankles and toward the midline
5. On the top of the feet in between the large and second toes
The methods that the students were shown consisted of applying pressure to these points with light tapping of the fingers and massaging with the thumbs or forefingers.
The study was a cross-over design: Half of the students applied the stimulation acupressure regimen at lunchtime during the first day of class followed by two days on the relaxation regimen, and the other half followed the reverse schedule.
The results showed that students reported significantly less sleepiness and fatigue on the days they used the acupressure stimulation regimen. This is a fertile area for research. People have also claimed to be able to fatigue with both Thought Field Therapy (TFT) and Emotional Freedom Technique (EFT), and I’ve certainly found them to be useful on some occasions. The challenge now is to replicate this acupressure research and also to try out TFT and EFT in a similar study design.
Technorati tags:Thought Field Therapy, acupressure, sleep, complementary medicine, Qi, Emotional Freedom Technique
Adjunctive Homeopathy in an Intensive Care Unit
Although we normally try to get articles quickly, we are sometimes thwarted and they can be delayed in arriving. I have only just got my hands on a study abstract that was published by a research team from Graz in Austria last October. The investigators from the Ludwig Boltzmann Institute for Homeopathy examined the use of homeopathy in a group of severely ill people in an Intensive Care Unit.
This was a double-blind, placebo-controlled trial to see whether homeopathy would be able to influence the outcome of critically ill people with severe sepsis. Seventy people entered the study, and 35 received homeopathic treatment and 35 received placebo, in addition to their regular treatment. The main outcome measure was survival. At day 30 there was no difference between the survival rates of the people receiving homeopathy and placebo. But at day 180, the survival rate in the homeopathy group was 75.8% compared to 50% in the placebo group.
One study does not make a revolution, and it is still early days for this kind of experimental work. Yet two things stand out from this small investigation:
1. The homeopathy was being used as an adjunct to conventional medical care. I sometimes get worried when practitioners of unorthodox medicine say that they would ONLY use herbs or homeopathy. The best approach has to be to combine conventional treatments with those unorthodox ones that can be shown to be helpful.
2. Trained homeopathic physicians did the prescribing. This is important: some studies have foundered because the studies tried to test just one remedy. Yet homeopaths individualize each treatment. So two people may have the same infection, but because they have different personalities and constitutional make-ups, they will receive different treatments.
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Technorati Tags: homeopathy, complementary medicine, integrated medicine
Glucosamine and Chondroitin
A study has been published in last week’s New England Journal of Medicine that seems to show that there’s no advantage in taking the popular dietary supplements glucosamine and chondroitin. Indeed that’s what has been reported in the media . But notice that I said, “Seems to show,” for on closer examination there is more to this paper than it appears.
The investigators are to be congratulated for doing the study in the first place. What they did was to take a large group of 1583 patients who all had osteoarthritis of the knees, and divide them into five groups:
- A placebo group
- A group that took celecoxib (Celebrex) 200mg/day
- 1500mg of glucosamine/day
- 1200mg of chondroitin/day
- A combination of 1500mg of glucosamine/day and 1200mg of chondroitin/day
The study lasted 24 weeks, and the main outcome measure was pain in the knees. The study showed that although patients on Celebrex did very well compared with the placebo group, those on glucosamine and chondroitin did not do better than placebo, although the combination was better than using either supplement alone. But one of the odd things was that people with moderate to severe pain WERE helped by the combination, and in fact the combination out-performed Celebrex!
Not only does the combination seem to help people with the biggest problems with pain, but also there are some other important points:
1. The worse someone is, the bigger the room for improvement. If someone only has mild pain, you need a lot more patients to find a statistically significant improvement.
2. As in most studies, multiple measurements were done, and Celebrex was no better than placebo in 12 out of 14 of them. So if the “active comparison” failed on multiple measures, we need to be very cautious about how we interpret the study.
3. The placebo response rate in the study was 60%, while the average is 30-35%. This is a huge difference. This may be because the patients knew that they had a four in five chance of getting a treatment that might help them, so they went into the study with high expectations.
