Galen's Watch

Alternative and Complementary Studies for Asthma in Children

I was looking over the last 2 issues of Galen's Watch and L-carnitine improves the asthma control in children with moderate persistent asthma was one of the most popular studies I reported on. There was also an issue earlier Massage Therapy and Pulmonary Function in Children with Asthma. Both of these alternative/complementary  therapies would be simple to implement. Looking at asthma and children I searched for other alternative/complementary therapies in older issues and also did a search and found a few studies that show some simple alternative/complementary therapies that can improve asthma in children. Could implementing these measures improves asthma attack frequency? It would certainly be worth trying.


From Galen's Watch Issue #2 2012

L-carnitine improves the asthma control in children with moderate persistent asthma.
 
One hundred children's (50 with moderate persistent asthma and 50 healthy controls) serum carnitine levels were measured and the asthma group was divided into 2 groups. One group was given 350mg L-carnitine tid and the other group was given a placebo for 6 months. Total and free carnitine levels were significantly lower in the asthma group than the control group. Both pulmonary function tests and childhood-asthma control test showed a significant improvement in the L-carnitine group.
 
J Allergy (Cairo). 2012;2012:509730. Epub 2011 Nov 23.
L-carnitine improves the asthma control in children with moderate persistent asthma.

 
From Galen's Watch Issue #1 2012

Massage Therapy and Pulmonary Function in Children with Asthma
 
Sixty children with asthma were randomly assigned to either 20 minutes of massage by their parents before bed each night for 5 weeks in addition to standard treatment or standard treatment alone. The massage groups mean FEV1 was significantly higher than the control group. The FEV1/FVC ratio was also significantly improved. There was no significant improvement in FVC or PEF. Pulmonary function was improved in the massage group.
 
J Altern Complement Med. 2011 Nov;17(11):1065-8.
Pulmonary functions of children with asthma improve following massage therapy.


From Galen's Watch #2 2011

Serum Vitamin D Levels Are Associated with Reduced Lung Function in Asthmatic Children
 
Forty-five children with intermittent asthma were evaluated for 25-hydroxyvitamin D concentrations and baseline forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and the percentage fall in FEV1 after a standardized exercise challenge. Only 11% of children had serum levels of at  least 30 to 40  ng/mL.  A positive correlation was found between 25-hydroxyvitamin D levels and FVC and FEV1. Subjects with a positive response to the exercise challenge had lower serum levels of 25-hydroxyvitamin D levels than subjects with a negative challenge, 16.2 versus 23.4 ng/mL.

Eur Respir J. 2010 Nov 11. [Epub ahead of print]
Vitamin D serum levels and exercise-induced bronchoconstriction in children with asthma.

Other Research:

Acta Paediatr. 2009 Apr;98(4):737-42. Epub 2008 Jan 11.
Omega-3 fatty acids, vitamin C and Zn supplementation in asthmatic children: a randomized self-controlled study.

AbstractOBJECTIVES:Bronchial asthma is a chronic inflammatory airways disease. Nutritional intervention is an important tool to decrease the severity of many chronic inflammatory diseases including asthma. The aim of this study is to evaluate the role of omega-3 fatty acids, vitamin C and Zn in children with moderately persistent asthma.
PATIENTS AND METHODS:Randomly assigned, placebo-self-controlled 60 children with moderate persistent asthma completed the study, were subjected to alternating phases of supplementation with omega-3 fatty acids, vitamin C and Zn either singly or in combination separated with washout phases. Childhood asthma control test (C-ACT), pulmonary function tests and sputum inflammatory markers were evaluated at the beginning of the study and at the end of each therapeutic phase.
RESULTS:There was a significant improvement of C-ACT, pulmonary function tests and sputum inflammatory markers with diet supplementation with omega-3 fatty acids, vitamin C and Zn (p < 0.001*). There was also significant improvement with the combined use of the three supplementations than single use of any one of them (p < 0.001*).
CONCLUSION:Diet supplementation with omega-3 fatty acids, Zn and vitamin C significantly improved asthma control test, pulmonary function tests and pulmonary inflammatory markers in children with moderately persistent bronchial asthma either singly or in combination.

PMID:19154523[PubMed - indexed for MEDLINE]

Intern Med. 2000 Feb;39(2):107-11.
Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma.

AbstractOBJECTIVE:The effects of perilla seed oil (n-3 fatty acids) on bronchial asthma were compared with the effects of corn oil (n-6 fatty acids) in relation to the pulmonary function and the generation of leukotriene B4 (LTB4) and C4 (LTC4) by leucocytes.
METHODS AND SUBJECTS:14 asthmatic subjects were divided randomly into two groups: one group (7 subjects) consumed perilla seed oil-rich supplementation and the other group (7 subjects) consumed corn oil-rich supplementation for 4 weeks. Generation of LTs by leucocytes and respiratory function were compared between the two groups.
RESULTS:The generation of LTB4 and LTC4 by leucocytes tended to increase in subjects (N=7) with corn oil-rich supplementation, and decrease in subjects (N=7) with perilla seed oil-rich supplementation. Significant differences between the two groups were observed in the generation of LTB4 at 2 weeks (p<0.05) and LTC4 at 2 weeks (p<0.05) after dietary supplementation. Significant increases in the value of PEF (p<0.05), FVC (p<0.01), FEV(1.0) (p<0.05) and V(25) (p<0.05) were found in subjects who received perilla seed oil supplementation for 4 weeks. And significant differences in the value of FVC (p<0.05) and FEV(1.0) (p<0.05) were observed between the two groups after 4 weeks of dietary supplementation.
CONCLUSION:These results suggest that perilla seed oil-rich supplementation is useful for the treatment of asthma in terms of suppression of LTB4 and LTC4 generation by leucocytes, and improvement of pulmonary function.

PMID:10732825[PubMed - indexed for MEDLINE]
Free full text

Diabetes and Naturopathic Medicine: A Good Fit

A study was published this week by BMC Complementary and Alternative Medicine Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year an open access platform. This was a prospective study to measure the effects of Adjunctive Naturopathic Care (ANC) in primary care patients with inadequately controlled T2 diabetes.

