Complementary and Alternative Medicine: What Works?


From fish oil to acupuncture, a new study assesses the application and efficacy of popular alternative treatments.

Patients often use complementary and alternative medicine (CAM) without informing their providers. When they do, some physicians can be skeptical, or have questions about what really works. The American Academy of Family Physicians has called for evidence-based investigations of these little-studied and under-regulated treatments.

The journal American Family Physician has published a study in its September 2016 issue discusses the most studied CAM treatments.

Fish oil for hypertriglyceridemia lowers triglyceride levels, but may not reduce cardiovascular events. A dose of four grams of combined eicosapentaenoic acid/docosahexaenoic acid (omega-3 fatty acids) per day is first-line therapy. Fish oil may cause minor gastrointestinal upset but is free from medication interactions.

Coenzyme-Q10 (ubiquinone) improved heart failure symptoms and reduced major cardiovascular events adjunctive to standard of care in a recent study. Low Coenzyme-Q10 plasma levels are associated with greater heart failure independent of ejection fraction mortality.

A meta-analysis of 29 studies found acupuncture is effective for chronic lower back pain. Licensed acupuncturists are the most common practitioners but family physicians with medical acupuncture training may provide these services. The Joint Commission has recommended acupuncture for first-line pain management.

St. John’s wort (Hypericum perforatum) effectively treats mild to moderate depression with population efficacy coverage similar to any particular prescription antidepressant (~30%). If patients with mild to moderate depression refuse conventional antidepressants, St. Johns wort may be an effective alternative. St. John’s Wort interacts with oral contraceptives, some antibiotics, protease inhibitors, and certain immunosuppressive through multiple liver enzymes and contributes to serotonin syndrome risk.

THe study encourages providers to seek reliable information regarding complementary and alternative medicines, assess interactions with the patients' existing medicine regimens, and encourage open discussion about the possibility of their application.

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Elizabeth Cerceo, MD | Credit: ACP
Elizabeth Cerceo, MD | Credit: ACP
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