Integrative Medicine and Children
Gtgt welcome everyone to our your child's health university presentation this evening.I'm nancy sanchez from community health education programs and it's my great pleasure to present our speaker this evening who is john mark.He's going to be speaking with us on integrative medicine and children, a fascinating subject.A little bit about Mark Mark received his medical degree from the university of kansas and he completed a residency in pediatrics at children's mercy, university of missouri in kansas city.He continued his training in pediatric pulmonary medicine during his fellowship.
At the university of rochester, rochester, new york.And then in 1999, he went to the university of arizona to complete the first fellowship in pediatric integrative medicine and that was funded by the national institute of health.He's now on the faculty at lucile packard children's hospital since 2005 and he's been utilizing different complementary and alternative health care practices with his patients with chronic pulmonary illnesses, asthma, cystic fibrosis.His interest is in nutrition, mind body approach to healing and trying to minimize medication and emphasis on such things as exercise.
Very fascinating subject and we thank you Mark for being here this evening.When i first got into academic medicine after i left my fellowship at the university of rochester, i came out to california and took a position at u.C.Davis in sacramento.And after about two years of being in academic medicine i discovered that it wasn't really for me.I mean it was like research and it wasn't like very holistic and not very caring.And plus i'd met my nowwife who wanted to live in santa cruz.
So i left academic medicine and moved to santa cruz.And for the next 15 years i learned mostly about how to care for children through nonconventional ways because about everybody in the central coast uses everything but medicine.They'd only come to see the if their acupuncture didn't work or their homeopathy didn't work, if their mindbody stuff didn't work.And so they were teaching me really over those next 15 years.And so in 1999, i was fortunate to find an offer for a fellowship at the university of arizona.
They got what was called a center grant where for the next five years, they were actually going to study alternative therapies in children.And so i applied just on kind of a whim and i got accepted to be a fellow down there.And what was really nice is that many of you may have heard of andrew weil who is kind of the guru in integrative medicine.He was at the university of arizona for a long time and he had an ongoing program that was a clinical program,.
What they call a residential fellowship but there was no pediatric part of it.And so we went down thinking i'd be down there for two years just doing research but actually they kind of adopted us into the program so that we got to hang out with weil and all his group for the next two years.And you know we would spend the day with deepak chopra or the day with patch adams and we would learn all these different therapies and we really got to know a lot about the different types.
Of alternative therapies.Plus i was doing research too.A couple of topics that i looked at was the use of echinacea in children one to five years of age who had recurrent or persistent otitis media.And we also looked at mindbody relaxation in children with recurrent abdominal pain.And we also looked at chamomile tea with kids with abdominal pain.And one of the interesting ones that we did is we looked at acupuncture and massage therapy in children with cerebral palsy to see if we could actually decrease their spasticity.
So we were doing all this research and at the same time, we got to be part of all the integrative therapies and go to all the clinics and listen to all the lectures on those things.I thought, well, after two years of being in the university of arizona, that's why i still have the u of a up there because i would come back down to santa cruz and i would never have to practice in academic centers again.But then i kind of got lured back into academics when i was.
At the u of a because as many of you know, the university of arizona has a long history of having an excellent respiratory therapy and respiratory both pediatrics and adult medicine.So i started hanging out with those guys and when i finished my fellowship they asked me if i wanted to be one of their staff, on the faculty.So i went back to academic medicine after being gone all those 15 years and started being a practicing pediatric pulmonary person again and using all these alternative therapies integrated.
Into conventional therapies, the socalled integrative medicine.And after being down there for another four years, i wanted to come back to the central coast because that's really where i wanted to be and i came back to stanford in 2005.So that's kind of my long journey.Actually i was out of academic medicine and then i kind of got into it by actually going back in and learning about alternative therapies and complementary medicine which we now call integrative medicine.And so that's kind of how i got interested in it and so.
Since being back here, i've been trying to use it more and more in the patients that i see, especially with chronic illnesses and we'll talk about that in a minute.And i was just telling nancy that i just came from a meeting where we're actually trying to set up an outpatient integrative medicine service here at packard.And we're trying to work on that for the next, hopefully for the next fiscal year which starts this september, where we'll actually have outpatient clinics in rheumatology, gi, infectious disease, pulmonary,.
And pain all kind of working together in different ways, not just using conventional therapies.That's kind of the background for tonight so i think we're moving along.It's taken me a while but if you know stanford or packard very well, everything takes a long time.You just have to be really persistent which i am and so we are just kind of working this along.So you might ask about what is cam, what sometime people refer to complementary and alternative medicine and what is the prevalence in 2007, you could see adults spent almost $34 billion.
Billion dollars out of pocket to visit practitioners and purchase the different products.So it's huge it's a huge industry out there.If you've ever walked into a health food store and you're saying, like i heard echinacea helps you when you get a cold to help decrease the severity and duration.Walk into it and try to figure out what echinacea to take.There's a whole wall of echinacea.You know, how do you have any idea it's such a big thing and such a big industry nearly twothirds of the total out of pocket costs.
By adults were for selfcare products and so people are really trying to stay healthy.They're actually trying to do things to avoid going to physicians and going to emergency rooms and going to urgent care and what can i do to help promote my own selfcare.And despite the emphasis on selfcare therapies, there's still 38.1 million adults who made over 350 million visits to practitioners of alternative medicine.So that's your acupunctures, that's your homeopathic physicians, that's your osteopathic person who does therapeutic massage.You have all these different people.
Who are doing all these different techniques.So this just gives you an idea, this is from an nih report trying to show you what the cam use is.You can see that in the united states, this is the percent of the population, about 42 of the population it's not as high as some place like canada which is up to 70 which is really amazing.And in the developing world really, we always talk about conventional medicine really is the alternative medicine in most conventional countries, in nonindustrial ones because really this is what they.
Practice and will only use conventional medicine on the side.But you can see like in ethiopia and stuff, it's up to almost 90.And then i put this little figure in here because even though people think they want to do selfcare, you know, it's a lot harder to really do good nutrition.And it's hard to do lifestyles.It's hard to do exercise.It's easier to just take a pill.So if you can go to the health food store and just take a pill, it's more conventional, it's more natural,.
It's dietary supplements which is one of the things i actually am going to talk about tonight.It's actually the most conventionallike.So it's one of the things that kind of bothers me about alternative medicine because a lot of people really rely on dietary supplements and it's actually my least favorite thing to talk about because it's the one that's most conventional.If you get my drift.Instead of trying to be healthy, it's like i'll just go get another bottle and even though it's supposed to be natural, i'll just take this medication.
And again, this one you could see cam use by adults and children and in 2007, it was this is all children.So this is not just children with chronic diseases because if you look at children with chronic diseases, it actually goes up to 50, 60 and even 80 in some studies.In overall children, it's still about 12.And then one of the things you can see here is that $14.8 billion were in nonvitamin, nonmineral natural products.So there's your dietary supplements huge, huge industries.
So really dietary supplements and natural products are still the thing that people use the most.You can see there's a little bit of what we're going to talk about is, there's almost $3 billion in homeopathic.You can see, they call it yoga here and then there's all the practitioners' costs.And you can see that only about $.2 billion in relaxation techniques and actually relaxation techniques and mindbody therapies which we'll talk about are actually one of the leading causes that actually showed there's some evidence behind it.Yes so nutrition actually doesn't really,.
They didn't really count that as being alternative and that's why it didn't really fit in.There is, i mean what is really alternative medicine in a way if you take 250 milligrams of vitamin c, that's considered to be the standard.How about if you take a gram of vitamin c well, that's a little bit more.How about if you take six grams every day of vitamin c well then all of a sudden you're into complementary alternative medicine and dietary supplements.So it's a fine line.So what is diet.
