The straight dope
Recent trends in alternative medicine and what to make of them.

By Ziba Kashef

THE BAY AREA'S rainy winter season has begun in earnest, meaning that sore throats, sniffles, and achy heads are sending many of us in search of some form of miracle relief. If, like me, you're at all inclined to use alternative medicine – and half of all adults in the United States are, according to a recent Newsweek report – you might opt for a natural remedy over a pharmaceutical one. You might try an herbal supplement like echinacea. Or perhaps an extra helping of vitamin C. Or any number of widely divergent cures your friends and coworkers swear by.

The past decade has seen a number of alternative treatments gain popular ground. But even if you have faith in the power of nonpharmaceutical remedies, you probably can't help wondering whether some of them could possibly work. After all, their popularity is often driven by a mixture of hope and rumor – not proof (perhaps a side effect of the mainstream medical profession's longtime resistance to exploring non-Western, nonstandard treatments). And now that mainstream medicine has become more willing to consider the benefits of complementary and alternative medicine – CAM for short – we're daily barraged by media reports on an endless stream of studies either confirming or disputing the efficacy of various alternative techniques.

The positive side of all of this controversy and continued interest in CAM is that we now have growing volumes of scientific evidence. Researchers may be debating the value of herbs, supplements, chiropractic care, and acupuncture for decades to come. But the evidence to date, along with some expert input, can shed some light and simplify our choices. Here's a rundown (by no means exhaustive) of some popular remedies and what you should know about them. To be on the safe side, always consult your health provider – alternative or otherwise – before trying any new therapy.

Common cold cure?

By this time you've no doubt heard about echinacea, the herb that is said to stop a cold or other upper-respiratory infection in its tracks. Derived from a purple coneflower, echinacea is an age-old Native American remedy used by healers to treat sniffles as well as certain skin conditions. Once word of its curative powers hit the mainstream, consumers began gobbling it up, and in 2000 Harvard Women's Health Watch reported that Americans were spending $300 million a year on echinacea products. Unfortunately, the herb's reputation has been harmed by bad studies. While numerous clinical trials of echinacea have found that it tends to reduce the severity and length of colds, many of those trials were flawed in one way or another – the studies were too small or were based on nonstandardized dosages. And the fact that the herb comes in different forms (echinacea purpurea, echinacea pallida, etc.) and is often combined with other botanicals makes it difficult to study conclusively.

Still, many cold sufferers and alternative providers swear by it. Suzann Wang, a naturopathic physician in Sausalito, says it's best to take echinacea in a tincture at the first sign of a cold. A teaspoon to a tablespoon every two hours, along with lots of water from morning till night, should do. "Usually by the next morning the feeling like you're going to catch a cold is gone," she says. Echinacea seems to work because it stimulates the immune cells that serve as the body's first line of defense against viral and bacterial infections. It's not effective, however, after a cold is full-blown or if you use it for several weeks at a time without stopping, Wang notes.

Some people, including asthmatics, may be allergic to the plant and should avoid it. Wang also cautions against using echinacea if you have HIV or AIDS. The Health Watch report warns against taking it if you're pregnant or on medications that could harm your liver or suppress immune function.

Nature's antidepressant

When the British Medical Journal reported in 1996 that St. John's wort, the curiously named blues-busting herb, was as effective for treating mild to moderate depression as certain antidepressant drugs, consumers flocked to health food stores. By 2000 some 17 percent of Americans had used it, and it was the second top-selling herbal preparation in the United States. Then subsequent studies and some nay-saying scientists began raising questions. One randomized, controlled trial published in the Journal of the American Medical Association (JAMA) questioned the validity of earlier ones, and another found that St. John's wort – a.k.a. Hypericum perforatum – was no more effective than a placebo in treating major depression. The latter study states that while St. John's wort is used for depression of "varying severity," its efficacy for major depression has not been demonstrated. Experts have also pointed to potentially hazardous interactions with other medications.

However, the bad press does not detract from the herb's benefits for low to moderate depressive symptoms, which is what most depressed people have, says Michael Rosenbaum, a physician who specializes in nutritional medicine in Corte Madera. "You have to take it for at least six to eight weeks to see if it's going to work," he adds. "Most people need 900 milligrams a day of the standard formula, which is .3 percent hypericin." While Rosenbaum says he wouldn't recommend St. John's wort as a first line of treatment for serious depression, he adds that it may be helpful for other mental health conditions such as anxiety. It may also serve as an alternative to drugs like Prozac and Zoloft for people with obsessive-compulsive disorder, according to a Harvard Health Letter article – and as a way of avoiding many of the unpleasant side effects of those prescription medications.

