NCCAM gets new name
Dec. 18, 2014 — The National Institutes of Health agency with primary responsibility for research on promising health approaches that already are in use by the American public has a new name — the National Center for Complementary and Integrative Health (NCCIH).
The revision from the National Center for Complementary and Alternative Medicine (NCCAM) was mandated as part of the omnibus budget measure signed by President Obama.
Large population-based surveys have found that the use of alternative medicine — unproven practices used in place of conventional medicine — is rare. Integrative health care, defined as a comprehensive, often interdisciplinary approach to treatment, prevention and health promotion that brings together complementary and conventional therapies, is more common. The use of an integrative approach to health and wellness has grown within care settings across the United States, including hospitals, hospices, and military health facilities.
“Since its establishment 16 years ago, the center has funded thousands of important research projects. Without this work, the American public would lack vital information on the safety and effectiveness of many practices and products that are widely used and readily available,” said NIH Director Francis S. Collins, M.D., Ph.D. “This change by Congress reflects the importance of studying the approaches to health and wellness that the public is using, often without the benefit of rigorous scientific study.”
“The intent of an integrative approach is to enhance overall health status, prevent disease, and alleviate debilitating symptoms such as pain and chemotherapy-induced nausea, among others. However, the scientific foundation for many complementary approaches is still being built,” said Josephine P. Briggs, M.D., Director of NCCIH. “The mission of NCCIH will remain unchanged. We will continue to focus on the study of the usefulness and safety of complementary and integrative interventions, and provide the public with research-based information to guide health care decision making.”
The name change is in keeping with the center’s pre-existing congressional mandate and is aligned with the strategic plan guiding the center’s research priorities and public education activities. Public comments on a revised name were invited in May and June 2014 and indicated overall support for the change.
The center’s research priorities include the study of complementary approaches — such as spinal manipulation, meditation, and massage — to manage pain and other symptoms that are not always well-addressed by conventional treatments. The center’s research also encourages self-care methods that support healthier lifestyles and uncovers potential usefulness and safety issues of natural products. The practices and products studied by the center are prioritized by four guiding principles: scientific promise, amenability to be studied using the highest quality research methods, use by the American public, and the potential impact on public health.
In 1992, the Office of Alternative Medicine (OAM) was established within the Office of the Director, NIH, to facilitate study and evaluation of complementary and alternative medical practices and to disseminate the resulting information to the public. In 1998, NCCAM was established by Congress, elevating OAM to the status of an NIH center. In February 2011, NCCAM released Exploring the Science of Complementary and Alternative Medicine: Third Strategic Plan 2011–2015, which continues to guide NCCIH’s work. (Source: NIH)
Yoga has the same potential as exercise to reduce the risk factors of cardiovascular disease
Effective for those 'who cannot or prefer not to perform traditional aerobic exercise'
Dec. 16, 2014 — Following a systematic review of 37 randomised controlled trials (which included 2768 subjects), investigators from the Netherlands and USA have found that yoga may provide the same benefits in risk factor reduction as such traditional physical activities as biking or brisk walking. "This finding is significant," they note, "as individuals who cannot or prefer not to perform traditional aerobic exercise might still achieve similar benefits in [cardiovascular] risk reduction."
Their study is published today in the European Journal of Preventive Cardiology.
Yoga, an ancient mind-body practice which originated in India and incorporates physical, mental, and spiritual elements, has been shown in several studies to be effective in improving cardiovascular risk factors, with reduction in the risk of heart attacks and strokes. This meta-analysis was performed, say the investigators, to appraise the evidence and provide a realistic pooled estimate of yoga's effectiveness when measured against exercise and no exercise.
Results showed first that risk factors for cardiovascular disease improved more in those doing yoga than in those doing no exercise, and second, that yoga had an effect on these risks comparable to exercise.
When compared to no exercise, yoga was associated with significant improvement in each of the primary outcome risk factors measured: body mass index was reduced by 0.77 kg/m2 (measured as a "mean difference"), systolic blood pressure reduced by 5.21 mm Hg, low-density (bad) lipoprotein cholesterol reduced by 12.14 mg/dl, and high-density (good) lipoprotein cholesterol increased by 3.20 mg/dl. There were also significant changes seen in secondary endpoints - body weight fell by 2.32 kg, diastolic blood pressure by 4.9 mm Hg, total cholesterol by 18.48 mg/dl, and heart rate by 5.27 beats/min. However, no improvements were found in parameters of diabetes (fasting blood glucose and glycosylated hemoglobin).
