An estimated 2 million Ontario residents now see a naturopathic doctor

According to the The Canadian College of Naturopathic Medicine (CCNM) commissioned  new survey ,it  reveals that almost half of Ontarians treated by naturopathic doctors report naturopathic medicine has helped reduce their use of prescription drugs. Further, approximately 4 in 10 of those individuals report fewer visits to their family doctors and 3 in 10 to hospitals as a result of the care they receive from naturopathic doctors.

Ontarians seeking more natural approaches to health and wellness are increasingly turning to naturopathic medicine. The survey conducted in August 2011 found that 72% of Ontarians familiar with the practice view naturopathic medicine positively, 43% say they are familiar with the practice and an estimated 18% of all adult Ontarians— an estimated two million people—have seen a naturopathic doctor.

According to the survey, women are both more likely to be familiar with naturopathic medicine (49% versus 36%) and more likely to have a positive impression of it (77% versus 66%) as compared to men. Of interest, the Ontario Ministry of Finance reports that females in Ontario enjoy a life expectancy which is over four years longer than their male counterparts.

“These results show more Ontario residents are not only increasingly using complementary therapies, but also indicating that naturopathic medicine is an effective alternative to help relieve the cost pressures on the publicly-funded provincial health system,” says Nick DeGroot, a naturopathic doctor and dean of the Canadian College of Naturopathic Medicine.

The demand for naturopathic medicine continues to grow with 41% of respondents indicating they are likely to see a naturopathic doctor in the next few years, and over half of these anticipating a visit within the next 12 months.

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Introduction

Like many people, you may be using or considering trying some form of complementary and alternative medicine (CAM). If so, it is a good idea to talk about it with your doctors, nurses, pharmacists, and other health care providers. This fact sheet explains why it’s important and offers some tips to help you get the conversation started.

Key Points

• Tell all your health care providers about all the complementary and alternative therapies you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.
• Be proactive. Don’t wait for your health care providers to ask about your use of complementary and alternative approaches.
• When you talk with your health care providers, make the most of the conversation. Bring a list of all prescription and over-the-counter medications and complementary and alternative therapies you use, keep a record of the information you receive, and ask questions if something is unclear.

About Complementary and Alternative Medicine

The terms complementary and alternative refer to health-related products and practices that are not generally considered part of conventional medicine. Complementary medicine is used together with conventional medicine, and alternative medicine is used in place of conventional medicine. Conventional medicine is medicine as practiced by holders of M.D. (medical doctor) or D.O. (doctor of osteopathic medicine) degrees and by their allied health professionals, such as physical therapists, psychologists, pharmacists, and registered nurses. Some health care providers practice both complementary and conventional medicine in what is known as integrative medicine.

Examples of complementary and alternative practices and products include mind and body interventions, such as acupuncture, meditation, spinal manipulation, and massage therapy, and natural products, such as herbal and botanical products, folk medicines, homeopathic remedies, and probiotics.

Reasons for Talking With Your Health Care Providers About Complementary and Alternative Medicine

• Some complementary or alternative approaches can have an effect on conventional medicines. For example:
  • The herb St. John’s wort can decrease the effectiveness of many conventional drugs, including some anti-cancer drugs, the heart medication digoxin, some HIV drugs like indinavir, cyclosporine (which prevents the body from rejecting transplanted organs), and birth control pills.
  • The herb yohimbe can increase blood pressure in people who are taking some types of antidepressant drugs.
  • Vigorous or deep tissue forms of massage therapy can be harmful to people who are taking blood-thinning medications such as warfarin.
• Some complementary or alternative products or practices can be unsafe for people with certain medical conditions. For example, certain types of yoga poses (those that involve an upside-down position) are harmful for people who have glaucoma, and certain herbs, such as chamomile and echinacea, may make allergy symptoms worse in people who are allergic to ragweed.
• Doctors, nurses, pharmacists, and other health care providers can help you decide whether a particular product or practice is right for you. They can answer questions, suggest reliable sources of information, and point out potential benefits and risks. Talking with all of your health care providers about your use of complementary or alternative therapies will help ensure coordinated and safe care.
• You are an important part of a team that includes all of the health care providers you rely on to manage your health. Giving your team a complete picture of everything you do to take care of your health makes them your fully informed partners—and it helps you stay in control of your own health care.

