Management of Obesity/Overweight through Integrative Medicine Approach...

Overview

Definition

 

Overweight is defined as a body-mass index (BMI) over 25 and obesity as a BMI over 30 (BMI is defined as the weight in kilograms divided by the square of the height in meters). A BMI of over 25 is associated with increased health risks. However. Approximately 33% of Americans 20 to 75 years of age are overweight, and of these, approximately one-third are severely obese. For both men and women, the prevalence of overweight increases with age.

 

Etiology 

While there is no single underlying etiology of simple obesity, the excessive weight reflects an imbalance between energy input and energy output. However, genetic and environmental factors may also play a role; for example, total body fat stores and the total number of fat cells are determined genetically and can make an individual susceptible to obesity. In addition, there are a number of rare congenital syndromes in which all affected individuals are obese, such as Prader–Willi syndrome, Cushing's syndrome, Alström syndrome, Laurence-Moon-Biedl syndrome, Cohen's syndrome, and Carpenter's syndrome. 

• Genetic predisposition 
• Insulinoma 
• Hypothalamic disorders 
• Overeating 
• High-fat diet 
• Decreased physical activity 
• Prescription medications (e.g., steroids, phenothiazines, tricyclic antidepressants, antiepileptics, antihypertensives) 
• Psychological factors (e.g., disturbance in body image, reaction to separation or death) 

Risk Factors 

• Familial predisposition 
• Sedentary lifestyle 
• High-fat diet 

Signs and Symptoms 

BMI over 25 to 30 

Differential Diagnosis 

• Cushing's disease—characterized by weight gain in the face, thorax, and abdomen, but sparing the buttocks and extremities 
• Hypothyroidism (60% of patients have only a modest weight gain) 
• Hypothalamic tumors (e.g., craniopharyngiomas) 
• Stein–Leventhal syndrome (in women)—characterized by obesity, hirsutism, and infertility 
• Klinefelter's syndrome (in men)—characterized by increased adipose tissue and reduced muscle mass 

 

Diagnosis

 

Physical Examination 

After determining the level of obesity in an individual patient, it is essential to determine whether complications such as diabetes, hypertriglyceridemia, and hypertension exist. It is also important to assess an obese patient's willingness and motivation to lose weight. 

Many obese patients are content being "overweight" and do not view 30 or 50 extra pounds as a problem. In addition, careful assessment of any previous history of weight loss; factors related to the onset of obesity; details of the patient's current eating habits; emotional well-being; and the patient's weight-losing goals is essential to the success of any treatment program.

 

Laboratory Tests 

• Fasting serum glucose 
• Thyroid function tests 
• Serum cholesterol and triglycerides 

Pathology/Pathophysiology 

Android (male) fat distribution is characterized by fat distributed above the waist. Upper body fat distribution appears to occur by hypertrophy of adipocytes. 

There are higher morbidity and mortality associated with the upper body than lower body fat distribution. 

Gynecoid (female) fat distribution is characterized by fat distributed in the lower body such as the buttocks, hips, and thighs. 

Lower body fat distribution appears to occur by hyperplasia (i.e., differentiation of new fat cells). Because it is easier to reduce the size of fat cells than the number of them, people with a lower body fat distribution often have a harder time losing weight. 

• Hyperplasia of adipocytes: Even if weight is lost, the number of fat cells is fixed. 
• Hypertrophy of adipocytes: Cell size will return to normal with weight loss. 

Imaging 

• Generally not necessary for diagnosis 
• Dual-energy X-ray absorptiometry—to analyze body fat 
• Magnetic resonance imaging and computed tomography—to measure regional fat distribution 

Other Diagnostic Procedures 

• Waist measure—above 35" in women or 40" in men is abnormal 
• Waist: hip ratio—to measure abdominal girth (>0.85 in women and >1.0 in men is abnormal) 
• Body-mass index (BMI)—to measure the level of obesity (BMI of 20 to 25 is considered normal)
• Weight and height tables (does not distinguish between obesity and overweight) 
• Skinfold thickness measured by skin calipers (triceps, biceps, subscapular, suprailiac)—to estimate total body fat 
• Underwater weighing—to calculate fat-free mass and body fat. 
• Measure total body water (fixed fat-free mass (FFM) equals water mass/0.73), which is subtracted from total body weight to obtain total body fat.

 

Treatment Options:

Treatment Strategy

 

• Lifelong lifestyle changes (e.g., exercise, behavior modification) and diet modification are necessary to control weight in obese patients. Many obese patients may have consumed more calories than they metabolized in their weight-gaining phase but currently may be eating enough merely to maintain weight gained previously. 
• Health care providers must assess the risks associated with obesity on an individual basis, using the BMI and fat distribution as well as comorbidities as guides for treatment. 
• Risk assessment may be critical to the process of setting goals and providing motivation. 
• No drug treatment has been shown to be safe and effective for long-term weight loss. 
• Surgical therapies for morbid obesity include gastric bypass (Roux-en-Y procedure), or stapling and liposuction for moderate fat redistribution. 
• It is important to enroll family members, especially spouses, in any lifestyle and diet changes that will affect the interactions of the relationship. Family activities such as shopping, cooking, and eating out all have an impact on diet and caloric intake.