Risk factor improvements (in BMI, blood pressure, lipid levels) were significant when yoga was used in addition to medication. Among patients with existing coronary heart disease, yoga provided a statistically significant benefit in lowering LDL cholesterol when added to medication (statins and lipid-lowering drugs). In comparisons with exercise itself, yoga was found to have comparable effects on risk factors as aerobic exercise. The investigators note that this might be because of yoga's impact on stress reduction, "leading to positive impacts on neuroendocrine status, metabolic and cardio-vagal function".
The similarity of yoga and exercise's effect on cardiovascular risk factors, say the investigators, "suggest that there could be comparable working mechanisms, with some possible physiological aerobic benefits occurring with yoga practice, and some stress-reducing, relaxation effect occurring with aerobic exercise".
Commenting on the results, senior author Professor Myriam Hunink from Erasmus University Medical Center, Rotterdam, and Harvard School of Public Health, Boston, said that, although the evidence of yoga's beneficial effect in cardiovascular health is growing, a physiological explanation for this effect remains unclear.
"Also unclear," she added, "are the dose-response relationship and the relative costs and benefits of yoga when compared to exercise or medication. However, these results indicate that yoga is potentially very useful and in my view worth pursuing as a risk improvement practice."
Moreover, in view of yoga's ease of uptake, the investigators also note that evidence supports yoga's acceptability to "patients with lower physical tolerance like those with pre-existing cardiac conditions, the elderly, or those with musculoskeletal or joint pain".
Thus, they conclude that "yoga has the potential to be a cost-effective treatment and prevention strategy given its low cost, lack of expensive equipment or technology, potential greater adherence and health-related quality of life improvements, and possible accessibility to larger segments of the population".
NIH, VA research will focus on nondrug pain management
Sep. 25, 2014 — Thirteen research projects totaling approximately $21.7 million over 5 years will explore nondrug approaches to managing pain and related health conditions such as post-traumatic stress disorder (PTSD), drug abuse, and sleep issues. The effort seeks to enhance options for the management of pain and associated problems in U.S. military personnel, veterans, and their families. The National Institutes of Health’s National Center for Complementary and Alternative Medicine (NCCAM) and National Institute on Drug Abuse (NIDA) and the U.S. Department of Veterans Affairs (VA) Health Services Research and Development Division provided funding for this initiative. The research projects are located at academic institutions and VA medical centers across the United States.
“Pain is the most common reason Americans turn to complementary and integrative health practices,” said Josephine P. Briggs, M.D., Director of NCCAM. “The need for nondrug treatment options is a significant and urgent public health imperative. We believe this research will provide much-needed information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions.”
A 2011 Institute of Medicine (IOM) report states that nearly 100 million American adults suffer from chronic pain at a cost of $635 billion per year and notes a need for a cultural transformation to change this problem. Chronic pain disproportionately affects those who have served or are serving in the military. A June 2014 report in JAMA Internal Medicine showed an alarmingly high rate of chronic pain—44 percent—among members of the U.S. military after combat deployment, compared to 26 percent in the general public.
“Unless the ‘cultural transformation’ called for by the IOM begins in earnest, our nation faces additional crises in the future. Many service members and veterans with pain also have comorbid conditions such as posttraumatic stress syndrome or traumatic brain injury,” a commentary in the journal said. “Many of them are at risk for a lifetime progression of increasing disability unless the quality, variety, and accessibility of evidenced-based ‘self-management’ skills are improved. Without more effective and less costly approaches to pain management, the estimated costs of care and disability to the country will approach $5 trillion.”
One co-author of the commentary is Eric B. Schoomaker, M.D., Ph.D., a retired U.S. Army lieutenant general who is a scholar-in-residence and Distinguished Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a member of NCCAM’s Advisory Council. The other is Wayne B. Jonas, M.D., a retired U.S. Army lieutenant colonel who is president of the Samueli Institute, a nonprofit organization in Alexandria, Virginia, with a mission that includes applying academic rigor to research on healing, well-being, and resilience; and translating evidence into action for the U.S. military and large-scale health systems.
Pain is not the only issue. According to the JAMA Internal Medicine report, 15 percent of U.S. military post-deployment use opioids, compared to 4 percent of the general public. Drugs such as opioids that are available to manage chronic pain are not consistently effective, have disabling side effects, may exacerbate pain conditions in some patients, and are often misused. According to NIDA, an estimated 52 million people (20 percent of those aged 12 and older) have used prescription drugs for nonmedical reasons at least once in their lifetimes.