Tips for Talking With Your Health Care Providers About Complementary and Alternative Medicine

• Don’t wait for your health care providers to ask about your use of complementary and alternative therapies. Be proactive—start the conversation.
• Keep a current list of all of your medical conditions and your therapies and treatments, including over-the-counter and prescription medicines and any products such as herbal and dietary supplements that you take. Also list any other complementary or alternative practices you use, such as meditation, acupuncture, or massage therapy. Note any medical specialists or other practitioners you see. Take the list with you whenever you visit a health care provider. Be sure to tell all your health care providers about all of your medical conditions, therapies, and treatments. Also include all medical conditions, therapies, and treatments on any patient history forms you fill out.
• Gather information on the complementary or alternative therapy you’re interested in. The resources listed below (see For More Information) are a good place to start. You may want to take the information with you; that way, you and your health care provider can reference them as you talk, and your health care provider can help you evaluate the information.
• Make a list of the things you want to talk about. For example, if you’re considering taking an herbal supplement, you might include:
  • Why I want to take the supplement
  • How I found out about it
  • Is it safe for me to take?
  • Can it cause problems for me because of my medical conditions?
  • Will it interact with any of my medications?
  • Is it likely to help me?
  • What else should I know about it? Where can I find reliable information?
  • Should I try this? If not, why not? Might something else be better?
• Take a notepad or recording device with you. Listen carefully and keep a record of what you find out. You may want to ask a family member or friend to accompany you, so you can compare notes after your visit.
• If something is unclear to you, or if you want more information, don’t be afraid to ask. Your health care providers may not be able to answer every question, but they can help you find the answers.

Selected References

• Be an active member of your health care team. U.S. Food and Drug Administration Web site. Accessed at www.fda.gov/Drugs/ResourcesForYou/ucm079487.htm on January 19, 2011.
• National Center for Complementary and Alternative Medicine. Time to Talk: Tell Your Health Care Provider About Your Use of Complementary and Alternative Medicine. National Center for Complementary and Alternative Medicine Web site. Accessed at nccam.nih.gov/timetotalk/forpatients.htm on January 19, 2011.
• Questions Are the Answer. U.S. Agency for Healthcare Research and Quality Web site. Accessed at www.ahrq.gov/questionsaretheanswer/ on January 31, 2011.
• Talking to your doctor: resources from NIH. National Institutes of Health Web site. Accessed at www.nih.gov/clearcommunication/talktoyourdoctor.htm on January 19, 2011.
• Talking with your doctor. National Library of Medicine Web site. Accessed at www.nlm.nih.gov/medlineplus/talkingwithyourdoctor.html on January 19, 2011.
• Talking with your doctor. NIH Senior Health Web site. Accessed at nihseniorhealth.gov/talkingwithyourdoctor/toc.html on January 19, 2011.

Colds and Flu

Complementary and Alternative Medicine (CAM) approaches.

Introduction

No one looks forward to the cold and flu season. Americans catch an estimated 1 billion colds each year. In fact, the common cold is among the leading reasons for visiting a doctor and for missing school or work. The flu, with its potential complications, can be an even greater concern. Each year, an estimated 5 to 20 percent of Americans come down with the flu. Although most recover without incident, flu-related complications result in more than 200,000 hospitalizations and 36,000 deaths annually.

In an effort to prevent or treat these all-too-common illnesses, some people turn to complementary and alternative medicine (CAM) approaches. This fact sheet provides basic information on colds and flu, as well as “what the science says” about some of these CAM approaches. If you are considering using a CAM therapy for colds or flu, this information can help you talk to your health care provider about it.

CAM and the Common Cold

About the Common Cold

The common cold is a viral infection of the upper respiratory system. Many different viruses, including various types of rhinovirus, can cause colds. Children are especially susceptible, in part because their immune systems have not yet developed resistance to cold-causing viruses. Research suggests that stress can lower resistance to colds. Researchers are also looking at possible connections between a number of other factors—environmental and personal—and susceptibility to colds.

People can catch a cold by touching a virus-contaminated surface and then touching their eyes or nose, or by inhaling airborne droplets of infected mucus. Symptoms usually appear 1 to 3 days after exposure and include sneezing, runny or stuffy nose, sore throat, and cough. The average cold lasts a week. Although colds sometimes are mistaken for influenza, the two conditions are caused by different viruses, and only the flu is likely to involve a high fever and extreme fatigue.

The chances of catching a cold can be reduced by washing the hands frequently and avoiding contact with people who have colds. People with colds are advised to rest and drink fluids. Over-the-counter pain or cold medicines can help relieve symptoms. Antibiotics do not fight cold viruses. There is no vaccine to prevent the common cold, and there is no known cure.

CAM Practices People Use for Colds

People try many different CAM therapies in their efforts to fight colds (see Fighting Colds With CAM). According to estimates based on the 2007 National Health Interview Survey (NHIS), colds ranked eighth among adults and third among children as a medical condition prompting CAM use.

What the Science Says About CAM and the Common Cold

There is no conclusive scientific evidence that any CAM therapy prevents colds or substantially reduces their duration or severity in adults or children. Although some studies suggest possible benefits, overall evidence for specific CAM therapies is limited and/or mixed, and many studies have been methodologically flawed. Given the public health burden of the common cold, and the widespread use of some CAM therapies to fight colds, researchers continue to investigate potential CAM options, including the dietary supplements commonly used for colds—echinacea, vitamin C, and zinc.