Details:

• 40 patients with T2 diabetes
• invited to receive up to 8 adjuncted naturopathic care visits for up to 1 year
  patients has hemoglobin A1c (HbA1c) values between 7.5-9.5%
• had at least one additional CV risk factor (hypertension, hyperlipademia, obesity)

Outcomes:

• There were significant improvements in key diabetes health indicators, including patient reported and clinical outcomes.
• the majority of patients felt there was a benefit from their ANC
• 62% of patents felt that the ANC visits changed the way they thought about their diabetes and 72% said they changed their diabetes care as a result of the visits
• The ANC group had a reduction in HbA1c and small improvements in glycemic control were present at 12 months

Recommendations

• reinforcement to monitor glucose - 64%
• adhere to prescription medication - 74%
• dietary changes - 95%
• physical activity - 100%
• stress reduction - 59%
• increase protein -54%
• increase vegetables - 46%
• add walking -79%
• dietary supplements - 74%
• omega-3 fish oil- 56%
• chromium- 46%
• multi-vitamin- 44%
• fiber - 36%
• Vitamin D3- 26%

- the study participants were not seeking naturopathic care or had any previous experience with naturopathic care. It would be interesting to see the difference with individuals seeking naturopathic care and how that would impact the outcome.

Other studies/articles of interest looking at diabetes and naturopathic medicine:

CAM: naturopathic dietary interventions for patients with type 2 diabetes.

How we eat may be more important than what we eat: Lessons from a clinical trial of a naturopathic nutrition study

Naturopathic Medicine and Type 2 Diabetes: A Retrospective Analysis from an Academic Clinic (full text)

Diagnosis and Possible Reversal of Pre-Diabetes Dr Mona Morstein ND PDF download

L-carnitine Plus Sibutramine for Insulin-resistant Patients
 
Two hundred and fifty-four patients with uncontrolled type 2 diabetes taking different oral hypoglycemic agents or insulin were randomized to take sibutramine 10 mg plus L-carnitine 2 g, or sibutramine 10 mg alone. Patients were evaluated at 3, 6, 9, and 12 months. Both groups had a decrease in body weight, body mass index, glycated hemoglobin (HbA1c), fasting plasma glucose (FPG),  homeostasis model assessment insulin resistance index (HOMA-IR) and retinol binding protein-4 (RBP-4), but the L-carnitine group values were lower than the sibutramine group. The sibutramine plus L-carnitine had a faster decrease in FPG, post-prandial plasma glucose (PPG),  total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high sensitivity-C reactive protein (hs-CRP) and resistin levels. Only sibutramine plus L-carnitine improved triglycerides  and visfatin.
 
Full free text article
Intern Med. 2010;49(16):1717-25. Epub 2010 Aug 13.
Sibutramine and L-carnitine compared to sibutramine alone on insulin resistance in diabetic patients.

Effect of Folic Acid Supplementation on Overweight Men with Type 2 Diabetes

    
Forty-eight overweight men (49-67 years) with type 2 diabetes were randomly assigned to take folic acid (5mg/d) or placebo for 8 weeks. The folic acid group had a 8% decrease in HbA1C, 7.5% fasting blood glucose, 16.2% serum insulin, 20.5% in insulin resistance and 21.2% in plasma homocysteine. The folic acid group had a significant increase in serum B12 and folate, 17.3% and 19% respectively.
 
Diabetes Res Clin Pract. 2011 Oct;94(1):33-8. Epub 2011 Jul 28.
Effect of folic acid supplementation on biochemical indices in overweight and obese men with type 2 diabetes.


Glycemic Controls Too Tight in Type 2 Diabetes
 
This review looked at large randomized trials of patients with type 2 diabetes and glycemic control. They found that tight glycemic control burdened patients with complex treatment programs, hypoglycemia, weight gain and costs but offered uncertain benefits in return. They recommend that clinicians should prioritise and support well-being, healthy life styles, preventative care and cardiovascular risk reduction in these patients.
 
Ann Intern Med. 2009 Jun 2;150(11):803-8. Epub 2009 Apr 20.
Erratum in:Ann Intern Med. 2009 Jul 21;151(2):144.
Glycemic control in type 2 diabetes: time for an evidence-based about-face?

Cinnamon Reduces Glycated Hemoglobin in Type 2 Diabetics
 
Fifty-eight patients with type 2 diabetes treated with only hypoglycemic agents and an HbA1c >7% were randomly assigned to 2 g of cinnamon or placebo for 12 weeks. Patients were 54.9 years of age ± 9.8 years,  57% Asian/Asian British (Indians/Pakistani/Bangladeshi), and 26% black. All patients were receiving antihyperglycemics: 76% metformin monotherapy, 34% antihypertensives and 33% statins. After 12 weeks, HbA1c decreased by 0.36% in the cinnamon group versus a 0.12% increase in the placebo group. Changes in systolic (-4 mm Hg vs +1 mm Hg) and diastolic (-4 mm Hg vs -1 mm Hg) blood pressure favoured the cinnamon group.
 
Diabet Med. 2010 Oct;27(10):1159-67
Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial.

 

Reduced Obesity? Increased Cognition? Have Breakfast! -support studies

A reader wrote me and said she was putting together some information sheets for her patients on the importance of eating breakfast and asked if I could find some support studies. She was looking for studies that supported eating breakfast and its effect on:

• obesity
• concentration
• school grades

We assume that breakfast is a good idea and it probably is for most people. I say that because I have been reading more and more about people trying IT (intermittent fasting), especially in the paleo eating community. However, they pay pretty close attention to their eating and it is a conscious choice to miss a meal with dietary compensation at other times. AS opposed to just not taking the time to eat!

So here is a list of studies that support eating breakfast. You will see the title followed by a clip from the study that shows support.

Lifestyle, Obesity, and Insulin Resistance

• that physical health is associated with the following seven favorable habits: sleeping 7–8 h, eating breakfast almost every day, avoiding eating between meals...

Association of Breakfast Skipping With Visceral Fat and Insulin Indices in Overweight Latino Youth

• Eating breakfast is associated with lower visceral adiposity in overweight Latino youth. Interventions focused on increasing breakfast consumption are warranted.

Association between eating patterns and obesity in a free-living US adult population.

• In contrast, skipping breakfast was associated with increased prevalence of obesity (odds ratio = 4.5, 95% confidence interval: 1.57, 12.90), as was greater frequency of eating breakfast or dinner away from home.

Breakfast frequency and quality may affect glycemia and appetite in adults and children.

• supporting the hypothesis that the breakfast meal and its quality may have important causal implications for the risk of obesity and type 2 diabetes.

Breakfast habits, nutritional status, body weight, and academic performance in children and adolescents.

• Breakfast eaters generally consumed more daily calories yet were less likely to be overweight, although not all studies associated breakfast skipping with overweight. Evidence suggests that breakfast consumption may improve cognitive function related to memory, test grades, and school attendance.

A systematic review of the effect of breakfast on the cognitive performance of children and adolescents.