 

Drug Therapies 

• Diuretics—for temporary use to reduce water retention; does not reduce adipose tissue stores 
• Ephedrine (20 to 60 mg/day) plus caffeine (200 to 600 mg/day)—to transiently increase the basal metabolic rate. (These over-the-counter drugs should not be taken by patients with heart disease, high blood pressure, thyroid disease, diabetes, or an enlarged prostate.) 

Complementary and Alternative Therapies 

The main thrust of alternative therapy is increasing the basal body metabolism and addressing the behavioral component. The bottom line is to expend more calories than are consumed. Most obese people have tried many diets and are frustrated with their lack of success. 

Alternative therapies can help stabilize blood sugars, promote a custom-tailored exercise plan, and treat emotional well-being. 

Mind-body techniques can be helpful, especially in reframing the goal of weight loss to the goal of health. 

Individual treatment plans addressing family history, personal health risks, and past successes can be important information in designing a plan. It is interesting to note that rates of both obesity and eating disorders are rising rapidly. 

Behavior modification (e.g., keeping a food journal, eating a diet low in total and saturated fats, beginning an exercise program, counseling to change eating and exercise habits) can be effective. Special emphasis should be placed on what has and has not been successful in the past. 

Nutrition 

• Protein: While the standard weight loss diet is low protein, high complex carbohydrates, some people will do better with a high protein, low carbohydrate diet. Regular meals that contain the protein are important for blood sugar stabilization. In either diet, it is important to use many foods that the patient enjoys. Liberal consumption of oat bran or garlic helps lower lipids slightly. Anecdotally, some people lose weight by eating protein at breakfast, which decreases afternoon or pre-dinner gorging and cravings for sweets. 
• Fluid: Six to eight glasses daily of nonsugared, caffeine-free drinks flush toxins, and increase a sense of satiety. 
• Fiber: Increasing dietary fiber (e.g., fruits, vegetables, psyllium, chitin, guar gum, glucomannan, gum karaya, and pectin) promotes weight loss by enhancing blood sugar control, reducing the number of calories that are absorbed, and increasing satiety. 
• Allergies: Many people find that avoiding allergenic foods (wheat, dairy, soy, eggs, and citrus) allows for diuresis and improved digestion. Other allergic foods may be discovered by using an IgG ELISA food allergy test. 
• Multiple vitamins to address any dietary imbalances 
• Chromium picolinate (200 to 500 mcg one to two times per day): claimed to preferentially burn fat, proven to increase insulin sensitivity, stabilize blood sugars. Helpful in those patients with sugar cravings. 
• Vitamin C (3,000 to 6,000 mg/day) speeds up metabolism, acts as an anti-inflammatory, and is needed for cholesterol metabolism. 
• Essential fatty acids (primrose oil, 2 to 4 g/day; flaxseed oil, 1 to 3 tbsp./day): One study showed a reduction in appetite and some weight loss without dieting. Fat cravings may be exacerbated by a fatty acid deficiency. 
• Lecithin, choline, methionine: (1 g/day of each) aids proper fat metabolism and decreases fat cravings 
• Thiamine: (2.5 mg/day) plays a role in fatty-acid metabolism and may decrease ketone formation, increased ketones may play a role in excessive hunger; in order to avoid imbalance, supplement with B-complex: B1 (50 to 100 mg), B2 (50 mg), B3 (25 mg), B5 (100 mg), B6 (50 to 100 mg), B12 (100 to 1,000 mcg), folate (400 mcg/day) 
• Kelp (1,000 to 2,000 mg/day, equivalent to 250 to 500 mcg of iodine per day) may aid in weight loss, as it provides nutrients for thyroid functioning. 
• L-glutamine (1,000 mg tid) may blunt carbohydrate craving. 
• Coenzyme Q10 is important in fatty-acid metabolism, may help break down fat into energy 
• 5-Hydroxytryptophan (5-HTP; 100 to 300 mg/day) to reduce food intake by promoting satiety. Acts as an antidepressant, especially with sleep disturbances 
• Fasting: For patients who don't have diabetes, fasting, or juice fasting one day a week is helpful to reset the appetite control system.

 

Herbs 

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted. 

Ma huang (Ephedra sinica) is used to stimulate the sympathetic nervous system in order to burn more fat. It is a constituent of most OTC weight loss products (1 cup tea or 30 drops tincture/day in the morning). Reacts with cardiac glycosides (arrhythmias), MAO-inhibitors (potentiates sympathomimetic effects), and secale alkaloids (hypertension). Patients need to be warned of the side effects and only use ephedra short term (if at all). 

A combination of four to six of the following herbs can be taken tid before meals (1 cup tea or 30 drops tincture). 

• Peppermint (Mentha piperita) carminative, spasmolytic, historically to reduce appetite 
• Bladderwrack (Fucus vesiculosus) historic use in obesity 
• Parsley (Petroselinum crispum) diuretic, historic use in gastrointestinal conditions 
• Dandelion (Taraxacum officinale) diuretic, dyspepsia 
• Hawthorn (Crataegus monogyna) reduces peripheral vascular resistance, historically a sedative 
• St. John's wort (Hypericum perforatum) antidepressant, historically with nerve pain 
• Valerian (Valeriana officinalis) bitter spasmolytic, sedative 
• Milk thistle (Silybum marianum) dyspepsia, specifically for liver and gallbladder 
• Lavender (Lavandula angustifolia) carminative, spasmolytic, relaxant 
• Gentian (Gentiana lutea) carminative, digestive stimulation 

Homeopathy

 

Homeopathic remedies may be of help in treating obesity, but the constitutional remedy for the specific individual should be prescribed by an experienced practitioner.

