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Complementary Medicine in the News
Geriatric Times September/October 2001 Vol. II Issue 5
Electrical Stimulation May Help Heal Diabetic Foot UlcersA study published in Archives of Physical Medicine and Rehabilitation (82[6]:721-724) has found that the application of electrical stimulation, in addition to standard care, helps foot ulcers heal in patients with diabetes. Electrical stimulation has previously been shown to have antibacterial effects, increase blood flow to tissues and facilitate the healing of fractures. Since faulty wound healing is one of the leading causes of eventual amputation, it is important that any foot wounds heal as quickly as possible.
In a 12-week, double-blind, randomized study, researchers at University of Texas Health Sciences Center in San Antonio looked at 40 patients who had diabetic foot ulcers. One group of 20 received electrical stimulation through a microcomputer to the feet for eight hours a night. The other group of 20 received sham stimulations that delivered no current. Additional wound care for both groups included weekly debridement, a topical hydrogel and use of removable cast walkers. Five patients (two treated, three placebo) withdrew due to severe infection.
Sixty-five percent of the patients in the electrical stimulation group healed, compared to only 35% in the placebo group. There was no significant difference in compliance between the two groups, nor in the time to wound healing.
The authors concluded that the electrical stimulation "may, therefore, contribute to the early return to function and help minimize the need for lower extremity amputation"--TB
Update on Antioxidant Supplements: Are They Helpful?
Dietary antioxidants, such as vitamin C, have been shown to play a protective role against some cancers, stroke, heart disease and other diseases. Whether supplementation provides the same benefits remains controversial, and some research has suggested it may even be detrimental. While findings that vitamin C may have pro-oxidant properties have been largely discounted, results from two recent studies have called into question the value of supplementation.
In a study published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology (2001;21[8]:1320), patients with coronary artery disease were randomized to groups receiving the statin simvastatin (Zocor) plus niacin, simvastatin plus niacin and antioxidants (including vitamins E and C, ß-carotene, and selenium), antioxidants only, or placebo. The researchers speculated that since the presence of high-density lipoproteins (HDL) can prevent oxidation of low-density lipoproteins, HDL levels might benefit from the addition of antioxidants. However, they found that patients taking antioxidants alone experienced no improvement. In addition, increases in HDL and HDL2 were higher in the simvastatin plus niacin group, as compared to the simvastatin plus niacin and anti-oxidants group (25% versus 18% and 42% versus 0%, respectively).
In a second study reported in Science (2001; 292[5524]:2083-2086), researchers added vitamin C to test-tube solutions of lipid hydro-peroxides (fat molecules in the blood) and found that, if given enough time, it reacted to form compounds that could potentially harm DNA. The study authors suggested that the concentration of vitamin C used was comparable to that found in the human body if a person were taking 200 mg/day. In a statement to the press, the study authors acknowledged that vitamin C is an essential human nutrient with dozens of important functions in the body, and they noted that further research is needed to see how these results might be applied to the study of disease in vivo.
Co-author Ian A. Blair, Ph.D., added, "The key finding is that vitamin C can do good things and bad things. I think it just redirects people's attention to the fact that you can't replace a good diet with magic bullets such as vitamin C."
The American Heart Association, publisher of the statin study, concurred with this sentiment, emphasizing that patients should obtain their nutrient needs through a balanced diet--JH
Diet, Supplement May Limit Prostate Tumor Growth
According to the National Cancer Institute, prostate carcinoma is the leading cancer among American men, second to skin cancer. However, in recent years, researchers have found that simple steps such as avoiding diets high in fat; eating lots of fruits, whole grains and vegetables; and consuming selenium, vitamin D and vitamin E, may help prevent prostate cancer. New research points to the possible role of flaxseed and diet in limiting the progression of this disease. In a pilot study (Urology 2001;58[1]:47-52), scientists at Duke University Medical Center in North Carolina found that low-fat diets that included flaxseed (Linum usitatissimum, also known as linseed) may affect prostate cancer biology and deter tumor growth.
Twenty-five patients with a diagnosis of clinically localized prostate cancer who were awaiting prostatectomy were given 30 g/day of a ground preparation of flaxseed and instructions for a low-fat diet (20% or less of total kilocalories as fat) for an average of 34 days. Blood was drawn at baseline and at a follow-up appointment scheduled one to three days before surgery. Histopathologic studies were performed on excised tumors; matched, historic controls were used for comparison purposes.
The study did not detect overall significant changes in prostate-specific antigen (PSA) levels. However, the results showed that PSA levels continued to rise in patients with Gleason sums of
7 and decreased in patients with Gleason sums <7, suggesting the intervention was unsuccessful in patients with more histologically aggressive disease. In addition, the study authors found significantly lower tumor proliferation rates and significantly higher rates of apoptotic cell death. A decrease in total serum cholesterol (mean change=-26.5, p<0.001), total testosterone (mean change=-62, p=0.002) and free androgen index (mean change=-7.0, p=0.01) were also noted. Reported side effects were minimal and included increased bowel movements (n=2), constipation (n=1) and flatulence (n=3); there were no reports of nausea or decreased libido.
Flaxseed has been of interest to scientists because it is the richest source of plant-based omega-3 fatty acids. In addition, it is an especially rich source of dietary lignans, containing 75 to 800 times more lignans than any other food. Lignans have been found to reduce PSAs and play a key role in influencing both estrogen and androgen metabolism. Previous studies have linked a-linolenic acid, the omega-3 fatty acid found in flaxseed, with decreased prostate cancer risk.
While the researchers were optimistic about their findings, they cautioned that the study was underpowered and exploratory in nature. Moreover, they emphasized that randomized, controlled clinical trials are needed to confirm the results. Meanwhile, preliminary results from a study currently being conducted on mice supports the Duke researchers' findings in humans. (To further help your patients, please see the patient teaching section on page 11 of the September/October issue of Geriatric Times--Ed.)--HAD
Use of Alternative Medicine Increases Over Past 50 Years
While recent studies have shown that one-third of the U.S. population uses some form of complementary and alternative medicine (CAM), little is known about long-term usage trends. Researchers from Harvard Medical School and the Center for Alternative Medicine Research and Education at Beth Deaconess Medical Center in Boston conducted a nationwide telephone survey of more than 2,000 individuals over the age of 18 to obtain information on current use, lifetime use and age of first use of 20 CAM therapies. The results appeared in the Annals of Internal Medicine (2001;135[4]:262-268).
The survey found that use of most of the 20 CAM therapies studied, which included megavitamins, self-help groups, biofeedback, energy healing, herbal medicine, massage, naturopathy, yoga and aromatherapy, has increased steadily since the 1960s. The use of CAM therapies was similar across gender, ethnicity and level of education. Regional and rural versus city differences were also absent.
While the use of CAM therapies increased in all age groups since the 1950s, the researchers found some generational differences. By age 33, for example, three out of 10 pre-baby boomers (born before 1945) had used some type of CAM; five out of 10 baby boomers (born 1945 to 1964) had; and seven out of 10 post-baby boomers (born 1965 to 1979) had. Nearly 50% of the respondents who had tried one of the therapies were still using it many years later--EAD