Many people take echinacea supplements to prevent or treat colds. (In the 2007 NHIS, echinacea was the most commonly used natural nonvitamin/nonmineral supplement among children, and the third most commonly used supplement among adults.) These products vary widely, using different echinacea species, plant parts, and preparations. The many clinical trials of echinacea for colds have also varied widely, in terms of products studied, research methodology, and study results. Reviews of the research have found some limited evidence that echinacea may be useful for treating colds in adults. Results are less promising for children and for preventing colds. Three NCCAM-funded trials found no benefit from echinacea for preventing or treating colds. A 2008 evaluation of the research concluded that clinical data on echinacea so far are not conclusive and suggested directions for further research.

Evidence of vitamin C for the prevention and treatment of the common cold has been mixed. A 2007 analysis of results from 30 clinical trials involving 11,350 participants found that taking vitamin C regularly (at least 0.2 grams per day) did not reduce the likelihood of getting a cold, but was associated with slight reduction in the duration and severity of cold symptoms. Among participants in six trials who were exposed to extreme physical or cold stress (e.g., soldiers in subarctic conditions) and took vitamin C, a 50-percent reduction in the risk of getting a cold was seen. Analysis of several other trials involving adults who started vitamin C therapy after onset of cold symptoms did not find convincing evidence of an effect on duration or severity of colds. A 2009 review of the research on vitamins and minerals for colds concluded that vitamin C supplementation has shown some potential for treating colds; the review noted, however, that few therapeutic trials have been published (none studying children) and that more research is needed to determine optimal doses and treatment strategies. Vitamin C is generally considered safe; however, side effects have been reported when taken in high doses.

Zinc is present in a number of products sold as natural medicines for colds. In 2009, the U.S. Food and Drug Administration warned consumers to stop using intranasal zinc products (zinc-containing homeopathic cold remedies), because of case reports of nosmia (loss of smell). The effect of zinc on the severity or duration of cold symptoms is inconclusive; some studies find benefits, others do not. In a 2007 review of the research, three of the four studies that met all of the reviewers’ quality criteria found no therapeutic effect from zinc lozenges or nasal spray; one study reported positive results for zinc nasal gel. A study reported in 2008 found that zinc acetate lozenges reduced the severity and duration of cold symptoms, compared with placebo. A 2009 review of the research on vitamins and minerals for colds noted that variations in the results of zinc lozenge trials are related mainly to variations in dosage, and that doses of more than 70 mg per day have consistently reduced the duration of colds; the review concluded that zinc has shown potential for treating colds, and that additional research is needed to determine optimal doses and treatment strategies.

CAM and the Flu

About the Flu

Influenza (flu) is a contagious respiratory illness caused by influenza viruses. Seasonal flu outbreaks occur annually. Flu viruses are very changeable, and the common strains are different from year to year. Usually these changes are gradual; however, sometimes a new, potent strain (such as 2009′s H1N1 virus) emerges suddenly and causes a major flu epidemic, or even a pandemic—i.e., the illness becomes very widespread.

The flu is not the same as the common cold (different viruses are involved), and it is unrelated to what is often called “stomach flu.” Like colds, though, the flu spreads easily from person to person through virus-contaminated surfaces or through the air. Symptom onset is likely to be abrupt for the flu, more gradual for colds. Flu symptoms are usually more severe than cold symptoms and are likely to include fever (often high), headache, muscle and joint pain, and extreme fatigue. Young children, older adults, pregnant women, and people with certain chronic health conditions are at increased risk of flu-related complications such as pneumonia.

Vaccination is the best protection against contracting the flu. As with colds, the chances of catching the flu can also be reduced by washing hands frequently and avoiding contact with people who have the flu. If taken within 48 hours of symptom onset, the prescription antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can reduce the severity and duration of flu symptoms.

CAM Practices People Use for the Flu

Although there are vaccines to prevent the flu, prescription drugs to treat it, and over-the-counter remedies that can help relieve symptoms, people may use CAM approaches—including various natural products and mind-body practices—in hopes of strengthening their resistance to flu viruses and recovering more quickly from bouts of the flu.

What the Science Says About CAM and the Flu

There is no conclusive scientific evidence that any CAM therapy is useful against the flu. Some studies suggest a potential role for certain therapies, but the evidence is very limited, and additional research is needed before any of these therapies can be recommended as safe and helpful in preventing or treating the flu. Research is ongoing in areas of CAM that may have relevance for combating the flu.

Examples of natural products that some people try in their efforts to combat the flu include elderberry, echinacea, North American ginseng, Chinese medicinal herbs, oscillococcinum, green tea, vitamin D, vitamin C, N-acetylcysteine (NAC), and dehydroepiandrosterone (DHEA). The mind-body practices sometimes used for flu include mindfulness meditation and tai chi.

NCCAM-Funded Research

NCCAM-supported researchers are conducting a variety of studies relevant to colds and flu. Examples of recent research include:

• Effects of echinacea, placebo, and doctor-patient interactions on the duration and severity of colds
• Biological mechanisms underlying the role of stress in susceptibility to colds
• Selenium supplementation for boosting immunity to colds and flu
• Meditation and exercise for preventing acute respiratory infections in men and women age 50 and older, including effects on antibody response to flu vaccination
• Methods for evaluating the effects of botanicals on the human immune response.