 

Physical Medicine 

Daily exercise program: exercise is critical to maintaining weight loss. While 20 minutes of aerobic exercise a day is ideal, as little as 10 minutes/day can help stabilize blood sugar and thereby reduce cravings. 

Gentle exercise (walking, yoga, swimming, biking) can increase cardiovascular health without undue stress on joints.

Dynamic Yoga practices (weight loss programs with yoga) are effectively used.

 

Acupuncture 

Acupuncture can be used to help balance the body's metabolism, stabilize blood sugar, correct digestive disorders, control certain eating disorders, aid in the elimination and relieve stress, anxiety, and depression that may lead to overeating. 

Massage 

May be beneficial. By decreasing stress, cortisol is decreased, which will help to stabilize blood sugar and help prevent or treat diabetes. also as a passive exercise.

 

Patient Monitoring 

.

A good provider-patient relationship is an essential ingredient for a successful treatment program. All obese patients must be monitored for the medical and psychological complications of obesity. 

Other Considerations 

Prevention 

Lifestyle changes are the key to successful weight loss in obese patients. Regular exercise and a long-term low-calorie diet can help to raise the basal metabolic rate (the rate at which calories are burned) and reset the set point (the weight the body tries to maintain by regulating the amount of food and calories consumed). 

Complications/Sequelae 

There is a known increase in morbidity (and mortality) associated with many of the complications of obesity. 

• Type II diabetes mellitus (adult-onset diabetes)—rare in individuals with a BMI <22
• Hypertension (blood pressure >160/95 mm Hg)— especially in patients 20% over ideal weight
• Coronary artery disease
• Hypercholesterolemia
• Hypertriglyceridemia as a result of increased insulin resistance and hyperinsulinemia
• Congestive heart failure and sudden death as a result of increased blood volume, stroke volume, cardiac output, and left ventricular end-diastolic volume
• Respiratory problems (e.g., Pickwickian syndrome, pulmonary hypertension) 
• Circulatory problems, such as varicose veins and venous stasis, which predisposes patients to venous thromboembolic disease 
• Endometrial and postmenopausal breast cancer in women, prostate cancer in men, and colorectal cancer in men and women 
• Gallbladder disease as a result of increased secretion of biliary cholesterol 
• Obstructive sleep apnea as a result of fat accumulation in the tracheopharyngeal area 
• Arthritis as a result of excess stress on joints especially of the lower extremities 
• Skin problems, such as acanthosis nigricans 

Prognosis 

• Eating and exercise habits are hard to change. Most obese patients have long histories of unsuccessful attempts to lose weight. 
• Approximately 10% to 60% of patients who attempt diet therapy are able to lose at least 20 pounds; however, only between 10% and 20% of patients are able to maintain their weight loss over time. 
• Patients should be told that losing 15 to 20 pounds is often responsible for a 10% to 25% decrease in health risks associated with obesity. 

Pregnancy

 

The complications of obesity can complicate pregnancy, resulting in increased risk for the fetus. Pregnancies in obese women should be considered high risk. 

• Gestational diabetes 
• Hypertension 
• Preeclampsia 
• Abnormally large infants resulting in difficult deliveries 
• Increase rate of cesarean sections with complications 
• Increased incidence of fetal distress and meconium staining

References: 

With regards Integrative Medicine

Management of Asthma through integrative medicine apporach...

Overview 

Definition

 

Asthma is a chronic inflammation of the airways associated with excess swelling and mucus, resulting in obstructed airflow. The airways may be further blocked when an irritant, or trigger, causes bronchial spasms to occur. Asthma symptoms are characteristically worse during sleep and may be intensified by emotion.

 

Etiology 

• Hypersensitivity to aeroallergens (including dust mites; cockroaches; dog, cat, or other animal proteins; fungal spores; pollens; dust; and fumes) 
• Respiratory infections 
• Gastroesophageal reflux 
• Air pollutants, such as tobacco, aerosols, perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone levels, and fumes from chemical-cleaning agents and gas stoves 
• Meteorological changes in temperature and humidity 
• Exercise 
• Emotional behaviors that alter breathing such as laughing, shouting, or crying 

Risk Factors 

• Family history of allergies or asthma 
• Genetic predisposition to immunoglobulin E (IgE) and genes located on chromosomes 5, 6, and 11 to 14 
• Exposure to aeroallergens and pollutants 
• Viral respiratory illness 
• Exposure to tobacco smoke 
• Exposure to irritants 
• Low socioeconomic status 
• African- and Hispanic-American race, for both prevalence and severity 
• Age and sex—older women and children 

Signs and Symptoms 

• Shortness of breath or dyspnea 
• Wheezing 
• Chest tightness or constriction 
• Cough (can be the only symptom) 
• Cyanosis 
• Flattened diaphragm and hyperinflated chest 