I mean you see a lot of children who have chronic illnesses.They do a lot of different types of diets.So when do you make it so it's not really just nutrition and when is it really a type of alternative therapies so it's hard to really sort out.So that's why these studies are hard to do.If you look at ethnicity, you can see that actually native american and alaskan natives are actually over 50.And as you go down, the hispanic and actually afroamericans are the two lowest.
And asians.But again, a lot of these studies depend on what they ask.You know, what do they mean by alternative therapies so really how about in children so about 8 million individuals younger than 18 years of age according to this pediatric article that just came out now two years ago, use alternative medicine in 2007.Adolescents and children living in the west like california, those with parents with 12 years of education and prescription medication use were independently associated with overall increase cam use.So the more educated they were and the more.
That the parents used alternative therapies, the more the kids tend to use it too.Common medical conditions included gi problems, anxietystress, skin issues, insomnia, musculoskeletal conditions, especially fatigue, sinusitis were increased with cam use.Parental cam use was a strong correlative of child cam use and many studies have found that the higher the cam use among children with chronic conditions like asthma, adhd, autism, food allergies, arthritis, type 1 diabetes and sickle cell were actually the highest.So the more chronic you got, the more it tended to go up.
So why do people use these i mean why don't they just go to the and get their normal care well therapies are consistent with the patients' and families' values which is you know, what they believe in.So that's really what they want to use.And a lot of times it has to do with what your grandmother used, your auntie used, what was traditional in your family and lifestyle.And it's really natural, ecological and maybe empowering because you're deciding what you're going to take.It's not just when you go to the or you go.
To your physician or you go to your health care clinic where they'll say, take this medicine.Take this medicine.Take this medicine.It's like i'm trying to make a decision as to what makes the best decisions for myself.The cam providers are felt to be more patientcentered.So we talk about being high touch, low tech.Because you know when you go to see physicians, a lot of times they only spend like 30, it seems like 30 seconds with you.They listen one, two and then they're out the door.
They charge you a lot of money.If you actually go into an alternative medicine practice, sometimes it's an hour, hour and a half, two hours.They really get a detailed history and maybe handson therapy if you're doing massage, your osteopathic manipulation or even a chiropractor and it's all very kind of high touch which people feel at times very soothing and actually very healing.And it is for a lot of families.It makes a tremendous difference.So it tends to be much more patientcentered.Conventional therapies are perceived to be emotionally.
Or spiritually without benefit.That sounds funny but it's really true.I mean if you go and just get another pill or another inhaler or whatever kind of therapy you get, it's not very spiritual and it doesn't feel like that there's much that you are going to get out of it emotionally.And conventional therapy is associated with side effects and significant risks in some conditions.So even the medicines i use for common asthma, we always talk about all the risks that are involved with it.And if you see the ones on tv like for advair or one.
Of those combinations, they're saying, oh yeah, you can play.You can run.You can do things.And then they have a little disclaimer thing where they talk really fast where they say, of course there's an increased number of deaths, an increased number of side effects, etc.Oh, okay, yeah, did they say something about death and so it's like why would i want to ever take this medicine that has an increased risk of death with this condition and it's also a circular process.And this is really, really important in california.
If there's a lot of alternative practitioners then there's a lot of alternative practice use.And they did a nice study in england where they had one children's hospital that had a lot of practitioners around that did alternative therapies and another one that didn't have very much and where they didn't have very many, they didn't use very much.Where they had a lot, they used a lot.So again, it tends to be more circular.So if you have people available, you tend to use it more often.And then you can say, what is.
i keep mentioning these back and forth because i want to make the distinction about what is cam or complementary alternative medicine and what's integrative medicine.So really complementary alternative medicine according to the nih, the national center for complementary and alternative medicine, is a group of diverse products and health care systems, practices and products not considered to be part of the conventional medicine.Which is kind of interesting because over the last 10, 15, 20 years, things that were one time not considered to be conventional now are conventional.
So now they're no longer cam any more.They're like, oh yeah, we do that.Oh yeah, that's okay to take certain things if you have diabetes.It's okay if you take certain things if you have heart disease.But even 15, 20 years ago it was considered to be the alternative.Some scientific evidence exists regarding cam therapies for some.For most, actually there's still a lot of questions regarding safety and efficacy because they haven't gone through randomized controlled trials.They're not quote evidencebased.And i'll mention that a little bit later because a lot.
Of things we do in conventional medicine aren't too evidencebased either.But since we're taught about them in medical school and that's what's practiced in our lives, they're okay.But what tends to be not taught in medical schools, they're not what's taught to us tends to be kind of more alternative.Integrative medicine actually is what we try to practice and what i was promoting when i was at the university of arizona.It really combines mainstream medical therapies and these different types of complementary alternative therapies for which there is some high quality scientific evidence.
Of safety and effectiveness.So you try to take the best of both worlds and try to make it.So if i have a child that has asthma, i'll say, i'm going to give you this medicine and this medicine.I'm going to try to get the cat out of the house, try to get the dad to quit smoking in the house.I'm going to do all these environmental things and then over the next 6 or 12 months, i'm going to improve your nutrition.I'm going to help your lifestyle.
I'm going to get you to exercise again.Maybe we're going to start you on some dietary supplements that have been shown to be more effective and not have the side effects that some of the medicine you're taking.And try to do a mix and try to how can you get the best therapies with the least amount of medications and it really changes the whole patient's and the family's life.So a couple of jokes just to break it up here, you can see 100 natural remedies, pure snake oil.
And i think that's the one thing i'll keep mentioning over and over again is that dietary supplements aren't regulated very well.We have really a you don't know what's in almost any product that you pick up on the shelf, unless you have a really good seal of approval so you don't know.This is herbal remedies versus verbal remedies.I kind of liked this because it kind of fits in my talk tonight which is dietary supplements versus mindbody, right so sometimes i think the mindbody, the verbal remedies are actually better.
snap out of it.And you can see here, the truth is, , i've lost faith in western medicine which is appropriate for being in california.So what are the major classes of cam with complementary alternative medicine again i use this because this is what the nih uses, the national institutes of health.So they have a national center for complementary alternative medicine.They broke it, kind of a little bit spuriously but they broke it into five categories which makes it easier to talk about.The first one which i'm not going to talk.
About in detail is alternative medical systems homeopathy, naturopathic, and traditional chinese, and ayurvedic treatments.These are systems that are completely different than conventional therapies.This is not you're not going to just take a medicine because you have an ear infection.So you take 10 days of antibiotics and you get over it.This is actually approaching medicine in a different way and i'll mention why that is.It has to do more with keeping your life in balance and not going after a specific symptom.The one that we are going to talk.
About is mindbody intervention which is actually my favorite one because i think there's very little side effects in using the person to really think about how they can control their illness, how they can control their chronic conditions and even their acute conditions.And we'll talk a little bit more about that as the night goes on but it enhances the mind's capacity to affect bodily functions and symptoms.I just talked to one of my nurses today and she thought she goes, you know i'm going to sound crazy..
I said, what do you mean she goes, i'm going to go to a hypnotic practice where they're going to do virtual lap bands.So instead of getting for obesity instead of getting your stomach banded, she's going to actually go to get hypnosis to get virtual bands placed so she'll feel full before she actually is full.So then she won't eat and she doesn't have to go through the surgery.And it sounds she goes, you think that sounds crazy i said, no, it sounds perfectly logical to me.
Because you can do that type of thing.You can really get your mind to change your way that you think about how you feel and that actually can promote health more than actually having that actual surgery.So but you have to be the right person, you have to have that kind of mindset to be able to do that.You have to be kind of accepting.The mind's capacity and it's actually almost not even considered to be alternative medicine anymore because really, the most of the research that's been done.
