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Alternative and complementary care practices are increasingly being considered in the field of diabetes. Should they be included as part of the care of people who have diabetes mellitus? Should they both be used? How do the two of these fit together? What use is the acronym PARENT?
THE PARENT APPROACH
Once upon a time, to have a full and healthful self-care program, you needed something to help you remember all the parts of that program. A full stress management or holistic health-care program involves not just diet and exercise. It is also a way of thinking that combines a way of acting, eating, balancing your life, and living life to its fullest. The first letters of the words Positive thinking, Assertiveness, Relaxation, Exercise, Nutrition, and Touch spell the word PARENT. As children, each of us was once nurtured or parented by an adult. Depending on how well you were parented, you learned a variety of things that have become a part of your life as you have become an adult. But as an adult, you now need to be able to parent yourself. The challenge goes on.
These letters can help you remember the overall picture of how to parent yourself. Allow the acronym PARENT to represent the parts of a total self-help or stress management program. Life is filled with stressors (things in the external environment that cause stress). To treat your stress (your responses: physically, emotionally, intellectually, and spiritually) you need a program that incorporates all of these parts.
WHERE TO BEGIN
Alternative and complementary care may be a part of where to begin. As my husband and I say: "You can't reach a goal without starting."
Just as you need a foundation on which to build any structure, you also need a foundation on which you can make more healthful choices. There are lots of choices out there. But having too many choices can be confusing. Which choice is right for me? Will this choice be helpful or harmful?Looking Backward
Ever since diabetes was first recognized, over 2,500 years ago, practitioners and people having the disease have tried to do something to stop it, stabilize it, or cure it. Before the origins of the disease were understood, people thought that chanting incantations or eating certain foods would either prevent it or cure it. Even nowadays, if diagnosed, many people grab at any "cure." Someone might say, "Take this herb; it helped my grandmother." Another might say, "Use this treatment. It made my diabetes go away," while others contend that, "Megadoses of vitamin X keep your blood sugars down."
We now know that either you inherit the disease or something happens directly or indirectly to cause your beta cells in the pancreas not to function or work the way they were supposed to.
Presumably you are receiving the traditional diabetes care from your health practitioner, which requires blood glucose monitoring, meal planning, exercise, medication (for most of you), and stress management (this last part fits more and more frequently into the picture of total management). The nontraditional care you might have chosen might include such things as therapeutic massage, acupuncture, magnets, various doses of vitamins, herbal remedies, and so forth.
Both the media and friends often offer suggestions to try this or use that. How many of you, if you are using anything but the "tried and true," are sharing this information with your health professional without being asked? Perhaps even more important, how many of your health professionals actually know anything about the remedies you are using, or even discount them without knowing if they might help?
You encounter choices about alternative and complementary care in magazines, television and radio ads, and increasingly on the Web. But if you have a chronic illness, then making the choice to use one or more of these remedies can be a potentially dangerous one. How does an herb or vitamin interact with the diabetes medicine you are taking? What happens to blood glucose levels when you perspire profusely or get overheated by sitting in a Jacuzzi? Is this food more beneficial than that food? Is too little fat in the diet as bad as too much fat in the diet? Questions, questions, questions . . . they keep arising, and yet to be safe, you must ask them over and over again.The Office of Alternative Medicine and Other Programs/ Information
Is anything being done to help you make safe and useful choices? In the 1980s, Senator Thomas Harkins of Iowa was suffering from allergies. A variety of traditional health professionals prescribed everything they could to give him some relief. He was at his wits' end when someone suggested that he contact a local holistic practitioner. The therapy recommended by this practitioner relieved his suffering and made his life worthwhile again.
Senator Harkins recognized two things: (1) he found relief through the nontraditional treatment versus the traditional ones and (2) in keeping down health care costs, wasn't it better to prevent disease rather than to wait to get a disease and then treat it?