Differential Diagnosis 

• Mechanical obstruction of air passages 
• Functional disorders of the extrathoracic airway, especially of the larynx 
• Chronic obstructive pulmonary diseases (COPD), such as chronic bronchitis or emphysema 
• Cardiac asthma as a result of myxoma and left ventricle or mitral valve disease 
• Pulmonary embolism, although few have bronchoconstriction and wheezing 
• Eosinophilic lung diseases 
• Carcinoid tumors, especially with wheezing accompanied by flushing, facial rash, or diarrhea
• Congestive heart failure 
• Tuberculosis 
• Hyperventilation 

Diagnosis 

Physical Examination 

Physical signs of asthma may include tachypnea, tachycardia, exaggerated normal inspiratory fall of systolic blood pressure, hyperinflation of the chest, diaphoresis, prolonged expiration, musical-sonorous rhonchi, and wheezing during auscultation. 

Laboratory Tests

• CBC normal 
• Blood test to determine eosinophil levels for diagnosis 
• Blood leukocyte and red blood cell count (limited usefulness in diagnosis) 
• To distinguish from chronic bronchitis, sputum or "wet prep" test to reveal bronchial epithelium, eosinophils, Charcot-Leyden crystals, and Curschmann's spirals 

Pathology/Pathophysiology 

• Serum test that indicates elevated IgE antibody levels 
• Increased eosinophil level 
• Mucous plugs 
• Mucosal edema 

Imaging 

• Chest radiographs and computerized tomography to rule out abnormalities or other diseases 
• Sinus X rays for differential diagnosis 

Other Diagnostic Procedures 

• The diagnosis of asthma is best confirmed by the spirometric measurement of lung volume and flow rate improvement after the use of a bronchodilator. A decrease in forced expiratory volume in one second (FEV1) by 20% occurs after inhalation of methacholine (25 mg/ml) in 95% of asthmatics. 
• Bronchoprovocation tests for patients in remission and to determine the extent of aeroallergens and occupational exposure can be helpful but risky. 
• Sophisticated tests of lung mechanics are occasionally used. 
• For severe asthma, measurements of arterial blood tensions of oxygen and carbon dioxide as well as pH are indicated. 
• PPD yearly 
• Exercise tolerance tests 
• Electrocardiograms: may show sinus tachycardia as well as right axis shift and P pulmonale, which is indicative of negative tidal pleural pressure and increased right-side heart transmural pressure 

Treatment Options 

Treatment Strategy 

• Controlling environmental stimuli or triggers 
• Anti-inflammatory drugs to promote relaxation of the bronchial smooth muscle 
• Bronchodilator drugs to stimulate the beta2-adrenergic agonist receptors during an attack 
• Antibiotics, when precipitated by a bacterial infection 
• Combination of these treatments for severe attacks, in addition to oxygen and injected epinephrine in emergencies 

Drug Therapies 

• Nonsteroidal anti-inflammatory inhalers, such as cromolyn sodium (Intal); prevents mediator release from airway mast cells; dose-dependent on severity; may cause coughing 
• Corticosteroids, such as methylprednisolone (60 to 80 mg intravenous push each six to eight hours for 36 to 48 hours), for severe attacks; prevents migration and activation of inflammatory cells 
• Corticosteroid inhalers, such as beclomethasone dipropionate (Beclovent, Vanceril, or Asthmacort), 1 to 5 puffs two to four times a day; side effects include: cough, hoarseness, oral candidiasis (thrush); chronic adverse side effects rare 

Bronchodilators: 

• Beta2-adrenergic agonists, such as albuterol (more than 8 puffs three to four times a week warrants reassessment), administered by metered-dose inhalers (MDI) or by nebulizer in the hospital (every one to two hours); stimulate adrenaline or epinephrine receptors; side effects include: rapid or irregular heartbeat, insomnia, shakiness, nervousness 
• Anticholinergic agents, such as ipratropium bromide (Atrovent), inhibit the parasympathetic nervous system; by inhaler (dose varies); side effects include: dry mouth, cough, headaches, urinary retention, worsening of glaucoma 
• Methylxanthines, such as aminophylline and theophylline, are now used only intravenously for severe attacks and for nighttime asthma because of side effects, which include: nausea, vomiting, headaches, insomnia, tremor, seizures, abnormal heart rhythms, death 

Complementary and Alternative Therapies 

Discerning and eliminating triggers are key to treating asthma. Suspect food allergy if asthma develops in childhood, if there is a positive family history, if atopic dermatitis is present, or with poorly controlled asthma with elevated total serum IgE levels. Following nutritional guidelines and using herbal support as needed may be effective in reducing inflammation and hypersensitivity reactions. 

Hypersensitivity reactions may be associated with stress and anxiety. Mind-body techniques such as diaphragmatic breathing, meditation, tai chi, therapeutic yoga, and stress management may help reduce the frequency, duration, and severity of symptoms.

 

Nutrition 

Note: Lower doses are for children. 