Like most things in life, St. John's wort is not without a down side. The herb tends to increase sun sensitivity and can cause rashes, so it's best to stay out of direct sunlight while taking it. It also shouldn't be combined with medications that increase such sensitivity, such as tetracycline antibiotics, Rosenbaum says. And don't mix it with other antidepressants or the drugs warfarin (Coumadin) and cyclosporin.

An answer for aches and pains

Instead of popping traditional painkillers for joint distress, many osteoarthritis sufferers are finding relief in a popular compound known as glucosamine sulfate. And research seems to be supporting this trend. An analysis of 15 studies, published in JAMA in 2000, found that glucosamine does reduce pain symptoms. Subsequent studies have either confirmed this benefit or called for more research. One review study found that glucosamine was as effective as over-the-counter painkillers known as NSAIDS (nonsteroidal anti-inflammatory drugs). A federally funded trial of both glucosamine and chondroitin (which is often combined with glucosamine to enhance its effects) is expected to provide further answers next year.

That news couldn't be better for the estimated 20 million Americans – mostly women – who complain of aches in their fingers, knees, and lower back as they age. While some investigators have faulted the glucosamine studies for their small size and other research flaws, according to a Harvard Health Letter article, satisfied patients have come to the defense of the therapy. Wang sometimes prescribes it as an adjunct to other natural treatments for joint pain. "It helps to rebuild cartilage in your joints," she says. "It can be very effective." To work, she adds, it needs to be taken at high doses: 1,500 milligrams a day, for about six weeks.

Though glucosamine has helped some of Wang's patients avoid knee surgery, she cautions against using it for general joint maintenance. "A lot of patients come in and say, 'I just heard that I need good joint health, and I think I should take this,' " she says. But there's no evidence it can be used preventively. Plus, glucosamine can aggravate blood sugar problems for people with type-two diabetes or those at risk for it, which includes many of us. Another option for knee pain? "I really like castor oil packs," Wang says. "They work amazingly well."

The wonders of soy

Of all the trendy alternative products making the rounds, soy may be among the most pervasive. A staple in Asian cuisines, it can now be found in U.S. restaurants and supermarkets in the form of tofu, soy sauce, soy milk, soy nuts, soy flour, soy ice cream, and so on. One reason for its popularity is that it provides a low-fat protein alternative to the fat-laden high-meat and -dairy diets that have clogged many an artery. It also holds some promise of relief to the millions of women who enter menopause each year and are justifiably wary of hormone replacement therapy.

But are you really gaining anything by ordering that latte with soy milk or taking a soy supplement? An analysis of soy trials conducted by the University of Kentucky found that high-soy diets lowered cholesterol and triglyceride levels. Both the Food and Drug Administration and the American Heart Association have endorsed soy as a cholesterol fighter. Some studies have also suggested that soy consumption might help alleviate menopausal problems such as hot flashes and bone loss.

But simply adding soy to the diet may not make much of a difference, Dr. Rosenbaum says, since "there are different amounts of soy estrogens found in different foods." For menopausal women, he often recommends 40 to 60 milligrams of a soy isoflavone supplement – sometimes in combination with natural progesterone cream – to relieve hot flashes. You can get too much of a good thing, however. "If you take too much, then you can get an estrogen effect, which would mean weight gain or fluid retention or breast swelling or tenderness," he says. In that case, lower your dose.

Wang is less enthusiastic about soy. While fermented soy foods such as tempeh and miso are safe, she says, other soy products may pose problems. She warns that vegetarians who rely primarily on soy for protein may suffer suppressed thyroids and other negative health effects. Also, since soy can be estrogenic, it may not be safe for women with breast cancer or a family history of the disease.

Speaking of menopause ...

Of all the natural remedies that have been touted for menopause, including dong quai and evening primrose oil, the herb black cohosh has emerged as one of the most promising. "Black cohosh works," Wang says. A review of 29 studies, published in Annals of Internal Medicine, found that black cohosh showed promise in reducing menopausal symptoms. Other studies have suggested that the phytoestrogen appears to work without increasing the risk of breast cancer.