• Few studies examined adolescents. Studies of school breakfast programmes suggest that such interventions can have positive effects on academic performance, but this may be in part explained by the increased school attendance that programmes encourage.

Does school breakfast benefit children's educational performance?

• In four studies, two in the USA and the others in Peru and Jamaica, findings reveal that when undernourished children missed breakfast, they performed worse in tests of cognition. Adequately nourished children's performance was unaffected by missing breakfast. A study in four Jamaican schools found that children had more creative ideas when they received a breakfast for 2 weeks than when they did not receive breakfast. Two Swedish studies found that children with a high-calorie breakfast improved in cognition compared to those receiving a low-calorie breakfast

Breakfast frequency and quality may affect glycemia and appetite in adults and children.

• Our results suggest that breakfast frequency and quality may be related in causal ways to appetite controls and blood sugar control, supporting the hypothesis that the breakfast meal and its quality may have important causal implications for the risk of obesity and type 2 diabetes.

The relationship of school breakfast to psychosocial and academic functioning: cross-sectional and longitudinal observations in an inner-city school sample.

• Students who increased their participation in the school breakfast program had significantly greater increases in their math grades and significantly greater decreases in the rates of school absence and tardiness than children whose participation remained the same or decreased. Child and teacher ratings of psychosocial problems also decreased to a significantly greater degree for children with increased participation in the school breakfast program.

Fasting and cognitive function

• Skipping breakfast was found to have adverse effects on the children's late morning problem-solving performance. These findings support observations that the timing and nutrient composition of meals have acute and demonstrable effects on behavior.

 

Fibromyalgia Studies: Treatment Strategies & Learning from Others

More fibromyalgia studies to come in the future that I have covered in the journal watch but today a few resources I found. It is always educational to see how other people structure their treatment plans.

There are 2 articles in the the latest Townsend Letter.

Effective Treatment of Chronic Fatigue Syndrome and Fibromyalgia: A Comprehensive Medicine Approach
by Jacob Teitelbaum, MD

• An interesting article using the SHINE "Sleep, Hormonal support, Infections, Nutritional support, and Exercise as able" protocol. In addition to natural suggestions he also lists pharmaceuticals that can help.

Chronic Fatigue-Fibromyalgia: The Adrenal–Thyroid Connection
by Michael Gerber, MD, HMD

• This article also has some gems but what I like is the personal way it is told with examples and cases.

If herbs are your practice focus then the article by Chanchal Cabrera is for you.
Chronic Fatigue Syndrome a Holistic Herbal Treatment Approach 
© Chanchal Cabrera MSc, MNIMH, AHG


Full of herbal suggestions, and case studies with  individualized herbal formulas. Chanchal also wrote a book on Fibromyalgia. Fibromyalgia: A Journey Toward Healing

I also did a post on the fibromyalgia study A program consisting of a phytonutrient-rich medical food and an elimination diet ameliorated fibromyalgia symptoms and promoted toxic-element detoxification in a pilot trial.

• This study used UltraClear MACRO and RENEW  (Metagenics) in female patients with fibromyalgia

Other fibromyalgia studies:

J Altern Complement Med. 2009 Apr;15(4):399-405.
A new nonpharmacological method in fibromyalgia: the use of wool.

2002 Jun;22(2):56-9. Epub 2002 Mar 29.

The effects of balneotherapy on fibromyalgia patients.

J Altern Complement Med. 2010 Apr;16(4):397-409.
Traditional Chinese medicine for treatment of fibromyalgia: a systematic review of randomized controlled trials.

J Altern Complement Med. 2009 Mar;15(3):247-57.
Intravenous micronutrient therapy (Myers' Cocktail) for fibromyalgia: a placebo-controlled pilot study.

Arch Phys Med Rehabil. 2010 Oct;91(10):1551-7.
The effects of 12 weeks of resistance exercise training on disease severity and autonomic modulation at rest and after acute leg resistance exercise in women with fibromyalgia.

Pain. 2010 Nov;151(2):530-9.
A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia.

J Altern Complement Med. 2010 Nov;16(11):1191-200.
Efficacy of Biodanza for treating women with fibromyalgia.

N Engl J Med. 2010 Aug 19;363(8):743-54.
A randomized trial of Tai chi for fibromyalgia.

Heat Therapy for Fibromyalgia Pain

In doing some continuing professional education I came across a study showing that patients with fibromyalgia found a benefit from wearing wool underwear. I wondered if any other studies supported warmth in patents with fibromyalgia for pain relief and found a few. As well, there was a case study of two patients using warmth for pain relief with success. Continuing my research into FM pain and warmth I found this article using a certain species of dog as heat therapy in FM.  Surely, as well as, offering unusual heat these dogs offer the comfort of companionship. Of course some patients do not feel better with heat and seem to respond better to cold and there are studies showing that people with FM do not deal well with temperature extremes or adjust quickly to temperature changes.


A new nonpharmacological method in fibromyalgia: the use of wool.

• 50 patients with fibromyalgia
• wore woollen underwear covering them from shoulders to thighs, used woollen bedding for 6 weeks
• The woollen group had a significant reduction in pain levels, tender point count and Fibromyalgia Impact Questionnaire scores

Effects of thermal therapy combining sauna therapy and underwater exercise in patients with fibromyalgia.

• 44 females with fibromyalgia
• underwent sauna therapy 3 days a week and underwater exercise 2 days a week for 12 weeks
• all patients reported significant reductions in pain and symptoms (31-77%)
• patients remained relatively stable during 6 month follow-up (28-68%)

Pain relief in women with fibromyalgia: a cross-over study of superficial warmth stimulation and transcutaneous electrical nerve stimulation.

• 32 women with fibromyalgia
• either used superficial warmth or transcutaeous electrical nerve stimulation
• Both treatments were effective in reducing pain
• warmth reduced pain from 77.5 to 62.5 pts and nerve stimulation from 80 to 62.5 pts
• there was a slightly higher preference for warmth therapy

Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls.