• Eliminate all food allergens from the diet. The most common allergenic foods are dairy, soy, citrus, peanuts, wheat, fish, eggs, corn, food colorings, and additives. An elimination/challenge trial may be helpful in uncovering sensitivities, or an IgG ELISA food allergy test may be used. Remove suspected allergens from the diet for at least two weeks. Re-introduce foods at the rate of one food every three days. Watch for reactions which may include gastrointestinal upset, mood changes, headaches, and exacerbation of asthma. Warning: Do not challenge peanuts, or any other food, if there is a history of anaphylaxis. 
• Reduce pro-inflammatory foods in the diet including saturated fats (meats, especially poultry, and dairy), refined foods, and sugar. Patients sensitive to antibiotics should eat only organic meats to avoid antibiotic residues. 
• Increase intake of fresh vegetables, whole grains, legumes, onions, and garlic if not sensitive to those foods. 
• Vitamin C (250 to 1,000 mg bid to qid) inhibits histamine release and increases prostacyclin production which promotes vasodilation. Vitamin C from rose hips or palmitate is citrus-free and hypoallergenic. Vitamin C taken one hour before exposure to the allergen may reduce reactions. This also applies to exercise-induced asthma. 
• B6 (50 to 200 mg/day) may improve symptoms, particularly in children with a defect in tryptophan metabolism. Use caution with a high dose (usually above 500 mg per day in adults). If neuropathy develops, discontinue immediately. Pyridoxal-5-phosphate (P5P) is an activated form of B6 that may be more readily bio-utilized. 
• Magnesium (200 mg bid to tid) relaxes bronchioles. Magnesium may cause loose stools in sensitive patients. 
• Consider hydrochloric acid supplementation as a deficiency is believed to increase the number and severity of food sensitivities and impair micronutrient absorption. 
• B12 is linked to hypochlorhydria and a deficiency may increase reactivity to sulfites. Dr. Jonathan Wright's protocol for childhood asthma: Hydroxycobalamin 1 cc (1,000 mcg) IM every day for 30 days, then three times weekly for two weeks, two times weekly for two weeks, then once weekly (according to the response). Oral B12, 1 mg per day, has also been shown to be helpful. 
• N-acetylcysteine (50 to 200 mg TID) and selenium (50 to 200 mcg/day) increase glutathione peroxidase activity and protect lung tissue from oxidative damage. 

Herbs 

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups/day. Tinctures may be used singly or in combination as noted. 

Green tea (Camellia sinensis) is a powerful antioxidant and contains theophylline. Drink 1 to 2 cups/day. 

For long-term lung support, combine equal parts of the following herbs in a tea and drink 3 to 4 cups/day. Licorice root (Glycyrrhiza glabra), coltsfoot (Tussilago farfara), wild cherry bark (Prunus serotina), elecampane (Inula helenium), plantain (Plantago major), and skullcap (Scutellaria lateriflora). Licorice root is contraindicated in hypertension. If given, blood pressure should be checked every six weeks. Coltsfoot contains pyrrolizidine alkaloids that can be hepatotoxic with prolonged use. Pyrrolizidine alkaloid-free coltsfoot products still have the desired therapeutic effect. The rest of the herbs in this section should be used only under the supervision of a physician. 

For a stronger formula to be used during periods of exacerbation, combine the following herbs in a tincture, 20 to 60 drops tid to qid. Ginkgo (Ginkgo biloba), thyme leaf (Thymus vulgaris), skunk cabbage (Symplocarpus factida), khella (Ammi visnaga), grindelia (Grindelia robusta), and valerian (Valeriana officinalis). Caution should be used when combining ginkgo with anticoagulant therapies. Ginkgo may reduce platelet aggregation. 

For acute antispasmodic action combine the following herbs in a tincture, 5 to 10 drops every 15 minutes up to eight doses. Indian tobacco (Lobelia inflata) two parts, thyme leaf (Thymus vulgaris) one part, ginger root (Zingiber officinale) one part, gelsemium (Gelsemium sempiverens) one part, ma huang (Ephedra sinica) 1/2 part, and belladonna (Atropa belladonna) 1/2 part. These herbs may produce toxic side effects and should be used under physician supervision and with caution. 

Essential oils that may be helpful are elecampane, frankincense, lavender, mint, and sage. Add 4 to 6 drops in a bath, atomizer, or humidifier.

 

Homeopathy 

An experienced homeopath should assess individual constitutional types and severity of the disease to select the correct remedy and potency. For acute prescribing use, 3 to 5 pellets of a 12X to 30C remedy, every one to four hours until acute symptoms resolve. 

• Arsenicum album for asthma with restlessness, anxiety, and fear of death Ipecac for constant constriction in the chest with an incessant cough that may lead to vomiting 
• Pulsatilla for asthma with pressure in the chest and air hunger. The patient may be thirstless and weepy 
• Sambucus for asthma that wakes the patient at night with the sensation of suffocation 

Physical Medicine/Hydrotherapy

Cold applications to the chest during an acute attack may lessen the severity. 

Contrast hydrotherapy may tone the lungs. Alternating hot and cold applications brings nutrients to the site and diffuses metabolic waste from inflammation. The overall effect is decreased inflammation, pain relief, and enhanced healing. If possible, immerse the part being treated (as with an extremity). Alternate three minutes hot with one minute cold. Repeat three times to complete one set. Do two to three sets/day. 

Castor oil pack. Used externally, castor oil is a powerful anti-inflammatory. Apply oil directly to the skin, cover with a clean soft cloth (e.g., flannel) and plastic wrap. Place a heat source (hot water bottle or heating pad) over the pack and let sit for 30 to 60 minutes. For best results, use for three consecutive days. 