But as stated in the Annals review, there is a lack of long-term data, particularly on black cohosh's estrogenic effects, which may raise a red flag for many women. "I'd be very careful taking anything for menopausal symptoms – natural or otherwise – if you have a family history of breast cancer," Wang says. That's why she discourages her patients from taking it preventively. "Some people take black cohosh without any symptoms," she explains. "They're going into menopause and hear it's a good thing to do. But menopause is a normal activity for the body." So unless you're dripping from night sweats and you're certain there's no breast cancer in the family, you may want to skip it.

It's also important to note that the herb does not help prevent conditions such as heart disease or osteoporosis, the risk of which increases as women age. And black cohosh isn't necessarily useful for everyone. Women who are suffering from menopausal symptoms may have to take a trial-and-error approach and experiment with various therapies – others include vitamin E and natural progesterone cream – to find the best one.

Antioxidants for age-related ills

Vitamins are good for you, right? Well, that depends on what vitamin and whom you ask. Some of the most celebrated – and controversial – vitamins to emerge in recent years belong to the group of nutrients known as antioxidants. Vitamins E and C, as well as coenzyme Q10, are just a few examples of fashionable antioxidants, nutrients that are purported to prevent the oxidation, or damage, of normal cells that can lead to disease. While everyone agrees the body needs these protective vitamins, minerals, and enzymes to function, experts vary on whether to recommend them as supplements.

Take vitamin E. Some large, reputable studies – including the famed Harvard nurses one – have suggested that people who take vitamin E supplements have a lower risk of heart disease and stroke. However, other studies show no benefit at all. One trial published last year in JAMA even pointed to some potential harm in antioxidant vitamins for postmenopausal women. But an earlier issue of the same journal suggested that high dietary intake of vitamins E and C lowered the risk of another age-related disease: Alzheimer's.

While nutrition experts continue to argue over study design and results, it's important to note that vitamins were never supposed to be consumed in isolation. "One of the big criticisms that we in the field have is that antioxidants work in synergy," Rosenbaum says. "They work together. And when you do long-term research just isolating one antioxidant, you may not get a good effect." That's why for most healthy adult patients, he recommends taking a multivitamin-mineral supplement that contains both antioxidant vitamins E and C, which enhance each other's effects. Rosenbaum prefers four- or six-a-day multivitamin formulas such as Twin Lab and Solgar because they contain more nutrients. Older patients and those who are exposed to chemicals or cigarette smoke daily may benefit from the use of whole food supplements, coQ10, or lipoic acid. If you're not sold on supplements, you could always get your antioxidants by eating green leafy vegetables and berries – foods that naturally pack a disease-fighting wallop.

Ephedra: A case of abuse

Of the few popular dietary supplements to raise real alarm in medical circles, ephedra, also known as ma huang, tops the list. In June the Department of Health and Human Services announced a review of herbal products containing ephedra. The problem? Consumers using such products for weight loss or increased energy have reported harmful side effects to supplement manufacturers and to the FDA, including irregular heartbeat, shortness of breath, and even loss of consciousness. Because of the severity of the effects, one ephedra supplement manufacturer, Metabolife International, has been investigated by the U.S. Justice Department for supposedly making false statements about adverse-reaction reports it received from consumers.

What's curious about all of this scrutiny is that the drug ephedrine, derived from ephedra, was once commonly used in asthma medications and can still be found in over-the-counter cold remedies. And at least some studies show that ephedra works for weight loss, according to Rosenbaum. "It increases your body's ability to burn fat," he says. But, he adds, "there's been abuse. It's been a street drug, and some people overdo it and take too much." In high doses ephedra can cause arrhythmia and even death. People with high blood pressure or heart disease are most at risk for side effects, as are those with thyroid disease, diabetes, glaucoma, seizures, or prostate enlargement. A federal consumer advisory also cautions against taking the herb while using antidepressants or medications for allergies and asthma.

Many people who take legal ephedra weight-management products according to the directions will have no problems. But while the government pursues investigations and further research into the herb, it may be safer to avoid it.