Over the last 50 years has been in this area.It's almost all been very positive.The one i'm reluctant to talk about but i have to because you saw how many people spent all these billions of dollars using are biologicallybased therapies the dietary supplements, the herbs, the foods, the vitamins, the natural substances and again, this is kind of a big quagmire of everything.And we'll talk about some that are very recently thought out, some actually have some very good scientific evidence behind it and i'll mention a couple of those studies.
And some are just people that are just nuts trying to make a lot of money.So it has a full range but when you talk about dietary supplements.The last one i mean the fourth one is manipulative bodybased therapies like chiropractic, osteopathy, and massage.And we'll talk a little bit more about that.Again massage is another one that's been a lot of press lately and the national institutes of health and national center for complementary alternative medicine now have now over $2 and a half million in studies just based.
On massage right now in the united states.And the last one is the one that's a little bit further out there just like it is with alternative medicine.These are all the energy therapies.This is the biofield therapies, the bioelectromagnetic therapies.So you think about you know, this goes all the way back to the 1700s where people tried to say, if you could just figure out your magnetic waves, you could really make people better.And if you think about it, you have emgs that do your muscles,.
You have ekgs that do your heart, you have eogs that do your eyes, you have eegs, you have all these things.All your body is just really electric all the time so it seems like if you could just try to coordinate all this electricity and all that stuff to kind of flow in the right way, it would make a big difference.Mesmer was this guy back in the 1700s in france.You know he used to put people in bathtubs surrounded with magnets and you know, he wore this big hat with a cone.
On it you know, he actually tried to they tried to ostracize him and then ben franklin was brought from the united states over there to put him on trial and say he was a quack.And they had all these things about having sap go up in trees and he could feel it.And it was really, this goes back hundreds and hundreds of years now, this whole thought about trying to really do magnetic therapy.When you think about it, you still see it, you still see people who put magnets in their shoes.
And magnets in their beds and try to hit their back pain and their arthritis.There's all these things that go along with magnet therapy.And so again, there's a lot to do with that but as you can imagine, it would be very hard to study.So what are a couple of examples of alternative medical systems well there's homeopathic medicine.This is the belief that likes cure likes which is very different from what we do.We give aspirin for a fever, tylenol for a fever to bring it down.
But if you're in homeopathic medicine, you'd actually give something that would cause the fever but you're just giving them a very, very small amount.That's where you get the idea that likes cure likes and the law of similars.So they actually went through thousands or hundreds of thousands of different remedies to find out what caused certain conditions and then they just give you very small amounts of it and that's what will make it better.So it's very different that's why it's called alternative.It's like very hard for people to kind of grasp it.
That's why people always say, you give such a small amount.Oh, don't worry about it.It's a homeopathic dose, it's so tiny of a dose.And they're all giving if you're giving the higher, more concentrated dose, it actually causes those symptoms.So the notation, if you've ever seen a homeopathic, i'll show it to you.6x means that the active substance so say we take something like sulphur and we have a 6x after it, that means that it's been diluted 110 in a wateralcohol mixture and succussed.
Which is shook shaken.And this procedure of diluting and succussing is repeated sequentially six times so that you have one part in a million for the notation of times six.So that's why people are like saying, oh don't worry about it, it's homeopathic, because there's hardly anything in there.The thing you have to remember though about homeopathic is it's not the law of similars but also the least concentrated it is where it's to the point that it's not even one molecule in there.That's actually the strongest.
So that's the law of dilutions.That's why people really think its nonsense because if it's so diluted, how could it actually have anything in there and that's where it kind of switches over to kind of more energy medicine because there's a memory in the water that when you did that shaking, that somehow that thing got memory into the water that you're taking.And when you take that pill or you take that little thing under your tongue, that actually is very effective.And the more diluted it is, the stronger it is.
So you could see that people, especially when conventionally trained to think like homeopathy, that's crazy.There's naturopathic medicine or naturopathy and there's actually three or four different schools in the united states that actually put out naturopathic physicians.And this is a great group of people if you ever run into a really good naturopath because you can see here, they believe in the power of the body that maintains and restores health.They use nutrition, lifestyle counseling, supplements, homeopathy, and chinese medicine.They kind of practice everything that allopathic medicine doesn't do.
So if you ever hook up with a good naturopath and you're the conventionally trained , you have the balance of almost everything.So they're actually can be very good counterparts.And bastyr is kind of the thing, this university and they have a lot of collaboration with the university of washington in seattle.Bastyr bastyr.And then there's traditional chinese medicine and again i just want to show you what these different alternative medicines are.We're not going to talk about them.These are all lectures in themselves as you can imagine.
That's the belief in unseen vital energy that effects the health and how this energy or qi kind of flows up and down your body.And that's what acupuncture, acupressure does.The thing you have to remember about traditional chinese medicine is it's not just acupressure or acupuncture.It also has to do with herbal remedies.It has to do with nutrition.It has to do with martial arts.It has to do with five different things really.They really all work together.So people think about traditional chinese medicine as just being acupuncture, but it's actually acupuncture.
And a lot of other things.And actually the herbal remedies in chinese medicine are what's getting a lot of press right now.And last week there was a big the allergy meetings in florida, the aaaai, they call them.And there was a lot of reporting on some of the chinese herbal mixtures showing that they really work and they're very effective in different animal models for allergies and eczema.And so it looks like there's a lot of the immunomodularly type of things that work with chinese medicine.
We'll talk a little bit more about it when we get to the herbal remedies and dietary supplements.But they don't just use one herb, they usually use five or 10 herbs and they have them mixed in a certain grade.They have gradations with one that's very strong and one that's very weak and they kind of have like little soldiers like they all kind of march together.So here's an example of one that i like that's called fluplus.This is one that hmm, i wonder what you use this for.
So this is the, you know you're supposed to be, in dietary supplements you're supposed to not say that you cure or treat anything but you always enhance health.Well this one enhances you not to have the flu.And so you can see that it has four times and now you all know what that 4x means now, it's been succussed times four, 110.This one you can see is one to a million.Actually that's ipecac.You all know what ipecac is.It makes you vomit if you take a poison.
Pulsatilla, here's a little mercury, a little phosphorus, here's a little sulphur, here's a little last year's influenza, that's 12 times.So that's like one in a billion pieces so i'm not too worried about you're going to get too sick from that.One in a billion which is more than even one molecule would be in the fluid and you can see here's my favorite.Bushmaster's snake venom, there it is right there.It's also is one to 12 times x.So you can see that this is a mixture of what they call more.
Clinical homeopathy.If you actually went to a classical homeopathic physician, they would never give you this mixture because this is a whole bunch of stuff they just throw together.They would actually get your symptom, your flu and they really try to countegorize it to the one thing that would work the most.And they would give you one, at the most maybe two remedies.And they would actually give you a not too diluted one because remember that's too strong.And as you got better, they would give you more diluted ones which are stronger.
So again, it's an interesting way of approaching things.But this is what most people tend to buy in the stores now which is a mixture of all these different homeopathic remedies.How about energy therapies they involve energy fields or usually two types.The biofield therapies are intended to affect energy fields.This is like qigong, reiki.A lot of nurses use this.You think about therapeutic touch or a natural touch.And this is trying to again, trying to get your energy in the right way to open up your chakras, to get your things.
To flow up and down to really improve.If you've ever seen a good qigong or reiki therapist, it's pretty amazing.I mean i've watched somebody actually make somebody's migraine headache go away right in front of me.She went from being nauseated, in sunglasses to being able to have a full meal right there within ten minutes in front of us.Again, that's just one woman just standing over her, never touched her, but just trying to move her energy around.So it's yeah she did the reiki method.