If You Are Considering CAM for Colds or Flu

• Do not use any CAM therapy as a substitute for vaccination against the flu. There is no conclusive scientific evidence that any CAM therapy works to prevent or treat colds or the flu, but evidence is especially limited for the flu.
• Talk to your health care providers. Tell them about the CAM therapy you are considering for preventing or treating colds or flu, and ask any questions you may have. They may know about the therapy and be able to advise you on its safety, use, and likely effectiveness.
• If you are considering dietary supplements, keep in mind that they can act in the same way as drugs. They can cause medical problems if not used correctly or if used in large amounts, and some may interact with medications. Your health care provider can advise you. If you are pregnant or nursing a child, or if you are considering giving a child a dietary supplement, it is especially important to consult your health care provider. To learn more, see the NCCAM fact sheet Using Dietary Supplements Wisely.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM’s Time to Talk campaign.

Selected References

• Arroll B. Non-antibiotic treatments for upper-respiratory tract infections (common cold). Respiratory Medicine. 2005;99:1477–1484.
• Barrett BP, Brown RL, Locken K, et al. Treatment of the common cold with unrefined echinacea: a randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine. 2002;137(12):939–946.
• Bukutu C, Le C, Vohra S. Complementary, holistic, and integrative medicine: the common cold. Pediatrics in Review. 2008;29(12):e66–e71.
• Caruso TJ, Prober CG, Gwaltney JM Jr. Treatment of naturally acquired common colds with zinc: a structured review. Clinical Infectious Diseases. 2007;45:569–574.
• Chen X, Wu T, Liu G, et al. Chinese medicinal herbs for influenza. Cochrane Database of Systematic Reviews. 2007;(4):CD004559.
• Cohen S. Keynote presentation at the Eighth International Congress of Behavioral Medicine: the Pittsburgh common cold studies: psychosocial predictors of susceptibility to respiratory infectious illness. International Journal of Behavioral Medicine. 2005;12(3):123–131.
• Common cold. National Institute of Allergy and Infectious Diseases Web site. Accessed at www.niaid.nih.gov/topics/commoncold/Pages/default.aspx on October 1, 2009.
• Common cold. Natural Standard Database Web site. Accessed October 2, 2009.
• Davidson RJ, Kabat-Zinn J, Schumacher J, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine. 2003;65(4):564–570.
• Dietary supplement fact sheet: zinc. Office of Dietary Supplements Web site. Accessed at ods.od.nih.gov/FactSheets/Zinc_pf.asp on November 3, 2009.
• Doyle WJ, Cohen S. Etiology of the common cold: modulating factors. In: Eccles R, Weber O, eds. Common Cold. Basel, Switzerland: Birkhäuser; 2009:149–186.
• Eccles R, Weber O, eds. Common Cold. Basel, Switzerland: Birkhäuser; 2009.
• Echinacea. Natural Medicines Comprehensive Database Web site. Accessed June 29, 2007.
• Flu (influenza). National Institute of Allergy and Infectious Diseases Web site. Accessed at www.niaid.nih.gov/topics/Flu/pages/default.aspx on November 9, 2009.
• Guo R, Pittler MH, Ernst E. Complementary medicine for treating or preventing influenza or influenza-like illness. American Journal of Medicine. 2007;120(11):923–929.
• Hemilä H. Vitamins and minerals. In: Eccles R, Weber O, eds. Common Cold. Basel, Switzerland: Birkhäuser; 2009:275–307.
• Hemilä H, Chalker E, Treacy B, et al. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2007;(3):CD000980.
• Influenza. Natural Standard Database. Accessed November 9, 2009.
• Information on Zicam cold remedy nasal gel, Zicam cold remedy nasal swabs, and Zicam cold remedy swabs, kids size. U.S. Food and Drug Administration Web site. Accessed at www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm166834.htm on November 4, 2009.
• Key facts about seasonal influenza (flu). Centers for Disease Control and Prevention Web site. Accessed at www.cdc.gov/flu/keyfacts.htm on November 9, 2009.
• Linde K, Barrett B, Bauer R, et al. Echinacea for preventing and treating the common cold. Cochrane Database of Systematic Reviews. 2006;(1):CD000530.
• Lissiman E, Bhasale AL, Cohen M. Garlic for the common cold. Cochrane Database of Systematic Reviews. 2009;(3):CD006206.
• Mihail F. Herbal, traditional and alternative remedies. In: Eccles R, Weber O, eds. Common Cold. Basel, Switzerland: Birkhäuser; 2009:309–347.
• Natural medicines in the clinical management of cold and flu. Natural Medicines Comprehensive Database. Accessed November 9, 2009.
• Prasad AS, Beck FWJ, Bao B, et al. Duration and severity of symptoms and levels of plasma interleukin-1 receptor antagonist, soluble tumor necrosis factor receptor, and adhesion molecules in patients with common cold treated with zinc acetate. Journal of Infectious Diseases. 2008;197(6):795–802.
• Rakel DP, Hoeft TJ, Barrett BP, et al. Practitioner empathy and the duration of the common cold. Family Medicine. 2009;41(7):494–501.
• Roxas M, Jurenka J. Colds and influenza: a review of diagnosis and conventional, botanical, and nutritional considerations. Alternative Medicine Review. 2007;12(1):25–48.
• Schoop R, Klein P, Suter A, et al. Echinacea in the prevention of induced rhinovirus colds: a meta-analysis. Clinical Therapeutics. 2006;28(2):174–183.
• Shah SA, Sander S, White CM, et al. Evaluation of echinacea for the prevention and treatment of the common cold: a meta analysis. Lancet Infectious Diseases. 2007;7:473–480.
• Song JM, Park KD, Lee KH, et al. Biological evaluation of anti-influenza viral activity of semi-synthetic catechin derivatives. Antiviral Research. 2007;76(2):178–185.
• Stokley S, Cullen KA, Kennedy A, et al. Adult vaccination coverage levels among users of complementary/alternative medicine-results from the 2002 National Health Interview Survey (NHIS). BMC Complementary and Alternative Medicine. 2008;8(6).
• Taylor JA, Weber W, Standish L, et al. Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial. Journal of the American Medical Association. 2003;290(21):2824–2830.
• Turner RB, Bauer R, Woelkart, et al. An evaluation of Echinacea angustifolia in experimental rhinovirus infections. New England Journal of Medicine. 2005;353(4):341–348.
• Vlachojannis JE, Cameron M, Chrubasik S. A systematic review on the Sambuci fructus effect and efficacy profiles. Phytotherapy Research. 2010;24(1):1–8.
• Wang X, Jia W, Zhao A, et al. Anti-influenza agents from plants and traditional Chinese medicine. Phytotherapy Research. 2006;20(5):335–341.
• Woelkart K, Linde K, Bauer R. Echinacea for preventing and treating the common cold. Planta Medica. 2008;74:633–634.
• Yamshchikov AV, Desai NS, Blumberg H, et al. Vitamin D for treatment and prevention of infectious diseases: a systematic review of randomized controlled trials. Endocrine Practice. 2009; 15(5):438–449.
• Yang Y, Verkuilen J, Rosengren KS, et al. Effects of a taiji and qigong intervention on the antibody response to influenza in older adults. American Journal of Chinese Medicine. 2007;35(4): 597–607.
• Zhang X, Wu T, Zhang J, et al. Chinese medicinal herbs for the common cold. Cochrane Database of Systematic Reviews. 2007;(1):CD004782.