With the help of other senators, he introduced a bill to Congress that funded the then designated Office of Alternative Medicine (OAM). In the first call for grant proposals to study various remedies-- or, as this office termed them, "modalities"-- the office was overloaded with the submission of over 450 proposals. Experts in the various fields reviewed these proposals under groupings such as mind/ body, energy, nutritionally focused, and so forth. The initial funding for these studies also lead to the formation of centers for the study of alternative and complementary care. The University of Texas for cancer; Columbia University's College of Physicians and Surgeons for women's health; the Kessler Institute for Rehabilitation for stroke and neuro-rehabilitation; Bastyr University for HIV and AIDS; the University of Virginia School of Nursing and the University of Maryland School of Medicine for pain; Stanford University for aging; Minneapolis Medical Research Center for Addictions; Beth Israel Hospital and Harvard Medical School for internal medicine; the University of California at Davis for asthma and allergy; and the Palmer College of Chiropractic for chiropractic care are some of the earliest funded programs. In 1999 the OAM became the National Center for Complementary and Alternative Medicine (CAM). In 1999 Capital University, in Washington, D. C., graduated for the first time medical health professionals who had attended a two-year course in alternative and complementary care-- or integrative medicine. Plans are underway to make such a program available to physicians in the Midwest and western parts of the United States.
To date, over 50 percent of the 127 medical schools in the country are now offering required or elective courses on alternative and complementary medicine. These schools are addressing not only what needs to be studied but also what resources are available to help answer the questions of clients. Many more physicians are obtaining extra training so that they are able to choose from a variety of remedies (or modalities) to best meet the needs of their patients. When asked in a survey, more than 80 percent of medical students indicated they would like further training in Complementary and Alternative Medicine (CAM). As of this writing, one-third of family practice residencies already provide some type of CAM education.Recommendations and Resources
As a health-care consumer you should know what the health-care experts are recommending. The following recommendations were made in 1996 by a panel of experts representing the American Medical Association, the American Academy of Family Practice, the American Association of Medical Colleges, the American Medical Students' Association, and other organizations: (1) medical and nursing education should include information about complementary practices; (2) medical and nursing education about each complementary and alternative practice should include information about the history of the remedy, its scientific foundation, the educational preparation needed to give or recommend a remedy, evidence of safety, being certified or licensed by a qualified organization; and (3) national centers of excellence should continue to be developed to foster cooperation among complementary practitioners, nurses, physicians, and to promote a smoother flow of information among education, research, and clinical practice.
More information appears daily. Web sites offer more and more choices, and it's up to you to judge whether the information is helpful or not. The National Diabetes Information Clearinghouse has a search line you may request: Complementary and Alternative Therapies for Treatment of Diabetes Mellitus (see appendix F). This is an annotated bibliography about articles that have appeared in lay publications. New journals have been published, including Alternative and Complementary Medicine, Alternative Therapies in Health and Medicine, Advances in Medicine, and the International Journal for Subtle Energy.
A nurse may be certified in aromatherapy and in holistic nursing. Lay people and health professionals may be certified in healing touch or become Reiki masters. Training is available to study acupuncture and be-come certified. Naturopathy and homeopathy are fields that have reawakened interest. But this is just the surface, because many people want to know more, especially about energy and healing.
The summer (1997) issue of Alternative Health Practitioner focused on "integrated" centers-- those centers that combine traditional with nontraditional care by making available physical facilities, developing plans with individual patients, and educating patients in the use of helpful remedies. Recognized universities, such as Harvard and Yale, are offering courses, some nationwide, on alternative and complementary health-care practices. These are attended by health professionals, by clergy, and by people such as you.
There is now a Physicians' Desk Reference for herbal medicine help line (888-859-8053). "Herbal Remedies in the Pharmacy," an article in the July 1997 issue of U. S. Pharmacist, has concluded that since herbal remedies are gaining in popularity, pharmacists need to know how to counsel patients.
More than four hundred herbs have been found to lower blood sugar levels. Only a small number of these, in proportion to what is possibly available, have been evaluated scientifically.