Bioelectromagnetic energy is what i talked about a little bit earlier.Electromagnetic fields such as pulse fields, magnetic fields or alternating current or direct current fields.And again, this is all this idea that you have all this energy running through you.And if you just try to figure out how to get your ekgs, your emgs, your eegs all to work together, you can imagine you should feel a lot better because there should be some kind of disconnect if you're not doing well.So let's go on to the last one is manipulative.
And bodybased therapies.And most people think about chiropractic as being one which is it focuses on the relationship between bodily structure or the spine and the function.That's for the kind of high velocity, low amplitude.That's when you get cracked, right and that's why you usually do a lot of different therapies for that.Osteopathic manipulation actually emphasizes diseases rising from the musculoskeletal system.The body systems work together and the disturbances in one system.People don't realize this but there's six major categories of osteopathic manipulation with over 100 different techniques.
So in the '60s and '70s, most osteopaths kind of quit learning about osteopathic manipulation.They kind of became more quote conventional s.Now it's making a big comeback and even in the santa cruz, monterey, salinas areas, there's osteopathic physicians who don't do any conventional therapies.All they do is manipulation.And they do craniosacral they do the high velocity low amplitude ones like the cracking the back.They do different types of lymphatic drainage.They do musculoskeletal they do pressure points.They have all these different ones they do.
And some of these places, like when i was giving a talk last year at the barbara bush children's hospital in portland, they had a lot of osteopathic manipulations going right on in their inpatient, even in the ed.So they, some hospitals especially in the midwest and the east coast have really embraced osteopathic manipulation as being acute therapies.And massage therapists manipulate muscles and connective tissue to enhance function of those tissues to promote relaxation and wellbeing.And there's been quite a few studies actually supporting the use of that as well.
So now let's move to research.There's been multiple studies showing the most popular treatments are dietary supplements, much to my chagrin.There's evidence lacking even for the most popular ones, even in adults.And the institute of medicine saying that the same principles and standards of evidence of treatment effectiveness apply to all treatments whether currently labeled as conventional medicine or cam.So really if you're going to use something, you really should have some type of evidence to support its use.And maybe it doesn't have to be large, randomized control trial.
Like you do for drugs, but it has to be some type of evidence where you actually try to study it and show.And sometimes it could be historical sometimes it could be traditional.But most of the time the institutes of medicine would like to have some type of research.And there's very few studies that are done very well in part because they're not very wellfunded which is another whole story.So funding in research is growing but is still relatively small for totals.So if you look at some of the studies that you look.
At that have shown to be effective, here are the ones.This is from the archives of disease in childhood article about six years ago and they thought this was welldocumented now that biofeedback for constipation and headache, hypnotherapy for headache and irritable bowel syndrome.So you can see mindbodies are really embraced and they are really felt to be part of almost standard protocols now.Lemon balm for herpes simplex, massage for constipation, these are all ones that have enough studies that people now can say these really work.These are uncertain, maybe acupuncture for asthma,.
Acupuncture for hay fever, for rheumatoid arthritis.Chromium for diabetes was a big one in the '60s and '70s and even up into the '90s.It's just like, if you just give enough chromium a lot of diabetes will get better.Now cinnamon is one that's taken over for a lot of diabetes.Echinacea for the common cold, evening primrose.And unlikely is some for acupuncture that you could see over there for smoking, for weight reduction.Flower remedies for anxiety, homeopathy for anxiety.Again these are very hard studies.You can imagine now just after i give you my talk.
About what these are, how could you really study these in a large group of patients because everybody's so individualized so again, this is what they felt to be effective and not effective.How about the use of supplements well alternative health supplements in the 2002 national health interview data on ten common herbs of 30,000 adults, 19 used herbs in the past 12 months.And in 57 of those, 20 which is a large amount used them for a specific condition.What was interesting is that approximately two out of three used herbs except for echinacea was not even.
In accordance of evidencebased indications.So they were going to health food stores and they were buying these different herbal remedies and they were using them for different indications not even what was on the bottle in the health food stores.So again, even though it's really used and is really used commonly by a lot of adults especially, they don't even use it for what's commonly practiced in the health food store.So again, it's kind of a really mixed bag.You can see why a lot of families and children don't really have a lot of direction.
Because there's nobody really telling them what to do.It's usually what your neighbor told you, your auntie told you, your grandmother told you.And you might try it just based on what you saw even in a newspaper or in a magazine article.So how about studies supporting conventional medicine i always like to throw this slide in here just to remind people that there was this nice article in archives of disease of children way back in 1999 where they did 240 consults and 1149 clinical actions were performed.
Good evidence was found by a randomized control trial or other appropriate study for only 40 of the 629 actions.So of all those ones in a hospital, there were only 40 that were evidencebased.So that's why when people say, oh you can't use these herbal remedies.You can't use this mindbody stuff.You can't use these energy medicines, alternative therapies because there's no evidence behind it.I can tell you that 40 of the time that what you do in the hospital doesn't have any evidence behind it either.
And you can even see nonexperimental is 7, inconclusive for 25.There's actually evidence of ineffectiveness for.2 and no evidence at all for almost a third of them.So you can see the people are just like, oh, it makes sense to me.I'll just try it.And since i'm a , there's evidence.So it just shows you how the whole kind of mindset kind of happens especially in the medical community.There was one even looking at surgery interventions in a regional pediatric surgical unit.This is about as old.
Of 281 patient interventions, 11 were based on controlled trials, and 66 were on nonconvincing, nonexperimental evidence.If you think about surgery, that's kind of how surgery developed.It's like, i don't know if that kidney transplant's going to work.Let's just throw one in there and see what happens.And then after after a few, five, 10, 15 years they actually started to work because it's very hard to do a randomized control trial for something that, like a surgery.I mean you can't say, well, i'm only going to take.
Out half the appendix.Usually you're going to take it out or you're not going to take it out.So again, it's very hard to do these types of trials.But people give you all types of grief for not having good evidence for doing alternative medicine when a lot of things that we do in conventional medicine doesn't have much evidence behind it either.So really what you want to do is you want to figure out the parts.So there's all this alternative medicine, there's all this conventional western medicine.
And integrative medicine is trying to take the best of both parts.You want to use conventional western medicine that has the least amount of side effects, that's most effective, that has the best safety profile and you want to take alternative therapies that have shown to be clinically effective to be safe and you want to marriage those two together.That's really the most important thing to do.And really, you have to bring in the patient's values because what they you can say acupuncture, acupuncture, acupuncture and if the person does not want needles,.
It's not going to work.I'm sorry it's not going to make a difference.So you really have to bring in what they think too.You have to look at the research, you have to look at the clinical data, and hopefully you'll come up with the optimal decision by trying to marry all those three together.So how about biologically based therapies well biologically based therapies or dietary supplements are used in herbs, foods, and vitamins.They include all the dietary supplements and herbal products that are used in socalled natural therapies.
The dietary supplement health and education act, the dshea act of 1994, this is what kind of threw everything into chaos.There was a tom harkin who was a senator from iowa and i just blanked his name what's the senator from utah orin hatch.Now you think that those guys don't have anything in common, right one's very republican and very right wing and one's very liberal and very democrat.But they got together and they wrote the dshea act because in iowa and utah are two of the hotbeds.
Of dietary supplements, where they're made.And they were saying, like, we don't want the fda to regulate this stuff.These are really just natural substances.They're like foods.They should be regulated like foods.And so they wrote the dshea act in 1994 which acknowledges the potential health benefits of dietary supplements which must contain vitamins, minerals, herbs or botanicals, amino acids or any combination of these and may affect the structure or function of the body.So that fluplus is not a very good name.I mean they could actually get into trouble.