Introduction

This fact sheet provides basic information about the herb ginkgo—common names, uses, potential side effects, and resources for more information. The ginkgo tree is one of the oldest types of trees in the world. Ginkgo seeds have been used in traditional Chinese medicine for thousands of years, and cooked seeds are occasionally eaten.

Common Names—ginkgo, Ginkgo biloba, fossil tree, maidenhair tree, Japanese silver apricot, baiguo, bai guo ye, kew tree, yinhsing (yin-hsing)

Latin Name—Ginkgo biloba

What Ginkgo Biloba Is Used For

• Ginkgo leaf extract has been used to treat a variety of ailments and conditions, including asthma, bronchitis, fatigue, and tinnitus (ringing or roaring sounds in the ears).
• Today, people use ginkgo leaf extracts hoping to improve memory; to treat or help prevent Alzheimer’s disease and other types of dementia; to decrease intermittent claudication (leg pain caused by narrowing arteries); and to treat sexual dysfunction, multiple sclerosis, tinnitus, and other health conditions.

How Ginkgo Biloba Is Used

Extracts are usually taken from the ginkgo leaf and are used to make tablets, capsules, or teas. Occasionally, ginkgo extracts are used in skin products.

What the Science Says

• Numerous studies of ginkgo have been done for a variety of conditions. Among the most widely researched are dementia, memory impairment, intermittent claudication, and tinnitus.
• An NCCAM-funded study of the well-characterized ginkgo product EGb-761 found it ineffective in lowering the overall incidence of dementia and Alzheimer’s disease in the elderly. Further analysis of the same data also found ginkgo to be ineffective in slowing cognitive decline, lowering blood pressure, or reducing the incidence of hypertension. In this clinical trial, known as the Ginkgo Evaluation of Memory study, researchers recruited more than 3,000 volunteers age 75 and over who took 240 mg of ginkgo daily. Participants were followed for an average of approximately 6 years.
• Some smaller studies of ginkgo for memory enhancement have had promising results, but a trial sponsored by the National Institute on Aging of more than 200 healthy adults over age 60 found that ginkgo taken for 6 weeks did not improve memory.
• Overall, the evidence on ginkgo for symptoms of intermittent claudication has not yet shown a significant benefit for this condition, although several small studies have found modest improvements. There is conflicting evidence on the efficacy of ginkgo for tinnitus.
• Other NCCAM-funded research includes studies of ginkgo for symptoms of multiple sclerosis, intermittent claudication, cognitive decline, sexual dysfunction due to antidepressants, insulin resistance, and short-term memory loss associated with electroconvulsive therapy for depression.