• 33 women with fibromyalgia (FM) matched to 44 healthy controls
• to examine the differences in habituation to cold pain in women with FM
• FM group showed sensitization and had decreased cold pain thresholds across trials (they felt cold pain at higher temperatures) the control group habituated to the cold stimuli
• both groups habituated to heat pain

Case Study:

J Psychosom Res. 2005 Apr;58(4):383-7.
The effects of repeated thermal therapy for two patients with chronic fatigue syndrome.
Masuda A, Kihara T, Fukudome T, Shinsato T, Minagoe S, Tei C.
Source


OBJECTIVE:This paper describes the successful treatment of two patients with chronic fatigue syndrome (CFS) using repeated thermal therapy.
METHODS: Two patients with CFS underwent treatment with prednisolone (PSL), with no satisfactory effect. They were subjected to thermal therapy that consisted of a far-infrared ray dry sauna at 60 degrees C and postsauna warming. The therapy was performed once a day, for a total of 35 sessions. After discharge, these subjects continued the therapy once or twice a week on an outpatient basis for 1 year.
RESULTS:Symptoms such as fatigue, pain, sleep disturbance, and low-grade fever were dramatically improved after 15 to 25 sessions of thermal therapy. Although PSL administration was discontinued, the subjects showed no relapse or exacerbation of symptoms during the first year after discharge. The patients became socially rehabilitated 6 months after discharge.
CONCLUSIONS:These results suggest that repeated thermal therapy might be a promising method for the treatment of CFS.

PMID: 15992574

Homeopathic Drops Reduce Ear Pain in Otitis Media Similar to Topical Benzocaine

A study that will be in the next Galen's Watch report.

Homeopathic ear drops may have a role in reducing antibiotics in otitis media using a watch and wait approach to care while using the homeopathic eardrops to manage pain and discomfort. The researchers noted that:

 The use of a delayed antibiotic prescription for certain patients with otitis media is a strategy recommended in the AAP guildeline. However, despite the recommendation, it has been estimated that the delayed prescription management plan is only utilized in approximately 15% of cases of pediatric otitis media

The researchers also noted that:

This (the results) suggests that homeopathic ear drops may be most effective in the early period after a diagnosis of AOM (acute otitis media) and could possibly reduce the use of delayed antibiotics.

 

Homeopathic Ear Drops for Otitis Media in Children

One hundred and nineteen children (6 months -11years) diagnosed with otitis media in an in-office visit were randomly assigned to standard care alone or standard care plus homeopathic ear drugs* The homeopathic drops were administered at 3-4 drops up to 3 times a day for a maximum of 5 days. The children receiving ear drops symptom scores tended to be lower than the stand care alone group, Those differences were significant at second and third assessments (24 and 36 hours). The ear drop group also had faster symptom improvement. By day 3 there was little difference between the groups although the ear drops group used less medication. Thirty children received delayed antibiotic prescriptions. Although the sample size was too small to find a statistical difference only 7.1% of the ear drop group filled their prescriptions compared to 36.5% of the standard therapy group. The researchers state that the efficacy of the ear drops  is comparable to the demonstrated effectiveness of topical benzocaine drops in alleviating ear pain in children with acute otitis media.

*Hylands Earache Drops, Pulsatilla, Chamomilla, Sulphur, Calcarea carbonica, Belladonna, ad Lycopodium, all in the 30c potency.

Homeopathy. 2011 Jul;100(3):109-15.
Homeopathic ear drops as an adjunct to standard therapy in children with acute otitis media.
21784326

 

Is Milk Thistle the Best Herb For Chronic Hepatitis C? Doesn't Look Like It.

Last week there it was reported that Milk Thistle No Help in Chronic HCV from an abstract presented at the AASLD conference. This of course peeked my interest and I had to go and read what I could on the report. I love these side-line investigations. So I am going to break down the report into point form and then look at a few other studies using milk thistle. Is milk thistle the best herb choice? And what about the dosage? After looking at the studies I think both are in question.


Fried MW, et al "A randomized, placebo-controlled trial of oral silymarin (milk thistle) for chronic hepatitis C: final results of the SYNCH multicenter study" AASLD 2011; Abstract 228.

• The study involved 154 patents with a history of failed interferon-therapy and Hepatitis C Visus (HCV) and a serum ALT >/= 65 IU
• 2 doses of silymarin were used 420 or 700 mg/day for 6 months
• Symptom scores and QoL were unchanged at study end
• There was little effect on ALT
• 4% of patients in each group met the endpoint decline of ALT to=/> 45 IU or at least a 50% decline from baseline
• Conc: had no detectable effect on hepatitis C virus (HCV) disease activity in comparison with placebo in patients with previously treated chronic disease,

To help put this report in context about milk thistle and hepatitis Let’s take a look at the properties of milk thistle (silymarin) and liver disease, past studies involving hepatitis C, milk thistle and anti oxidants.

Milk Thistle (silybum marianum)

• Has been traditional used for the treatment of liver disorders and as a hepatoprotective
• In experimental models is has shown hepatoprotective and anti carcinogenic activity
• Has been shown  to lower liver enzymes in alcohol-related disorders and non-alcoholic fatty liver disease
• Contains flavanolignan mixture (silymarin: mostly silybin, silychristin and silydianin)

Simon Mills MNIMH says "it can be concluded that milk thistle should not be solely relied on for the treatment of hepatitis C, but may have some role as an hepatoprotective agent"

Milk thistle may not be the been the best herb choice in this study for HCV.  As as seen in the studies below In combination with other agents it may have faired better. As well the dosage of silybum in this report may have been low or perhaps as they outline  not effective given orally.

There are a few studies  and case studies showing that antioxidant therapy in Hepatitis C  has fairly good results:

Med Klin (Munich). 1999 Oct 15;94 Suppl 3:84-9.
A conservative triple antioxidant approach to the treatment of hepatitis C. Combination of alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories.
Berkson BM.

World J Gastroenterol. 2007 Oct 28;13(40):5317-23.
Antioxidant therapy for chronic hepatitis C after failure of interferon: results of phase II randomized, double-blind placebo controlled clinical trial.
Gabbay E, Zigmond E, Pappo O, Hemed N, Rowe M, Zabrecky G, Cohen R, Ilan Y.

J Med Virol. 2008 Nov;80(11):1900-6.
Treatment with silybin-vitamin E-phospholipid complex in patients with hepatitis C infection.
Falasca K, Ucciferri C, Mancino P, Vitacolonna E, De Tullio D, Pizzigallo E, Conti P, Vecchiet J.


There was a study in the spring of 2011 on the Effects of silybum marianum on patients with chronic hepatitis C.

• In this study 55 patients with HCV received 620 mg/day of silymarin for 24 weeks.
• Liver fibrosis markers (YKL 40 and HA) results before treatment, patients were divided into three stages: Fibrosis group: YKL 40 > 150 ng/ml and HA > 60 ng/ml or YKL 40 > 150 ng/ml or HA > 100 ng/ml; Non-fibrosis group: YKL 40 < 100 ng/ml and HA < 20 ng/ml
• They found there was improved serum HCV-RNA, ALT and AST, hepatic fibrosis and quality of life. There was a statistical improvement only in the Fibrosis group.