In the November/ December issue (1997) of Practical Diabetes International, an article appeared on the "Prevalence of Complementary Medicine Usage within a Diabetes Clinic." Authors recognized its use and shared how the use of complementary medicine may have effects on the management of diabetes in the United Kingdom.
As of 1994, herbs, minerals, and vitamins (also termed phytomedici nals or neutraceuticals) can be sold as dietary supplements. The Dietary Supplement Health and Education Act (DSHEA)( 1994) specifies that to qualify for this "category," no therapeutic claims can appear on any label. The label must also note that the product has not been reviewed by the Food and Drug Administration. As part of this DSHEA, the president appointed a new commission comprised of leaders in the field of herbal medicine. They are charged to amass information in order to guide the future process of labeling and handling these products.
CONCERNS AND CAUTIONS
Of increasing importance is the ongoing research to help us understand the role of the immune system and its association with the ability to get infections. It has been found that an overactive immune system as well as an underactive immune system can both lead to problems. An overactive immune system might attack itself (for example, autoimmune diseases such as Type 1 diabetes; allergies; rheumatoid arthritis; ulcerative colitis). An underactive immune system leads to frequent infections, so you must take great care in what treatment you choose to use or to not use. This is especially important when choosing herbal remedies.
Certain herbs have been identified, through existing evidence, not to be safe (either by specific action or potential for incorrect use), and they should be used only under the directions of a qualified professional. They are listed below for emphasis and will be discussed again in the chapter on herbs (chapter 7). Based on references dated from 1993 to 1997, the following herbs are considered unsafe: chaparral (Larrea tridentata) as it can lead to liver damage; ephedra (also known as mahuang or Ephedra sinica) should not be used if someone is taking an MAO inhibitor (monoamine oxidase, which is found in some antidepressants), or if heart disease, diabetes, or high blood pressure is present. Hydrangea (Hydrangea arborescens) can be problematic, depending on the choice of the source. The correct source is the root, but using the leaves can lead to a severe problem, as the leaves contain cyanide. Poke root (Phytolacca decantra) may be fatal in children and results in vomiting. Sassafras (Sassafras albidum) though an old-time, springtime remedy, contains a carcinogen (a chemical capable of causing cancer) and is also known to cause liver damage. Yohimbine (Corynanthe yohimbe) can cause high blood pressure and anxiety. This herb should not be used if a person has kidney disease or a mental illness.
Note that moderately unsafe herbs are considered to be bearberry (not recommended for use in acute inflammation, pregnancy, or for prostate disorders), or black/ blue cohosh (should not be used during pregnancy or for anyone having a chronic disease such as diabetes). A large dose of boneset is toxic. Liver damage can be caused by comfrey. Juniper should not be used during pregnancy and is known to cause kidney disease if used too long. Licorice should not be used if a person is pregnant or has diabetes, heart disease, or high blood pressure. Lobelia has a nicotinelike effect and should not be used in pregnancy. If used it should be given in doses of less than 50 mg/ day and only for a short time. Wormwood should not be used during pregnancy.
On the other hand, in American Druggist, April 1997, a physician promotes that diabetes patients can benefit from certain supplements. The doctor felt that primrose oil, which contains gamma-linolenic acid (GLA), taurine (which thins the blood), vitamin E, and magnesium (which can increase insulin sensitivity), would be useful for people who have diabetes. Reputable scientific journals are the sources for his claims.
The chapter on diabetes in Alternative Medicine: The Definitive Guide compiled by the Burton Goldberg Group explains the disease and then follows with recommendations for treatment. It includes references from the work of James Anderson, a physician from the Department of Veterans Affairs at the University of Kentucky in Lexington, speaking on complex fibers and complex carbohydrates, and Dr. Jonathan Wright, director of the Tahoma Clinic I, Kent, Washington, who presents guidelines for people with diabetes.What they say sounds familiar:
- Eliminate concentrated, refined sugar and sugar products.
- Avoid junk foods.
- Eat whole grains, fresh fruits and vegetables; reduce or eliminate stimulants; eat a small amount of protein in snacks; and take off excess weight.
