Complementary and Alternative Nutrition Therapies

Textbooks and chapters

Greenwald J, Brendler T, Jaenicke C (eds.). PDR for Herbal Medicines, Third Edition. Thomson PDR, Montvale NJ, 2004. This is also a highly referenced, encyclopedic resource of botanicals with an evidence-based approach.
Hendler SS, Rorvik D (eds.) PDR for Nutritional Supplements. Medical Economics/Thomson Healthcare, Montvale NJ, 2001. This is a first-line reference for nutritional supplements that is highly descriptive and referenced with complete discussions of adverse effects.

Jellin JM, Batz F, Hitchens K. Pharmacist’s letter/prescriber’s letter natural medicines comprehensive database. Stockton CA:Therapeutic Research Faculty, 1999. Evidence-based directory of dietary supplements organized according to levels of substantiation for risk and benefit.

Micozzi MS (ed). Fundamentals of complementary and alternative medicine. Churchill Livingstone, New York, 1996. Easy to read text reviewing many aspects of alternative care with a strong emphasis on historical context.
Schulz V et al. Rational Phytotherapy. Springer, New York; 1998. Exhaustive text on herbal supplements including manufacturing processes and terminologies.
 

Review articles

Martinez-Gonzalez, Estruch R. Mediterranean diet, antioxidants and cancer: the need for randomized trials. Eur J Cancer Prev 2004; 13: 327-335. Evidence-based focus on antioxidant therapies and the Mediterranean diet in particular. There are discussions of effects on cancer and heart disease.

Gardiner P, Kemper KJ. Herbs in Pediatric and Adolescent Medicine. Pediatrics in Review Feb. 2000;21(2): 44-57. Discusses the herbs used most commonly by children and adolescents, the common chemical constituents in herbs, and the herbs known to be toxic on either an acute or chronic basis. Also serves as a referral source for additional information about herbal medicine with multiple references.

Khosh F, Khosh M. Natural approach to hypertension. Alt Med Rev 2001; 6:590-600. Detailed evidence-based review of 18 dietary supplements, including botanicals, used for hypertension.
Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomized, controlled trials. Ann Int Med 2002; 137: 805-813. Meta-review of 29 PRCTs of alternative therapies and review of literature.

Murkies AL, Wilcox G, Davis SR Phytoestrogens. J Clin Endocrinol Metab. 1998;83:297-303. This is a long review paper and the most comprehensive to date. Data regarding the use of soy with issues in women’s health are presented (metabolic bone disease, breast cancer, and atherosclerosis).
 

Original reports

Agnusdei D, Crepaldi G, Isaia G et al. A double-blind, placebo-controlled trial of ipriflavone for prevention of postmenopausal spinal bone loss. Calcif Tissue Int 1997;61:142-147. In this well-designed study of postmenopausal women, ipriflavone, a synthetic derivative of daidzein that inhibits bone resorption and stimulates estrogen- induced calcitonin secretion, increased spinal bone mineral density.

Villareal DT, Holloszy JO. Effect of DHEA on abdominal fat and insulin action in elderly women and men: a randomized controlled trial. JAMA 2004; 292: 2243-2248. DHEA 50 mg/d x 6 months was associated with decreased visceral fat, subcutaneous fat and improved insulin sensitivity in the elderly.

Clark LC, Combs GF, Turnbull BW et al. Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. JAMA 1996;276:1957-1963. 1312 patients with a history of basal cell or squamous cell carcinoma of the skin were randomized to receive selenium 200 mcg a day or placebo. Treatment was associated with a reduced total cancer mortality and total cancer incidence.

Heart Outcomes Prevention Evaluation Study Investigators. Vitamin E supplementation and cardiovascular events in high-risk patients. New Engl J Med 2000;342:154-160. Significant study refuting prior claims that vitamin E supplementation is beneficial with respect to cardiovascular risk.

Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel AM, Favier A, Briancon S. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Int Med 2004; 164: 2335-2342. Antioxidants decreased total cancer incidence and all-cause mortality in men but not women.

Khatta M, Alexander BS, Krichten CM, et al. The effect of coenzyme Q 10 in patients with congestive heart failure. Ann Int Med . 2000;132: 636-640. This randomized, double-blind, controlled trial of 46 patients with congestive heart failure, failed to demonstrate any effect of coenzyme Q 10 , 200 mg/day, on ejection fraction, peak oxygen consumption, or exercise duration.

Moghadasian MH, Frohlich JJ. Effects of dietary phytosterols on cholesterol metabolism and atherosclerosis: clinical and experimental evidence. Am J Med . 1999;107:588-594. Plant stanols, which can be incorporated into margarine, have a hypocholesterolemic effect owing to inhibition of intestinal dietary and biliary cholesterol absorption.

Sacks FM et al. Short report: the effect of fish oil on blood pressure and high density lipoprotein cholesterol levels in phase I of the Trials of Hypertension Prevention. J Hypertension 1994;12:209-213. Antihypertensive and lipid-lowering effects of fish oil are demonstrated in this study.

Wilt TJ, Ishani A, Stark G, MacDonald R, Lau J, Mulrow C. Saw palmetto extracts for treatment of benign prostatic hyperplasia. JAMA 1998;280:1604-1609. Saw palmetto extract interferes with 5-alpha-reductase activity and therefore, dihydrotestosterone production and binding to the androgen receptor. It improves urologic symptoms and urine flow measures in men with benign prostatic hypertrophy according to this meta- analysis of 18 controlled trials involving 2939 subjects; this effect was comparable to that of finasteride but with fewer adverse events.

Wyatt KM, Dimmock PW, Jones PW, et al. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. Brit Med J 1999;318: 1375-1381. Pyridoxine (vitamin B6) is a cofactor for the biosynthesis of dopamine and serotonin. Meta-analysis of prospective, randomized, placebo-controlled studies using 50-100 mg/day of pyridoxine suggests efficacy in relieving premenstrual depressive symptoms.
 

Seminal papers

Eisenberg DM et al. Unconventional medicine in the United States. New Engl J Med 1993;328:246-252. 72% or patients availing themselves of alternative care fail to disclose this to their physicians.

Eisenberg DM et al. Trends in alternative medicine use in the United States, 1990 – 1997. JAMA 1998;280:1569-1575. Expenditures for alternative medicine professional services increased 45% from 1990 to 1997 at a cost of $21 billion in 1997, with $12 billion paid out-of-pocket.
 

Web sites

ConsumerLab
National Center for Complementary and Alternative Medicine
NIH Office of Dietary Supplements
Rosenthal Center for Complementary and Alternative Medicine, at Columbia University
US National Institutes of Health Office of Alternative Medicine
 

Clinical algorithms, practice guidelines and/or position papers

Alternative Medicine Alert (subscription periodical), American Health Consultants. Subscription information available here.

Zeisel SH. Regulation of nutraceuticals. Science 1999;285:1853-1855. Nutraceuticals are dietary supplements that deliver a concentrated form of a presumed bioactive agent originally derived from a food, now present in a nonfood matrix, and used to enhance health in dosages exceeding those that could be obtained from normal foods. Nutraceuticals do not require a prescription and their use is governed by the 1994 Dietary Supplement and Health Education Act, though more specific regulations that differentiate nutraceuticals from dietary supplements are needed.

Mechanick JI, Brett EM, Chausmer AB, et al. American Association of Clinical Endocrinologists Medical Guidelines for the Clinical Use of Dietary Supplements and Nutraceuticals. Endocr Pract 2003; 9: 417-470. A comprehensive evidence-based report on many dietary supplements with a detailed discussion of alternative care and DSHEA.