4. This is only one study, concerning one type of joint problem. There are more than 30 others that have in general been even more positive then the findings in the moderate to sever group, including a very long-term study that showed that over an eight-year period, the combination dropped the rate of knee replacement by almost 75%. It is crucially important to examine the results of any study in the context of everything else that has been known and discovered. Every type of study has to be checked, and verified.
5. The study was funded by the National Institutes of Health and is the first of two parts, with a second study of the impact of the treatments on X-rays of the knees still pending.
6. None of the groups had many side effects, but it is worth remembering that medicines of the Celebrex type are under intense scrutiny because of the possible association with cardiovascular disease.
7. Many specialists use anti-inflammatory medicines together with glucosamine/chondroitin, at least at the beginning of a course of treatment. And that makes good sense.
8. What about the dosing of the supplements? Although those are the doses used by most people, they may not always be enough. In patients who weigh more than 200 pounds, many experts recommend 2000mg of glucosamine and 1600mg of chondroitin. It is also wise to take the supplement in divided doses with food. (I have sometimes also found it very useful to add Methylsulfonylmethane (MSM), 1000mg/day to the glucosamine and chondroitin, though there is little research to support it.)
None of these treatments can be given to pregnant women or nursing mothers.
One other small caveat, if you are having surgery make sure that you tell you surgeon if you are taking these supplements. Chondroitin has minor anticoagulant activity , and so may glucosamine.
And remember that the maintenance of joint health is not just a matter of taking some supplements. It is a judicious mixture of taking the right medication when needed, together with supplements, a healthy diet containing some omega-3 fatty acids and antioxidants, exercise, management of posture, particularly of the spine, and weight management. To say nothing of ensuring that joint problems are not being compounded by psychological and relationship problems, and disturbances in the subtle systems of the body.
Technorati tags: glucosamine, chondroitin, knee pain, arthritis
Marital Conflict and Hardening of the Arteries
The Bible contains at least three references to the undesirability of hardening one’s heart:
“And the Lord said unto Moses, When thou goest to return into Egypt, see that thou do all those wonders before Pharaoh, which I have put in thine hand: but I will harden his heart, that he shall not let the people go.” — Exodus 4: 21
The BBC is carrying a report of a paper presented to the American Psychosomatic Society meeting in Denver Colorado. Researchers from the University of Utah have added another piece of evidence that marital conflict bad for you. In a previous posting I discussed the evidence that marital conflict can compromise the immune system. Now we have confirmation that marital conflict can also have an adverse effect on the coronary arteries, leading to hardening and calcification of these crucial blood vessels.
The researchers studied 150 married couples, with at least one partner in their sixties. None of the people in the study had ever been diagnosed with cardiovascular disease. Each couple was asked to pick a topic that caused disagreements in their marriage: topics included money, disagreements about in-laws, children, vacations and household chores. They were then videoed while they discussed the topic, and the videos were watched by psychology students who coded comments as friendly or hostile, submissive, or dominant or controlling. Cardiac scans were then done to look for signs of disease.
Wives who made the most hostile comments during the discussion had a greater degree of calcification of their coronary arteries, indicating the build up of plaque in these crucial arteries. It is not just the behavior of one person: the highest levels of calcification were found in women who behaved in a hostile and unfriendly way and who were interacting with husbands who were also hostile and unfriendly. Husbands who were more controlling, or who were more dominating, or whose wives were controlling or dominating, were also more likely to have more severe hardening of their arteries than other men.
These findings are in line with everything that I have been writing about looking at all the five dimensions or domains of a person: physical, psychological, social, subtle and spiritual. If you ask most people what they are doing to protect themselves against heart disease, they will probably talk about not smoking, taking exercise and healthy eating. That response is correct, but inadequate. Toxic relationships are just as dangerous, as are certain psychological response styles. For many years it was thought that the so-called “Type A personality,” was a risk factor for coronary artery disease, but research has shown that it is just two aspects of this response style that are responsible for the increased risk of coronary artery disease: anger and hostility.