The diet chapter discusses food intolerances and nutritional supplements, such as the B, C, and E vitamins, and the minerals, magnesium, potassium, chromium, and zinc, plus coenzyme (CoQ10 ), amino acids, and the digestive enzymes. Credible references are included.
Dr. Andrew Weil, in another resource, advises that rest provides a boost for the immune system, along with eating whole foods, less protein, more carbohydrate foods, such as vegetables, fruits, and grains, and less fat. He states that the following natural substances boost the immune system. These are shiitake or reishi mushrooms, echinacea (this will be discussed in detail later) or astragalus, vitamin C, vitamin E, selenium, alpha-and beta-carotenes, CoQ10 , and B complex vitamins (people with Type 2 diabetes should be careful of the amount of B 3 or niacin the product contains). These have been found to block chemical reactions and neutralize free radicals that cause tissue damage. He also recommends maintaining good oral health and exercising almost daily.
But there will still be disagreements among credible people and sound scientific references, especially in this field. What about antibiotics killing good bacteria with the bad? An American Druggist 1997 article makes a case for the indiscriminate use of antibiotics when they aren't really needed. Physicians are recognizing (and now being taught) that antibiotics should be used only for specific purposes. They are also learning about how to replace good bacteria through the use of lactobacillus tablets or drinking acidophilus milk (which you can buy from a grocer). If the good bacteria are killed, then the yeast growth can rise rapidly, and you end up with a yeast infection or worse. Acidophilus keeps yeast under control, helps digestion, and supplies B vitamins.
Sheila Hunter is a pharmacist who is the author of a home study course on nontraditional medication, homeopathy, and herbal medicine. Besides describing the field, her course on homeopathy gives a listing of some of the signs and symptoms a person might report and the corresponding remedies that might be used. Each group of remedies includes alternatives, but not dosages. It reports the need to look for color of the skin and/ or eyes, to feel general or specific areas of the body, to locate discomfort, to note the time of day the symptoms are worse, the person's mood, and so on. It includes summaries on the most frequently used homeopathic remedies. The herbal section includes a description and explanation of a variety of uses of specific herbs as well.
Good, careful studies can give much useful information rather than be looked at as "taking away" the "herb I want to use." In India, for instance, researchers studied guar gum and other herbs and compared them to conventional diabetes medication. In this instance, they found that the herb was useful as an adjunct to therapy or as complementary to the traditional therapy they were using. It made a good treatment even better. In this particular study, they also found some herbs, when used in a certain way, had a better effect on lowering the blood sugar than the standard treatment. These may be the origins of new medications once they have undergone other tests. Studying these herbs has the potential of bringing about the discovery of more effective medicines.What Is "Natural"
Since herbs are considered natural, you often read or hear the statement, "If it's natural, it has to be safe." But this is not necessarily so. The term "natural" in the United States means that the product does not contain slaughterhouse byproducts or petrochemical derivatives. It also means that the product is made up of mainly botanicals (things from earth pigments). The European criteria for something termed "natural" include the information that the product must: support the natural functions of the skin, the active ingredients must be natural (from the earth), no testing can have been done on animals or obtained in any way cruel to animals, must fulfill the legal requirements, must be environmentally sound, and must be biodegradable in a short period of time.Special Care
You should be aware of the "worst case scenario," such as a person who has Type 1 diabetes stopping insulin while using a certain remedy. This is a clear cause for concern. The claims of certain remedies to improve diabetes might be helpful only as long as the principles are maintained. For example, the major principle would be to normalize blood glucose levels the majority of the time, with few below normal blood sugar episodes experienced. If the rest of the body is not harmed, the use of the complementary therapy would really be a blessing. An alternative therapy such as exercising after meals, rather than continued eating, would clearly be beneficial.
