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Dr. Refaat Hamed
Sunday, 14 June 2015
Complementary and Alternative
Medicine
Introduction
The main goals of these lectures are :
- To understand the basics of alternative and complementary
medicine a...
Introduction: Complementary and Alternative Medicine (CAM)
 What is CAM? CAM is a term used to describe a diverse group o...
Introduction: Examples of CAM
1. The use of hypnotherapy together with pain medications to reduce
anxiety and enhance rela...
Introduction: What is Integrative Medicine?
 Integrative Medicine: combines alternative medicine with evidence-
based med...
Introduction: Classification of CAM?
The National Center for Complementary and Alternative Medicine
classifies CAM therapi...
Introduction: Classification of CAM?
4. Manual Medicine: based on manipulation and/or movement of one or
more parts of the...
Introduction: Physical Therapy
Other Types of Alternative Medicine: Acupuncture
 Acupuncture is a treatment based on Traditional Chinese Medicine
(TCM),...
 Aromatherapy is the use of essential oils (volatile oils) from plants for
healing purposes.
 The word aroma in aromathe...
 Stimulation of these structures influences our physical, emotional,
and mental health. For example, lavender is believed...
 Other conditions for which aromatherapy may be helpful include
Alopecia areata (hair loss) , anxiety, insomnia, constipa...
 The term Ayurveda is taken from the Sanskrit words ayus, meaning
life or lifespan, and veda, meaning knowledge.
 The ba...
 Hahnemann postulated a theory that “like cures like” or the “Law of
Similars”.
 This law states that when a substance i...
 Hypnotherapists typically use exercises that bring about deep
relaxation and an altered state of consciousness. Many peo...
 Massage is a "hands-on" therapy in which muscles and other soft
tissues of the body are manipulated to improve health an...
 Clinical nutrition is the study of the relationship between food and the
well-being of the body. More specifically, it i...
 Herbal medicine = botanical medicine = phytomedicine or
phytotherapy, refers to the use of the entire plant or any plant...
 Dosage Forms? often used as food additives or as a
tea (Infusions, decoctions) or tinctures. Capsules, tablets, tincture...
1. The extract of Digitalis leaves is far more active than the equivalent
content of pure digitoxin (a cardiac glycoside)....
3. Chamomile flowers have well-known spasmolytic effects and are
used to treat cramps and stomach problems. The effects ar...
 Herbal drugs treat many conditions such as asthma, eczema,
rheumatoid arthritis, migraine, menopausal symptoms, chronic
...
 Ginkor contains approximately:
1. 24% flavone glycosides (primarily quercetin, kaempferol and
isorhamnetin),
2. 6% terpe...
2. Kava kava (Piper methysticum) has become popular as a treatment
for anxiety, but recent reports have traced liver damag...
4. Valerian (Valeriana officinalis) has had a long tradition for treating
insomnia, with the added benefit of producing no...
 Because herbal products are unregulated, they are often mislabeled
and may contain undeclared additives and adulterants....
 Standardization: means adjusting the herbal drug preparation to a
defined content of a constituent or a group of substan...
 CAM is mainly in the hands of doctors with MDs in Austria and
Germany , and half or more of the American alternative pra...
Dr. Refaat Hamed
Sunday, 14 June 2015
Complementary and Alternative
Medicine
The Five Domains of Complementary and Alternative Medicine
Spending on CAM??
• In 2009, American spent $33.9 billion for “complementary and
alternative medicine” — everything rangin...
Spending on CAM??
Spending on CAM??
Spending on CAM??
Spending on CAM??
Phytotherapy
• Herbal medicines are also referred to as herbal remedies,
phytomedicines, phytotherapeutic agents and
phyto...
Control of herbal ingredients in the UK
• Most of the herbal ingredients used in licensed herbal medicines have been
used ...
Control of herbal ingredients in the USA
• The majority of medicinal herbs and their products are regulated in the USA
as ...
Comparison of herbalism with rational phytotherapy
• Herbalism
1. Assume that synergy or additive
effects occur between he...
Conditions grouped by organ/body system
1 Allergy
2 Respiratory System
3 Heart& Vascular Disorders
4 Blood& Circulation
5 ...
Allergy: Allergic Rhinitis
• Allergic rhinitis is an allergic
inflammation of the nasal
airways. It occurs when an
allerge...
Allergy: Allergic Rhinitis
Inflammation associated with
allergic rhinitis.
• The characteristic symptoms of allergic
rhini...
Allergy: Treatment of Allergic Rhinitis
• The goal of rhinitis treatment is to prevent or reduce the symptoms
caused by th...
Allergy: Treatment of Allergic Rhinitis
• Bromelain Extract: mainly obtained from the stems of pineapples (Ananas
sp.). Br...
Allergy: Treatment of Allergic Rhinitis
• Borage seed oil has one of the highest amounts of γ-linolenic acid of seed
oils ...
Allergy: Treatment of Allergic Rhinitis
• Evening primrose oil (EPO, Oenothera
biennis oil) is considered to have benefici...
Allergy: Treatment of Allergic Rhinitis
• Echinacea (Echinacea angustifolia/ E. purpurea) Several
studies suggest that Ech...
Allergy: Sinusitis
• Sinusitis, also known as
rhinosinusitis, is inflammation
of the paranasal sinuses. It
can be due to i...
Allergy: Treatment of Sinusitis
• Antibiotics are prescribed if a bacterial infection is present or
suspected
• Decongesta...
Allergy: Sinusitis
• Bromelain, Quercetin and Vitamin C.
• N-Acetylcysteine (NAC): is an amino
acid derivative that can re...
Allergy: Sinusitis
• Sinuvil contains, among other constituents, N-ACETYLCYSTEINE,
QUERCETIN, PANAX GINSENG, BROMELAIN, WI...
Respiratory System: Asthma
• Asthma is a disease in which inflammation of the airways restricts airflow.
• Many patients w...
Respiratory System: Asthma
• Buteyko Breathing Technique is a form of complementary physical
therapy that proposes the use...
Respiratory System: Asthma
• Dietary modification can influence the severity and incidence of asthma.
The increased incide...
Respiratory System: Asthma
• Adding onion, garlic, pungent spices, and antioxidants (such as foods rich
in vitamin C, vita...
Respiratory System: Asthma
• Black seed (Nigella sativa) oil has been traditionally used for centuries for
easing respirat...
Respiratory System: Asthma
• Thymoquinone has antioxidant effects and has been shown to protect
against heart, liver and k...
Respiratory System: Cough
• Cough (Latin: tussis) is a sudden and often repetitively occurring
protective reflex which hel...
Respiratory System: Cough treatment
• Bromelain containing supplements may help suppress cough, reduce
nasal mucus associa...
Respiratory System: Cough treatment
• Food and Drug Administration believes that foods containing liquorice
and its deriva...
Respiratory System: Cough treatment
• Eucalyptus (Eucalyptus globulus): Eucalyptus oil acts as an expectorant.
It is found...
Respiratory System: Cough treatment
• Echinacea is used to reduce the symptoms of
cough.
• Garlic (Allium sativum) oil: is...
Respiratory System: Common cold
• Marjoram Leaf: Origanum marjorana (V.O.): The plant is traditionally used
to treat respi...
Respiratory System: Common cold
• Goldenseal (Hydrastis canadensis): contains berberine and hydrastine
alkaloids. Goldense...
Dr. Refaat Hamed
Sunday, 14 June 2015
Complementary and Alternative
Medicine
Conditions grouped by organ/body system
1 Allergy
2 Respiratory System
3 Heart& Vascular Disorders
4 Blood& Circulation
5 ...
Heart& Vascular Disorders: Hypertension
• Hypertension is a condition in which the systolic
blood pressure is at or above ...
Heart& Vascular Disorders: Hypertension cause
• The genetic basis of hypertension is
still poorly understood; however, it ...
Heart& Vascular Disorders: Hypertension cause
• Many mechanisms have been
proposed to account for the rise in
peripheral r...
Heart& Vascular Disorders: Hypertension cause
Heart& Vascular Disorders: Hypertension TTT
• Medications: Diuretics, Beta-blockers, Calcium-channel blockers. The
America...
Heart& Vascular Disorders: Hypertension TTT
• The DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern...
The DASH diet
The DASH diet
Heart& Vascular Disorders: Hypertension TTT
• Garlic (Allium sativum): Garlic has long been used for a variety of
cardiova...
