2. Complementary and Alternative Medicine, Dietary Supplements, and Medications

3. CAM- every where you look

4. Complementary and Alternative Medicine (CAM) Complementary and alternative medicine Complementary and alternative medicine A group of diverse medical and health care systems, practices, and productsA group of diverse medical and health care systems, practices, and products Not considered part of conventional medicineNot considered part of conventional medicine Some scientific evidence exists regarding CAM therapiesSome scientific evidence exists regarding CAM therapies For most, questions of safety and efficacy persistFor most, questions of safety and efficacy persist Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.

5. Integrative or Holistic Medicine Integrative combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. Integrative combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. “Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” “Healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” http://nccam.nih.gov/health/whatiscam/ http://www.integrativemedicine.arizona.edu/about2.html

6. Enhance the mind’s capacity to affect bodily function and symptoms  Chiropractice  Osteopathy  Massage Major Classes of CAM Alternative medical systems Mind-body interventions Manipulative & body-based methods Energy therapies  Homeopathic  Naturopathic  Traditional Chinese and Ayurvedic treatments  Dietary supp  Herbs  Foods  Vitamins  Natural substances  Biofield therapy  Bioelectro- magnetic therapy Biologically -based therapies http://nccam.nih.gov/

8. CAM Treatments Commonly Thought Effective in Pediatrics Effectiveness uncertain Effectiveness uncertain Acupuncture for asthmaAcupuncture for asthma Acupuncture for hay feverAcupuncture for hay fever Acupuncture for rheumatoid arthritisAcupuncture for rheumatoid arthritis Chromium for diabetesChromium for diabetes Echinacea for common coldEchinacea for common cold prevention or treatmentprevention or treatment Evening primrose for eczemaEvening primrose for eczema Effectiveness unlikely Effectiveness unlikely Acupuncture for body weight reduction Acupuncture for smoking cessation Flower remedies for anxiety Homeopathy for anxiety Spinal manipulation for asthma Spinal manipulation for infantile colic

9. Biologically Based Practices Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods Includes: botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, whole diets, and functional foods Dietary supplements are a subset of biologically based practicesDietary supplements are a subset of biologically based practices

10. Energy Medicine Veritable - energy that can be measured Veritable - energy that can be measured Includes sound, visible light, magnetismIncludes sound, visible light, magnetism Putative – energy that has yet to be measured Putative – energy that has yet to be measured human beings are infused with a subtle form of energyhuman beings are infused with a subtle form of energy Includes qi (ki in Japanese); doshas; prana, homeopathic resonanceIncludes qi (ki in Japanese); doshas; prana, homeopathic resonance

11. Energy Medicine - Acupuncture Few complications Few complications Scientific evidence? Scientific evidence? post chemotherapypost chemotherapy management of nauseamanagement of nausea pain reliefpain relief NIH Consensus Statement (1997) NIH Consensus Statement (1997)

12. Manipulative and Body-Based Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems Structures and systems of the body, including the bones and joints, the soft tissues, and the circulatory and lymphatic systems Includes chiropractic manipulation, massage therapy, reflexology, rolfing, Alexander technique, Feldenkrais methodIncludes chiropractic manipulation, massage therapy, reflexology, rolfing, Alexander technique, Feldenkrais method

13. Mind-Body Medicine Interactions among the brain, mind, body, and behavior Interactions among the brain, mind, body, and behavior The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health The ways in which emotional, mental, social, spiritual, and behavioral factors can directly affect health Includes relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, group support, and spiritualityIncludes relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, tai chi, group support, and spirituality

14. Other CAM Therapies Aromatherapy Aromatherapy Colonic Irrigation Colonic Irrigation Therapeutic Touch Therapeutic Touch EDTA Chelation EDTA Chelation Cupping Cupping Primordial Sound Meditation Primordial Sound Meditation

16. Dietary Supplements RUN THE WHOLE GAMUT!!! vitamins- C, E. minerals- Ca, Se minerals- Ca, Se amino acids-lysine amino acids-lysine fats- fish oil fats- fish oil hormones- DHEA hormones- DHEA herbs- ginseng herbs- ginseng phytochemicals-garlic phytochemicals-garlic etc etc

17. FDA Regulations Protect Consumers FDA regulates: Drugs are highly regulated by FDA FDA regulates: Drugs are highly regulated by FDA Vitamins & minerals regulated as foods Vitamins & minerals regulated as foods Supplements are considered safe until demonstrated to be hazardous by FDA Supplements are considered safe until demonstrated to be hazardous by FDA Herbals & botanicals totally unregulated Herbals & botanicals totally unregulated

18. Who Benefits? Those at risk for developing nutritional deficiencies only! People with vit, mineral deficiency People with vit, mineral deficiency Vegans- vit D, B12 Vegans- vit D, B12 Pregnant women- folate Pregnant women- folate Elderly persons- B12/folate Elderly persons- B12/folate People at risk of osteoporosis- Ca, vit D People at risk of osteoporosis- Ca, vit D People at risk of losing blood- Fe People at risk of losing blood- Fe People on restricted diets- vit, minerals People on restricted diets- vit, minerals

19. Hormones HGH HGH EPO EPO BHCG BHCG Steroids Steroids

20. Human Growth Hormone Human Growth Hormone Normally secreted by the pituitary Normally secreted by the pituitary Normal function of GH is growth and development of every body system, including bone and muscle Normal function of GH is growth and development of every body system, including bone and muscle Can be stimulated by propanolol, vasopressin, clonidine, and levodopa Can be stimulated by propanolol, vasopressin, clonidine, and levodopa Synthetic growth hormone Synthetic growth hormone