It is possible that some unusual practices could be indirectly effective. If you "tied some coral to your arm" or "drank milk that had pearls boiled in it"--practices suggested by an Indian healer-- you might be more aware of your activity and food intake to the point where your blood sugars did improve. This could be due to your increased awareness of doing something believed to be helpful that in itself might not necessarily be so. Therefore, your use of a product may not result directly in blood glucose levels decreasing but indirectly, by the awareness you have of controlled caloric intake and use of a product in relation to what you usually eat to feel satisfied. Various models of practice, in this way, could actually offer some support to attaining the goal of normal glucose levels.
MODELS OF PRACTICE
There are many other practices of which you should be aware.
The allopathic model is the traditional model, which focuses on medicine and surgery.
The Piman model might include an allopathic physician or nurse, but more often a shaman or herbalist who assists in getting rid of impurities of the body and upholding spiritual needs.
The Curanderismo model often includes an herbalist or a medium. This model works with individuals or groups and provides them a specific regimen to follow to restore balance.
The Chinese programs could include a physician, a shaman, an herbalist or a masseur, as all address the concerns of energy blockages in the body and the balance of the yin versus the yang (that is, male versus female; hot versus cold, etc.).
The homeopathy model looks at the essence or history and can then suggest diluted solutions to mimic the illness but at a much lower strength, so that the body's immune system responds, as it might with a vaccination.
The chiropractic model studies bones and specifically the nerves of various parts of the body. This is said to complement allopathic treatments by adjusting or balancing the person's body so that the individual would respond better to the treatment or medicine given.
The naturopathic model uses the herbs and vitamins of a balanced diet as well as supplements when needed. Supplements may be helpful for healing but not necessarily curing.Culture and Beliefs
A study about Mexican Americans of Hispanic origin found that 17 percent of patients reported using herbs to treat their diabetes. This needs to be taken into consideration by health professionals working with this or any other specific culture. Their religious and spiritual beliefs are also important to consider. You may be one of this group (78 percent in this particular population) that believes it is God's will for you have diabetes. If this is your belief, it should be honored as should any other beliefs that do not hurt or harm yourself or others.
Cultural norms will influence an individual's response to having diabetes in that culture. If you have a headache, the healer treats it. For Tongans, who are Polynesian, the massage of the head by a foot might be the solution. If that doesn't work, then it might be thought to be due to a spiritual cause. If your headache was due to low blood glucose levels, unless your health-care worker cooperated with what the healer was doing and vice versa, it might be possible for you to suffer from problems that would result from an even lower blood sugar.
African-Americans and others enjoy "spiritualcise"-- a mind-body exercise program that includes low-impact aerobic movement, gospel music, and a forum for discussion.
Programs that originate in various cultures could be useful to assist people from other populations. Sharing information helps all people with diabetes to live a better life.Healing versus Curing
Just to set the record straight, healing is not curing, but curing is certainly healing. Healing is described as rebalancing the body so that curing (when the body moves from an ill state to a well state) might occur. Healing might occur only spiritually or emotionally or mentally rather than physically. Many energy therapies are based on healing rather than curing. For example, healing practices might sooth the pain, but the illness doesn't go away.
A more recognizable example of healing is when hypnosis is used to help people in pain imagine that their few minutes of comfort actually seem like hours of comfort.
In Lourdes, France, a person might be healed (feel better in mind or mind and body) or be cured-- get up and walk. This healing may have a holistic effect or just an effect on being able to miraculously walk. (A team of doctors and priests determines if the "walking" was truly a miracle or not.)
WHERE TO START
(she) stands in moments of comfort and convenience, it is
where he (she) stands at times of challenge and controversy."
All parts of the body (including genetics), mind (includes perceptions, intelligence), emotions, and beliefs (spirituality) are involved in holistic interventions. This is why the initials of the PARENT approach should get you back to the initial purpose of this book, which is to give you resources from which to obtain further information and from which the most appropriate decisions might be made. This should take into account the unique needs of your total being.
The results of any or all of these interventions have the potential to help or to harm. If wise choices are made, the potential is an increased quality of life for many people and a potentially increasing basis for the prevention of disease in spite of having diabetes.