Side Effects and Cautions

• Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported.
• There are some data to suggest that ginkgo can increase bleeding risk, so people who take anticoagulant drugs, have bleeding disorders, or have scheduled surgery or dental procedures should use caution and talk to a health care provider if using ginkgo.
• Fresh (raw) ginkgo seeds contain large amounts of a chemical called ginkgotoxin, which can cause serious adverse reactions—even seizures and death. Roasted seeds can also be dangerous. Products made from standardized ginkgo leaf extracts contain little ginkgotoxin and appear to be safe when used orally and appropriately.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM’s Time to Talk campaign.

Search the scientific literature for potential herb-drug interactions

Sources

• Brinkley TE, Lovato JF, Arnold AM, et al. Effect of Ginkgo biloba on blood pressure and incidence of hypertension in elderly men and women. American Journal of Hypertension. 2010;23(5):528–533.
• DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. Journal of the American Medical Association. 2008;300(19):2253–2262.
• Ginkgo. Natural Medicines Comprehensive Database Web site. Accessed at www.naturaldatabase.com on August 20, 2009.
• Ginkgo (Ginkgo biloba L.). Natural Standard Database Web site. Accessed at www.naturalstandard.com on August 20, 2009.
• Ginkgo biloba. In: Coates P, Blackman M, Cragg G, et al., eds. Encyclopedia of Dietary Supplements. New York, NY: Marcel Dekker; 2005:249–257.
• Ginkgo biloba leaf extract. In: Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Lippincott Williams & Wilkins; 2000:359–366.
• Snitz BE, O’Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. Journal of the American Medical Association. 2009;302(24):2663–2670.
• Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: a randomized controlled trial. Journal of the American Medical Association. 2002;288(7):835–840.

What Is Cosmetic Acupuncture?

Cosmetic Acupuncture is an effective way to remove fine lines and wrinkles from the face. It can reduce the signs of aging by revitalizing the skin and providing a more youthful look to the face. Cosmetic Acupuncture will also help to rejuvenate facial tissue by increasing circulation to the area, and stimulating collagen production, resulting in a healthy glowing complexion. It is based on the ancient principles of Chinese Medicine and has been used for over 3,000 years.

By inserting very fine, hair-thin, disposable needles into specific acupuncture points on the face, there is a rush of blood circulation. The skin becomes nourished, oxygenated and moisturized, from the inside out. When there is more circulation, the body produces more collagen and this, in turn, gives the skin more tightness and elasticity, helping to reduce and/or eliminate sagging skin, wrinkles, double chin, etc..

A 1996 report in The International Journal of Clinical Acupuncture reported that among 300 cases treated with Cosmetic Acupuncture, 98% had marked effects with one course of treatment. The effects included: the skin becoming tighter and lifted, improvement of the elasticity and overall rejuvenation.

Cosmetic Acupuncture has been very popular in New York and Los Angeles in recent years. In the past, it was exclusively used by the rich and famous. Many Hollywood actresses are known to have this treatment done and super models receive acupuncture facelifts prior to photo shoots to make them glow. The real advantage to Cosmetic Acupuncture is that there is no risk involved, no downtime from work, and no side effects. By also using acupuncture points on the body, the circulation of blood and energy will be enhanced, thus promoting overall health and well being.

Benefits of Cosmetic Acupuncture

   * Reduce or eliminate fine lines and wrinkles
   * Reduce or eliminate puffy eyes
   * Reduce double chin
   * Improve circulation
   * Tighten pores
   * Reduce or eliminate frown lines
   * Raise drooping eyelids
   * Increase collagen production
   * Lift sagging skin
   * Reduce or eliminate dark circles under the eyes

Cosmetic Acupuncture Treatments Ten to twelve one hour sessions are the recommended protocol. Two treatments per week over five to six weeks is most beneficial, however, one treatment per week for ten to twelve weeks can show noticeable results, however, at a slower rate.

Skin Care Therapy In addition to Cosmetic Acupuncture, Facial Massage and Chinese Herbal Formulas can be used to enhance the desired results. Botanical creams and masks, dietary changes and supplementation if necessary is included in the therapy. Results are noticeable after the first treatment and can last 3-5 years with monthly maintenance.

Introduction

Traditional Chinese medicine (TCM) originated in ancient China and has evolved over thousands of years. TCM practitioners use herbs, acupuncture, and other methods to treat a wide range of conditions. In the United States, TCM is considered part of complementary and alternative medicine (CAM). This fact sheet provides a general overview of TCM and suggests sources for additional information. Key Points

• Herbal remedies and acupuncture are the treatments most commonly used by TCM practitioners. Other TCM practices include moxibustion, cupping, massage, mind-body therapy, and dietary therapy.
• The TCM view of how the human body works, what causes illness, and how to treat illness is different from Western medicine concepts. Although TCM is used by the American public, scientific evidence of its effectiveness is, for the most part, limited. Acupuncture has the largest body of evidence and is considered safe if practiced correctly. Some Chinese herbal remedies may be safe, but others may not be.
• TCM is typically delivered by a practitioner. Before using TCM, ask about the practitioner’s qualifications, including training and licensure.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

Background

Traditional Chinese medicine, which encompasses many different practices, is rooted in the ancient philosophy of Taoism and dates back more than 5,000 years. Today, TCM is practiced side by side with Western medicine in many of China’s hospitals and clinics.