For calling it fluplus.But like if you have joint pain, you have to have something like jointhealth, you can't say arthritis.If you have some type like liver, you can say liverhealth you can't say hepatitis.You can say anything to promote the health, but you can't say it will actually treat a disease.So that's where you make the distinction.So when you look at a dietary supplement, you should look and if it makes a claim that it's going to treat or cure something, that's actually a red flag.
That maybe that's not a very good product.Because really, what they're supposed to do the ones that really follow the law are the ones that enhance the health in that area.It cannot claim to cure or treat a disease.That way they don't need any new drug application process which is millions and millions of dollars, all that safety, all that animal data, all that lab data, all those trial one, two, three, all those have to do that.All you have to do is just put it in a pill and put it.
In a bottle and put it on the market and you're good to go.There's no quality control, there's no good manufacturing standards enforced and no oversight by the fda.They actually changed that in 2007 but the fda was never funded to actually make a difference.So actually it's still not regulated.So you know there's i'll talk about it in a minute, but there's things you can do to try and figure out which ones are safe and which ones aren't safe.But right now, it's kind of chaos.
The herbal industry at first didn't really care about this because they were selling everything off the shelves.In the late 1990s and early 2000s, they started to have more problems like you might remember the kavakava causes some type of liver problem.There was this that saint john's wart causes problems with people who had aids who were taking hiv medications.So then they thought, oh my gosh.People were really starting to all their sales started to drop off.So now they're actually trying to, actually try to police themselves.
So certain groups are actually trying to make some of their products much more safe and much more reliable.Here's the different approaches.I think this is actually one of my more important slides that i talk about dietary supplements.There's traditional use, like the western approach.These are the folk medicinal traditions.These are like your teas, your tinctures, your poultices.This is what your grandma might have taught you.This is what your curandero might have taught you.This might be what your aunt or uncles used to take.
When they were in the old country whatever that is.This is all the kind of the western approach for folk medicine and these don't have a lot of studies behind them but they have thousands or hundreds of years of tradition behind them.So a lot of times these on ones that have been very effective.There's indigenous use, native american, polynesian and a lot of times, these are drinks or even smoking of certain substances.There's chinese and ayurvedic and again, i mentioned earlier these are using multiple herbs.
They give it to you in a paper sack, you go home and you make it into a concoction or a tea.Usually they really smell awful, they really taste bad and they give you a bellyache and kids really hate them.But these are actually some of the ones that have the most research behind that shows them to be most effective.But they're hard for pediatrics because they don't taste very good.And there's homeopathy i talked about which are tiny doses of mineral, plants or even animal products.
Like snake venom.Then over here is the nontraditional use and this is based on theory.Like glutathione is an antioxidant.So these guys thought, well you need antioxidants in your lungs, so let's just nebulize some to your lungs and let's treat cystic fibrosis with it.And they must make this whole thing up and people just started using it all across the country.It was written up in one of the women's articles, women's magazines and pretty soon everybody was using it.In fact to the point that the cystic fibrosis foundation had.
To come out with a policy statement because everybody just started using inhaled glutathione based on nothing except that the theory that if you could take it orally, it must be good if you take it nebulized.Combination therapies which i think is one that really drives me crazy is that you'll find if you pick up a bottle of dietary supplements, you'll say, there's a chinese herb.There's an ayurvedic herb.There's a western herb.There's a mineral.There's a vitamin.They just mix everything in there so if you have something.
To do with joint pain, they'll take every tradition, and they'll take a little bit of that herb and put it in one capsule and charge you a lot of money for it and say that it works.It makes no sense.Why would it work you don't know what the interactions are.You don't know how they're all going to do.So i always tell families and patients that if you see something that has like lots of different things in it that come from lots of different backgrounds, that's not usually a very good dietary supplement to take.
Yeah so vitamins are another one.You know again, vitamins are like i said earlier, that if you take a lowdose, it's supposed to be okay but if you take higher doses and you mix them in with a lot of things.So with vitamins, no one really knows.The thing you have to be worried about vitamins is that sometimes you'll be taking one say that has so many international units of vitamin a.Then another one has so many international units of vitamin a.Then another one has so many international units of vitamin a.Then another one has.
So many units of vitamin a.It's kind of like acetominophen.Pretty soon you're getting toxic on vitamin a because you're taking all these different herbal remedies that have all that in them.So you really have to look at everything very carefully.Here's one i just like on garlic.You can see here, depending on the intended use by the manufacturer, garlic products are classified for regulatory purposes in one of eight categories conventional food, dietary supplement, food for special dietary uses, biological, drug medical device, cosmetic, or food additive.
So you can take garlic for about anything.You can say that it helps all these different areas depending on how you take it.So garlic is one of these things that traditionally have been used for a very long time to help you with all kinds of things.It kind of depends on how it's marketed.You could see how it's either regulated or not regulated.So these are things that you think and again i was going to mention this earlier that anybody wants any of these slides, you can just ask nancy or felice there.
At the end and they'll have email addresses.They can send you all the talk some of these are very nice to have.Here's the national center of complementary alternative medicine.It's become a very good website in a lot of ways, for definitions.It has some herbal remedies that you can look up and it has some monographs.The office of dietary supplements, medwatch, cam which has to do with research and the canadian health directorate.But the best one probably in this slide for government sites is the national center.
For alternative medicine.There are academic sites.There's the bostonlongwood herbal task force.This is actually a great one.This one has to, if you look up echinacea, it has all the animal studies, all the human studies.It has a monograph.It has one that you could hand out to parents, a onepage like this works and this doesn't work.So this is one that was done up at boston children's years ago.University of pittsburg, beth israel, columbia and even berkeley still has their good old wellness letter which is still very effective and very nice.
And they really try to keep it up to date.There's herbs and courses you can take like the dietary supplements by wake forest.And this is one of my favorite ones i'll talk about which is consumer labs and this is one that you actually have to subscribe to.And what it does, every month it takes a commonly used dietary supplement and it takes like 15 to 20 popular brands and it actually looks to see what's in them.So they're not paid by anybody.So you go look and see.
And what you do, when you can start looking at it, you can start getting the ideas.Well this company seems to be always spot on.This company seems to be always way off.So maybe i should start buying my herbal remedies from this company.So i can't really tell people what to buy anywhere because it's all so richly different.I mean it's even different in santa cruz than it is in palo alto.So again, every one depends on what you have but this is actually a very good website.
The natural medicines and comprehensive database is also a very good one.This is one especially for medical types.This one really tells you about all the, it's like a pda for herbal remedies and dietary supplements.So this tells you all the uptodate studies that have ever been done on these different medication.And the same way for nutrition and dietary supplements.So if you go to the nccam website, here's like this, i just took one of their pages and just put it on this paper.You can see like here's all these things you can click.
On to learn about all these different ones you can see.So if you hit on dietary supplements, here's all the e's and the g's and the h's.You can see there's the introduction to naturopathy, you can see grape seed extract, you can see what's new, past highlights, and then you can subscribe to their newsletter and their ebulletin which is also very good.So when you do a resource evaluation, say you're going to a website and you're trying to figure out, is this a good website is this not a good website.
I always tell people, what's the introduction who runs the site who pays for the site i mean they're asking you for information.They ask you for a credit card number.They ask you what your address is.Does your computer pick up spyware when you go there i mean these are all things you want to know about.What's the purpose of the site does it actually help you or does it try to sell something to you and how much advertising is there where does the information come from.
What's the basis of their information sometimes they'll say 'references' and you go look at the references, they're all like in 1966 and they're in china and they all have to do with dogs.So that's probably not the best references for somebody.Some of them are very good.Some are right up to date.Some have been done locally.Some have been done at some of the osteopathic or naturopathic colleges.How is the information selected how current is it where does the site choose the links to other sites.