Acupuncture 

Acupuncture can be helpful for reducing the frequency and intensity of asthma attacks.

 

Massage 

Therapeutic massage may help reduce stress which exacerbates hypersensitivity reactions. 

Patient Monitoring

 

Patient education and compliance with inhaler and drug administration are designed to prevent asthma attacks. A peak-flow meter should be used at home; instruct patient to notify provider if it drops below 70% of baseline.

Other Considerations 

Prevention 

Conservative introduction of solid foods as child is weaning may help prevent hypersensitivity conditions. If there is a strong family history of allergies or atopic conditions and/or if the child's immunity has been compromised in infancy, delay the introduction of highly allergenic foods, such as grains and dairy, until one year or older. 

Prognosis

 

Good with attention to health and proper use of medications.

References

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:40-41. Hope BE, Massey DB, Fournier-Massey G. Hawaiian materia medica for asthma. Hawaii Med J. 1993;52:160-166. Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:21-27. Middleton E, ed. Allergy: Principles and Practice. 5th ed. St. Louis, Mo: Mosby-Year Book, Inc; 1998. Monteleone CA, Sherman AR. Nutrition and asthma. Arch Intern Med. 1997;157:23-24. Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:150-155. Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Co; 1998. Regards INTEGRATIVE MEDICINE

Management of Hypertension(High Blood Pressure) through Integrative medicine apporach

Overview

Definition

Hypertension is an average or sustained systolic blood pressure over 140 mm Hg and/or a diastolic blood pressure over 90 mm Hg. Hypertension has an overall incidence of 20%, with onset usually occurring after age 20. The prevalence rises with age to over 50% over age 65. Ninety-five to 99% of hypertensive individuals have essential hypertension. Persons with hypertension are three to four times more likely to experience a major cardiovascular event (e.g., myocardial infarction, cerebrovascular accident, congestive heart failure). 

Categories of hypertension (measured in mm Hg): 

• Stage 1 (mild)Systolic BP 140 to 159Diastolic BP 90 to 99 
• 
  
• Stage 2 (moderate)Systolic BP 160 to 179 Diastolic BP 100 to 109 
• 
  
• Stage 3 (severe)Systolic BP 180 to 209 Diastolic BP 110 to 119 
• 
  
• Stage 4 (very severe)Systolic BP >210Diastolic BP >120 

Etiology 

• Essential, or primary, hypertension has no identifiable cause. 
• Secondary hypertension may be caused by renal, endocrine, and vascular conditions; coarctation of the aorta, certain neurological conditions, acute stress, and chronic heavy alcohol use. Use of oral contraceptives, decongestants, and antidepressants may also cause secondary hypertension. 

Risk Factors 

Hypertension is more common in African-Americans at all ages and in persons from lower socioeconomic groups. Individual risk factors include the following. 

• Family history 
• Alcohol use 
• High sodium intake 
• Stress 
• Sedentary lifestyle 
• Obesity 
• High sugar intake  

Signs and Symptoms

Essential hypertension has no symptoms except in extreme cases or after cardiovascular complications result. Extremely high blood pressures may cause headaches. 

Severe hypertension or hypertensive crisis (usually secondary hypertension) with end-organ damage may produce headache, nausea and vomiting, seizure, retinopathy, and other symptoms. 

Differential Diagnosis 

Tests to determine possible causes are performed only if a secondary cause is suspected. 

Diagnosis 

Physical Examination 

Hypertension is diagnosed through blood pressure measurements. Guidelines include controlling the patient's posture when taking the blood pressure; restricting the use of caffeine, nicotine, and other stimulants before taking the blood pressure; using the appropriate size cuff; and taking at least three readings at least one week apart. 

Diagnostic procedures focus on screening for causes and risk factors, assessing potential end-organ damage from sustained hypertension. 

The history should include past blood pressure levels, family history, past conditions, diet (especially salt and cholesterol intake), exercise, current medications, alcohol and tobacco use, and stressors. 

Physical examination should include the following. 

• Blood pressure taken on right and left arms, both sitting and standing 
• Heart rate and rhythm 
• Peripheral and femoral pulses
• Fundoscopy 
• Weight 
• Complete family and patient history 

Laboratory Tests 

• Complete blood count 
• Calcium level 
• Creatinine level 
• Potassium level 
• Sodium level 
• Fasting glucose and insulin levels 
• Cholesterol levels 
• Uric acid level 
• Urinalysis

Imaging 

Only required for differential diagnosis or if end-organ damage is suspected. 

• Chest X ray 
• Ultrasonography 
• IVP and renal arteriogram 
• Provocative renal nuclear scan 
• Digital subtraction arteriography 
• Angiogram

Treatment Options 

Treatment Strategy 

The goal of treatment is to lower the risk of future cardiovascular damage by lowering the blood pressure to below 140 mm Hg (systolic) and 90 mm Hg (diastolic). In stage 3 or 4 hypertension, significant partial reduction is acceptable. 

Nonpharmacological therapies may be used with or without drug therapy. Nondrug therapies are generally used with stage 1 hypertension and should be evaluated over the course of 6 to 12 months. Drug treatment is usually required for more severe hypertension and usually provides control within one to three months. 

Lifestyle modifications that lower blood pressure include the following. 