Disagreements are bound to come up in any relationship, but the way that we communicate gives us a great opportunity to do something healthier for both people. In my book Healing, Meaning and Purpose I discuss the wonderful work of Riane Eisler, and I talk a lot about methods of transforming relationships from an unhealthy dominator model into a healthy partnership model.
Particularly if you are in a relationship, I urge you to take some action today to move towards greater heart health.
Technorati tags: marriage, heart disease, Riane Eisler, bad relationships
Acupuncture for Migraine
It was frustration at being unable to help so many people with migraine, that first lead me to begin my training in acupuncture. At the time I was working as a young research fellow in the main migraine clinic in London and I quickly discovered that acupuncture could be a wonderful treatment for many people suffering from this illness. I did my advanced training in acupuncture in China and even there – working with some of the best practitioners in the world – I confirmed my observation that acupuncture is no panacea. But it is a very helpful addition to our therapeutic toolbox.
There is a most interesting article in this week’s Lancet Neurology, that was also picked up by the BBC. The study came from Germany, and involved 960 patients who were randomly assigned to normal migraine medication treatment, traditional acupuncture, and sham – or fake – acupuncture. People in all three groups got better, and there was nothing to choose between the treatments in terms of efficacy.
So what does that mean? That acupuncture was in this trial as good as medications. But it adds to the growing literature that indicates that the precise placement of needles is not always as important as we used to think. But we also need to know exactly where the “sham” needling was done. During my years with the Research Council for Complementary Medicine and Prince Charles’ Foundation for Integrated Medicine, I saw a great many studies and proposals for studies in which the “sham” needles had actually been placed in highly active acupunctures points.
When I was training in China, most of my fellow students had trained in classical acupuncture in Europe, and some were outraged when they heard Chinese professors of acupuncture say that only some acupuncture points were always in the same place, and that it was not necessary to follow all the classical teachings. Some of the Europeans felt that the Chinese were destroying an ancient legacy. The Chinese simply responded by saying that the practice of acupuncture was being evolved on the basis of clinical observations and empirical research. It looks as if they were correct!
Technorati tag: acupuncture, migraine
Migraine and Hormones
Migraine (can be a frightfully difficult problem to treat. It is such an interesting puzzle, that the first book that I ever wrote was on migraine and other types of headache. Migraine is a great deal more than just a severe headache. It is can also be associated with neurological symptoms, and people often become exquisitely sensitive to light and sound. Additionally, at the beginning of the attack, the stomach stops working properly, which can make the absorption of medicines very difficult. Then comes the vomiting and sometimes diarrhea.
Although migraine is usually described as a “vascular” headache, there are strong reasons for thinking that it is more than that. People who suffer from the classic type of migraine often have spreading visual problems or partial visual loss, which goes on for between ten and sixty minutes. These visual problems are likely the result of a spreading wave of neurological depression spreading over the visual cortex at the back of the brain. The sensitivity to light and sound suggests that something is going wrong in the neurological systems that normally filter sensations, and the gastrointestinal problems indicate that something is going wrong in some of the control centers of the brain. There are some real oddities about migraine: it is exceptionally uncommon in people with diabetes; appears to be slightly more common in people who are left handed and is one of the only illnesses that tends to gets better as we get older.
There are a number of well-known triggers to migraine attacks. Though the scientific literature on triggers is not conclusive, here are some of the more common ones, that if avoided, have helped a great many people:
- Stress (either during stress, or when the pressure comes off)
- Cheese
- Chocolate
- Coffee
- Citrus fruit
- Red wine
- Changes in the weather (especially when there are a lot of positive ions in the atmosphere)
- Mono-sodium glutamate (MSG)
One of the best-known features of migraine is that it is considerably more common in women and that there is often a relationship between headaches and phases of the menstrual cycle, in particular during the pre-menstrual days. There have been many small studies that have indicated that oral contraceptives might increase the risk of suffering from migraine. A new study from Trondheim in Norway, has confirmed a link between oral contraceptive and migraine. The Nord-Trøndelag Health Study was done between 1995 and 1997. It included 14,353 pre-menopausal women, of whom 13,944 (97%) responded to questions regarding their use of contraceptives. There was a significant association between migrainous and non-migrainous headaches and the women’s reported use of estrogen-containing oral contraceptives. An important finding was that there was no relationship between the number of headaches and the amount of estrogen in the contraceptive pill.