Heart& Vascular Disorders: Hypertension TTT
• Chronic administration of Pet ether extract (50 mg/kg/day), toluene fraction...
Heart& Vascular Disorders: Hypertension TTT
• α-Linolenic acid, an essential fatty acid that appears to be beneficial for ...
Heart& Vascular Disorders: Hypertension TTT
• Apium graveolens (Family: Apiaceae; Common name: Celery). In China,
celery w...
Heart& Vascular Disorders: Varicose Veins
• Varicose Veins are large, twisted veins, usually in
the legs and feet that do ...
Heart& Vascular Disorders: Varicose Veins
The symptoms of varicose veins can be controlled with the following:
• Elevating...
Heart& Vascular Disorders: Varicose Veins
• A commonly performed non-surgical treatment for varicose and "spider" leg
vein...
Heart& Vascular Disorders: Varicose Veins
Nutrition and Dietary Supplements
• Food rich in dietary fiber in the form of co...
Heart& Vascular Disorders: Varicose Veins
• Horse chestnut (Aesculus hippocastanum) 500 mg three times per day or
standard...
Blood & Circulation: Anemia
• Anemia: Deficiency in red blood cells or
in haemoglobin (the iron-containing
oxygen-transpor...
Blood & Circulation: TTT of Anemia
• Vitamin B12, iron (II) and folic acid (vitamin M, vitamin B9).
• Pernicious anemia re...
Blood & Circulation: Anemia
• Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of
hot water), is ...
Blood & Circulation: Anemia
1. Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of
hot water), is...
Blood & Circulation: Hypercholesterolemia
• Hypercholesterolemia is a high level of cholesterol in the blood that can caus...
Blood & Circulation: Hypercholesterolemia
• Diet: Reduce the amounts of saturated fat and cholesterol consumed each
day. I...
Blood & Circulation: Hypercholesterolemia
Dietary guidelines for reducing cholesterol and fat consumption
1. Fish: contain...
Blood & Circulation: Hypercholesterolemia
6. Soluble fiber, which is found in oats, flaxseed, beans, psyllium, and fruits
...
Blood & Circulation: Hypercholesterolemia
• Bulk producers as Psyllium, Foenugreek,
Linseed, produce a sense of fullness, ...
Dietary Fiber: Insoluble vs. Soluble
• Dietary fiber, the indigestible cell wall
component of plant materials, plays an
im...
Dietary Fiber: Insoluble vs. Soluble
• The term "fiber" is misleading, since many types of so-called dietary fiber are
not...
Dietary Fiber: Soluble and Insoluble
• Current recommendations from the United States National Academy of
Sciences suggest...
Dr. Refaat Hamed
Sunday, 14 June 2015
Complementary and Alternative
Medicine
Conditions grouped by organ/body system
1 Allergy
2 Respiratory System
3 Heart& Vascular Disorders
4 Blood& Circulation
5 ...
Central Nervous System: Dementia and Alzheimer's Disease
• Dementia, a loss of brain function, can occur with a variety of...
Central Nervous System: Dementia and Alzheimer's Disease
• There are two types of AD:
1. Early onset where symptoms become...
Central Nervous System: Dementia and Alzheimer's Disease
• Once the disease reaches a severe stage, family members are not...
Central Nervous System: Dementia and Alzheimer's Disease
 Alzheimer's disease leads
to nerve cell death and
tissue loss t...
Central Nervous System: Dementia and Alzheimer's Disease
Central Nervous System: Dementia and Alzheimer's Disease
Illustration of how Alzheimer's
Disease spreads through the
brain...
Central Nervous System: Dementia and Alzheimer's Disease
• The brains of AD patients have a buildup of two types of protei...
Central Nervous System: Dementia and Alzheimer's Disease
Role of tau proteins
• Abnormalities in tau in the brain cause am...
Diagnosis of Alzheimer's Disease
• Apamin is an 18 amino acid cyclic
peptide neurotoxin found in apitoxin
(bee venom). Dry...
Drug TTT of Alzheimer's Disease
• Acetylcholinesterase inhibitors: Reduction in the activity of the
cholinergic neurons is...
Drug TTT of Alzheimer's Disease
• Solanezumab is a monoclonal antibody, being investigated by Eli Lilly
as a neuroprotecto...
TTT of Alzheimer's Disease: Life style and Diet
• Cardiovascular risk factors: hypercholesterolaemia, hypertension,
diabet...
TTT of Alzheimer's Disease: Life style and Diet
• Calming music may reduce restlessness, boost brain chemicals, and
improv...
TTT of Alzheimer's Disease: Life style and Diet
• Eat more high-fiber foods, including beans, oats, and root vegetables
(s...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• Phosphatidylserine (Pps) is an important phospholipid membr...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• Caffeine, flavonoids and generally antioxidants (e.g. vitam...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• American ginseng (Panax quinquefolium) improves blood flow ...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• Several cannabinoids (e.g. cannabidiol) occurring in Cannab...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• S-adenosylmethionine (SAM): Brain SAM levels
are severely d...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• Dietary omega-3 PUFA, SAM and B vitamin supplementation is
...
TTT of Alzheimer's Disease: Alternative medicinal approaches
• Acupuncture may improve memory and daily living
skills in p...
Dr. Refaat Hamed
Sunday, 14 June 2015
Complementary and Alternative
Medicine
Conditions grouped by organ/body system
1 Allergy
2 Respiratory System
3 Heart& Vascular Disorders
4 Blood& Circulation
5 ...
Digestive System: Constipation
Constipation can be caused by a low fiber diet, low liquid intake, or dieting.
Nutrition an...
Digestive System: Constipation
• They also stimulate peristaltic action and can be dangerous under certain
circumstances. ...
Digestive System: Diarrhea
• Diarrhea is the condition of having at least three loose or liquid bowel
movements each day. ...
Digestive System: Diarrhea
• Bile acid sequestrants such as cholestyramine can be effective in chronic
diarrhea due to bil...
Prebiotics
• Prebiotics is a general term that refers to chemicals that induce the
growth and/or activity of commensal mic...
Live probiotic cultures
are available in
fermented dairy
products and probiotic
fortified foods. However,
tablets, capsule...
Probiotics ≠ Antibiotics
• Probiotics are microorganisms that
are believed to provide health
benefits when consumed. They ...
Probiotics ≠ Antibiotics
• Probiotics are also useful in the treatment of
(1) antibiotic-associated diarrhea; (2)
Lactose ...
Digestive System: Gallbladder Disease
• Gallbladder disease is swelling of the gallbladder, a pear-shaped organ
under the ...
Digestive System: Gallbladder Disease
Types of Gallstones:
• There are two types of gallstones: cholesterol stones and pig...
Digestive System: Gallbladder Disease
Nutrition and Dietary Supplements:
• Decrease total fat intake, especially saturated...
Digestive System: Gallbladder Disease
Herbal drugs:
• Choleretic herbs stimulate bile production and increase bile solubil...
Digestive System: Liver Cirrhosis
• Cirrhosis is the damage of liver cells and their gradual replacement with
scar tissue ...
Digestive System: Ascites
• Ascites (fluid retention in the abdominal cavity) is the most common
complication of cirrhosis...
Digestive System: Hepatic encephalopathy
• Hepatic encephalopathy is the confusion, altered level of consciousness,
and co...
Digestive System: Liver Cirrhosis
Nutrition and Dietary Supplements
• Antioxidants
• Betaine: may help protect against fat...
Digestive System: Liver Cirrhosis
Herbal drugs
• Green Tea (Camellia sinensis): Drinking 10 cups of green tea per day is
l...
Digestive System: Liver Cirrhosis
• Silibinin is the major active constituent of silymarin, a standardized
extract of the ...
Digestive System: Liver Cirrhosis
• Turmeric (Curcuma longa): Animal studies provide evidence that turmeric
may protect th...
Digestive System: Viral Hepatitis
• Hepatitis is a serious disorder in which liver cells become inflamed. The
inflammation...
Digestive System: Viral Hepatitis
• Those at risk for viral hepatitis include workers in the health care
profession, peopl...
Digestive System: Viral Hepatitis
Medications
• Interferons – this group of medications are natural proteins that activate...
Digestive System: Viral Hepatitis
Herbal drugs:
• Milk thistle (Silybum marianum)
• Licorice root (Glycyrrhiza glabra): In...
Digestive System: Viral Hepatitis
• Turmeric (Curcuma longa): in animal studies, turmeric has been shown to
have a protect...
