Sports Medicine: Just the Facts

CHAPTER 75 • COMPLEMENTARY AND ALTERNATIVE MEDICINE 455

HOW DOI ADVISEMYPATIENTS
ABOUTCAM THERAPIES?
•Ninety-five percent of patients who use CAM thera-
pies also use conventional, Western biomedicine; how-
ever, over 60% of these patients do not inform their
physicians of their CAM therapy use (Eisenberg et al,
1998). This CAM communication gap results in a
wasteful, and potentially dangerous, patient-physician
environment.
•Patients who use CAM practices possess character
traits that incline them to active participation and part-
nering in their medical care (Eisenberg, 1997). A
physician who refuses to discuss and denies any
knowledge of CAM treatments does not alter the
patient’s need for partnering, but merely forces them
to seek association elsewhere—thus widening the
already precipitous CAM communication gap.

• Many effective strategies can be used to partner with
  patients on CAM therapies; however, we recommend
  the strategy proposed by Jonas. He suggests that
  depending on the specific patient and the specific
  treatment, physicians should protect, permit,and pro-
  moteCAM therapies (Jonas, 1998).

PROTECTINGFROMHARM

• Many CAM practices are inherently low risk when
  performed or prescribed by competent providers;
  however, herbal remedies and high dose vitamin
  supplementation (both very popular CAM thera-
  pies) can cause serious or fatal consequences
  (DeSmet, 2002).


• Naturaldoes not equal safe, contrary to the popular
  conceived connotation. Herbs and vitamins have
  real effects, real side effects, and real toxicities.
  Even without direct toxicity, herb–herb and
  herb–drug interactions can be severe. Other quality
  issues, such as contamination, varying potencies,
  and differing absorption rates abound in the unregu-
  lated domain of nutritional supplements (Eisenberg,
  1997).
  •Biofeedback, meditation, prayer, and acupuncture
  pose minimal risk for direct toxicity; however, even
  these safe practices may indirectly result in harm if
  used in place of more effective treatments. The physi-
  cian should detail the risks and benefits (both direct
  and indirect) of all therapeutic options.


• Ephedra (or Ma Huang) especially in combination
  with caffeine (or guaraná), chromium picolinate, and
  pulsed magnetic field therapy are examples of thera-
  pies from which patients should be protected. (See
  following section on specific CAM treatments.)

Permitting Unproven, Nontoxic Therapies
•Physicians may experience trepidation in allowing
patients to engage in unproven practices or therapies.

But if the therapy has no toxicity and is not used in

place of a proven-effective treatment, the practice can

be safely permitted and may be encouraged.

• The physician’s ultimate goal should be to relieve
  patient suffering. Patients welcome relief—and physi-
  cians should do likewise—even should relief come
  through nonquantifiable means (spiritual effect,
  placebo effect, prior plausibility). (Moerman and
  Jonas, 2002)


• Homeopathic arnica, acupuncture, spinal manipula-
  tion, ginko biloba supplementation, and many other
  CAM therapies can be safely permitted when properly
  administered and appropriately prescribed.

Promoting Proven Treatments

•Physicians should promote safe, effective treatments

regardless of their medical system of origin. Western

biomedicine has adopted and should continue to

incorporate proven techniques and therapies from

other systems of medical care (Eisenberg, 1997).

• Glucosamine supplementation is a prime example of a
  CAM therapy that should be promoted for individuals
  with knee osteoarthritis.

WHAT’S THECURRENTEVIDENCE FOR ORAGAINST

SOMEPOPULARCAM TREATMENTS?

• Summaries of the evidence for and against a few of
  the most popular CAM treatments used by athletes
  and the general population appear below. They are
  organized into the sections of Prevent, Permit, and
  Promote.
  Prevent


• Ephedra (Ma Huang, Herbal Ecstasy, Zhong Mahuang)
  (Gilles et al, 1996; Bell et al, 2000; Haller and
  Benowitz, 2000; Congeni and Miller, 2002)
  
  
  1. Primary use: Weight loss or enhanced athletic per-
     formance and endurance. Less commonly used for
     respiratory conditions or asthma.
     2.Evidence: Ephedra can potentiate a small weight
     loss of 2–5 kg over 6 weeks to 6 months, but only
     in patients with body mass index(BMI) over 30.
     The weight loss is typically transient and often
     requires combination the use of other stimulants
     (i.e., caffeine or guaraná). Multiple studies show no
     performance enhancing effect unless combined
     with caffeine/guaraná or used in very high dosages.
  
  
  2. Toxicity: High dosages and combination with caf-
     feine known to increase toxicity. High dosages
     cause dizziness, restlessness, anxiety, palpitations,
     and hypertension. Fatal events have been reported.
     Capsules have been found to contain many impuri-
     ties, to include banned substances.
     4.Regulated/Banned: Banned by International
     Olympic Committee (IOC), likely to be restricted