There is one more thing to factor into the equation. Over the last two decades, there have been many reports of an association between certain types of migraine and cerebrovascular accidents (“strokes”). In the largest analysis of the data, that was published in the British Medical Journal, there was indeed a higher rate of strokes in women who had migraine and who were taking oral contraceptives. These studies included some of the older ones done in the days when the doses of hormones were higher than they are today, but when making decisions, it is important to be aware of this rare association.
An editorial in the British Medical Journal made these recommendations, with which I agree:
1. In an otherwise healthy young person, there is little cause for concern because the absolute risk of stroke is very low.
2. People with migraine who are on oral contraceptives have another reason for not smoking
3. Use low dose estrogen or progesterone only contraceptives in young women with migraine.
4. Although there isn’t much good evidence, many neurologists suggest stopping oral contraceptive pills if the migraine becomes more frequent or changes in character.
5. The risk of stroke gradually increases over age, particularly in smokers, so a slightly older smoking woman with migraine, should probably not be taking an oral contraceptive, unless it is the only option for her.
Technorati tags: migraines,hormones, headache, womens health
Acupuncture Without Needles
There are, in the United States, over 7 million people who are partially or completely disabled by back pain and another 40-50 million people who suffer from chronic recurrent headaches. Frustrated with my inability to help all my patients with conventional treatments, I have been using acupuncture since 1981. But about ten years ago I started using more acupressure, particularly since I could teach a lot of people to continue treating themselves.
Last month we saw evidence from a study using magnetoencephelography (MEG) scanning equipment that acupuncture reduces the activity of regions of the limbic system of the brain. MEG is a relatively new technology that measures the very faint magnetic fields that emanate from the head because of brain activity, instead of measuring electrical activity itself, which is a fairly blunt instrument. This reduced activity only occurred with deep needling, and when the patient experienced what is known as de qi. In Chinese medicine it is normally considered that the needle has not been correctly positioned until the patient and the practitioner both get the sensation of de qi. By contrast, superficial needling just caused activation of sensory areas of the cortex. Many doctors trained in needling techniques ignore the de qi experience, which is, I think, a mistake. When you are able to elicit it, the efficacy of acupuncture increases enormously.
Keep in mind what I have said before: just because acupuncture is associated with neurological changes, does not mean that they are responsible for the effects of acupuncture.
In this week’s British Medical Journal is an article from Taiwan, showing the effectiveness of acupressure in 129 patients with chronic low back pain. Like every study ever done, it is possible to pick some holes in this one, but overall it appears to be sound.
Now I am interested to see a press release about a form of needle-less therapy. I have written before about Thought Field Therapy (TFT), and the subject of the press release is a development of it called Emotional Freedom Technique, or EFT. While TFT uses tapping at specific points, together with humming, counting and eye movements, EFT is much simpler. It combines gentle fingertip tapping on key acupuncture points with focused thought. It is claimed to effectively reduce – and often permanently eliminating – chronic pain. According to its practitioners, EFT is more than 80-percent effective in treating headaches, back pain, cancer pain, arthritis, and pain from other conditions.
There is the rub: I could find no published research when I did a Medline search. That being said, I have reported elsewhere that I went to California to debunk TFT and became a convert after being treated by its inventor, Roger Callahan. There is a small amount of research on TFT that appears to confirm its effectiveness in some conditions, and I have certainly found it to be very helpful for many people.