TCM is widely used in the United States. Although the exact number of people who use TCM in the United States is unknown, it was estimated in 1997 that some 10,000 practitioners served more than 1 million patients each year. According to the 2007 National Health Interview Survey, which included questions on the use of various CAM therapies, an estimated 3.1 million U.S. adults had used acupuncture in the previous year. In addition, according to this same survey, approximately 17 percent of adults use natural products, including herbs, making it the most commonly used therapy. In another survey, more than one-third of the patients at six large acupuncture clinics said they also received Chinese herbal treatments at the clinics. Underlying Concepts

Underlying the practice of TCM is a unique view of the world and the human body that is different from Western medicine concepts. This view is based on the ancient Chinese perception of humans as microcosms of the larger, surrounding universe—interconnected with nature and subject to its forces. The human body is regarded as an organic entity in which the various organs, tissues, and other parts have distinct functions but are all interdependent. In this view, health and disease relate to balance of the functions.

The theoretical framework of TCM has a number of key components:

• Yin-yang theory—the concept of two opposing, yet complementary, forces that shape the world and all life—is central to TCM.
• In the TCM view, a vital energy or life force called qi circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi.
• The TCM approach uses eight principles to analyze symptoms and categorize conditions: cold/heat, interior/exterior, excess/deficiency, and yin/yang (the chief principles). TCM also uses the theory of five elements—fire, earth, metal, water, and wood—to explain how the body works; these elements correspond to particular organs and tissues in the body.

These concepts are documented in the Huang Di Nei Jing (Inner Canon of the Yellow Emperor), the classic Chinese medicine text. Treatment

TCM emphasizes individualized treatment. Practitioners traditionally used four methods to evaluate a patient’s condition: observing (especially the tongue), hearing/smelling, asking/interviewing, and touching/palpating (especially the pulse).

TCM practitioners use a variety of therapies in an effort to promote health and treat disease. The most commonly used are Chinese herbal medicine and acupuncture.

• Chinese herbal medicine. The Chinese materia medica (a pharmacological reference book used by TCM practitioners) contains hundreds of medicinal substances—primarily plants, but also some minerals and animal products—classified by their perceived action in the body. Different parts of plants such as the leaves, roots, stems, flowers, and seeds are used. Usually, herbs are combined in formulas and given as teas, capsules, tinctures, or powders.
• Acupuncture. By stimulating specific points on the body, most often by inserting thin metal needles through the skin, practitioners seek to remove blockages in the flow of qi.

Other TCM therapies include moxibustion (burning moxa—a cone or stick of dried herb, usually mugwort—on or near the skin, sometimes in conjunction with acupuncture); cupping (applying a heated cup to the skin to create a slight suction); Chinese massage; mind-body therapies such as qi gong and tai chi; and dietary therapy. Status of TCM Research

In spite of the widespread use of TCM in China and its use in the West, scientific evidence of its effectiveness is, for the most part, limited. TCM’s complexity and underlying conceptual foundations present challenges for researchers seeking evidence on whether and how it works. Most research has focused on specific modalities, primarily acupuncture and Chinese herbal remedies.

Acupuncture research has produced a large body of scientific evidence. Studies suggest that it may be useful for a number of different conditions, but additional research is still needed.

Chinese herbal medicine has also been studied for a wide range of conditions. Most of the research has been done in China. Although there is evidence that herbs may be effective for some conditions, most studies have been methodologically flawed, and additional, better designed research is needed before any conclusions can be drawn. Examples of TCM Uses and Studies

Both acupuncture and Chinese herbal medicine have been used and studied for a wide range of conditions. A few examples are Acupuncture

   * Back pain
   * Chemotherapy-induced nausea
   * Depression
   * Osteoarthritis

Chinese herbal medicine

   * Cancer
   * Heart disease
   * Diabetes
   * HIV/AIDS

Safety

The U.S. Food and Drug Administration (FDA) regulations for dietary supplements (including manufactured herbal products) are not the same as those for prescription or over-the-counter drugs; in general, the regulations for dietary supplements are less strict. Some Chinese herbal treatments may be safe, but others may not. There have been reports of products being contaminated with drugs, toxins, or heavy metals or not containing the listed ingredients. Some of the herbs are very powerful, can interact with drugs, and may have serious side effects. For example, the Chinese herb ephedra (ma huang) has been linked to serious health complications, including heart attack and stroke. In 2004, the FDA banned the sale of ephedra-containing dietary supplements used for weight loss and performance enhancement, but the ban does not apply to TCM remedies or to herbal teas.

