Pushing the envelope of nutrition support: complementary therapies

Abstract

When the survey on unconventional medicine in the USA appeared in the New England Journal of Medicine in January 1993, most practitioners were surprised at the findings.1 One-third of those surveyed were using at least one unconventional therapy. However, in 1992, the National Institutes of Health (NIH) had already established an Office Alternative Medicine (OAM). An NIH workshop on alternative medicine was held in late 1992, from which a report on alternative medical systems and practices in the United States was later published.2 Six fields of alternative medicine were identified: 1. alternative systems of practice 2. bioelectromagnetic applications 3. diet/nutrition/lifestyle changes 4. herbal medicines 5. manual healing methods 6. mind/body control 7. pharmacologic and biological treatments The six NIH categories listed for diet, nutrition, and lifestyle changes were: 1. changes in lifestyle 2. diet 3. Gerson therapy 4. macrobiotics 5. megavitamins 6. nutrition supplements For clinical nutrition practitioners counseling patients on therapeutic diets, this report came as somewhat of a surprise. We did not consider that the low-fat–high-fiber diet, lots of fruits and vegetables, the vegetarian diet, or the Asian or Mediterraneanstyle diet regimens as being under the guise of complementary or alternative therapy. In addition, during the 1990s, growing interest in and use of optimal levels of individual vitamins, minerals, and phytochemicals by the lay public in general and cancer patients in particular thrust nutrition health professionals into this new area of practice. We found ourselves needing to be knowledgable and involved in this rapidly expanding field to provide responsible information and advice to patients and clients. The area of true concern for nutritionists and all health professionals is patient use of unproven nutrition regimens and diet therapies in place of traditional therapy and treatment for cancer. Alternative dietary management is usually combined into regimens referred to as “metabolic therapies.”3 These therapies are unproved, are not based on sound scientific principles, or have failed to show efficacy in studies or controlled clinical trials. Metabolic-therapy practitioners believe that most diseases, including cancer, result from an accumulation of toxins that must be removed from the body. This accumulation is the result of an unhealthy lifestyle; the consumption of unnatural foods; food preservatives and additives; the use of pesticides; and industrial pollution, which in turn lead to disruption of the immune system and susceptibility to degenerative diseases. However, when one looks at complementary and alternative medicine (CAM) dietary regimens, one sees a striking resemblance to current conventional dietary practices. Common features of CAM diets are: 1. usually plant based (vegetarian) 2. usually low in dietary fat and high in fiber 3. plenty of fruits and vegetables 4. most often result in weight loss These recommendations are similar to the dietary goals used by the American Heart Association, the American Cancer Society, the US Dietary Guidelines, and the American Dietetic Association. Obviously, practiced in the conventional setting as we present them, these are healthy eating patterns. In contrast, a number of CAM nutrition therapies appear questionable. The following are some of the better-known alternative nutrition regimens3,4: 1. Gerson therapy 2. Kelley regime 3. macrobiotic diet 4. Harold Manner diet 5. the Hoxsey regimen 6. the Livingston Wheeler regimen Another rapidly growing area of interest to patients is the use of herbal therapies or botanicals. Of the more than 1000 agents known, the following are popular choices, especially among cancer patients:5,6 1. astragalus 2. echinacea 3. cat’s claw 4. essiac 5. ginger 6. goldenseal 7. ginseng 8. garlic 9. iscador (mistletoe) 10. kombucha tea 11. laetrile 12. milk thistle (silymarin) 13. pau d’arco (lapachol) 14. pycnogenol 15. shiitake mushrooms When considering garlic, a common agent familiar to all of us, one can appreciate the difficulty in trying to become an expert on these products as herbal therapies. Research is available on many of these agents, but the studies are often conflicting, and study designs are not always well controlled. As noted, even this food product is not always benign if ingested in excessive amounts by patients with preexisting medical conditions.