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Alternative medicine lectures by Dr. Refaat Hamed

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The main goals of these lectures are :
To understand the basics of alternative and complementary medicine and its application in therapeutics.
To get knowledge about the available (OTC) various herbal preparations, nutritional supplements and homeopathy.
To get knowledge about the role of the pharmacist to help clients make an informed choice of available products/techniques as well as monitoring the client use of these products.

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Alternative medicine lectures by Dr. Refaat Hamed

  1. 1. Dr. Refaat Hamed Sunday, 14 June 2015 Complementary and Alternative Medicine
  2. 2. Introduction The main goals of these lectures are : - To understand the basics of alternative and complementary medicine and its application in therapeutics. - To get knowledge about the available (OTC) various herbal preparations, nutritional supplements and homeopathy. - To get knowledge about the role of the pharmacist to help clients make an informed choice of available products/techniques as well as monitoring the client use of these products.
  3. 3. Introduction: Complementary and Alternative Medicine (CAM)  What is CAM? CAM is a term used to describe a diverse group of healing systems that are not presently considered to be part of mainstream medicine.  Complementary medicine: refers to medical practices used together with conventional medicine.  Alternative medicine: is used in place of conventional medicine (Allopathy; treatment of a disease with drugs having effects opposite to the symptoms # Homeopathy).  Homeopathy: Treating symptoms with minute doses of disease- causing natural substances.  Evidence-based medicine: is a form of medicine that aims to optimize decision-making by emphasizing the use of evidence from well designed and conducted research.
  4. 4. Introduction: Examples of CAM 1. The use of hypnotherapy together with pain medications to reduce anxiety and enhance relaxation in people recovering from severe burns. 2. Following a special diet rather than taking medications to treat “Attention Deficit Hyperactivity Disorder” (ADHD) is an example of alternative medicine. 3. The use of acupuncture for alleviation of vomiting and pain associated with anticancer drugs.
  5. 5. Introduction: What is Integrative Medicine?  Integrative Medicine: combines alternative medicine with evidence- based medicine. Proponents claim that it treats the “whole person”. It focuses on wellness and health rather than on treating disease, and emphasizes the patient-physician relationship.  For example, an integrative treatment for Alzheimer's disease may include a combination of the following: 1. Medication that increase certain brain chemicals, 2. Antioxidants as vitamin E and Ginkgo biloba extract that scavenge free radicals, 3. Changes in lifestyle (such as walking programs and relaxation training) to reduce anxiety and improve behavior, and 4. Music therapy to strengthen the immune system.
  6. 6. Introduction: Classification of CAM? The National Center for Complementary and Alternative Medicine classifies CAM therapies into five major groups: 1. Alternative Medical Systems: built upon complete systems of theory and practice. Examples include homeopathy, aromatherapy, naturopathy, traditional Chinese medicine (TCM), and Ayurveda. 2. Biological Medicine: use of substances found in nature, such as herbs, foods, and vitamins to promote health. 3. Energy Medicine: involves the use of energy fields to promote health. One of the forms of energy medicine (known as bioelectromagnetic- based medicine) involve the use of electromagnetic fields, such as electro-acupuncture.
  7. 7. Introduction: Classification of CAM? 4. Manual Medicine: based on manipulation and/or movement of one or more parts of the body. Examples include osteopathy ꞈ¢̳ ԛ҇£�⁶₅$� physical therapy, massage and reflexology. Reflexology: A natural healing art based on the principle that there are reflexes in the feet, hands and ears and their referral areas within zone related areas, which correspond to every part, gland and organ of the body. Through application of pressure on these reflexes without the use of tools, crèmes or lotions, the feet being the primary area of application, reflexology relieves tension, improves circulation and helps promote the natural function of the related areas of the body. 5. Mind-Body Medicine: uses a range of techniques that help boost the mind's ability to influence body functions and symptoms. Examples include biofeedback, deep relaxation, hypnotherapy, prayer, support groups, music therapy and yoga.
  8. 8. Introduction: Physical Therapy
  9. 9. Other Types of Alternative Medicine: Acupuncture  Acupuncture is a treatment based on Traditional Chinese Medicine (TCM), a system of healing that dates back thousands of years.  At the core of TCM is the idea that a type of life force, or energy flows through energy pathways (meridians) in the body. Each meridian corresponds to one specific organ, or group of organs, that regulate particular bodily functions.  Acupuncture points, or the specific locations where needles are inserted, are places where the energy pathway is close to the surface of the skin.  The theory is that by stimulating these point with a needle, we actually trigger the body’s own healing mechanisms.
  10. 10.  Aromatherapy is the use of essential oils (volatile oils) from plants for healing purposes.  The word aroma in aromatherapy is misleading because essential oils are not solely used as inhalants. They can also be massaged into the skin or even taken orally (although this is less common). Whether inhaled, absorbed, or ingested, essential oils are gaining new attention as an alternative treatment for infections, stress, inflammation and other health problems.  The "smell" receptors (olfactory receptors) in human nose communicate with two structures that are embedded deep in human brain. These structures are amygdala and hippocampus. When essential oil molecules are inhaled, they affect these parts of the brain directly. Other Types of Alternative Medicine: Aromatherapy
  11. 11.  Stimulation of these structures influences our physical, emotional, and mental health. For example, lavender is believed to stimulate the activity of brain cells in the amygdala in the same way that certain sedative medications work.  Aromatherapy massage is a popular way of using essential oils because it works in several ways at the same time: it produces benefits from absorbing the oils into the skin, from inhaling the oil's vapors, and from the physical therapy of the massage process itself.  Constituents of certain essential oils have antibacterial and anti- fungal properties. Citrus oils may enhance immune function and peppermint oil promotes proper digestion. Fennel and aniseed have estrogen-like compounds which may make them effective in relieving symptoms associated with menopause and the menstrual cycle. Other Types of Alternative Medicine: Aromatherapy
  12. 12.  Other conditions for which aromatherapy may be helpful include Alopecia areata (hair loss) , anxiety, insomnia, constipation (via abdominal massage using aromatherapy), Pruritis (itching) and Psoriasis  People who use aromatherapy require fewer pain medications for treatment of rheumatoid arthritis, cancer (e.g. use of topical chamomile), and headaches (e.g. use of topical peppermint). Other Types of Alternative Medicine: Aromatherapy
  13. 13.  The term Ayurveda is taken from the Sanskrit words ayus, meaning life or lifespan, and veda, meaning knowledge.  The basic principle of Ayurveda is to prevent illness by maintaining balance in the body, mind, and consciousness through proper drinking, diet, and lifestyle, as well as herbal remedies.  The goal of Ayurvedic medicine is to prevent diseases before they occur.  Combining yoga with an Ayurvedic herbal remedy containing Winter cherry (Withania somnifera), Boswellia (Boswellia serrata), and Turmeric (Curcuma longa) can reduce pain and disability if you have arthritis. Other Types of Alternative Medicine: Ayurveda (life style)
  14. 14.  Hahnemann postulated a theory that “like cures like” or the “Law of Similars”.  This law states that when a substance in large doses causes certain symptoms, in small doses it can cure the same symptoms.  Some treatments in conventional medicine (allopathy) rely on this like- cures-like principle; vaccines, for instance, introduce small doses of an illness-causing agent to prevent disease. Homeopathy
  15. 15.  Hypnotherapists typically use exercises that bring about deep relaxation and an altered state of consciousness. Many people routinely experience a trance-like state while they are watching television or sitting at a red light.  Hypnosis can actually teach people how to master their own states of awareness. By doing so they can affect their own bodily functions and psychological responses.  Studies on children in emergency treatment centers show that hypnotherapy reduces fear, anxiety, and discomfort and improves self-control and cooperation with medical personnel.  In another study, children significantly or completely recovered from the following: obesity, asthma, fecal incontinence, anxiety, pain, problematic habits (e.g. sleep walking, thumb sucking, nail biting). Hypnotherapy
  16. 16.  Massage is a "hands-on" therapy in which muscles and other soft tissues of the body are manipulated to improve health and well-being.  Music Therapy: using music.  Aqua-therapy: using water. Massage, music therapy and aqua-therapy