Acupuncture

Six years ago the National Institutes of Health gave acupuncture, an ancient Chinese system of healing, a thumbs-up. Well, at least a vertical thumb. In a consensus statement, a panel of investigators concluded that acupuncture was indeed a useful therapy, particularly for postoperative surgical and dental pain, as well as nausea caused by chemotherapy. They also suggested that the treatment could be effective for a wide array of ailments when used in combination with other therapies.

This conditional approval was significant coming from Western medicine experts who don't acknowledge the existence of chi, or qi, the invisible energy or life force that much of traditional Chinese medicine (TCM) is based on. "The acupuncturist stimulates the energy movements," says Dennis Lee, a licensed acupuncturist in Oakland. "Whatever the problem you have in the organs, if there's a stagnation or a blockage, the acupuncturist can free that stagnation and open the channels. Once the channel is open, the problem disappears." Because acupuncture addresses the whole patient – practitioners may ask you about everything from your stress level and sleeping patterns to your bowel movements, no matter what your complaint is – it can be beneficial for multiple health conditions, including some of women's most vexing complaints. Lee says practitioners in China have successfully applied acupuncture to problems such as menstrual cramps, breast tenderness, morning sickness, uterine fibroids, and even breech babies. It also holds promise for alleviating addictions, headaches, fibromyalgia, carpal tunnel syndrome, and asthma.

There are many forms and styles of acupuncture, and depending on the technique, it can provide relief very quickly after just one session, though it may take longer. Unlike Western treatments, acupuncture and other aspects of TCM, such as herbs, are tailored to an individual patient's overall condition: two patients with the same symptoms may receive different recommendations as opposed to a standard drug dose or therapy. Though mainstream medical experts still don't understand exactly how acupuncture heals, they are pursuing several studies that will yield results in the coming years. Stay tuned.

Working out the kinks with chiropractic

For more than a hundred years, chiropractors in the United States have been giving patients "adjustments" to relieve their health problems. Chiropractic therapy is based on the idea that since all nerve impulses from the brain pass through the spine to other parts of the body, any interruption in the flow of those impulses can result in disease. To alleviate the problem, chiropractors try to realign the vertebrae with gentle manual thrusts. These days chiropractors may also incorporate massage, physical therapy, and nutritional counseling into their practices to further stimulate healing.

Though chiropractic care is a broadly recognized therapy – and is increasingly covered by insurance – the theory behind it remains controversial in the mainstream. And while studies and expert panels have concluded, according to a review in the journal Primary Care, that spinal manipulations can work to relieve low-back pain, neck pain, whiplash, and headaches, other research has shown chiropractic care to yield no better results than conventional medical care. More research on chiropractic is on the way, however. The federal National Center for Complementary and Alternative Medicine is sponsoring the Consortial Center for Chiropractic Research to support new studies. In the meantime, many people are as faithful to their chiropractors as they are to their friends. According to the Primary Care article, low-back pain sufferers are typically quite satisfied with the care they receive.

While chiropractic is usually risk-free, it can cause some initial pain or fatigue that should fade after treatment. Some skeptics have pointed to the potential for injured disks and even strokes caused by pressure to blood vessels in the neck. However, these complications are extremely rare. Just make sure the practitioner is licensed and has extensive experience.

Yoga

You probably don't need studies to tell you how good yoga can make people feel, both mentally and physically – it combines postures that stretch tight muscles and breathing techniques that relax the body and quiet the mind. In the era of big gyms and tight abs, it can be a gentle, soothing alternative exercise routine for toning muscles and increasing flexibility.

Some studies have pointed to even broader benefits. A randomized trial reported in JAMA found that a yoga regimen was more effective than conventional treatment or no treatment in relieving symptoms of that all-too-common office disease, carpal tunnel syndrome. Another trial found that asthmatics who practiced yoga three times a week for four months reduced their need for inhalers.

But yoga's most important benefit may be in helping to alleviate the number-one reason people go to the doctor: stress-related ills. The deep breathing exercises that are part of yogic traditions are an excellent way to release tension, says Lee, who often recommends yoga to patients who are under physical or emotional stress – like pretty much all of us. Since the movements and stretching inherent in yoga can be difficult for some, he advises people to take it slow. With all of the different styles of hatha yoga being practiced today – power yoga, Bikram, Iyengar, Kripalu, etc. – anyone can find a technique that works for him or her. So take a class. Buy a tape. And say om.

Ziba Kashef writes frequently about health issues for Essence, Mother Jones, and RaceWire.