Finally there was a study on the oral availability of milk thistle and the dosages required.  This last study found to achieve steady-state concentrations of silybin A and B that silymarin must be dosed tid and at dosages above 2.1g day. And at 2.1g a day silybin A and B concentrations "were still 1 to 2 orders of magnitude below those concentrations associated with antiviral effects in vitro"

• 32 patients with chronic non cirrhotic HCV  who previously failed interferon therapy were divided into 4 groups and given 140, 280, 560, or 700 mg silymarin were administered every 8 hours for 7 days.
• They concluded that Oral doses of silymarin up to 2.1 g per day were safe and well tolerated. The nonlinear pharmacokinetics of silybin A and silybin B suggests low bioavailability associated with customary doses of silymarin may be overcome with doses above 700 mg.
• These data suggest that multiple daily oral doses must be administered at least 3 times per day if steady-state concentrations and antiviral effects are to be achieved.
• At the highest dose of 700 mg, which may represent a reasonable pill burden limit for patients, the steady-state peak plasma concentrations of silybin A and silybin B achieved were still 1 to 2 orders of magnitude below those concentrations associated with antiviral effects in vitro, and trough concentrations were approximately 25-fold lower than peak concentrations

Silymarin Ascending Multiple Oral Dosing Phase I Study in Noncirrhotic Patients With Chronic Hepatitis C 

Alternative therapies for Children: Nutritional Status in Autism, Yoga for IBS, Allergenic Foods and Acupuncture

The latest edition of Galen's Watch just went out. Here is a sample of the studies in the Pediatrics section on alternative therapies for children. There are a few interesting studies. 

Nutritional and Metabolic Status of Children with Autism

Yoga for Children with IBS or Functional Abdominal Pain

Introduction of Allergenic Foods in Infants Does Not Affect Wheezing or Eczema

Acupuncture Reduces Visceral Adipose Tissue in Obese Children

And from Previous Issues:

Probiotic Supplement VSL#3 Improves IBS Symptoms in Children (GW#9, 2010)

Lactobacillus rhamnosus for Children with IBS (GW#2, 2011)

 

The study abstracts:

Nutritional and Metabolic Status of Children with Autism

Fifty-five children (5-16 years) with Autism Spectrum Disorder were compared to control children for nutritional and metabolic biomarker differences. None of the subjects had taken vitamin/mineral supplements for 2 months prior to samples being taken. For most vitamins, children with autism had levels that lay within the neurotypical childrens’ reference range. More than 25% of the Austism group was lower in total carotenes and higher in vitamin C, free choline, total choline and Formiminoglutamic acid (FIGLU). There was also a lower level in whole blood lithium and a higher red blood cell iron (above the 90th percentile for 42%) in the autism group. SAM and reduced plasma glutathione were significantly lower in the autism group and uridine was significantly higher. Oxidized glutathione (the ratio of oxidized to reduced glutathione)  and plasma nitrotyrosine were significantly higher in the autism group.  Several of the biomarker groups were significantly associated with variations in the severity of autism. 

Free open access article

Nutr Metab (Lond). 2011 Jun 8;8(1):34.

Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity.

Yoga for Children with IBS or Functional Abdominal Pain 

Twenty children with irritable bowel syndrome (IBS) or functional abdominal pain (FAP) were enrolled to receive 10 yoga classes. Each yoga class was 1.5 hours in length with a children's yoga teacher. The children began with an education about their condition and a high-fibre diet but with insufficient effect. The baseline period was one month which functioned as a control phase, followed by a 12 week treatment period and a 3 month follow-up. Pain frequency was significantly decreased by end of therapy compared to baseline in the 8-11 and 11-18 year olds. Pain intensity was significantly decreased  in the 8-11 group at 12 weeks. After 3 months, there was still a significant reduction in pain frequency in the 8-11 group  and a borderline significant decrease in pain frequency for the total group. Parents reported better quality of life after yoga treatment. 

Complement Ther Med. 2011 Jun;19(3):109-14. Epub 2011 May 26.

A pilot study of yoga treatment in children with functional abdominal pain and irritable bowel syndrome.

From Previous Issues  studies on alternative therapies for children

Probiotic Supplement VSL#3 Improves IBS Symptoms in Children (GW#9, 2010)

Fifty-nine children aged 4-18 years were randomly assigned to receive either VSL#3* or placebo for 6 weeks. After a 2-week wash-out period, the patients were switched to the opposite group for an additional 6 weeks. Both placebo and VSL#3  groups had improvement in some of the parameters. VSL#3 was significantly superior to placebo in the primary endpoint of subjective symptom relief. VSL#3 also improved abdominal pain/discomfort, abdominal bloating and family assessment of life disruption. No adverse effects were recorded.

* VSL#3® is the medical food probiotic with the highest available concentration of beneficial live bacteria. Each packet of VSL#3® contains 450 billion live lactic acid bacteria, which collectively act as a Living Shield™ in the gastrointestinal (GI) tract.

J Pediatr Gastroenterol Nutr. 2010 Jul;51(1):24-30.

VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.

Lactobacillus rhamnosus for Children with IBS (GW#2, 2011)

One hundred and forty-one children with irritable bowel syndrome (IBS)  or functional abdominal pain were randomized to  Lactobacillus rhamnosus GG (LGG) or placebo for 8 weeks with 8 weeks of follow-up. There was a significant reduction in frequency and severity of abdominal pain in the LGG group compared to placebo. Treatment success was achieved in 48 children in the LGG group and 37 children in the placebo group, and this success was maintained at end of follow-up. Intestinal permeability tests were done and at study entry, 59% of children had abnormal results. There was a significant decrease in the number of patients with abnormal results in the LGG group , and these results were mainly seen in children with IBS.

Pediatrics. 2010 Dec;126(6):e1445-52. Epub 2010 Nov 15.

A randomized controlled trial of Lactobacillus GG in children with functional abdominal pain.

Introduction of Allergenic Foods in Infants Does Not Affect Wheezing or Eczema

A total of 6905 preschool children were included in this study. Using the International Study of Asthma and Allergies in Childhood core questionnaire, information was gathered on the outcome of eczema and wheezing and the age of food introduction at 6 and 12 months. At the age of 2, wheezing was reported in 31% of children and in 14% of children at 3 and 4 years. Eczema at 2, 3 and 4 years was 38%, 20% and 18%. The introduction of cow's milk, hens’ eggs, peanuts, tree nuts, soy and gluten before the age of 6 months was not associated with eczema or wheezing at any age after including potential co-founders:  birth weight, gender, daycare attendance, older siblings, and family history of atopy. The results did not change with the addition of child's cow milk allergy or parental history of atopy. A study weakness could be the potential for recall bias for food introduction timing.