21. Side Effects: Acromegaly (may be irreversible) Acromegaly (may be irreversible) Peripheral Neuropathy Peripheral Neuropathy Coronary Artery Disease Coronary Artery Disease Cardiomyopathy Cardiomyopathy Diabetes, Hypothyroidism, arthritis Diabetes, Hypothyroidism, arthritis No available urine test available, but banned by NCAA and IOC No available urine test available, but banned by NCAA and IOC

22. Erythropoietin Hormone released by the kidneys in response to low Hct Hormone released by the kidneys in response to low Hct Stimulates RBC production from bone marrow Stimulates RBC production from bone marrow Has recently been manufactured by recombinant DNA technique Has recently been manufactured by recombinant DNA technique Can increase Hct in renal patients by up to 35%, lasting up to 7 months Can increase Hct in renal patients by up to 35%, lasting up to 7 months Used most by cyclists Used most by cyclists

23. Blood Doping Induced Erythrocythemia: An increase in Hb following reinfusion of an athlete’s blood Induced Erythrocythemia: An increase in Hb following reinfusion of an athlete’s blood Goal: to increase the oxygen- carrying capacity of Hb Goal: to increase the oxygen- carrying capacity of Hb Has been used as far back as 1947 Has been used as far back as 1947 1984: seven US Olympic cyclists guilty 1984: seven US Olympic cyclists guilty Banned by IOC in 1985 Banned by IOC in 1985

25. Anabolic Steroids The ultimate ergogenic aid aka “Juice” The ultimate ergogenic aid aka “Juice” Creates the Superhuman Athlete Creates the Superhuman Athlete Testosterone derivatives (cholesterol) Testosterone derivatives (cholesterol) Produced in the adrenal/ testes Produced in the adrenal/ testes

26. Anabolic/Androgenic Steroids Anabolism - Constructive Anabolism - Constructive Catabolism - Destructive Catabolism - Destructive Anabolic effects : inc. skeletal mm mass Anabolic effects : inc. skeletal mm mass anticatabolism anticatabolism Androgenic effects: secondary sexual characteristics - pubic hair, genital size Androgenic effects: secondary sexual characteristics - pubic hair, genital size No Pure Anabolic Steroids No Pure Anabolic Steroids

27. Desired Effects: Increase in strength Increase in strength Increase in weight Increase in weight Increase in aggressiveness Increase in aggressiveness Increased capability of sustaining repetitive, high intensity workouts Increased capability of sustaining repetitive, high intensity workouts Enhanced performance Enhanced performance

29. Specific Side Effects Women (Virilzation): Women (Virilzation): Clitoril enlargement, Deepening of voice, Male pattern baldness, dec. breast size, libidoClitoril enlargement, Deepening of voice, Male pattern baldness, dec. breast size, libido Children: Children: premature closure of growth plate in long bones & thus short staturepremature closure of growth plate in long bones & thus short stature

31. “Prohormones” Androstenedione Androstenedione DHEA DHEA Androstenediol Androstenediol Norandrostenedione Norandrostenedione Norandrostendiol Norandrostendiol

32. Effects: Benefits: Same as Testosterone Benefits: Same as Testosterone Increased energyIncreased energy Enhanced recovery and growth from exerciseEnhanced recovery and growth from exercise heightened sexual arousal and functionheightened sexual arousal and function greater sense of well-beinggreater sense of well-being Plasma levels of testosterone increased from 140% to 330% of normal levels after 50mg and 100mg doses Plasma levels of testosterone increased from 140% to 330% of normal levels after 50mg and 100mg doses SE’s : Same as Testosterone SE’s : Same as Testosterone Banned by IOC, NCAA, NFL Banned by IOC, NCAA, NFL

33. Stimulants Caffeine Caffeine Amphetamines Amphetamines Cocaine Cocaine Ephedrine Ephedrine

34. Amino Acids Creatine Creatine L-Carnitine L-Carnitine Choline Choline Inosine Inosine HMB (B-OH-B- Methylbutyrate) HMB (B-OH-B- Methylbutyrate)

35. Amino Acids Essential amino acids: found in a balanced diet Essential amino acids: found in a balanced diet Recommended protein intake: 0.8 g /kg/day Recommended protein intake: 0.8 g /kg/day Athletes may benefit from up to 1.4 -2.4 g/kg/day Athletes may benefit from up to 1.4 -2.4 g/kg/day Most beneficial for athletes on a poor diet, or vegetarians Most beneficial for athletes on a poor diet, or vegetarians In endurance athletes, up to 10% of energy expenditure is from protein breakdown In endurance athletes, up to 10% of energy expenditure is from protein breakdown

37. Creatine Methylguanidine-acetic acid - made from glycine, arginine & methionine Methylguanidine-acetic acid - made from glycine, arginine & methionine Estimated Daily requirement: 2gms Estimated Daily requirement: 2gms Available in meats and fish (1/2 EDR) Available in meats and fish (1/2 EDR) Sold as Creatine Monohydrate Sold as Creatine Monohydrate Stored in Skeletal MM Stored in Skeletal MM 2000 NCAA banned distribution in training rooms 2000 NCAA banned distribution in training rooms

38. Antioxidants Vitamins E & C Vitamins E & C potential damage from free oxygen radicals produced by lipid peroxidation in exercise potential damage from free oxygen radicals produced by lipid peroxidation in exercise exercise performance is not improved exercise performance is not improved

39. Herbs Ginseng Ginseng Yohimbe Yohimbe Tribulus Terresteris Tribulus Terresteris Ma haung Ma haung