  17. 17.  Clinical nutrition is the study of the relationship between food and the well-being of the body. More specifically, it is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and discharged by the body.  Nutrients are substances that are involved in the creation of every molecule in the body. Carbohydrates, proteins, and fats (called macronutrients) are broken down (metabolized) to give the body energy.  Vitamins and minerals (called micronutrients) are not themselves metabolized for energy, but they are crucial in helping the macronutrients to be converted to energy, via enzyme-catalysis. Nutrition
  18. 18.  Herbal medicine = botanical medicine = phytomedicine or phytotherapy, refers to the use of the entire plant or any plant organ (e.g. seeds, fruits, roots, leaves, bark, or flowers) for medicinal purposes.  Herbal medicines are crude drugs utilized for the treatment of disease states, often of chronic nature, or to attain or maintain a condition of improved health.  Herbal drugs can be whole, fragmented or cut plants, parts of plants, algae and fungi, usually in dried form but sometimes fresh. Certain exudates (unorganized drugs). are also considered to be herbal drugs.  Herbalists prefer using whole plants rather than extracting single components from them. Herbal Medicine = Phytotherapy
  19. 19.  Dosage Forms? often used as food additives or as a tea (Infusions, decoctions) or tinctures. Capsules, tablets, tinctures, tintments, creams ….etc are also available in the market.  For many herbs, the specific ingredient that causes a therapeutic effect is not known. Whole herb/plant extract contains many ingredients, and it is likely that these constituents work together (synergistically) to produce the desired therapeutic effect.  The therapeutic activity of a plant does not depend solely upon a single readily identifiable constituent but upon the entirety of the chemicals in the plant extract/product.  Many factors affect how effective an herb will be (e.g. the climate, soil quality, how and when it was harvested and processed). Herbal Medicine = Phytotherapy
  20. 20. 1. The extract of Digitalis leaves is far more active than the equivalent content of pure digitoxin (a cardiac glycoside).  The pure glycoside is sparingly soluble in water at body temperature; hence its absorption from the GIT is limited.  The leaves (part used) contain another constituent, the saponin digitaline, which though is not a cardioactive compound, that assists the dispersion of the glycoside (digitoxin) in water and facilitates its absorption from the intestine. 2. Senna is an example of standardized crude laxative drug with a mixture of components (mainly anthraquinone glycosides ) that is more effective than the purified anthraquinones. The presence of aloe-emodin glucoside synergistically elevates the potency of sennosides about four-times. Efficacy of Entire Herbal Drug: Examples
  21. 21. 3. Chamomile flowers have well-known spasmolytic effects and are used to treat cramps and stomach problems. The effects are due to some water soluble flavonoids (e.g. apigenin) and sesquiterpenes (e.g. bisabolol) found in the essential oil. No single component of Chamomile is responsible for the overall activity of the crude drug. This is also true for the anti-inflammatory effects of Chamomile. 4. Khellin (a furano-chromon derivative) in Ammi visnaga fruits is insoluble in cold water but soluble in boiling water. Therefore the use of Ammi visnaga necessities its extraction by decoction for a comparatively long period. Efficacy of Entire Herbal Drug: Examples
  22. 22.  Herbal drugs treat many conditions such as asthma, eczema, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, constipation, irritable bowel syndrome,…….etc.  Herbal preparations are best taken under the guidance of a trained professional. Patients are advised to consult their pharmacist, and/or physcian before self-treating. 1. Ginkgo biloba, particularly as a standardized leaf extract known as EGb 761 (Ginkor), seems to produce improvements in awareness, judgment, and social function in people with Alzheimer's disease and dementia.  In a year-long study of 309 people with Alzheimer's disease, those taking Ginkor (Tanakan) consistently improved while those on placebo worsened. What is herbal medicine good for?
  23. 23.  Ginkor contains approximately: 1. 24% flavone glycosides (primarily quercetin, kaempferol and isorhamnetin), 2. 6% terpene lactones (2.8-3.4% ginkgolides A, B and C, and 2.6-3.2% bilobalide). 3. Other constituents include proanthocyanadins, glucose, rhamnose, organic acids, D-glucaric and ginkgolic acids.  Ginkor has antioxidant properties as a free radical scavenger. It promotes vasodilation and improves blood flow through arteries, veins and capillaries. It inhibits platelet aggregation and prolongs bleeding time. What is herbal medicine good for?
  24. 24. 2. Kava kava (Piper methysticum) has become popular as a treatment for anxiety, but recent reports have traced liver damage to some patients who have used kava so that the Food and Drug Administration (FDA, USA) has issued a warning regarding its use and other countries, such as Germany and Canada, have taken kava off of the market. 3. St. John's wort (Hypericum perforatum) is an effective treatment for mild to moderate depression.  Hyperforin (a prenylated phloroglucinol derivative) is proposed to be the active constituent responsible for the antidepressant and anxiolytic properties of the extract of St. John's wort. It acts as a reuptake inhibitor of monoamines, including serotonin, norepinephrine, dopamine, and of GABA and glutamate. What is herbal medicine good for?
  25. 25. 4. Valerian (Valeriana officinalis) has had a long tradition for treating insomnia, with the added benefit of producing no hangover feeling the day after. 5. Echinacea preparations (from Echinacea purpurea and other Echinacea species) may enhance immunity. In a study of 160 volunteers with flu-like symptoms, echinacea extract reduced both the frequency and severity of cold symptoms. What is herbal medicine good for?
  26. 26.  Because herbal products are unregulated, they are often mislabeled and may contain undeclared additives and adulterants.  Some herbs are associated with allergic reactions or interact/contradict with conventional drugs.  Self-prescribing herbal products is risky; it is important to consult the pharmacist and/or your doctor before taking herbal medicine.  St. John's wort causes sensitivity to the sun's ultraviolet rays.  St. John's wort also interferes with the effectiveness of many drugs, including warfarin (a blood thinner), protease inhibitors for HIV, birth control pills, and many other medications.  In addition, St. John's wort must not be taken with anti-depressant medication. Is there anything I should watch out for?
  27. 27.  Standardization: means adjusting the herbal drug preparation to a defined content of a constituent or a group of substances with known therapeutic activity by adding excipients or by mixing herbal drugs or herbal drug preparations (e.g. standardized extract from the European Pharmacopoeia).  Standardized: contains a certain level of compound(s) known or believed to indicate a biological activity. Ginkor with its 24% flavone glycosides and 6% terpene lactones is a classic example. Standardization of Herbal Medicines
  28. 28.  CAM is mainly in the hands of doctors with MDs in Austria and Germany , and half or more of the American alternative practitioners are licensed MDs. In Germany herbs are tightly regulated: half are prescribed by doctors and covered by health insurance.  Some professions of CAM, such as chiropractic, have achieved full regulation in North America and other parts of the world and are regulated in a manner similar to that governing science-based medicine.  In contrast, other approaches may be partially recognized and others have no regulation at all. Regulation and licensing of CAM varies widely from country to country! Regulation of alternative medicine
  29. 29. Dr. Refaat Hamed Sunday, 14 June 2015 Complementary and Alternative Medicine
  30. 30. The Five Domains of Complementary and Alternative Medicine
  31. 31. Spending on CAM?? • In 2009, American spent $33.9 billion for “complementary and alternative medicine” — everything ranging from acupuncture and massage therapy to yoga and herbal supplements, with $14.8 billion of that going toward over-the-counter “natural products” such as Echinacea and fish oil. • Americans spend almost a third as much money on herbal supplements and other alternative medicines as they do on prescription drugs. • This represents just 1.5% of overall annual health care costs, which hover around a $2.2 trillion. • 38% of adults use some type of alternative or complementary care to ease their ailments.
  32. 32. Spending on CAM??
  33. 33. Spending on CAM??
  34. 34. Spending on CAM??
  35. 35. Spending on CAM??
  36. 36. Phytotherapy • Herbal medicines are also referred to as herbal remedies, phytomedicines, phytotherapeutic agents and phytopharmaceuticals. • The use of herbal medicines in an evidence-based approach for treatment and prevention of disease is known as rational phytotherapy. This approach to the use of herbal medicines contrasts with traditional medical herbalism (Ethnomedicine), which uses herbal medicines in a holistic manner and mainly on the basis of their empirical and traditional uses. • Plants have been used medicinally for thousands of years by cultures all over the world. According to the World Health Organization, 80% of the world’s population uses plant-based remedies as their primary form of healthcare.