Arch Pediatr Adolesc Med. 2011 Jun 6. [Epub ahead of print]

The introduction of allergenic foods and the development of reported wheezing and eczema in childhood: the generation R study.

Acupuncture Reduces Visceral Adipose Tissue in Obese Children

Ten healthy obese children with a BMI of 29.03 ± 4.81 were assigned to 1 month of acupuncture sessions. The acupuncture sessions lasted 15 minutes twice a week. The children were diagnosed with either excessive 'heat' in the stomach and intestine (7 cases) or 'dampness' due to spleen and primary qi deficiency (3 cases). The excessive heat pattern was treated at acupoints: Tianshu (ST25), Liangqiu (ST34), Zusanli (ST36), Gongsun (SP4), Quchi (LI11), Hegun (LI4), Zhigou (SJ6), Shangjuxu (ST37), and Neiting (ST44). The dampness pattern was treated at acupoints: Tianshu (ST25), Liangqiu (ST34), Zusanli (ST36), Gongsun (SP4), Zhongwan (RN12), Yinlingquan (SP9), Fenglong (ST40), Qihai (RN6), and Shuifen (RN9).   There was a decrease in visceral adipose tissue (VAT) but not subcutaneous adipose tissue (SAT). After 1 month of treatment, subjects’ BMI was reduced by 3.5%, VAT volume by 16.04%, abdominal total adipose tissue by 10.45%,  and abdominal visceral to subcutaneous fat ratio by 10.59%. The reduction in VAT may be explained by VAT's increased sensitivity to lipolytic stimulation thanSAT. There were no significant changes in body weight but there was a reduction is VAT content. 

J Altern Complement Med. 2011 May;17(5):413-20.

Effects of acupuncture therapy on abdominal fat and hepatic fat content in obese children: a magnetic resonance imaging and proton magnetic resonance spectroscopy study.

 

Sabra

Natural Flu Remedies: Stock Your Medicine Cabinet Now-Probiotics, Vit D, Maxingshigan-yinqiaosan, Elderberry

 Natural flu remedies, you want to stock them in your dispensary, recommend them to patients in your handouts or over the phone on a call-in. Good prevention is in lifestyle but everyone gets busy and even the healthiest can get the flu so having some natural flu remedies on hand is a great idea. Be prepared before it strikes so when the chills and fever come on you can hunker down and grab your stock of natural flu remedies and hopefully be back on your feet, a few days earlier.

The first two studies were reported on earlier Galen's Watch editions and are all about proven prevention. They really are natural flu remedies but you need to plan ahead. Of course many would say that Vitamin D and probiotics are just part of a healthy living program. 

The third study is scheduled for up coming Galen's Watch and compares the Chinese Formula Maxingshigan-yinqiaosan to Oseltamivir for H1N1.

The fourth study is on elderberry from 2004.

Probiotics Reduce Number of Missed School Days in Children
This double-blind, placebo-controlled study randomly assigned 326 children (3-5 years of age) to receive placebo, Lactobacillus acidophilus NCFM, or L acidophilus NCFM in combination with Bifidobacterium animalis subsp lactis Bi-07 twice a day for 6 months. With single and combination probiotics, but not placebo, reduced fever incidence, coughing incidence and rhinorrhea incidence were observed. Overall, fever, coughing, and rhinorrhea duration was decreased significantly, relative to placebo, by 32% (single strain) and 48% (combination). Antibiotic use and absentee days were also reduced. Results were better for the combination probiotics group than the single strain probiotics group. The researchers concluded that daily dietary probiotic supplementation for 6 months was a safe, effective way to reduce fever, rhinorrhea, and cough incidence,  duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age. In a 2008 study, it was found that that a regular, long-term intake of various synbiotics may improve health by reducing the incidence and severity of respiratory diseases during the cold season. That 3-stage prospective, randomized, double blind, placebo-controlled study was carried out over a 3-year period with several synbiotic preparations containing 3-5 strains of Lactobacillus plantarum, Lactobacillus rhamnosus, and Bifidobacterium lactis, lactoferrin and prebiotics such as either FOS (short-chain fructooligosaccharides) or GOS (galactooligosaccharides).

Free full text
Pediatrics. 2009 Aug;124(2):e172-9. Epub 2009 Jul 27.
Probiotic effects on cold and influenza-like symptom incidence and duration in children.
 
J Clin Gastroenterol. 2008 Sep;42 Suppl 3 Pt 2:S224-33.
A new chance of preventing winter diseases by the administration of synbiotic formulations.
 
Vitamin D Supplementation in School-aged Children Reduces Incidence of Influenza A
 
The study randomized 334 school-aged children to either receive vitamin D(3) supplements (1200 IU/day) or placebo for December through March. Influenza A occurred in 10.8% of children in the D3 group and 18.6% of the placebo group. The reduction in influenza A was more predominant in children who had not been taking other vitamin D supplements and who started nursery school after age 3. In children with a previous diagnosis of asthma, two children in the D3 group had asthma attacks compared to 12 in the placebo group.
 
Ann Intern Med. 2011 Aug 16;155(4):217-25.
Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.

Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial.

BACKGROUND: Observational studies from Asia suggest that maxingshigan-yinqiaosan may be effective in the treatment of acute H1N1 influenza.
OBJECTIVE:To compare the efficacy and safety of oseltamivir and maxingshigan-yinqiaosan in treating uncomplicated H1N1 influenza.
DESIGN:Prospective, nonblinded, randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00935194)
SETTING:Eleven hospitals from 4 provinces in China.
PATIENTS:410 young adults aged 15 to 59 years with laboratory-confirmed H1N1 influenza.
INTERVENTION:Oseltamivir, 75 mg twice daily; maxingshigan-yinqiaosan decoction (composed of 12 Chinese herbal medicines, including honey-fried Herba Ephedrae), 200 mL 4 times daily; oseltamivir plus maxingshigan-yinqiaosan; or no intervention (control). Interventions and control were given for 5 days.
MEASUREMENTS:Primary outcome was time to fever resolution. Secondary outcomes included symptom scores and viral shedding determined by using real-time reverse transcriptase polymerase chain reaction.
RESULTS:Significant reductions in the estimated median time to fever resolution compared with the control group (26.0 hours [95% CI, 24.0 to 33.0 hours]) were seen with oseltamivir (34% [95% CI, 20% to 46%]; P < 0.001), maxingshigan-yinqiaosan (37% [CI, 23% to 49%]; P < 0.001), and oseltamivir plus maxingshigan-yinqiaosan (47% [CI, 35% to 56%]; P < 0.001). Time to fever resolution was reduced by 19% (CI, 0.3% to 34%; P = 0.05) with oseltamivir plus maxingshigan-yinqiaosan compared with oseltamivir. The interventions and control did not differ in terms of decrease in symptom scores (P = 0.38). Two patients who received maxingshigan-yinqiaosan reported nausea and vomiting.
LIMITATIONS:Participants were young and had mild H1N1 influenza virus infection. Missing viral data precluded definitive conclusions about viral shedding.
CONCLUSION:Oseltamivir and maxingshigan-yinqiaosan, alone and in combination, reduced time to fever resolution in patients with H1N1 influenza virus infection. These data suggest that maxingshigan-yinqiaosan may be used as an alternative treatment of H1N1 influenza virus infection.

