Prevention, Not Treatment
By David Seaman, MS, DC, DACBN
In clinical practice, chiropractors deliver various procedures for a desired effect, such as manipulating a joint, doing myofascial work, and using stabilization exercises to improve function and reduce pain in a desired segment of the spine. A similar method applies when prescribing herbs, which are seen as a means to an end; i.e., if the patient takes these herbs, they will have a desired effect.
I am often asked about what herbs are good for treating back pain, osteoarthritis, rheumatoid arthritis, dizziness, fatigue, hypertension, and many other conditions. My impression is that we tend to think this way due to a culture in which medications are designed to treat various diseases and herbs can be viewed with a similar mind set as medications. St John's Wort is an example, wherein it is sometimes used as a treatment for depression. Most medications are prescribed because of poor lifestyle choices. Your patients may also start taking herbs in an effort to overcome those same choices, rather than making different choices.
An excellent example of this is hypertension. Most hypertensive patients have the metabolic syndrome, which is caused by overeating inflammatory foods and living a sedentary life. In other words, powerful medications are used to combat a diet-induced state of metabolic dysfunction. No herb by itself has the pharmacologic power to combat such a state. Even powerful medications are often ineffective, which should make us question the wisdom trying to treat various diseases with less powerful herbs. Consider the following scenario.
When an individual packs on visceral adipose, it does not merely function as a storage depot of excess calories. The adipose tissue mass begins to function as a hyperactive endocrine organ, releasing increased amounts of pro-inflammatory cytokines such as tumor necrosis factor (TNF) and interleukin-6 (IL-6). Adipose tissue also modifies the release pattern of its own unique mediators called adipokines; leptin and resistin release increases, while adiponectin release is reduced. Adiponectin is an interesting substance that improves insulin sensitivity and maintains/increases mitochondrial mass in skeletal muscle.1
The outcome of increased adipose tissue release of TNF, IL-6, leptin, and resistin and reduced adiponectin includes: insulin resistance, endothelial activation (atherosclerosis), depression and hypertension. This is a manifestation of syndrome X.1 Consider that millions of patients are taking one or more of the following medications: metformin for insulin resistance, a statin for endothelial activation, an antidepressant, and/or a diuretic and ACE inhibitor for hypertension.
Since the underlying problem is increased adipose tissue mass and syndrome X, it makes more sense to address the cause of the problem rather than trying to just substitute herbs or drugs that are often ineffective. From a clinical perspective, we are actually rewarded if we address the cause of syndrome X. I say this because the nutritional approach for syndrome X is generally the same as the nutritional approach if your goal was to prevent it from developing in the first place.
Dr. Bruce Ames wrote several interesting articles that point to an excellent goal of healthy eating and proper supplementation.2-5 The theme of the papers is that we should optimize or "tune up" metabolism. It goes without saying that proper caloric intake is a must and should come from the most nutrient-dense foods such as vegetables, fruit, sweet potatoes, nuts, lean animal protein and fish. In addition, Ames suggests that we consider using the following supplements: a multivitamin, magnesium, vitamin D, fish oil, lipoic acid, acetyl-L-carnitine, and fiber (I would add coenzyme Q10 to that list as an option).
In my view, the purpose of supplementation is not to treat specific diseases. For years, my perception has been that we should supplement to enhance metabolism, improve mitochondrial function, and reduce free-radical activity and chronic inflammation. Fortunately, from a practice application perspective, this view of supplementation is consistent with the goals of health maintenance and the resolution of syndrome X and other conditions.
References
- Axelsson J, Heimburger O, Lindholm B, Stenvinkel P. Adipose tissue and its relation to inflammation: The role of adipokines. J Ren Nutr 2005;15(1):131-6.
- Ames BN. The metabolic tune-up: Metabolic harmony and disease prevention. J Nutr 2003;133:1544S-8S.
- Ames BN. Supplements and tuning up metabolism. J Nutr 2004;134(11):3164S-8S.
- Ames BN. Increasing longevity by tuning up metabolism. To maximize human health, lifespan, scientists must abandon outdated models of micronutrients. EMBO Rep 2005;6(S1):S20-4.
- Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scare nutrients by triage. Proc Natl Acad Sci USA 2006;103(47):17589-94.
[pb]Prescribing Herbs For Patients
By Bill Egloff
Prescribing herbs is the right treatment for many chiropractors' patients. Herbs are easily understood by patients to be an adjunct to nutritional and lifestyle counseling, and the goal of achieving balance in one's life. Culturally, many patients look forward to using the herbs that their grandparents and ancestors have used to nurture their health and overcome various ailments. There are many different perspectives on herb usage that patients are comfortable with and, therefore, more compliant with.
Single-herb prescribing is more common in Europe and the West than in Asia. Culturally, it is more like a Western medicine model than one of traditional Chinese medicine The patient should tell you if they prefer to have a standardized single-herb product or a whole herb prepared for its complete complex characteristics. A quick and simple explanation of the herb's benefit and the different delivery strategies will empower the patient to be more of a partner in their treatment, and it is easier for them to relate to an herb than to a vitamin, mineral or supplement. Patients are looking for a more natural solution.
Similarly, prepared combinations of herbs can be understood to be similar to multivitamin and mineral tablets, and that they are trying to address a number of different issues at the same time. These combinations tend to be for more chronic conditions and can be seen as long-term nutritional support. Remind the patient to be expecting short-term results with many acute ailments.
For those patients who value the practitioner understanding their unique conditions and suffering, Chinese herbs also offer a very personal and customized treatment that puts the focus on the specific symptoms that the patient is experiencing. This aspect of custom Chinese herb prescriptions is unique to the cultural integration of herbs into the traditional Chinese health care model.
There are many cases that need more than normal dietary supplementation of vitamins and minerals. Many menstrual problems like irregular, painful, scanty menses are easily treated with herbs. Infertility responds well with herbs for both women and men. In fact, some of the most prescribed herb formulas used in integrative practices are for infertility. There is no more effective strategy to support the fertility of a couple than herbs, especially Chinese herbs.
The irony that the earthiest and most ancient of healing would be effective when the patient has not been helped by the leading high-tech solutions is stunning yet true. There are no other natural methods that are considered at this stage. This is an example of the power that is inherent in herbal formulas when prescribed by a knowledgeable herbalist.