“Prescription opioids are important tools for managing pain, but their greater availability and increased prescribing may contribute to their growing misuse,” said Nora D. Volkow, M.D., Director of NIDA. “This body of research will add to the growing arsenal of pain management options to give relief while minimizing the potential for abuse, especially for those bravely serving our nation in the armed forces.”
Read about the researchers and descriptions of the thirteen projects.
Grant Will Help Study Link Between Blueberries, Bone Health
Sep. 23, 2014 — A $3.7 million grant will allow Purdue University researchers to study how blueberries reduce bone loss in postmenopausal women. "We are taking a systematic, deep-dive to learn if blueberries are helpful to counter menopause-induced and age-related bone loss," said Connie Weaver, distinguished professor and head of nutrition science.
"Human studies have not been done before, and this project also will look at what dosage levels protect bone. This is one of most compelling avenues to pursue in natural products research because blueberries would be a new alternative to osteoporosis drugs and their side effects."
The project begins Sept. 30 under a five-year grant from the National Institutes of Health's National Center for Complementary and Alternative Medicine.
Blueberries, from the family of vaccinium, are polypheolic-rich plant sources. Previous research in animal models and epidemiological studies show that polypheolic and flavanoids reduce age-related bone loss. Research on this topic is fairly new with some of the first findings published in 2008.
"How bioactive polyphenol metabolites from these berries protects bone is what we will try to answer, and it is our hypothesis that they help the immune system defend against bone loss," said Weaver, who is an expert in mineral bioavailability, calcium metabolism, botanicals and bone health. Weaver also is working with Mario Ferruzzi, professor of food science and nutrition science, who is known for his work in bioactive food components and phytochemicals in food and assessing their bioavailability and distribution to body tissues. The project's collaborators also include George McCabe, professor of statistics, and Elsa Janle, an associate research professor in nutrition science.
The partnership includes investigators from Indiana University School of Medicine, David Burr and Teresito Bellido and Munro Peacock. All are experts in bone health. Burr and Bellido are professors of anatomy and cell biology and Peacock is a professor of medicine. "This is a strong interdisciplinary team, and we have the capacity to look at the big picture from profiling bioactive compounds to understanding the botanical aspects and connecting it all to bone health," Weaver said.
The first phase will focus on genetic screening. The researchers will be working with the Blueberry Genetic Consortium to profile 1,200 lines of blueberry varieties to determine the five that will be most effective. They also will look at other varieties of vaccinium, including white blueberry and cranberry. The second phase will evaluate the most effective dosage levels in humans.
Weaver is a member of the Institute of Medicine, which is the health arm of the National Academy of Sciences, and she is deputy director of the National Institutes of Health-funded Indiana Clinical and Translational Science Institute. She also is director of Purdue's Women's Global Health Institute. In 2011 she was appointed to the Institute of Medicine's Food and Nutrition Board, and in 2005 she was appointed to the U.S. Dietary Guidelines Advisory Committee, and she served on the National Academy of Sciences Food and Nutrition Board Panel to develop new requirement recommendations for calcium and related minerals.
Fish and Fatty Acid Consumption Associated With Lower Risk of Hearing Loss in Women
Sep. 14, 2014 — Researchers at Brigham and Women’s Hospital found that consumption of two or more servings of fish per week was associated with a lower risk of hearing loss in women. Findings of the new study Fish and Fatty Acid Consumption and Hearing Loss study led by Sharon G. Curhan, MD, BWH Channing Division of Network Medicine, are published online on September 10 in the American Journal of Clinical Nutrition (AJCN). “Acquired hearing loss is a highly prevalent and often disabling chronic health condition,” stated Curhan, corresponding author. “Although a decline in hearing is often considered an inevitable aspect of aging, the identification of several potentially modifiable risk factors has provided new insight into possibilities for prevention or delay of acquired hearing loss.”
Although evidence suggests higher intake of fish and long-chain omega-3 polyunsaturated fatty acids (PUFA) may be associated with lower risk of hearing loss, prospective information is limited. This prospective study examined over time the independent associations between consumption of total and specific types of fish, long-chain omega-3 PUFA, and self-reported hearing loss in women.