Ann Intern Med. 2011 Aug 16;155(4):217-25.
Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial.

Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.

Elderberry has been used in folk medicine for centuries to treat influenza, colds and sinusitis, and has been reported to have antiviral activity against influenza and herpes simplex. We investigated the efficacy and safety of oral elderberry syrup for treating influenza A and B infections. Sixty patients (aged 18-54 years) suffering from influenza-like symptoms for 48 h or less were enrolled in this randomized, double-blind, placebo-controlled study during the influenza season of 1999-2000 in Norway. Patients received 15 ml of elderberry or placebo syrup four times a day for 5 days, and recorded their symptoms using a visual analogue scale. Symptoms were relieved on average 4 days earlier and use of rescue medication was significantly less in those receiving elderberry extract compared with placebo. Elderberry extract seems to offer an efficient, safe and cost-effective treatment for influenza. These findings need to be confirmed in a larger study.

J Int Med Res. 2004 Mar-Apr;32(2):132-40.
Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections.

                                                                                                                    Sabra

Recent Acupuncture Studies - Depression, TMD, Low back pain, Plantar Faciitis

 

The Immediate Effect of Acupuncture on Obstructive Sleep Apnoea
 
Forty patients with moderate obstructive sleep apnoea were randomly assigned to either a manual acupuncture treatment group, an electroacupuncture 10 Hz treatment group, an electroacupuncture 20 Hz treatment group or a control group. The treatment was done just before sleep at 8 pm. The manual acupuncture points used were as follows: LU6, LU7, LI4, LI20, GV20, CV23, ST36, ST40, SP6, KI6. An extra point is located between the hyoid bone and the menton symphysis (Shanglianquan). For electroacupuncture the electrodes were placed in the points of the neck (deep enough to reach the genioglossus muscle - CV23 and Shanglianquan)  and also along the body in LI4 and ST36 bilaterally. The Apnoea-Hypopnoea Index results for the manual acupuncture group and the electroacupuncture 10 Hz group were significantly different from the control and electroacupuncture 20 Hz groups. Manual acupuncture and electroacupuncture 10 Hz exerted better immediate effects than electroacupuncture 20 Hz and no treatment in reducing the Apnoea-Hypopnoea Index as well as the number of nocturnal respiratory events.
 
Acupunct Med. 2010 Sep;28(3):115-9. Epub 2010 Jun 15.
Immediate effect of acupuncture on the sleep pattern of patients with obstructive sleep apnoea.
 
 
Electro-acupuncture Improves Specific Functions in Children with Autism Spectrum Disorder
 
Fifty-five children with autism spectrum disorder (ASD) were randomly assigned to either electro-acupuncture (EA) or sham electro-acupuncture (SEA). There were a total of 12 sessions of EA or SEA over 4 weeks. Eight acupoints were used: Sishencong (EX-HN1), Yintang (EX-NH3), Neiguan (PC6), Shenmen (HT7), TaiChong (LR3), Ear naodian (AT3), Ear shenmen (TF4), and Sanyinjiao (SP6). The EA group had significant improvements in the language comprehension domain of the Functional Independence Measure for Children (WeeFIM), self-care caregiver assistant domain of the Pediatric Evaluation of Disability Inventory (PEDI), and Clinical Global Impression-Improvement (CGI-I) scale. The parental report showed significantly better social initiation, receptive language, motor skills, coordination and attention span.
 
Full free text article
Altern Med Rev. 2010 Jul;15(2):136-46.
Randomized controlled trial of electro-acupuncture for autism spectrum disorder.
 
 
Acupuncture Improves Depression and Myalgia Scores in Patients with Chronic Hepatitis B and C
 
This prospective, uncontrolled, observational study enrolled 28 patients with chronic hepatitis B and C divided them into 3 groups. Group A (n=13) had high Beck's Depression Inventory (BDI) and myalgia scores. Group B  (n=11) had low BDI scores and high myalgia scores and Group C (n=4) had high BDI and low myalgia scores. The following needling points were bilaterally sued: Yintang (0.3 cun), LU9 (0.2 cun), CV 17 (0.2-0.3 cun), SP6 (0.5-1 cun), LI4 (1 cun), ST36 (1-1.5 cun), KI3 (0.5 cun) and LR3 (0.5 cun). Patients received 2 weekly 20-minute sessions for 6 weeks. The mean age of the patients was 35,89% had chronic hepatitis B and 1 patient had both hepatitis B and C. Three patients were receiving interferon. The median BDI and myalgia scores decreased significantly in Groups A and B after treatment. Group C had a non-significant change in the BDI score and the myalgia score was similar before and after treatment. Exclusion criteria were pregnancy, psychiatric disorders, and history of antidepressant use during the preceding 3 months, coagulation disorders and drug addiction.
 
Acupunct Med. 2010 Sep;28(3):136-9. Epub 2010 Jun 7.
Acupuncture for depression and myalgia in patients with hepatitis: an observational study.
 
 
Acupuncture Helpful for Depression
 
Eighty patients with major depressive disorder (MDD) were randomized into 2 groups. Group 1 received verum acupuncture, 10 mg/day of fluoxetine and placebo. Group 2 received sham acupuncture, 20-30 mg/day of fluoxetine for 6 weeks. Acupuncture in Group 1 was applied 5 times a week at 6 different locations: GV20 (Baihui), EX-HN1 (Sishencong), EX-HN3 (Yintang), GV26 (Shuigou), P6 (Neiguan), H7 (Shenmen), Liv3 (Taichong) and L14 (Hegu). Needling was done until there was needling sensation and retained for 30 minutes and manipulated once again during treatment. Group 2 was needled in non-specific locations 1-3 cm from the acupuncture points not recognized as true acupoints of meridians. Patients were allowed to use Zolpidem 10 mg prn for insomnia. No statistical difference was seen between groups at the end of the study even though Group 1 received a lower dose of fluoxetine. Group 1 also showed better improvement in symptoms of anxiety and antidepressant side effects. Group 1 also showed a statistically reduced use of zolpidem in the third period of the study.
 