Whether the claims of EFT will be born out remains to be seen. I have seen the techniques work, and I have to give credit where it is due. In exchange for your email address Gary Craig, who developed EFT, allows you to download a EFT manual from his website. You may also purchase DVDs from his site to learn more about this treatment modality. As always, I do not suggest using EFT or any other method in place of tried and tested treatments, but it may be a good adjunctive treatment for mild conditions.
In future message and in my newsletter I shall share some of the precise techniques that I have found useful, as well as ones that did not work out for me.
Technorati tags: Emotional Freedom Technique, headaches, acupuncture, acupressure, chronic pain
Sheryl, Lance and Kylie
I was very sorry indeed to hear that the amazingly gifted singer Sheryl Crow, who is only 43 years old, is facing a challenge with cancer. She is, of course, by no means the first. Cancer is not something that just hits the older people in the population. Two recent examples: Lance Armstrong who even now, after years of treatment and triumph is only 34, and Kylie Minogue, who is 37. Those two are apparently doing very well indeed, and have used their celebrity to publicize the importance of health screening and of looking at all the options in treatment.
Because of the kind of work that I do, I know of many other well-known people who have dealt with similar problems, and are doing extremely well, but who have chosen to maintain their privacy. Most forms of cancer are no longer the death sentence that they once were.
For more than two decades, I have been heavily identified with holistic medicine, which has gone through more names than the artist formerly known as Prince: alternative, complementary, integrative and integrated. So people are often surprised that I am also an expert in conventional medicine. “After all,” I am asked, “If integrated medicine is so great, then why bother with conventional medicine at all?” The answer is that the best way to treat anyone is by an integrated approach that treats the five principle dimensions of a person: physical, psychological, social, subtle and spiritual.
I regularly receive mailings from people and organizations claiming that they can cure all types of cancer using all sorts of unusual approaches, from nutrition to detoxifications and methods for getting rid of parasites. I have never recommended these approaches because the evidence is so flimsy, and we have data to show that there are indeed treatments that can improve survival and quality of life. But what I am very keen on is using conventional treatment as well as these less orthodox approaches, which are precisely tailored to the individual.
The United States Department of Health and Human Services has Task Forces that make screening recommendations, and I thought that it would be a good idea to make a note of some of their recommendations:
- Breast Cancer: Mammography every 1-2 years over age 40. Interestingly, the Task Forces don’t recommend routine breast self-examination, although many European countries do.
- Cervical Cancer: Screening every three years after age 21 or after becoming sexual active.
- Colon Cancer: “Regular” screening for everyone over age 50
- Prostate Cancer: They do not recommend routine PSA screening, but certainly clinical examination.
All of these recommendations get ramped up if an individual has a family history of a specific cancer and breast and colon cancer screening should start earlier in African Americans.
So I wish the very best to Sheryl, Lance and Kylie. And if you have been following my posts about spirituality and healing, it is, I think, highly likely that if enough of us think kindly of them, it will help them heal.
Technorati Tags: Sheryl Crow, cancer screenings, breast cancer
Interactions Between Drugs, Herbs and Other Therapies
The New Frontier in Brain Control
This is important work for several reasons:
It may well help people with chronic pain to use non-pharmacological approaches to the control of their pain, even if they do not have access to fancy high-tech scanners.The work is pushing the frontier of what is possible in terms of controlling one’s own body.It is an amazing confirmation of the teachings of many schools of teaching about health, from yoga and qigong, to Science of Mind.It raises very interesting questions about who or what is actually controlling the pain: it gets us straight back to the whole question of where is the mind and is it the same as the brain. (The answer to that is NO: a subject for many more entries)It is important not to lose sight of the fact that pain is often a lot more than aberrant firing of neurons or an imbalance in the some of the serotonin and norepinephrine systems of the brain. It can be brought on or exacerbated by psychological and social factors, and I have seen many people in extreme spiritual crisis, who then began to develop pain in various part of their bodies, yet had no overt signs of depression or of any other psychological or psychiatric problem.
Technorati Tags: pain control, chronic pain,