Data were from the Nurses’ Health Study II, a prospective cohort study. In the study, 65,215 women were followed from 1991 to 2009. After 1,038,093 person-years of follow-up, 11,606 cases of incident hearing loss were reported. In comparison with women who rarely consumed fish, women who consumed two or more servings of fish per week had a 20 percent lower risk of hearing loss. When examined individually, higher consumption of each specific fish type was inversely associated with risk. Higher intake of long-chain omega-3PUFA was also inversely associated with risk of hearing loss.
“Consumption of any type of fish (tuna, dark fish, light fish, or shellfish) tended to be associated with lower risk. These findings suggest that diet may be important in the prevention of acquired hearing loss,” stated Curhan.
Fighting prostate cancer
with a tomato-rich diet
Aug. 27, 2014 — Men who eat over 10 portions a week of tomatoes have an 18 per cent lower risk of developing prostate cancer, new research suggests.
With 35,000 new cases every year in the UK, and around 10,000 deaths, prostate cancer is the second most common cancer in men worldwide.
Rates are higher in developed countries, which some experts believe is linked to a Westernised diet and lifestyle.
To assess if following dietary and lifestyle recommendations reduces risk of prostate cancer, researchers at the Universities of Bristol, Cambridge and Oxford looked at the diets and lifestyle of 1,806 men aged between 50 and 69 with prostate cancer and compared with 12,005 cancer-free men.
The NIHR-funded study, published in the medical journal Cancer Epidemiology, Biomarkers and Prevention, is the first study of its kind to develop a prostate cancer ‘dietary index’ which consists of dietary components – selenium, calcium and foods rich in lycopene – that have been linked to prostate cancer.
Men who had optimal intake of these three dietary components had a lower risk of prostate cancer.
Tomatoes and its products – such as tomato juice and baked beans - were shown to be most beneficial, with an 18 per cent reduction in risk found in men eating over 10 portions a week. This is thought to be due to lycopene, an antioxidant which fights off toxins that can cause DNA and cell damage.
Vanessa Er, from the School of Social and Community Medicine at the University of Bristol and Bristol Nutrition BRU, led the research.
She said: “Our findings suggest that tomatoes may be important in prostate cancer prevention. However, further studies need to be conducted to confirm our findings, especially through human trials. Men should still eat a wide variety of fruits and vegetables, maintain a healthy weight and stay active.”
The researchers also looked at the recommendations on physical activity, diet and body weight for cancer prevention published by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR).
Only the recommendation on plant foods – high intake of fruits, vegetables and dietary fibre - was found to be associated with a reduced risk of prostate cancer. As these recommendations are not targeted at prostate cancer prevention, researchers concluded that adhering to these recommendations is not sufficient and that additional dietary recommendations should be developed.
The research was carried out at the National Institute for Health Research Bristol Nutrition Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol (NIHR Bristol Nutrition BRU). The research was carried out as part of the ProtecT study, which is funded by the NIHR Health Technology Assessment programme.
‘Adherence to Dietary and Lifestyle Recommendations and Prostate Cancer Risk in the Prostate Testing for Cancer and Treatment (ProtecT) Trial’ by Vanessa Er, J. Athene Lane, Richard M. Martin, Pauline Emmett, Rebecca Gilbert, Kerry N. L. Avery, Eleanor Walsh, Jenny L. Donovan, David E. Neal, Freddie C. Hamdy and Mona Jeffreys in Cancer Epidemiology, Biomarkers and Prevention.
Grape Skin Extract May Soon Be Answer to Treating Diabetes
May 8, 2014 — Preliminary studies by researchers at Wayne State University have demonstrated that grape skin extract (GSE) exerts a novel inhibitory activity on hyperglycemia and could be developed and used to aid in diabetes management. Recently funded by the National Center for Complementary and Alternative Medicine of the National Institutes of Health, this $2.1 million transitional study will provide insights into the novel inhibitory action of GSE on postprandial hyperglycemia and will also provide preclinical data in support of the biological effectiveness and safety of GSE and its components in potential prevention and treatment of type 2 diabetes.
“It is hopeful that our research may eventually lead to the successful development of a safe, targeted nutritional intervention to support diabetes prevention and treatment,” said Kequan Zhou, Ph.D., assistant professor of food and nutrition science in the College of Liberal Arts and Sciences, and lead investigator on the grant. “Our study will provide important pre-clinical data regarding the anti-diabetic mechanisms, biological efficacy and safety of GSE that should facilitate eventual translation into future clinical studies to assess GSE and its components as a safe, low-cost and evidence-based nutritional intervention for diabetes.”
