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Integrative Health and Wellness

Heidi Maloni, PhD, APRN, BC-ANP, CNRN, MSCN

No longer secret practices hidden from your health care provider, people are talking about complementary and alternative medicine (CAM). CAM practices, which can include dietary supplements, food and diet modifications, and mind-body therapies, are increasingly accepted by patients, providers, health care systems, and insurance payers as important aspects of comprehensive care and wellness. In the US, 38% of adults use CAM, while 80% of people with MS report using CAM.

What exactly is complementary and alternative medicine? When the US Food and Drug Administration (FDA) reviews and approves the safety and effectiveness of a drug or device, it becomes a part of conventional medicine. Complementary means using a non-mainstream practice together with conventional medicine. Alternative means using non-mainstream practices in place of conventional medicine. For instance, using an herb to manage your MS alone would be alternative. Using an herb together with an MS disease-modifying drug would be complementary. Bringing conventional and complementary approaches together in a coordinated way is known as “integrative” health care. Integrative health is gaining recognition and is an acknowledgment of your preferences.

Evidence of the increased recognition is a change in the name of the National Institutes of Health, National Center for Complementary and Alternative Medicine to the National Center for Complementary and Integrative Health (NCCIH). NCCIH has studied complementary medicine practices since 1998. Their aim is to study the safety and effectiveness of CAM to help you make the right decisions about your health.

Driving the increased recognition of CAM is you. The National MS Society did some “social listening”. They looked at what was being said by people affected by MS on the internet from blogs, message boards, social networks like Facebook, video sites like YouTube, and their own website. The most frequent postings related to wanting emotional support and wellness. In the past few years the interest in wellness strategies for symptom management has been high, exceeding the interest in medications.

Wellness for you may mean changing your lifestyle to adopt health-promoting behaviors like diet and exercise. It may mean taking a yoga class, increasing your circle of friends, or adding supplements to your diet. Wellness is about physical, emotional, spiritual, and psychological well-being. Wellness is important. According to a National MS Society survey, wellness is the most important priority for people living with MS. The wellness strategies survey respondents were most interested in were diet, cannabis, exercise, vitamins, supplements, and mindfulness. Many said they use complementary approaches to help manage their MS symptoms.

While the survey respondents were very interested in using wellness strategies and complementary approaches, very little is known about the effect of these methods on MS symptoms and disease management. The American Academy of Neurology CAM Guideline Development Subcommittee reviewed studies of CAM therapies for treating MS. The Subcommittee found little evidence, from the few studies that met criteria for good science, that CAM is effective at treating either MS symptoms or the disease. They were concerned about the lack of FDA approval to assure the safety and effectiveness of CAM therapies, the lack of information to know if CAM therapies interfered with MS prescription drugs, and noted that CAM therapies are generally not covered by insurance. The following is a summary of highlights from the Subcommittee:

  • Ginkgo biloba does not improve thinking ability, although it may help reduce tiredness. It is well tolerated, but may increase bleeding; watch if you take a blood thinning drug.
  • Low-fat diet and fish oil probably do not help decrease MS symptoms or relapses.
  • Reflexology (pressure on areas of the feet, hands, or ears) might help reduce numbness and tingling.
  • Bee sting therapy might not help MS symptoms, and can cause an allergic reaction and possible death, itching, tenderness and swelling at the sting site, and flu-like symptoms.
  • Cari Loder regimen (a combination of amino acids, vitamin B12, and antidepressants) might not help improve MS symptoms, and can cause constipation, dry mouth, nausea, and insomnia.
  • Magnet therapy (putting magnets in contact with the body) probably helps reduce tiredness, but does not help depression.
  • Oral cannabis extract may reduce symptoms of spasticity and nerve pain. A derivative of tetrahydrocannabinol (THC), called dronabinol (trade name, Marinol) also may reduce spasticity and help lessen frequent urination. Dronabinol does not reduce tremor and has not been shown to improve sleep, anxiety, tiredness, thinking, overall bladder problems, or quality of life. There is no good evidence that smoking marijuana is safe or helpful for treating MS. Cannabis extracts do have side effects, including difficulty with attention and concentration, drowsiness, and possible long-term memory impairment, which could worsen cognitive problems and fatigue caused by MS. (VA providers cannot prescribe or recommend marijuana and cannabis as Federal law prohibits their use. It also is VHA policy to prohibit VA providers from completing forms regarding a Veteran’s participation in a State marijuana program. State laws authorizing the use of marijuana, even when characterized as medicine, are contrary to Federal law.)

All VA Medical Centers incorporate health and wellness into medical practice, referring Veterans when facilities lack programs. Talk to your provider about your wellness goals.