You know, where does it kind of link you to and what information about you does the site collect and why so this is all from nccam as to kind of how to resource whether a site is any good or not.And how does the site manage interactions with visitors so this consumer labs i mentioned, this is a nice one.It's a provider of independent test results and information to evaluate health, wellness, and nutrition products.They get about 2.5 million visits per year and has a certification.And actually you can on the bottles, you can get the cl.
They've actually been tested by cl.Sort of like the good housekeeping seal of approval.It enables companies of all sizes to have their products voluntarily tested and that way they get the cl seal.In the past seven years, they've tested more than 1,800 products, representing 350 different brands and supplements.A oneyear, 12month subscription is only $27 so really it's very inexpensive and if you're into dietary supplements, especially if you have families and patients coming to see you, this is a very nice one because you could look it up very easily.
Natural products encyclopedia and there's a free newsletter.Another one i like is the natural medicine database.This again has a search method and again this one also costs about $30 a year.And you enter the natural product names like echinacea or you can enter a disease like migraine headaches or you can do a condition like fibromyalgia or a drug name.It gives you objectional product information, effectiveness ratings and potential interactions even with conventional medicines.So this is a very nice one.You can actually search in a lot of different ways.
To give you a lot of good information.The natural product effectiveness checker tells you the level of effectiveness for natural products.So it has a gradiation from 'a' to 'd'.This one's an 'a' it has a lot of history behind it.It has a lot of research behind it.It looks to be very safe and very efficacious all the way to 'd', maybe it's not even that safe.And then 'c' with a lot of middle like in the middle, we don't have much about it.It has a natural product drug interaction checker.
It tells you potential interaction between any natural product and any drug which is very important because people always mix and match all this stuff, and you have no idea what's going to interact or not interact.The disease medical condition search which shows you medical condition.It allows you to see which natural products might be effective.So you can see, it'll actually show you here's a western one, here's an ayurvedic one, here's a mix of chinese ones from traditional chinese medicines.So you can kind of get a mix.
As to all the different ways you can approach a certain condition by looking at dietary supplements.You actually can search colleague interaction.It shows you questions, answers, and comments posted by other health professionals.So you can say like, i tried this on my patient and they had this kind of reaction.And colloidal silver is one of my favorite ones.Colloidal silver is this thing that people considered to be a natural antibiotic and you can actually make it yourself.And if you take it it's supposed to cure,.
I think the last time i looked it up online, it can cure like 1,000 different diseases.The thing is if you take it too long or you take too much of it, it actually causes you to have permanent discoloration of your hands and your skin.It actually, the silver gets out into your hands and into your skin so it's always there.And there's some families in some parts of the united states where everybody looks kind of blue because they all have this colloidal silver that's into their bodies and never can go out of them.
So again, it can be and we had written up a case a couple of years ago in a cystic fibrosis patient in denver who thought that would really be the new approach to treating their chronic lung infection.And they got all this colloidal silver involvement.There are also supplements and books out there.The abc clinical guide to herbs by blumenthal.Again, it's a very good book.Blumenthal's kind of 'the' name in natural products.Contraindication and drug interactions by frances brinker.He's at the university of arizona.
He's a naturopath he's very good.Integrative medicine by dave rakel, integrative pediatrics by tim culbert and olness.She's in cleveland and tim culbert is in minnesota.Then there's the journals of herbal pharmacology, the journal of alternative and complementary medicine, alternative therapies in health and medicine, and evidence based complementary and alternative medicine.These are all very nice journals.And we can get almost all of these now on lane here at stanford.So i'm just going to give you a quick example of a couple of things we might see.
For cystic fibrosis, these are all just a smidgeon of all the ones i've heard about in the last five years.And again you can see that people use probiotics, b complex, all the different vitamins and again, vitamins is like a funny mix.It's like, it could be just fine but if you're taking high doses of vitamins like megavitamins then it becomes a little bit different.All these different ginko, garlic, ginger, echinacea, essential oils inhalation.We sometimes find inhalation of different essential oils can be very powerful.Lipoic acid, especially.
For cystic fibrosisrelated diabetes.And actually lipoic acid is actually used by a lot of endocrinologists right now for even standard, especially if you have any type of neurological side effects from your diabetes.Milk thistle to help protect your liver.Grapefruit seed extract, baker's yeast, green tea, airborne.Everybody knows about airborne, right you get that before you get on the airplane.It's all, it's a mixture, it's not just homeopathic.It's got some homeopathic it's got some chinese medicines it's got ayurvedic medicines it's got some vitamins in it.
And people will swear by airborne.You know, i get airborne and i never get sick on an airplane.Coenzyme q10 which again, for cardiology, for heart strength, that's one that's almost not considered alternative any more.A lot of cardiologists now use it for their patients.And then all these ones, or most of these have to do with a very strong antioxidants.Gingseng, licorice, boswellia.These are ones that are from from the ayurvedic and india.And pycnogenol there was just a cochrane review on pycnogenol because it's really promoted for asthma.
And all kinds of chronic conditions.So it's one that's been very popular and it actually has to do with french white pine bark, is where pycnogenol comes from.I just wanted to put the one study that was done just two years ago on pulmonology looking at probiotics and cystic fibrosis.And we found out that studies of fecal calprotectin concentration and rectal nitric oxide have found to be increased, suggesting a constant intestinal inflammatory.So your gut is really full of a lot of inflammation.So people feel like if you could just decrease the inflammation.
In your gut, you can actually promote health elsewhere including your lungs.And so probiotics have live bacteria you give orally.It's to decrease the severity of gastroenteritis and prevent atopic diseases in children.And the mechanism may be through improvement of intestinal barrier function and through modification of immune responses.So we know that children who are born by cesarean section, they don't get that same vaginal flora, they sometimes, or they have a lot of antibiotics in their first year of life.Those children sometimes go on to have more lung problems.
So this whole idea of really getting the right, proper type of bugs in your gut from the very early on can actually be very powerful.So they did 10 cf patients with mild to moderate lung disease and pseudomonas colonization were treated with lactobacillus gg which is one of the most common probiotics that are used.And the pfts didn't change and there wasn't really a change in sputum but they did find a reduction of pulmonary exacerbation rates.And then they got sick less often and had to come into the hospital.
This is just a cartoon to show you about what people think.You have all these pathogens, allergens coming into your lungs.And if you have all this stuff in your gut, it helps you.With this probiotic it actually blocks all these inflammatory responses.So again, this is from chest which is one of the more traditional conventional therapy journals for pulmonary physicians and they have a whole thing, a whole article just on probiotics and lung health.And then here's some dietary supplements for asthma and allergies you can see.
Again, here's butterbur, pycnogenol, vitamin c, magnesium and the ones that are in blue are all the ones that actually have had some studies.Ma huang or ephedra is one that's been off the market now for the last few years although you can still get it on the internet.That's because people were mixing it with caffeine and other dietary supplements.And that's when all these athletes were having all these seizures and heart disease because they were taking high doses and going out and trying to overexercise.But it used to be, it was a very easy one to use for children.
With very mild bronchospasm.And they had one that's called breathe easy tea that we used to use a lot.And it was for children that just got a little bit of wheeze when they had a little bit of viral illness.And people would really overuse it so they took it off the market.So here's just some other ones too for allergies.You can see that there's all these different ones out there and every day people will ask me about one that i've never heard of.So there's so many dietary supplements out there.
So let's move into the next group which i like the most.Which is kind of your mindbody.So these guys are all meditating.You can see this guy he's got the legs going here.So mindbody therapies are a cognitive behavior therapy that encompasses several approaches relaxation, breathing, biofeedback, hypnosis, and guided imagery.In fact, these are ones that are almost considered to be, have so much evidence behind them anymore they're almost not considered to be complementary alternative.Although there're still people who feel like they just make you feel better.
