Friday, 4 July 2014

Complementary and Alternative Medicine in the USA

Masullo L, Papas MA, Cotugna N, Baker S, Mahoney L, Trabulsi J. Complementary and Alternative Medicine Use and Nutrient Intake Among Individuals with Multiple Sclerosis in the United States.J Community Health. 2014 Jul . [Epub ahead of print]

Individuals with multiple sclerosis (MS) often use complementary and alternative medicine (CAM). However, specific CAM therapies used within this population have not been thoroughly described, particularly the use of supplements, herbal remedies, and dietary modifications. The aim of this pilot study was to determine the prevalence of specific types of CAM used by adults with MS in the United States. Participants included adults who were diagnosed with MS at least 1 year prior to study enrollment. CAM use was measured using the CAM Supplement of the National Health Interview Survey, and nutrient intake was assessed using an Automated Self-Administered 24-h Recall. This study found that a majority (77 %, n = 27) of the sample used CAM within the past 12 months, the most prevalent type being vitamins/minerals (88.9 %, n = 24), nonvitamin, nonmineral, natural products (NP) (44.4 %, n = 12), relaxation techniques (33.3 %, n = 9), and special diets (29.6 %, n = 8). Regarding diet, median percent calories from fat (37 %) and saturated fat (12 %) were higher than current recommendations, while dietary fibre intake met only 87 % of the adequate intake. Participants following the Paleo (7.4 %, n = 2) diet did not meet the Estimated Average Requirement (EAR) for vitamins D and E, while those on the Swank diet (7.4 %, n = 2) were below the EAR for vitamins C, A, E, and folate. The results support previous findings that CAM therapies are commonly used by individuals with MS. Inadequate intakes of certain vitamins and minerals by those following the Swank and Paleo diet suggest these diets may be too restrictive.


Well I am not going to lecture you on CAMs, as we know many of you use some. 

Unfortunately there is seldom proper evidence to support their use. 

In contrast to a pharmaceutical story, with a nutriceutical you seldom need to provide proof it does something.  This is the manta of the Pot Docs who will prescribe cannabis for so many conditions. 

So whilst the FDA are struggling to accept that Sativex is of any use for MSers, the States are surrendering to medical marijuana initiatives bit by bit, without any real evidence for efficacy . 

The recreational use bandwagon is clearly hitching a lift on the coat tails of the medical campaign. There are so many claims for medical benefits. However where is the actual proof? There is plenty of anecdote but this is not the antidote to good solid data

There are loads of varieties of cannabis with weird and wonderful names, but it can be any old rubbish named to help get that old pot off the shelve. This can be seen when the content is analysed. 

In the States, medical pot contains on average 12% THC and less than 1% cannabidiol, so no where near to the 1:1 mix in Sativex, and taylor-made to get the user high. So if these strains bring benefit the question is what does the CBD do? An angle to make the product different from synthetic THC?

Then there is the cost. NICE in the UK are still muttering about the cost v benefit. Medicinal pot in USA is going to be a fraction of the cost where will people go to get their stuff from? 

6 comments:

  1. Your post on cannabis is interesting but doesn't seem to address the findings of the study. The fact that MSers are taking vitamins is no surprise and is probably a good thing - or at the very least a fairly neutral thing. Likewise, diet is important in relation to MS, particularly given recent findings around co-mordibities amongst MSers. I would also like to see the figures on how many non MSers get enough fibre and folate. Similarly, it's not too surprising that many MSers regularly use relaxation techniques

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    1. Yes i know. There is not much i can say about cams you guys are the experts.

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  2. I don't actually have MS so I'm definitely not an expert but my mum does and she thinks that the most important change she has made since being diagnosed is dietary. Whether or not it has had a direct impact on her MS symptoms couldn't be proved but I'm sure that maintaining a healthy weight and not consuming excessive amounts of salt, saturated fat etc. but eating fibre, vegetables and oily fish would be a good thing for us all.

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  3. MD, you forgot to sign. CoI= Canbex? (Which I hope will be succesful, of course)
    "You guys are the expert".... Some of us are, even if there is no class A evidence of efficacy, there will hardly be any as this would mean paying millions of dollars/ euros. Yet it is worth a try, if other positive side effects can be expected.

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  4. AIDS patients, cancer patients and spinal cord injury patients have been helped with pain, spasticity, sleep and appetite. I don't need it yet, but it's on my list for when things get bad. Honestly I get really annoyed with the recreational folks who want medical cards. I don't care what they smoke, but they don't need or want medical care. Using a doctor to get them a card wastes resources.

    As for CAM, if I thought there was actually a pathway for trials leading to what you call first class evidence, I might wait. There isn't so I rely on stage two trials for paths to explore and worry about adverse effects and interactions. Maybe your newest drugs will work and take the burden off us, but we won't know for ten or more years. Meanwhile those of us on the firing line have to do what we can.

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  5. Changing your environment plays a key role for recovery within the MS Community. Me and 1000's of others are testament. This needs to e promoted not just in MS community but also wider communities for the prevention and onset of disease.

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