Type 2 diabetes is the most common form of diabetes. With type 2 diabetes, the body does not produce enough insulin or the cells ignore the insulin. In addition, some groups have a higher risk for developing type 2 diabetes, including African Americans, Latinos, Native Americans, Asian Americans/Pacific Islanders, and the elderly. “Type 2 diabetes is one of the major chronic diseases of modern societies," said Gloria Heppner, Ph.D., associate vice president for research at Wayne State University. "It threatens the health of a variety of populations, with growing numbers of young people being diagnosed with the disease every day.
The diabetes rate in the United States nearly doubled in the past 10 years. Approximately 26 million Americans are now classified as diabetic, stressing an urgent need for safe and effective complementary strategies to enhance the existing conventional treatment for diabetes.
"Dr. Zhou’s study offers great hope for a potential treatment that is natural and without harmful side effects for the many people inflicted with type 2 diabetes,” Heppner said.
The grant number for this National Institutes of Health research project is AT007566.
Complementary Medicine Widely Used for Children with Autism
January 11, 2014 — In a study of the range of treatments being employed for young children with autism and other developmental delays, UC Davis MIND Institute researchers found that families often use complementary and alternative medicine (CAM) treatments and that the most frequent users of both conventional and complementary approaches are those with higher levels of parental education and income.
There is no FDA-approved medical treatment for the core symptoms of autism spectrum disorder, a lifelong neurodevelopmental condition whose hallmarks are deficits in social relatedness, repetitive thoughts and behaviors and, often, intellectual disability.
In the search for treatments to help their children, families may turn to unconventional approaches such as mind-body medicine (e.g. meditation or prayer), homeopathic remedies, probiotics, alternative diets or more invasive therapies such as vitamin B-12 injections, intravenous immunoglobulin or chelation therapy — some of which carry significant risks.
The research is published online today in the Journal of Behavioral and Developmental Pediatrics. It was led by Robin Hansen, director of the Center for Excellence in Developmental Disabilities at the MIND Institute and chief of the Division of Developmental Behavioral Pediatrics in the UC Davis School of Medicine.
“In our Northern California study population, it does not appear that families use complementary and alternative treatments due to the lack of availability of conventional services, as has been suggested by other research,” Hansen said. “Rather, they use the treatments in addition to conventional approaches.”
The cause or causes of most neurodevelopmental disorders are not known, and the conditions have no cure. Many children suffer from a wide array of associated symptoms that may not be directly associated with their condition and that make their daily lives and those of their families stressful. Such symptoms include irritability, hyperactivity, gastrointestinal problems and sleep disorders.
The study included nearly 600 diverse children between 2 and 5 years with autism and developmental delay who were enrolled in the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. Of the participants, 453 were diagnosed with autism and 125 were diagnosed with developmental delay.
CAM use was more common among children with autism than children diagnosed with other types of developmental delay, 40 percent versus 30 percent respectively. Nearly 7 percent of children with autism were on the gluten-free/casein-free diet, particularly children with frequent gastrointestinal problems.
“We were pleased to find that most families utilizing CAM therapies were choosing ones that were low risk," said Kathleen Angkustsiri, assistant professor of developmental and behavioral pediatrics and a study co-author.
However, a small but statistically significant number — about 9 percent — were found to use alternative treatments classified by the study as potentially unsafe, invasive or unproven, such as antifungal medications, chelation therapy and vitamin B-12 injections.
“Our study suggests that pediatricians and other providers need to ask about CAM use in the context of providing care for children with autism and other developmental disorders, and take a more active role in helping families make decisions about treatment options based on available information related to potential benefits and risks,” said Roger Scott Akins, lead author and a former postdoctoral fellow at the MIND Institute, who now is chairman of the Division of Neurodevelopmental Pediatrics at Naval Medical Center Portsmouth, Va.
Irva Hertz-Picciotto, professor of public health sciences and principal investigator for the CHARGE study, said the research supports the emergent need for identifying validated treatments for neurodevelopmental conditions.
"These findings emphasize the enormous and urgent need for effective treatments and for rigorous research that can identify them and verify their effectiveness and safety,” Hertz-Picciotto said. “Of course it is reasonable for parents to keep searching for ways to help their children, when there are few effective treatments and none that can help every child."