But they don't really do anything for you.They just make you feel like you don't have disease or they make you feel like you don't have lung problems, but actually there are some studies now showing they actually decrease the inflammatory response in all different types of situations including inflammatory bowel disease, arthritis and even asthma.But theories based on decreasing the inflammatory process that can be triggered by autonomic nervous system through strong emotions.And if you think about it, asthma back in the '60s and '50s used to be considered to be a psychiatric disease.
Because kids would get so anxious and adults would get so anxious, they actually used to treat them with phenobarbital to try to sedate people.They found that they got better.That's probably because they reduced the anxiety, there was a very strong autonomic component to it and actually it would enhance bronchial dilatation.So i'm not saying you should sedate your patients with asthma when they're having a reaction or having an asthma attack.But again, if you can calm them down and you can have them do relaxation, you can have them doing belly breathing,.
You can actually break a lot of people who have respiratory issues.Stress has been associated with higher morbidity and cytokine levels attributed to airway inflammation.And now they're even doing studies in preterm babies and mothers and looking at their stress level and find that the kids that have, the mothers that have even more stress prenatally and postnatally, their children have more problems with inflammatory diseases.In addition to anxiety, stress is shown to influence the immune response and prevent increased sympathetic activity, promote airway inflammation without overt symptoms.
And the way i remember that is that they had a group of patients with moderate asthma who were college students.And they did induced sputums on them.And even though they were having normal lung functions, they were having no symptoms at all on their induced sputums during times of finals and midterms, they actually showed they had an inflammatory response in their sputum.Even just the stress showed they had more inflammation in the lungs even when they had no overt signs.Their lung function didn't changed at all.
And they had no wheezing or cough.So self hypnosis, breathing exercises including yoga, relaxation with or without guided imagery have all been studied.And imagery and self hypnosis have been shown to decrease shortness of breath in asthma and abdominal pain in children with recurrent abdominal pain.And often these services are available in most communities.Actually anybody in this room can be taught how to do imagery, taught how to do hypnosis, taught about how to do relaxation.They're very easy to do.In some services, it's the social workers,.
Sometimes it's the nurse, sometimes it's the , sometimes it's the mas, sometimes the respiratory therapist.Almost anybody in a medical situation can be taught how to do some of these mindbody relaxation techniques.And breathing exercises may also help, especially deep breathing and yoga and martial arts and that's one of the ones i like to use for little boys especially.They all want to take kungfu or karate and it's actually very good for them because it really teaches them control and really how to use all their lungs and it tends to be very disciplined.
So there is a pilot study of mindbody changes in adults with asthma who practice mental imagery, that was in 2004.There's effect of selfhypnosis on hay fever symptoms in 2005 hypnosis and asthma a critical review in 2000.Again, these are all positive studies showing that all these work in all these different areas of lung disease.Biofeedback interventions where you look at heart rate variability and abdominal breathing.And heart rate variability alone, placebo eeg feedback, and wait control in 94 adults with stable asthma.Medications were titrated following the symptoms,.
Lung function and peak flow meters were monitored.And the ones that had the heart rate variability groups were given less medication, decrease in severity, improved lung function.And they all got better just using biofeedback.So it's a very powerful one for children and adults who have respiratory symptoms.So behavioral interventions in asthma such as biofeedback, overall the evidence was as an objective treatment in asthma is meager but they only reviewed 12 studies.So what is progressive relaxation and guided imageries so i'll just kind of walk you through what i use with my kids.
When i did a study down at the university of arizona.We took children who had mild to moderate asthma.They were on medications.They were stable.They had normal lung function tests.And we introduced the goals and techniques, discussed the importance of practicing, modeled the practice techniques.We identified their sensations with relaxation such as warmth and tingly feelings.We identified relaxation as a positive feeling and we introduced this to guide their asthma reduction imagery.So what you do is has anybody ever done a guided imagery.
Or relaxation so again, you can see that you tell a child that it's going to consist of learning to tense and relax various groups of the body.So they tense them up and they relax them.You can move top to bottom.You can do it all different ways.Usually you start at the top and you move all the way down.And you go through while at the same time you pay very close and careful attention to the feelings associated with both tension and relaxation.Because when they get an asthma attack or they have some type.
Of problem with their breathing or pain, you want to associate that with a certain feeling.Sometimes that's that tense feeling.So they get an image of what that seems like when they have that tense feeling and then when they relax it, they get another image of what that image is when they relax it.So it's very, and the kids are great.If i had to do it for you guys in this room, i'd have to turn down the lights.I'd have to have you all sit up.
You'd all have to you know, close your eyes and put you to start taking deep, nice breaths and start to think about and try to clear your mind of all the other crap that's going on there.But for kids you can say, okay, i want you to relax.Okay.I want you to have an image when you think about something.Okay.I mean they're just like right there.They can go just right there.You can just do imagery so fast with children because their mind is already there.
We beat it out of them, we say, quit daydreaming, you know, pay attention.Get back here.But you know we kind of beat it out of kids by the time that they get to be in junior high or high school or college.But little kids especially 8, 9, 10, 12 year olds, they can go right there, right away.They're just like, okay, i'm right there.And you start off by running through each muscle group and modeling for each child how to tense and relax.And you practice this tensing and releasing twice.
After each tension and relaxation, you ask the child what it feels like and it's important for them to tell you what they feel like.You don't want to put too many images in their mind.You don't want to tell them, oh you feel like it's something .They may not like that image.So you want to be very careful when you try to do imagery.You want to make sure you use the image of what the child or the young adult is using.And then you want to know what that's.
Like when they're relaxing.And then you tell the child that while his body remains relaxed that you're going to ask him to do some imaging.And you ask him that when was the last time they had a tickle in their throat or felt like they were having trouble breathing and try to imagine what that would look like.You get all kinds of ideas what they might come up with.I mean it's really amazing what they'll come up with.And sometimes it's stuff that makes sense, sometimes it makes no sense at all, but it doesn't matter.
Because that's their image for whatever they're having.Then you ask the child to describe what it's like.Is it tight is it heavy is it cold does it tickle you really try to get them to use all their senses.Do they feel something on their face do they feel something on their skin do they smell something do they hear something you really try to use all their senses.And they really get into it.They really say, oh yeah, i do this, and they're really telling you all this stuff.
And i had this little girl that had migraines.And she was telling me how it was like a rose and she could smell it and the smell would go away and it would get really right.And it would really like close up all the way.And she would and thorns would get bigger.I mean she really got into this whole thing about what the rose was doing when she had this migraine headache of hers.Then you have to imagine what the discomfort would look like or come up with a mental picture of what the pain could be like.
If they're having difficulty breathing, you can give examples like a block of ice in the throat but i don't even like to do that with them.I like to just let them do their own imagery.And then you reinforce the description and encourage the child to elaborate on details and clarify.Like i said, the colors, the sounds, the involvement.You really try to get them to go for it.Then you tell the child that the clearer the image is, the more powerful the pain reliever will be.
So really when they get it specific, then when you make it better, it's much better.So you want to make it really specific and then you want to make what makes it better very specific too.And when the child has a clear image of the discomfort, you ask them, well get rid of the image.And you can image like the block of ice or for the rose or whatever you can imagine, the kids will come up with something very quickly with how to make that much better.
And you guide the child to describe the second image including how the second image may make the pain disappear.And you ask the child to imagine the second image to make the first image disappear and you notice the good feeling that comes with the less discomfort.So you have them go through the whole thing again.How do they feel, what does it smell like, is it cold, is it warm what's the air like you know, how are they feeling with all these different things you try to put together.