• Weight reduction 
• Sodium restriction 
• Discontinuation or restriction of alcohol 
• Discontinuation of caffeine 
• Exercise 
• Patient education about the importance of lowering blood pressure 
• Biofeedback and relaxation techniques 

Drug Therapies

 

Each case should be considered individually, yet drug therapy is recommended for patients with sustained systolic pressure over 160 mm Hg or diastolic pressure over 100 mm Hg. Traditionally, therapy with a diuretic or beta-blocker is tried first. The dosage may be modified or an additional drug from another class may be added. Ten percent of patients may require three drugs. 

• Diuretics—e.g., hydrochlorothiazide (Hydrodiuril; 12.5 to 50 mg/day); side effects include decreased level of potassium and increased cholesterol and glucose levels; contraindicated in patients with gout and diabetes 
• Potassium-sparing agents—spironolactone (Aldactazide; 25 to 100 mg/day); side effects include hyperkalemia and gynecomastia 

Adrenergic inhibitors include the following. 

• Alpha-blockers—doxazosin (Cardura; 1 to 20 mg/day); side effects include postural hypotension and lassitude 
• Beta-blockers—acebutolol (Sectral; 200 to 800 mg/day); side effects include congestive heart failure, bronchospasm, masking of hypoglycemia induced by insulin, depression, insomnia, fatigue; contraindicated relatively in heart failure, airway disease, heart block, diabetes, and peripheral vascular disease
• Alpha/beta blockers—labetalol (Normodyne; 200 to 1,200 mg/day in two doses); side effects include postural hypotension and beta-blocker side effects 
• Centrally acting sympatholytics—methyldopa (Aldomet; 500 to 3,000 mg/day in two doses); side effects include hepatic disorders, sedation, dry mouth 
• Peripherally acting sympatholytics—reserpine (Serpasil; 0.05 to 0.25 mg/day); side effects include sedation and depression 
• Calcium-channel blockers—verapamil (Isoptin; 90 to 480 mg/day); side effects include constipation, nausea, headache, conduction defects; use with caution in heart failure or block 
• Dihydropyridines—amlodipine (Norvase; 2.5 to 10 mg/day); side effects include flushing, headache, ankle edema 
• Direct vasodilators—hydralazine (Apresoline; 50 to 400 mg/day in two doses); side effects include headache, tachycardia, lupus syndrome 
• Angiotensin-converting enzyme (ACE) inhibitors—benazepril (Lotensin; 5 to 40 mg/day); side effects include cough, rash, loss of taste; use with caution in renovascular disease 

Complementary and Alternative Therapies 

Mind-body techniques (such as biofeedback, yoga, meditation, and stress management), nutritional and herbal support may be effective in improving hypertension and concurrent pathologies. 

Nutrition 

• Avoid caffeine and decrease intake of refined foods, sugar, and saturated fats (meats and dairy products). Some kinds of hypertension respond to a reduction of salt intake. 
• Eliminate food allergens as these may exacerbate hypertension. Increase dietary fiber, vegetables and vegetable proteins, and essential fatty acids (cold-water fish, nuts, and seeds). 
• EPA, flaxseed oil, or evening primrose oil (1,000 to 1,500 mg one to two times/day) lowers cholesterol and mildly reduces hypertension. 
• Magnesium (200 mg bid to tid) induces mild vasodilation to decrease blood pressure. 
• Zinc (30 mg/day) may help reduce blood pressure that is associated with high levels of cadmium (usually secondary to cigarette smoking). 
• Coenzyme Q10 (50 to 100 mg one to two times/day) is protective to the cardiovascular system. 
• B complex (50 to 100 mg/day) with additional folic acid (800 mcg/day), B12 (1,200 mcg/day), and betaine (1,000 mg/day) may increase resistance of stress and lower blood pressure that is secondary to homocysteinemia. 
• Vitamin E (400 IU/day) reduces platelet aggregation. 
• Some patients are sensitive to grains.A trial of limiting grain-based foods in the diet should be implemented to assess the effect on blood pressure. 

Herbs 

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, it is important to ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink two to four cups/day. Tinctures may be used singly or in combination as noted. 

Hawthorn (Crataegus monogyna), linden flowers (Tilia cordata), passionflower (Passiflora incarnata), valerian (Valeriana officinalis), and cramp bark (Viburnum opulus) may be safely used long-term. These herbs relax and strengthen the cardiovascular system while moderately reducing blood pressure. Combine equal parts in a tincture, 20 to 30 drops tid or qid. Hawthorn may be taken as a dried extract, 250 mg tid. 

Dandelion leaf (Taraxacum officinale) has a diuretic effect and spares potassium. Drink three to four cups/day. 

The following herbs have a stronger hypotensive effect and may have toxic side effects. These herbs must be used under the supervision of a qualified practitioner. Lily of the valley (Convallaria majalis), night-blooming cereus (Selenicereus grandiflorus), mistletoe (Viscum album), motherwort (Leonurus cardiaca), and Indian tobacco (Lobelia inflata). Combine 3 to 4 of these herbs with equal parts of cramp bark and valerian and take 30 to 60 drops tid. 

Homeopathy 

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency. 

 

Acupuncture 

Acupuncture can be helpful in reducing blood pressure, alleviating stress, and addressing concurrent pathologies.