J Altern Complement Med. 2009 Aug;15(8):837-44.
Combination of acupuncture and fluoxetine for depression: a randomized, double-blind, sham-controlled trial.
 
 
Acupuncture Treatment for Plantar Faciitis
 
In this randomized trial, patients were assigned to either a treatment group or a control group. The treatment group recefacuived needling at acupoint PC 7 and the control group received needling at acupoint Hegu (LI 7). Morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain and pressure pain threshold was significantly different, in favour of the treatment group.
 
Evid Based Complement Alternat Med. 2009 Nov 23. [Epub ahead of print]
Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up.
 
 
Acupuncture and its Effect on Type I Hypersensitivity Itch
 
Thirty patients with atopic eczema received acupuncture before (direct effect) and after (preventative effect) exposure to an allergen stimulus (house dust mite or grass pollen skin prick). Patients either received verum acupuncture at points Quchi and Xuehai dominant side, or placebo acupuncture on the dominant side, or no acupuncture.  Direct and preventative effect itch intensity was significantly lower in the verum acupuncture group compared to the placebo and no acupuncture groups. Mean wheal and flare size were significantly lower in the verum acupuncture group compared to the placebo and no acupuncture groups. In both treatment approaches, itch questionnaire results were significantly lower in the verum acupuncture group.
 
Allergy. 2010 Jul;65(7):903-10. Epub 2009 Dec 11.
Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema: a blinded, randomized, placebo-controlled, crossover trial
 
 
Acupuncture Effective Treatment in Temporomandibular Disorders (TMD)
 
Seventeen patients (37-50 years of age) with Temporomandibular joint (TMJ) pain, including signs and symptoms of TMD with a primarily muscular origin and  pain for at least 6 months received acupuncture treatment for 10 weeks. The acupuncture needling bilateral points were IG4, E6, E7, B2, VB14, VB20, ID18, ID19, F3, E36, VB34, E44, R3, and HN3, with 10 sessions conducted on a weekly basis, for 20 minutes each session.  After acupuncture treatment electromyography (EMG) was decreased at rest, as well as, clenching for all muscles. The molar maximal bite force increased after treatment. The EMG decrease did not reach an ideal of zero and EMG activity persisted and was higher in temporalis rather than masseter muscles. There was a better distribution of EMG activity after treatment. Individuals in this study also reported decreased pain and this may have contributed to the increased bite strength. However, the trial was of small size and lacked a sham placebo component.
 
J Altern Complement Med. 2009 Dec;15(12):1307-10.
Acupuncture and temporomandibular disorders: a 3-month follow-up EMG study.
 
 
Combined Abdominal Acupuncture with Conventional Acupuncture Improves Knee Osteoarthritis
 
One hundred and five patients with knee osteoarthritis were divided randomly into 3 groups. Group A received abdominal acupuncture at Zhongwan (CV 12), Guanyuan (CV 4), Wailing (ST 26), Daheng (SP 15), Lower Rheumatism point and Qipang with needles retained for 30 minutes. Group B received conventional acupuncture at Neixiyan (EX-LE4) and Dubi (ST 35) of the affected limb, Yanglingquan (GB 34), Liangqiu (ST 34), Xuehai (SP 10) and Xiyangguan (GB 33). Group C received both abdominal and conventional acupuncture. Treatment was given once daily, 6 days a week, for 4 weeks. Group C had the most "remarkably relieved" patients with 13 of the 35, followed by Group A with 8 of 25 and Group B with 7 of 35. Group C also had a higher number of "relieved" patients with 16 of the 35.  Abdominal acupuncture has a synergized function when combined with conventional acupuncture.
 
J Tradit Chin Med. 2009 Dec;29(4):249-52.
Clinical research on abdominal acupuncture plus conventional acupuncture for knee osteoarthritis.
 
 
Acupuncture Superior to Western Medicine and Chinese Medicine for Relieving Hyperemesis Gravidarum
 
Ninety individuals were randomly divided in an acupuncture group, a Western medicine group and a Chinese medicine group for 7 days of treatment. All subjects received a water and electrolyte supplement.  The acupuncture group recieved acupuncture at Dazhu (BL 11), Shangjuxu (ST 37), Neiguan (PC 6), and Gongsun (SP 4). The Western medicine group received Luminal 30 mg tid and the Chinese medicine group received a herbal decoction according to TCM syndrome differentiation.  The therapeutic effect, ketone bodies, carbon dioxide combining power (CO2-CP) and electrolyte imbalanceswere observed in all the groups. The acupuncture group had an efficacy rate of 96.7%, the Western group a rate of 46.7% and the Chinese medicine group a rate of 60%.
 
Zhongguo Zhen Jiu. 2009 Dec;29(12):973-6.
Observation on therapeutic effect of acupuncture on hyperemesis gravidarum
[Article in Chinese]
 
 
Acupuncture Plus Baclofen Works Better than Baclofen Alone for Lower Back Pain
 
Eighty-four men (50-60 years) with non-specific back low back pain (LBP) were randomly assigned to 4 groups for 5 weeks. Group 1 received baclofen 30 mg/day, Group 2 received acupuncture, Group 3 received both treatments, and Group 4 was a control group. For the acupuncture protocol each patient in Group 2 and 3 received needles bilaterally at points Shenshu (BL23), Dachangshu (BL25), Panguanshu (BL28), Ciliao (BL32), Kunlun (BL60), Huantiao (GB30) and Yanglingquan (GB34). Each acupuncture session consisted of 10-12 needles which were used bilaterally and needles were left in place for 20-25 minutes. Bacolfen alone was effective in reducing pain, but pain relief was not found to be significantly different from baseline at 3, 4, 5 and 10 weeks follow-up. Acupuncture alone significantly decreased pain at weeks 2, 3, 4 and 5 compared to baseline.  Relief was stable in the acupuncture group at week 10. The baclofen and acupuncture groups had significant pain reduction and the pain scores were lower than the baclofen or acupuncture monotherapy groups. 
 
Free full text article
Chin Med. 2010 Apr 24;5:15.
Reduction of chronic non-specific low back pain: a randomised controlled clinical trial on acupuncture and baclofen.