And then you do this postsession reinforcement where you reinforce the effort of success.You describe the practice, you tell the child to practice at least twice a day.They should use their rescue inhaler if they have asthma before practicing techniques because if the child has breathing difficulties because you don't want to put them into an asthma attack by having the bad feeling about it, right you don't want to say i want you to practice when you can't breathe.So when they need to, you have them actually take their.
Albuterol inhaler or one of the rescuers prior to doing their relaxation techniques.Do not tell the child to stop using medications if they need them, especially with the exercises.And when you develop a plan with the child about practicing these techniques.And he or she should be in quiet place with privacy when practicing.And ask the child where and when they might practice because they'll come up with all kinds of crazy ideas about when they're going to do it and how they're going to do it.And so some of the images that came up you can imagine,.
This is a little child that was having problems with the breathing, it was like a fish out of water.I think it was either an advertisement i think i saw on tv last night where they have a fish that's like flopping around on the ground and it shows you like, they can't breathe.And they give him the medication of course and throw it back in the water and it swims away, you know.But you could see if you just do that image without the medication, it could also be very effective.
You can have flowers opening up and closing.These are ones that people have told me about.We had a big fire in tucson when i was there.And the whole catalina mountains were on fire for about two months.So one person was telling me about their asthma, it felt like their whole life, like their whole chest was burning up.And so that was one thing which they gave.This is like a fireworks display about trying to open up things and it gets much better.You can see an ice pick in the throat is always a popular one.
Darth vader was very popular for a while raspy noises.The elephant that pushes on your chest, the giant, the giraffe with the very long neck, these are all very powerful images that kids came up with while i was talking to them.And so that's kind of my talk.This is one that i actually used to put in as a joke.But actually, have people seen this this is not a joke.This is one that just came out.It just came out on the market just about a month ago.
It's aeroshot.You can see it here it says pure energy.Dry energy shot dietary supplement.Breathable energy anytime, anyplace.It's actually caffeine that you sucking noise.It's about the size of a lipstick.And so the fda did not let this one get past them.They saw this one.Now they're saying, well you're really not supposed to inhale it.But this is after it just came out on the market, just in the last couple weeks.And so it's being stopped by the fda.So this is one that people came up with the idea, it's like,.
Qsciences EMpowerplus Q96 Mood Optimizer
Contact Noa at 7077182036 2441 imola ave napa ca 94558 drnoa.Myqxlife.Empowerplus q96 is specifically formulated to provide essential nutritional support to the brain and central nervous system.Empowerplus q96 delivers a wellbalanced blend of 36 vitamins, minerals, and amino acids to the brain in a safe and effective dose to boost mood stability, mental clarity, and overall brain health in both children and adults.A proprietary 96 hour micronization and nanochelation process increases the bioavailability of these nutrients for maximum nutrient uptake in the brain.Empowerplus q96 is backed by scientific research at fourteen universities in four countries,.
As well as research published in peerreviewed journals.Key benefits supports mood stability, improved cognition, and overall brain health contains a wellbalanced blend of 36 vitamins, minerals, and amino acids specially formulated for the brain and central nervous system unique 96hour micronization and nanochelation processes increase bioavailability for maximum nutrient uptake in the brain backed by scientific studies conducted at major universities in four countries, as well as research published in peerreviewed journals qsprays by q sciences provide additional nutritional support in a unique spray mist delivery method.Each product is formulated with the highest quality natural ingredients to provide maximum.
Absorption and effectiveness.The spray delivery method facilitates quick absorption in the bloodstream.All qsprays have a pleasant flavor and are safe and beneficial to use in conjunction with qssentials.Index of published empirical reports 1.Rodway, m., vance, a., watters, a., lee, h., elske, b., kaplan, b.J.2012.Efficacy and cost of micronutrient treatment of childhood psychosis.Bmj case reports.2.Frazier, e., fristad, m., arnold, e.2012.Feasibility of a nutritional supplement as treatment for pediatric bipolar spectrum disorders.Journal of alternative and complementary medicine, 187, 678685.3.Rucklidge, j., andridge, r., gorman, b., blampied, n., gordon, h., boggis, a.2012.
Effects of micronutrients on stress and trauma after an earthquake rct evidence comparing formulas and doses.Human psychopharmacology clinical and experimental.4.Rucklidge, j., blampied, n.2011.Postearthquake psychological functioning in adults with attentiondeficithyperactivity disorder positive effects of micronutrients on resilience.New zealand journal of psychology, 404.5.Rucklidge, j., johnston, j., harrison, r., boggis, a.2011.Micronutrients reduce stress and anxiety in adults with attentiondeficithyperactivity disorder following a 7.1 earthquake.Psychiatry res.1892.6.Rucklidge, j., johnstone, j., harrison, r.2011.Can micronutrients improve neurocognitive functioning in adults with adhd and severe mood dysregulation a pilot study.Journal.
Of alternative and complementary medicine.172.7.Simpson, j.S.A., crawford, s.G., goldstein, e.T., field, c., burgess, e., kaplan, b.J.2011.Safety and tolerability of a complex micronutrient formula used in mental health a compilation of eight datasets.Bmc psychiatry, 1162.8.Rucklidge, j., taylor, m., whitehead, k.2011.Effect of micronutrients on behavior and mood in adults with adhd evidence from an 8week open label trial with natural extension.Journal of attention disorders, 151, 7991.9.Rucklidge, j., gately, d., kaplan, b.J.2010.Database analysis of children and adolescents with bipolar disorder consuming.
Complementary Alternative Medicine Tips For Colds And Flu Packard Childrens Hospital
Complementary alternative medicine tips for colds and flu packard childrens hospital,In this 2009 tutorial pediatric pulmonologist john mark md discusses the use of complementary and alternative cam medicines for kids facing a cold or flulike. Denver alternative medicine acupuncture natural pediatrics applied kinesiology homeopathy,Alternative medicine in denver colorado springs castle rock and parker co integrative therapeutic medicine using natural medicine biofeedback. Complementary and alternative medicine in ms,The american academy of neurology released a new guideline cam in ms learn more about the various cam treatments for ms.
Integrative medicine helps kids fight cancer,When a pediatric patient is fighting through cancer and receiving chemotherapy or radiation there is a pain and sickness component that is not always. Physician roundtable discussion on complementary and alternative treatments for tourette syndrome,Roundtable discussion on complementary and alternative treatments for tourette syndrome taken from the tourette association dvd hot topics in evaluation. Integrative medicine and children,What parents want to know about dietary supplements and mind body therapies dr john mark clinical professor of pediatrics pediatric pulmonary medicine.
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Alternative Treatments For DrugResistant Epilepsy
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Beyond reflux feeding intolerance aversion the interplay of systems,About this upcoming webinar many infants and children have feeding difficulties and intolerance as well as vomiting gastroesophageal reflux and feeding. Reiki on cnn w carolyn coleridge honor your spiritauthor,Carolyn worked at ucla pediatric pain program for 6 years as an intuitive healer for children in chronic pain she assisted the members on the complementary. Traditional chinese medicine kids health pediatrics aoma graduate school austin,Friend us sfacebookpsychetruthtutorialspsychetruth traditional chinese medicine kids health pediatrics aoma graduate.
Cystic fibrosis an integrativeholistic approach,John d mark md a pulmonologist at lucile packard childrens hospital stanford shares his extensive knowledge of integrative medicine and its. Do 42 million children really need ritalin an integrative approach to adhd 2014 update,Visituctvtv dr sanford newmark specializes in the integrative and holistic treatment of children with autism and adhd he combines conventional. Patricia hibberd talks about probiotics and omics,Dr patricia hibberd answers some questions about probiotics fecal transplants and omics technologies she spoke with us after giving a lecture at the national.