Acupuncture is considered safe when performed by an experienced practitioner using sterile needles. Training, Licensing, and Certification

Most states license acupuncture, but states vary in their inclusion of other TCM components (e.g., herbal medicine) in the licenses they issue. The federally recognized Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) accredits schools that teach acupuncture and TCM, and about one-third of the states that license acupuncture require graduation from an ACAOM-accredited school. The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers separate certification programs in acupuncture, Chinese herbology, and Oriental bodywork. Almost all licensing states require completion of NCCAOM’s national written exam; some states also require a practical exam.

If You Are Thinking About Using TCM

• Look for published research studies on TCM for the health condition that interests you.
• If you are thinking about trying TCM herbal remedies, it is better to use these products under the supervision of a medical professional trained in herbal medicine than to try to treat yourself.
• Ask about the training and experience of the TCM practitioner you are considering.
• Do not use TCM as a replacement for effective conventional care or as a reason to postpone seeing a doctor about a medical problem.
• If you are pregnant or nursing, or are thinking of using TCM to treat a child, you should be especially sure to consult your health care provider.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about CAM, see NCCAM’s Time to Talk campaign.

Selected References

• Barnes PM, Bloom B, Nahin R. Complementary and alternative medicine use among adults and children: United States, 2007. CDC National Health Statistics Report #12. 2008.
• Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Rev. ed. Seattle, WA: Eastland Press; 1993.
• Cassidy, C. Chinese medicine users in the United States. Part I: utilization, satisfaction, medical plurality. Journal of Alternative and Complementary Medicine. 1998;4(1):17–27.
• Eisenberg DM, Cohen MH, Hrbek A, et al. Credentialing complementary and alternative medical providers. Annals of Internal Medicine. 2002;137(12):965–973.
• National Center for Complementary and Alternative Medicine. Acupuncture: An Introduction. Bethesda, MD: National Center for Complementary and Alternative Medicine. NCCAM publication no. D404.
• National Center for Complementary and Alternative Medicine. Using Dietary Supplements Wisely. Bethesda, MD: National Center for Complementary and Alternative Medicine. NCCAM publication no. D426.
• National Institutes of Health Consensus Panel. Acupuncture: National Institutes of Health Consensus Development Conference Statement. National Institutes of Health Web site. Accessed at http://consensus.nih.gov/1997/1997acupuncture107html.htm on July 15, 2008.
• O’Brien KA, Xue CC. The theoretical framework of Chinese medicine. In: Leung PC, Xue CC, Cheng YC, eds. A Comprehensive Guide to Chinese Medicine. River Edge, NJ: World Scientific Publishing Co.; 2003.
• Shang A, Huwiler K, Nartey L, et al. Placebo-controlled trials of Chinese herbal medicine and conventional medicine comparative study. International Journal of Epidemiology. 2007;36(5):1086–1092.
• Shankar K, Liao, LP. Traditional systems of medicine. Physical Medicine and Rehabilitation Clinics of North America. 2004;15(4):725–747.
• Traditional Chinese medicine. Natural Medicines Comprehensive Database. Accessed on June 4, 2008.
• Traditional Chinese medicine (TCM). Natural Standard Database Web site. Accessed on June 4, 2008.
• Xue CC, O’Brien KA. Modalities of Chinese medicine. In: Leung PC, Xue CC, Cheng YC, eds. A Comprehensive Guide to Chinese Medicine. River Edge, NJ: World Scientific Publishing Co.; 2003.

Many people take dietary supplements in an effort to be well and stay healthy. With so many dietary supplements available and so many claims made about their health benefits, how can a consumer decide what’s safe and effective? This fact sheet provides a general overview of dietary supplements, discusses safety considerations, and suggests sources for additional information.

Key Points

• Federal regulations for dietary supplements are very different from those for prescription and over-the-counter drugs. For example, a dietary supplement manufacturer does not have to prove a product’s safety and effectiveness before it is marketed.
• If you are thinking about using a dietary supplement, first get information on it from reliable sources. Keep in mind that dietary supplements may interact with medications or other dietary supplements and may contain ingredients not listed on the label.
• Tell your health care providers about any complementary and alternative practices you use, including dietary supplements. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Dietary Supplements

Dietary supplements were defined in a law passed by Congress in 1994 called the Dietary Supplement Health and Education Act (DSHEA). According to DSHEA, a dietary supplement is a product that:

• Is intended to supplement the diet
• Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents
• Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid
• Is labeled as being a dietary supplement.

Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or therapeutic properties. “Botanical” is often used as a synonym for “herb.” An herbal supplement may contain a single herb or mixtures of herbs.

Research has shown that some uses of dietary supplements are effective in preventing or treating diseases. For example, scientists have found that folic acid (a vitamin) prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the age- related eye disease macular degeneration. Also, calcium and vitamin D supplements can be helpful in preventing and treating bone loss and osteoporosis (thinning of bone tissue).

Research has also produced some promising results suggesting that other dietary supplements may be helpful for other health conditions (e.g., omega-3 fatty acids for coronary disease), but in most cases, additional research is needed before firm conclusions can be drawn.

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