More and more, Western and integrative medicine draw upon each other
In Western medicine, physicians and other health-care professionals primarily treat symptoms and diseases with drugs, radiation, rehabilitation or surgery.
In integrative medicine, practitioners combine conventional Western medicine with complementary and alternative therapies from other healing traditions.
The line, however, is blurring as ever more Western physicians look to some of these non-mainstream treatments, which may include herbs and supplements, acupuncture, meditation, massage, hypnosis and homeopathy.
According to the Mayo Clinic and the National Institutes of Health, about 40 percent of adults report using some form of integrative medicine. The Center for Advancing Health, a patient advocacy organization, says that about 75 percent of doctors, nurses and other health care professionals use complementary and alternative therapies for themselves.
Despite the overlap, there remain stark differences between the two medical models. The Journal talked to Dr. Mark Raterink, who practices integrative medicine at the Expanding Choices clinic, and Dr. Dion Gallant, medical director for primary care, Presbyterian Medical Group, to compare and contrast these differences.
In general, Raterink says conventional medical doctors overprescribe drugs, which he calls “a short-term fix for symptom management.” His integrative approach uses traditional Western medical technology and testing to see how cells and organ systems are “out of balance,” he says. Treatment then may involve diet and lifestyle changes and neutraceutical supplements, including vitamins, minerals, herbs, hormones and enzymes, he says.
Gallant agrees that lifestyle change can prevent or improve many conditions, “but there are times when medications are required.” Despite known side effects, those medications have been approved by the Food and Drug Administration after years of extensive testing for purity, safety and efficacy,” he says. The tests often involve double-blind studies and a placebo control group, a protocol that most supplements do not undergo.
Raterink, however, says that the supplements he prescribes for his patients have been tested and shown to work. Further, he estimates 70 percent to 80 percent of his patients turned to integrative medicine after traditional Western treatments and pharmaceuticals did not help their conditions or resulted in unwanted side effects.
Looking at a half dozen common maladies, Raterink and Gallant explain the approaches to treatment each might take:
Integrative: For an alternative to the commonly used statin drugs, Raterink is more likely to prescribe niacin or pantothenic acid, B vitamins to lower cholesterol, as well as omega-3 fish oils to lower triglycerides, another component of blood fat.
Statins, he says “deplete the body of CoQ10, an enzyme and vital nutrient for energy production and which is good for the heart.” Statins can also cause muscle pain and brain fog.
Western: “What matters at the end of the day is the outcome,” says Gallant. “People who take statins have fewer heart attacks and strokes, especially if they have heart disease and diabetes in addition to high cholesterol.”
He agrees that the first focus should be on diet and exercise. As for the depletion of CoQ10, it does happen, “but we don’t know what it means.”
High blood pressure
Integrative: First and foremost, people should eat a healthier diet, lower their salt and alcohol intake, exercise to reduce stress and stop smoking, says Raterink. Where a magnesium deficiency is indicated, supplements can be helpful, as can herbs like Hawthorne and nutrients such as arginine, an amino acid that increases the body’s level of nitric oxide, which dilates blood vessels so that they stay flexible.
Raterink is not a fan of the Western approach of prescribing diuretics, ACE inhibitors and beta blockers, all of which can deplete the body’s CoQ10 reserves, as well as deplete B and C vitamins, or prescribing calcium channel blockers that inhibit calcium from entering into the cells and thus interfere with cell processes.
Western: Gallant agrees with the lifestyle recommendations. FDA-approved blood pressure medications have been studied and despite their risks have been shown to decrease the incidence of heart attacks, strokes, kidney damage and eye damage, he says. Many of the supplements used for this purpose, “do not have long-term safety and efficacy studies.”
Integrative: When there is not enough acid in the stomach to digest food and move it through, “it sits and putrefies, which can cause reflux,” Raterink says. Antacids like Tums, Prilosec, Pepcid or Zantac de-acidify the stomach “and make it worse.”
Raterink may treat this with a hydrochloric acid supplement to increase the acid in the stomach. For those who have a thin stomach lining and can’t initially tolerate an increase in stomach acid, he might first do “other supplementation with nutrients that restore the lining.”
Western: There is a downside to acid-suppressing medications, agrees Gallant. When acid is suppressed, “things grow that shouldn’t be there,” like clostridium difficile, or “C. diff,” a bacteria that can cause severe diarrhea and other intestinal problems. He does not, however, recommend supplements to increase stomach acid.
He also agrees that lifestyle changes can be particularly effective: “Don’t eat too much, don’t eat late at night, don’t eat and lie down, and don’t eat greasy or spicy foods that are prone to cause heartburn.”
A surgical procedure to tighten the sphincter valve at the top of the stomach, preventing acid from entering the esophagus and causing acid reflux, may be of great benefit for some patients.
Integrative: In treating inflammation of the joints, Raterink avoids the standard nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen or naproxen and their various brand names.
“These can thin the lining of the stomach and cause gastrointestinal complications,” and they are hard on the kidneys. Instead, he suggests supplements like willow bark and the herbs boswellia and devil’s claw.
Western: The risks associated with long-term use of NSAIDs are real, but the drugs do provide relief for many people. Another option is Tylenol (acetaminophen), which is not an NSAID and is relatively safe.
Gallant agrees with Raterink that lifestyle changes are often helpful. People who have arthritis and are overweight can relieve pressure on their joints through weight loss and regular nonweight-bearing exercises.
Integrative: Early on, Raterink does comprehensive blood tests on patients to look for things like thyroid and adrenal functions that can affect mood. He also does a urine neurotransmitter panel “to give us an idea of the body’s stores of neurotransmitters, such as serotonin,” which also affect brain chemistry.
Neurotransmitters are protein, he says, and depression can sometimes be treated with protein supplements and supplements of amino acids in protein. Vitamin D deficiencies have also been correlated with depression, while the herb St. John’s Wort can also mitigate depression. Exercise is known to improve mood, and “talk” sessions with a counselor or therapist “often have better results than taking drugs, and there are no side effects.”
Western: It can take time to find the right medicine or combination of drugs to treat people for depression, says Gallant, “but for people with moderate or severe depression they can be life-saving.”
Yes, there is a correlation between low vitamin D and depression, “it’s the causality that’s unclear,” he says, and studies show that St. John’s Wort is only “minimally effective” for minor depression.
Not every case of depression is treated with drugs. In fact, Gallant notes, all Presbyterian primary care clinics have an integrated behavior clinician, such as a psychologist, on staff and can do on-site counseling and therapy.
Type 2 diabetes
Integrative: Also called acquired diabetes or insulin resistant diabetes, it is the most common type.
“If people change their diet and get some exercise, the results are better than medication,” Raterink says. It’s about discipline and lifestyle changes,” though he may also recommend nutrients for insulin resistance, such as alpha lipoic acid, chromium and herbs like gymnema or bitter melon.
Western: Gallant agrees that the first line of defense is change of diet, portion control and exercise. Supplements are not generally effective and severely diabetic people will need medication.
“The truth is more people than not will need medication when they are diabetic or pre-diabetic.”