 

Massage

Therapeutic massage can be effective in reducing the effects of stress and inducing relaxation and lowered blood pressure.

 

Patient Monitoring 

Since patient compliance is poor with antihypertensive medications, with up to 20% of patients discontinuing the drug, patient education and follow-up are critical. Even after blood pressure is stabilized, changes in the medical regimen will be required for some patients for months and years. Schedule follow-up visits every three to six months. 

Other Considerations

 

Prevention

 

Individuals with high normal or stage 1 hypertension may be able to prevent hypertension with a low-sodium diet, exercise, relaxation techniques, weight reduction, alcohol avoidance, and smoking cessation. 

 

Complications/Sequelae 

The complications of untreated hypertension include the following. 

• Stroke 
• Aortic aneurysm 
• Myocardial infarction 
• Congestive heart failure 
• Cardiac enlargement 
• Left ventricular hypertrophy 
• Renal insufficiency 
• Cerebral thrombosis or embolization 

Prognosis

 

Controlled hypertension results in greatly diminished risks of complications and a generally good prognosis.

 

Pregnancy

• Mild elevation of blood pressure can be normal in pregnancy, however, pregnancy-induced hypertension can progress rapidly to life-threatening sequelae. 
• Blood pressure should be monitored frequently during pregnancy. 
• Hawthorn, linden flowers, passionflower, valerian, and cramp bark may be used safely in pregnancy after the first trimester. 
• Further intervention must be under the supervision of a physician. 

References

Barker LR, Burton JR, et al., eds. Principles of Ambulatory Medicine. 4th ed. Baltimore, Md: Williams & Wilkins; 1995:803-843. Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:240. Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999. Detre Z, Jellinek H, Miskulin R. Studies on vascular permeability in hypertension. Clin Physiol Biochem. 1986;4:143-149. Golik A, Zaidenstein R, Dishi V, et al. Effects of captopril and enalapril on zinc metabolism in hypertensive patients. J Am Coll Nutr. 1998;17:75-78. Kwan CY. Vascular effects of selected antihypertensive drugs derived from traditional medicinal herbs. Clin Exp Pharmacol Physiol. 1995;(suppl 1):S297-S299. Liva R. Naturopathic specific condition review: hypertension. Protocol J Botan Med. 1995;1:222. Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:90-96, 107-112. Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif.: Prima Publishing; 1998. Stein JH, ed. Internal Medicine. 4th ed. St. Louis, Mo: Mosby-Year Book; 1994:302-323. Werbach M. Nutritional Influences on Illness. New Canaan, Conn: Keats Publishing; 1988:227-240. The fifth report of the joint national committee on detection, evaluation, and treatment of high blood pressure. Arch Intern Med. 1993;153:154. Regards INTEGRATIVE MEDICINE

Nature Cure & its relevance in today's life Separate health perspective for regaining health naturally

Nature Cure & its relevance in today's life

Separate health perspective for regaining health naturally

Naturopathy, otherwise known as nature cure is a drug-less, non-invasive, rational and evidence based system of medicine imparting treatments with natural elements(earth, water, air, fire, space.) based on the theory of vitality, theory of toxemia, theory of self healing capacity of body & the principles of healthy living.

The unbridled growth of industrialization accentuated by modern science & technology has created a situation, which prevents man from bestowing adequate care and attention even to his minimal personal health needs. Health is not something that can be purchased in a bottle from a drug store, but a condition built over the years from within by our own vital processes through conscientious efforts and self control or will power.

According to the basic concept of naturopathy or nature cure, healing comes from within the body itself.

Diseases are caused due to "the violation of nature's law," i.e. going away from the rules of diet, exercise, sleep, relaxation, water drinking etc.

"Acute disease as such is the self- purifying effort of nature."

Every acute disease is the result of the cleansing and healing effort of nature. If you suppress these conditions by drugs or by any other means you are simply laying foundation for chronic diseases.

All diseases (symptoms), from a simple cold to skin eruptions, diarrhoea, fever, etc. represent nature's effort to remove from the system some of accumulated morbid matter & some poisons dangerous to health and life.

Drugging is like whipping an already exhausted horse.

Germs are seen in the diseases only where morbid matter has accumulated. A disease cannot attack unless there is already a soil in which the germs can thrive. When waste products in the body become very strong, the self- curative forces (vitality) or the immune power work at low pace and nature loses its fight, and diseases result in.

Naturopathic medicine is a system of primary health care practiced by naturopathic physicians for the prevention, diagnosis and treatment of diseases. This approach to health care emphasizes education, self responsibility & therapies to support & stimulate the individual's self healing capacity.

In the order of healing sciences, naturopathy stands first, but unfortunately it is practiced last after hopelessly trying all other medical sciences.

It is beyond doubt that nature cure is sure cure for majority of the diseases and though inexpensive, it is a drugless healing which is unique because it has no side-effects what so ever. It has preventive, curative & rehabilitative aspects of health.

It only demands a little sacrifice, time, patience and perseverance.

Best regards with "National Naturopathic day"

Dr. Om P Khaniya, BNYS

Yoga & Naturopathic Physician

Canyon Ranch Wellness Ltd.

Former Vice- Chair, Yoga & Naturopathic Doctors' Association Nepal