  37. 37. Control of herbal ingredients in the UK • Most of the herbal ingredients used in licensed herbal medicines have been used as traditional remedies for centuries without major safety problems, and the majority is included in the General Sales List (GSL). • Potentially hazardous plants such as digitalis, rauwolfia and nux vomica are specifically controlled under the Medicines Act as prescription–only medicines, and thus are not available other than via a registered medical practitioner. • In addition, certain herbal ingredients are controlled under The Medicines (Retail Sale and Supply of Herbal Remedies) Order 1977 SI 2130. This Order (Part I) specifies 25 plants which cannot be supplied except via a pharmacy, and includes well–known toxic species, such as Areca, Crotalaria, Dryopteris and Strophanthus. In Part II, the Order specifies plant species, such as Aconitum, Atropa, Ephedra and Hyoscyamus, which can be supplied by ‘herbal practitioners’, and in Part III defines the dosages and routes of administration permitted.
  38. 38. Control of herbal ingredients in the USA • The majority of medicinal herbs and their products are regulated in the USA as foods or food additives, and most of the regulatory action has been concerned with safety. In 1990, the FDA reported on over–the–counter drugs, including herbs. Some herbs (e.g. cascara, senna) were pronounced safe and effective, but the majority were not. Overall, 250 herbs, primarily based on their use as food additives, i.e. flavours and fragrances, were designated GRAS (Generally Regarded As Safe) status; however, this does not mean that such herbs (e.g. ginger, liquorice) are FDA-approved for therapeutic purposes. • In 1994, the Dietary Supplement Health and Education Act (DSHEA) became law. This Act allows publications, book chapters and scientific reports to support the sale of dietary supplements. Although medicinal claims cannot be made for such products, labelling may describe effects on general well– being.
  39. 39. Comparison of herbalism with rational phytotherapy • Herbalism 1. Assume that synergy or additive effects occur between herbs. 2. Holistic prescribing. 3. Preparations mainly formulated as tinctures. 4. Mainly uses combinations of herbs. 5. Opposition towards standardization. 6. Not scientifically evaluated. • Rational phytotherapy 1. Seek evidence that synergy or additive effects occur between herbs. 2. Not holistic. 3. Preparations mainly formulated as tablets and capsules. 4. Single-herb products used mainly. 5. Using standardization. 6. Science-based approach.
  40. 40. Conditions grouped by organ/body system 1 Allergy 2 Respiratory System 3 Heart& Vascular Disorders 4 Blood& Circulation 5 Central Nervous System 6 Digestive System 7 Endocrine System 8 Musculoskeletal System 9 Reproductive System 10 Others
  41. 41. Allergy: Allergic Rhinitis • Allergic rhinitis is an allergic inflammation of the nasal airways. It occurs when an allergen, such as pollen, dust, or animal dander (particles of shed skin and hair) is inhaled by an individual with a sensitized immune system. • In such individuals, the allergen triggers the production of the antibody immunoglobulin E (IgE), which binds to mast cells and basophils resulting in the release of of inflammatory mediators such as histamine. • This usually causes sneezing, itchy and watery eyes, swelling and inflammation of the nasal passages, and an increase in mucus production. • When caused by pollens of any plants, it is called pollinosis, and, if specifically caused by grass pollens, it is known as hay fever.
  42. 42. Allergy: Allergic Rhinitis Inflammation associated with allergic rhinitis. • The characteristic symptoms of allergic rhinitis are: rhinorrhoea (excess nasal secretion), itching, sneezing, and nasal congestion and obstruction. • Hay fever is not a true fever, i.e. it does not cause a core body temperature in the fever range of 37.5–38.3 °C. However, it can cause increased fluctuation in the core temperature of the sufferer, in conjunction with inflammation. • Allergy testing may reveal the specific allergens to which an individual is sensitive. Skin testing is the most common method of allergy testing.
  43. 43. Allergy: Treatment of Allergic Rhinitis • The goal of rhinitis treatment is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Measures that are effective include avoiding the allergen. • Antihistaminics can be taken orally, nasally or as eye drops to control symptoms such as sneezing, rhinorrhea, itching, and conjunctivitis. • First generation Antihistaminics such as diphenhydramine have undesirable side-effects (mainly drowsiness). • Second- and third-generation antihistamines such as cetirizine and loratadine are less likely to cause drowsiness. • Pseudoephedrine is also indicated for nasal congestion with antihistamines. • Steroid nasal sprays are effective and safe(!), and may be effective without oral antihistamines.
  44. 44. Allergy: Treatment of Allergic Rhinitis • Bromelain Extract: mainly obtained from the stems of pineapples (Ananas sp.). Bromelain is a mixture of heat-labile proteolytic enzymes (proteases) together with several other constituents found in smaller quantities. Bromelain has anti-inflammatory properties and may help suppress symptoms of sinusitis, and relieve the swelling and inflammation caused by hay fever. • Dose: 750-1,000 mg (tablets) daily in divided doses between meals. • Bromelain is one of the most popular proteases to use for meat tenderizing (directly sprinkled as powder on the uncooked meat). • Fatty Acids: γ-linolenic acid (ω-6 fatty acids, found in the oil of evening primrose and borage seeds) and omega-3 fatty acids (ω-3 fatty acids, found in the oil of fish, linseed, and walnuts) may relieve allergy symptoms.
  45. 45. Allergy: Treatment of Allergic Rhinitis • Borage seed oil has one of the highest amounts of γ-linolenic acid of seed oils (24%) and it has anti-inflammatory and anti-thrombotic effects. • Quercetin: a flavonols with antioxidant properties and inhibits the production and release of histamine. 200-400 mg, 3-times a day. • Quercetin can be found in apples, berries, and onions and is associated with the reduced risk of coronary heart disease and stroke. • Vitamin C: Some studies suggest that vitamin C plays a role in treating symptoms of hay fever and year-round allergic rhinitis
  46. 46. Allergy: Treatment of Allergic Rhinitis • Evening primrose oil (EPO, Oenothera biennis oil) is considered to have beneficial health effects, largely due to its GLA content. Evening primrose is sometimes used to treat eczema. • Most studies evaluating the effectiveness of EPO used a dose of 1600 mg of standardized extract (4 capsules) by mouth twice daily for up to 12 weeks. • Nettle Root Extract - Nettle Root Extract (Stinging nettle, Urtica dioica) is proposed to have antihistamine properties and recommended to be taken as a freeze dried preparation well before the start of hay fever season.
  47. 47. Allergy: Treatment of Allergic Rhinitis • Echinacea (Echinacea angustifolia/ E. purpurea) Several studies suggest that Echinacea contains substances that enhance the activity of the immune system and reduce inflammation. For these reasons, professional herbalists may recommend Echinacea to treat allergic rhinitis. • Goldenseal (Hydrastis canadensis): It is suggested that berberine, the active ingredient in goldenseal, has antibacterial and immune-enhancing properties, and many herbalists include it in herbal remedies for allergic rhinitis. • Liquorice (Glycyrrhiza glabra) contains anti-inflammatory triterpenoidal saponins and flavonoids.
  48. 48. Allergy: Sinusitis • Sinusitis, also known as rhinosinusitis, is inflammation of the paranasal sinuses. It can be due to infection (Bacterial, viral or fungal), allergy, or autoimmune problems. • Headache/facial pain or pressure of a dull, constant, or aching sort over the affected sinuses is common with both acute and chronic stages of sinusitis.
  49. 49. Allergy: Treatment of Sinusitis • Antibiotics are prescribed if a bacterial infection is present or suspected • Decongestants and Nasal steroidal spray • Surgery
  50. 50. Allergy: Sinusitis • Bromelain, Quercetin and Vitamin C. • N-Acetylcysteine (NAC): is an amino acid derivative that can reduce inflammation in mucus membranes, via its direct-antioxidant property and indirectly as a precursor of glutathione synthesis. • It has a mucolytic activity via splitting the disulfide bonds of mucoproteins and thus reduces the sputum viscosity. • It slows down HIV virus replication and is recommended treatment for AIDS.
  51. 51. Allergy: Sinusitis • Sinuvil contains, among other constituents, N-ACETYLCYSTEINE, QUERCETIN, PANAX GINSENG, BROMELAIN, WILD CHERRY, ZINC & SELENIUM. • Zinc: Zinc supplementation enhances immune system activity and protects against a range of infections including colds and upper respiratory infections. • Zinc gluconate products contain the lowest cadmium levels. Exposure to high levels of cadmium over a long time can lead to kidney failure. • A study showed that elderly patients who received zinc and selenium had fewer infections than patients who received a placebo.
  52. 52. Respiratory System: Asthma • Asthma is a disease in which inflammation of the airways restricts airflow. • Many patients with asthma also have allergies. Treatment • Bronchodilators as β2- adrenergic agonists (e.g. salbutamol) and theophylline. • Steroids (such as prednisone) are needed for acute asthma attacks.
  53. 53. Respiratory System: Asthma • Buteyko Breathing Technique is a form of complementary physical therapy that proposes the use of breathing exercises as a treatment for asthma as well as other conditions. • At the core of the Buteyko method is a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation. https://www.youtube.com/watch?v=fdnTvfooGn8 https://www.youtube.com/watch?v=dtY0AZKJYnU https://www.youtube.com/watch?v=hx-3dt9L72c
  54. 54. Respiratory System: Asthma • Dietary modification can influence the severity and incidence of asthma. The increased incidence of asthma in Western societies may be due to the consumption of a proinflammatory diet (20- to 25-fold more ω-6 polyunsaturated fatty acids (PUFA) than ω-3 PUFA), which causes the release of proinflammatory arachidonic acid metabolites (leukotrienes and prostanoids). Diet with increased ω-3 fatty acids and reduced ω-6 fatty acids protects children against symptoms of asthma. • pharmaceutical-grade fish oil (omega-3 PUFA) supplementation reduces airway hyperresponsiveness after exercise, medication use, and proinflammatory mediator generation in athletes with exercise-induced bronchoconstriction.
  55. 55. Respiratory System: Asthma • Adding onion, garlic, pungent spices, and antioxidants (such as foods rich in vitamin C, vitamin E, flavonoids, and β-carotene) to the diet may help reduce symptoms of asthma. • Quercetin and vitamin C. • Lobelia (Lobelia inflata): contains piperidine alkaloids lobeline and lobelanine. • Thyme (Thymus vulgaris): V.O. (thymol), saponins. • Tr. Benzoin Co. (Benzoin): benzoic and cinnamic acids. • Ginkgo (Ginkgo biloba). • Senega (Polygala senega): saponins • Red Clover (Trifolium pretense): flavonoids and saponins.
  56. 56. Respiratory System: Asthma • Black seed (Nigella sativa) oil has been traditionally used for centuries for easing respiratory problems. • It was rediscovered in Germany in 1995 when the horse of a doctor was cured of acute asthma from black seed. The doctor was so astounded that he applied black seed to one of his patients who was also cured. The anti-inflammatory, anti-spasmodic effects of the black seed oil reduces the intensity of the asthma symptoms. • An antispasmodic effect and increase in mucociliary clearance has been reported for nigellone but not for thymoquinone. • Asthma may be prevented by the use of black seed oil. The altered immune response in terms of hypersensitivity is the root cause of asthma.
  57. 57. Respiratory System: Asthma • Thymoquinone has antioxidant effects and has been shown to protect against heart, liver and kidney damage in animal studies as well as having potential anti-cancer effects. It also has analgesic and anticonvulsant effects in animal models. Thymoquinone and dithymoquinone appear to inhibit mast cell histamine release in response to certain stimuli.
  58. 58. Respiratory System: Cough • Cough (Latin: tussis) is a sudden and often repetitively occurring protective reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes. • Treatment should target the cause; for example, smoking cessation or discontinuing ACE inhibitors. • 10-25% of people who take ACE inhibitors suffer from cough as a side effect. • As it is a natural protective reflex, suppressing the cough reflex might have damaging effects, especially if the cough is productive. • Cough can be non-productive (dry) or productive (when sputum is coughed up).
  59. 59. Respiratory System: Cough treatment • Bromelain containing supplements may help suppress cough, reduce nasal mucus associated with sinusitis. It is often administered with quercetin. Quercetin has anti-histamine properties and, therefore, may be helpful if your cough is related to allergies. • Zinc: Several important studies have revealed that zinc lozenges may reduce the intensity of the symptoms associated with a cold, particularly cough. • Licorice = Liquorice (Glycyrrhiza glabra): It contains triterpenoidal saponins. Liquorice has long been valued as expectorant, demulcent (soothing, coating agent) and continues to be used by professional herbalists today to relieve allergies, bronchitis, colds, and sore throats. • People with high blood pressure, obesity, diabetes and heart conditions should avoid licorice.
  60. 60. Respiratory System: Cough treatment • Food and Drug Administration believes that foods containing liquorice and its derivatives (including glycyrrhizin) are safe if not consumed excessively. No more than 100mg to 200mg of glycyrrhizin per day, the equivalent of about 70g to 150g of liquorice, should be used. • Inappropriate use of licorice can produce pseudoaldosteronism, by inactivating 11-β-hydroxysteroiod-dehydrogenase and by binding to mineralocorticoid receptors. This is expressed in the form of sodium retention, potassium loss and suppression of the renin-angiotensin- aldosterone system. • Licorice possesses many other therapeutic properties as to potentiate the action of cortisol, to reduce testosterone synthesis, and, especially in women, to exert an estrogen-like activity.
  61. 61. Respiratory System: Cough treatment • Eucalyptus (Eucalyptus globulus): Eucalyptus oil acts as an expectorant. It is found in many lozenges, cough syrups, and vapor baths. • Lobelia • Peppermint (Mentha piperita) and thyme: Menthol and thymol have expectorant properties. • Guava leaves, fennel, and senega: Expectorant • Ipecachuana: isoquinoline alkaloids cephaline, psychotrine and emetine (Expectorant) • Myrrh: Oleo-gum-resin (Expectorant) • Asafoetida: Oleo-gum-resin (Expectorant) • Benzoin: Expectorant • Honey: Expectorant
  62. 62. Respiratory System: Cough treatment • Echinacea is used to reduce the symptoms of cough. • Garlic (Allium sativum) oil: is often used to help reduce symptoms of coughs, and bronchitis. • Ginger (Zingiber officinale): is believed to help common cold and flu-like symptoms, which may include cough. • Tilia (Tilia cordata) flowers may be recommended by an herbalist for colds, cough, or fever. • Stinging nettle (Urtica dioica): may act as an expectorant. • Turmeric (Curcuma longa)
  63. 63. Respiratory System: Common cold • Marjoram Leaf: Origanum marjorana (V.O.): The plant is traditionally used to treat respiratory diseases. It is also used to relieve the symptoms of common cold. • Astragalus (Astragalus membranaceus): Astragalus has been used traditionally to enhance the immune system, • Celery seed (Apium graveolens) (V.O.): Celery seed is used to treat colds and flus. • Echinacea is primarily used to shorten the duration of the common cold. • Eucalyptus • Garlic oil: In one study, patients who received garlic had significantly fewer colds than those who received placebo. • German Chamomile (V.O. and flavonoids): it has been used to treat a variety of symptoms related to cold including chest and nasal congestion as well as sore throats.
  64. 64. Respiratory System: Common cold • Goldenseal (Hydrastis canadensis): contains berberine and hydrastine alkaloids. Goldenseal is often combined with echinacea in preparations designed to strengthen the immune system. • Licorice • Tilia: Active ingredients in Tilia help promote sweating, which may be helpful if you have a fever. • Peppermint • Siberian ginseng: It may improve the immune system.
  65. 65. Dr. Refaat Hamed Sunday, 14 June 2015 Complementary and Alternative Medicine
  66. 66. Conditions grouped by organ/body system 1 Allergy 2 Respiratory System 3 Heart& Vascular Disorders 4 Blood& Circulation 5 Central Nervous System 6 Digestive System 7 Endocrine System 8 Musculoskeletal System 9 Reproductive System 10 Others
  67. 67. Heart& Vascular Disorders: Hypertension • Hypertension is a condition in which the systolic blood pressure is at or above 140 mm Hg, or the diastolic blood pressure is at or above 90 mm Hg, or both. Currently, hypertension is thought to affect roughly 1 billion patients worldwide. • Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. • Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as primary hypertension which means high blood pressure with no obvious underlying medical cause. • Hypertension occurs in approximately 8–10% of pregnancies. • Hypertensive crisis: Severely elevated blood pressure (equal to or greater than a systolic 180 or diastolic of 110 mm Hg.
  68. 68. Heart& Vascular Disorders: Hypertension cause • The genetic basis of hypertension is still poorly understood; however, it is believed that hypertension results from a complex interaction of genes and environmental factors. • Several environmental factors as well as life style influence blood pressure. • Events in early life (for example low birth weight, maternal smoking and lack of breast feeding) act as risk factors for adult essential hypertension. • In most people with primary hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal.
  69. 69. Heart& Vascular Disorders: Hypertension cause • Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. Most evidence implicates either disturbances in renal salt and water handling (particularly abnormalities in the intrarenal renin-angiotensin system) and/or abnormalities of the sympathetic nervous system. • Endothelial dysfunction and vascular inflammation may also contribute to increased peripheral resistance and vascular damage in hypertension.
  70. 70. Heart& Vascular Disorders: Hypertension cause
  71. 71. Heart& Vascular Disorders: Hypertension TTT • Medications: Diuretics, Beta-blockers, Calcium-channel blockers. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion. • Alternative/complementary approaches: Lifestyle changes are recommended to lower blood pressure, before starting drug therapy. The British Hypertension Society guidelines for the prevention of hypertension include: 1. maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2) 2. reduce dietary sodium intake to <6 g of sodium chloride or <2.4 g of sodium per day. 3. Engage in regular aerobic physical activity. 4. limit alcohol consumption to no more than 2-3 units/day. 5. Consume a diet rich in fruit and vegetables. • Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results!
  72. 72. Heart& Vascular Disorders: Hypertension TTT • The DASH diet (Dietary Approaches to Stop Hypertension) is a dietary pattern promoted by the National Heart, Lung, and Blood Institute (USA) to prevent and control hypertension. • The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans; and is limited in sugar- sweetened foods and beverages, red meat, and added fats. • In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public (recommended by the United States Department of Agriculture as one of its ideal eating plans for all Americans). • DASH reduced systolic blood pressure by 11 mm Hg and diastolic blood pressure by 6 mm Hg in hypertensive patients. • The DASH dietary pattern is adjusted based on daily caloric intake ranging from 1600 to 3100 calories.
  73. 73. The DASH diet
  74. 74. The DASH diet
  75. 75. Heart& Vascular Disorders: Hypertension TTT • Garlic (Allium sativum): Garlic has long been used for a variety of cardiovascular conditions, especially hyperlipidemia. Garlic has antioxidant and hypotensive activities. Garlic increases nitric oxide production, resulting in smooth muscle relaxation and vasodilatation. • Hawthorn (Crataegus monogyna): benefit in treating chronic heart failure, cardiovascular disorders and regulate blood pressure. A professional herbalist may recommend between 160 and 900 mg of hawthorn leaf and flower extract per day for six weeks or more. • Rauwolfia (R. serpentine) roots: The most powerful hypotensive plant. Reserpine, the purified alkaloid of R. serpentina, was the first potent drug widely used in the long-term treatment of HTN. • Red Korean ginseng (Panax ginseng) • German Chamomile: through its sedative effect • Punica granatum (Pomegranate; Family: Punicaceae). Pomegranate reduces the activity of angiotensin converting enzymes (ACE) by about 36%.
  76. 76. Heart& Vascular Disorders: Hypertension TTT • Chronic administration of Pet ether extract (50 mg/kg/day), toluene fraction (10 mg/kg/day) of ginger rhizome, and Korean ginseng extract (30 mg/kg/day) significantly reduced the BP in deoxycorticosterone acetate salt-induced hypertensive rats. Ginger acts to improve blood circulation and relaxes muscles surrounding blood vessels. • Triticum aestivum (Family: Gramineae; Common names: Bran, Wheat bran). Increasing dietary wheat bran intake by 3 to 6 g/day modestly reduces systolic and diastolic BP. • Theobroma cacao (Family: Malvaceae; Common names: Chocolate, Cocoa Butter). Cocoa powder is used for preventing cardiovascular disease. Flavonoids, contained in chocolate, stimulate formation of nitric oxide, increase vasodilatation, and reduce endothelial dysfunction. • Sesamum indicum (Family: Pedaliaceae; Common name: Sesame). Alcoholic extract of seeds (1–30 mg/kg) caused hypotension in anesthetized rats.
  77. 77. Heart& Vascular Disorders: Hypertension TTT • α-Linolenic acid, an essential fatty acid that appears to be beneficial for the heart diseases, inflammatory bowel disease, arthritis, and other health problems. Diet rich in omega-3 fatty acids lower BP significantly in people with HTN. • Hibiscus sabdariffa (Family: Malvaceae): The antihypertensive effects of the crude extract of HS have been attributed to mediation through acetylcholine and histamine like dependent mechanism through direct vasorelaxant effects. • A standardized dose of HS (9.6 mg per day) given to 39 patients and captopril, 50 mg per day, given to the same number of patients did not show significant difference relative to hypotensive effects. • Daucus carota (Family: Umbelliferae; Common name: Carrot): Activity- directed fractionation of aerial parts of D. carota resulted in the isolation of two coumarin glycosides. Intravenous administration of these compounds caused a dose-dependent (1–10 mg/kg) fall in arterial BP in rats, likely through blockade of calcium channels.
  78. 78. Heart& Vascular Disorders: Hypertension TTT • Apium graveolens (Family: Apiaceae; Common name: Celery). In China, celery was useful in reducing HTN in 14 of 16 patients. The juice was mixed with equal amount of honey and about 8 ounces were taken orally three times a day for up to one week. It has also been reported to reduce systolic and diastolic BP. The difference of BP in human beings before and after treatment has been found to be significant (P<0.05), indicating that seeds of A. graveolens can be used as a safe and effective treatment of high BP.
  79. 79. Heart& Vascular Disorders: Varicose Veins • Varicose Veins are large, twisted veins, usually in the legs and feet that do not transport blood effectively. If ignored, serious complications, such as phlebitis (inflammation of veins), skin ulcers, and blood clots can occur. • Veins have pairs of leaflet valves to prevent blood from flowing backwards. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work (valvular incompetence). This allows blood to flow backwards and veins enlarge. • Varicose veins are more common in women than men, and are linked with heredity. Other factors include pregnancy, obesity, menopause, aging, prolonged standing and leg injury.
  80. 80. Heart& Vascular Disorders: Varicose Veins The symptoms of varicose veins can be controlled with the following: • Elevating the legs often provides temporary symptomatic relief. • Regular exercise. • The wearing of graduated compression stockings with variable pressure gradients (Class II or III) has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by varicose veins. Caution should be exercised in their use in patients with concurrent arterial disease. • Diosmin/Hesperidine and other flavonoids. • Anti-inflammatory drugs (e.g. ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis. Topical gel application, helps in managing symptoms related to varicose veins such as inflammation, pain, swelling, itching and dryness.
  81. 81. Heart& Vascular Disorders: Varicose Veins • A commonly performed non-surgical treatment for varicose and "spider" leg veins is sclerotherapy in which a special chemical (sclerosant) is injected into a varicose vein to damage and scar the inside lining of the vein. This causes the vein to close. During this procedure, the affected leg is elevated to drain blood, and the sclerosant is injected into the varicose vein. The procedure takes 15 to 30 minutes, depending on how many varicose veins are treated and how big they are. Commonly used as sclerosants include polidocanol, sodium tetradecyl sulphate, Hypertonic Saline and Glycerin. The salt solution/ sclerosant is injected through a very fine needle directly into the vein. Polidocanol
  82. 82. Heart& Vascular Disorders: Varicose Veins Nutrition and Dietary Supplements • Food rich in dietary fiber in the form of complex carbohydrates (whole grains) and flavonoids (dark berries, dark leafy greens, garlic, and onions). • Beneficial nutrient supplements include vitamin C (500 to 1,000 mg three times per day), vitamin E (200 to 600 IU per day), and zinc (15 to 30 mg per day). Herbal drugs • Butcher's broom (Ruscus aculeatus) standardized extract (9% to 11% ruscogenin, steroidal saponin) 100 mg three times per day. • Ruscogenin has strengthening action on the walls of vessels, reducing their fragility, porosity, and permeability. It is also a powerful vasoconstrictor – the means to prevent vessels dilation. • Ruscogenin also inhibits the enzyme elastase, which is involved in the acceleration of the recycling of the lining of veins. Via inhibition of elastase, ruscogenin prolongs the life of the lining.
  83. 83. Heart& Vascular Disorders: Varicose Veins • Horse chestnut (Aesculus hippocastanum) 500 mg three times per day or standardized Aescin (saponin, 10 mg three times per day). • Aescin or escin is a mixture of saponins with anti-inflammatory, vasoconstrictor and vasoprotective effects. • Gotu kola (Centella asiatica) 1,000 mg two to four times per day, or standardized extract (asiaticoside 40%, Asiatic acid 30%, madecassoside 1% to 2%) 60 mg one to two times per day. Gotu kola may help reduce swelling and improve blood flow. • Buchu leaves: due to the flavonoid glycoside diosmin.
  84. 84. Blood & Circulation: Anemia • Anemia: Deficiency in red blood cells or in haemoglobin (the iron-containing oxygen-transport metalloprotein in the red blood cells of almost all vertebrates and some invertebrates). • It can also be defined as a lowered ability of the blood to carry oxygen. It affects about a quarter of the population globally. • Hemoglobin = 35% of the total content of RBCs. • The mammalian hemoglobin molecule can bind up to four oxygen molecules. Heme
  85. 85. Blood & Circulation: TTT of Anemia • Vitamin B12, iron (II) and folic acid (vitamin M, vitamin B9). • Pernicious anemia results in loss of gastric parietal cells, which are responsible, in part, for the secretion of intrinsic factor, a protein essential for subsequent absorption of vitamin B12 in the ileum. • Folate deficiency can lead to macrocytic anemia. Nutrition and Dietary Supplements • Dietary supplementation, without determining the specific cause, is not recommended. • Dietary sources of iron include meat (liver), beans, green leafy vegetables, blackstrap molasses and almonds. Leafy vegetables are principal sources of folic acid. Dietary sources of Vitamin B12 include liver, meats, eggs, tuna, and cheese. • Vitamin C: (250 to 500 mg twice a day) to help in absorption of iron (II). Dietary sources include citrus fruits and juices, tomatoes, broccoli.
  86. 86. Blood & Circulation: Anemia • Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative. • Blackstrap, is the dark, viscous molasses remaining after maximum extraction of sugar from raw sugar cane. • It contains significant amounts of vitamin B6 and minerals, including calcium, magnesium, iron, and manganese; one tablespoon provides up to 20% of the recommended daily value of each of those nutrients. Blackstrap is also a good source of potassium.
  87. 87. Blood & Circulation: Anemia 1. Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative. • Blackstrap, is the dark, viscous molasses remaining after maximum extraction of sugar from raw sugar cane. • It contains significant amounts of vitamin B6 and minerals, including calcium, magnesium, iron, and manganese; one tablespoon provides up to 20% of the recommended daily value of each of those nutrients. Blackstrap is also a good source of potassium. 2. Spirulina (blue-green Algae) that is rich in protein, vitamins, minerals, and antioxidants. 3. Alfalfa (Medicago sativa), F.Fabaceae. Alfalfa is high in protein, calcium and other minerals, vitamins in the B group, vitamin C, vitamin D, vitamin E, and vitamin K. • Alfalfa, like other leguminous crops, is a known source of phytoestrogens.
  88. 88. Blood & Circulation: Hypercholesterolemia • Hypercholesterolemia is a high level of cholesterol in the blood that can cause plaque to form and build up leading to blockages in the arteries (arteriosclerosis), increasing the risk for heart attack, stroke, circulation problems, and death. • The normal range for total blood cholesterol is between 140 and 200 mg per decilitre (mg/dL) of blood. Levels between 200 and 240 mg/dL indicate moderate risk, and levels surpassing 240 mg/dL indicate high risk. High cholesterol is characterized by elevated levels of LDL cholesterol (low density lipoproteins), normal or low levels of HDL cholesterol (high density lipoproteins), and normal or elevated levels of triglycerides. • Risk factors: Obesity , physical inactivity , stress, smoking, underactive thyroid and diabetes, and genetic predisposition. • Preventive Care: Maintaining a healthy body weight through increased physical activity and appropriate caloric intake is important.
  89. 89. Blood & Circulation: Hypercholesterolemia • Diet: Reduce the amounts of saturated fat and cholesterol consumed each day. Increase daily consumption of fruits, vegetables, fish, and whole grains. Supplement the diet with other protective components such as fiber. • Whole grains are cereal grains that contain cereal germ, endosperm, and bran, in contrast to refined grains, which retain only the endosperm. Common whole grains include: Wheat, Oat, Barley, Maize and Brown rice. • Dietary sucrose and fructose can raise LDL cholesterol levels in the blood.
  90. 90. Blood & Circulation: Hypercholesterolemia Dietary guidelines for reducing cholesterol and fat consumption 1. Fish: contains beneficial omega-3 fatty acids, which help to reduce inflammation and LDL cholesterol levels, and raise HDL cholesterol. Salmon and mackerel are particularly good sources. 2. Garlic: helps reduce cholesterol, thins the blood, and has antioxidant properties. 3. Phytosterols and/or phytostanols reported an average of 9% lowering of LDL- cholesterol. 4. Nuts (almonds and walnuts) help lower cholesterol levels. Nuts contain fibre and nutrients such as vitamin E, α-linolenic acid, magnesium and potassium, which are important for heart health. Although nuts are high in calories, some studies have found that increasing nut consumption by several hundred calories per day does not cause weight gain. 5. Olive oil: Limited and not conclusive scientific evidence suggests that eating about 2 tbsp. (23 g) of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil.
  91. 91. Blood & Circulation: Hypercholesterolemia 6. Soluble fiber, which is found in oats, flaxseed, beans, psyllium, and fruits (avocado), helps to lower cholesterol levels. Insoluble fiber, which is found in whole grains, vegetables, and fruits, does not lower cholesterol, but studies have shown that it helps protect against heart disease. Aim for a total of 35 g of fiber daily. 7. Soy products (soybeans and soy protein powder) can help lower cholesterol and triglycerides. Lunasin, a peptide found in soy, has been the subject of research focusing on cancer, cholesterol and cardiovascular diseases and inflammation. Soybean oil contains a significant amount of the omega-3 fatty acid α-linolenic acid. FDA approved soy as an official cholesterol-lowering food, along with other heart and health benefits. Soybeans also contain isoflavonoids (phytoestrogens) and antioxidants. 8. Yogurt and fermented milk products have been shown to lower cholesterol levels. 9. Oat bran: rich in soluble fiber (β-glucan) that has been shown to lower cholesterol levels. A typical dose of oat bran is 5–10 g taken with each meal. The recommended intake is 10–15 g of β-glucan per day.
  92. 92. Blood & Circulation: Hypercholesterolemia • Bulk producers as Psyllium, Foenugreek, Linseed, produce a sense of fullness, as they contain dietary fibers, Slow the movement of food from the stomach to the intestines, Decrease cholesterol & triglycerides, Rich in vitamins and minerals. 10.Green Tea (Camellia sinensis): Green tea has antioxidant effect. It has also demonstrated the ability to lower total cholesterol and raise HDL cholesterol in both animals and people. Results from the study suggest that the catechins in green tea may block intestinal absorption of cholesterol and promote its excretion from the body. 11.Thermogenic agents (e.g. Capsicum and Piper): Although they are appetizers, they increase basal metabolic rate or stimulate thermogenesis. 12.Non-Calorie Sweeteners: e.g. Glycyrrhizin is 50 times sweeter than sucrose.
  93. 93. Dietary Fiber: Insoluble vs. Soluble • Dietary fiber, the indigestible cell wall component of plant materials, plays an important role in human health. • Soluble fiber: The edible parts of plants or similar carbohydrates resistant to digestion and absorption in the human small intestine with complete or partial fermentation in the large intestine. • When soluble fiber is fermented, short-chain fatty acids (SCFA) are produced. SCFAs are involved in numerous physiological processes promoting health as: 1. Suppress cholesterol synthesis by the liver and reduce blood levels of LDL cholesterol and triglycerides responsible for atherosclerosis. 2. lower colonic pH (i.e., raises the acidity level in the colon) which protects the lining from formation of colonic polyps and increases absorption of dietary minerals.
  94. 94. Dietary Fiber: Insoluble vs. Soluble • The term "fiber" is misleading, since many types of so-called dietary fiber are not actually fibrous. • Soluble fiber attracts water and turns to gel during digestion. • Insoluble fiber, does not dissolve in water, is metabolically inert and provides bulking, or it can be prebiotic and metabolically ferment in the large intestine. Bulking fibers absorb water as they move through the digestive system, easing defecation.
  95. 95. Dietary Fiber: Soluble and Insoluble • Current recommendations from the United States National Academy of Sciences suggest that adults should consume 20–35 grams of dietary fiber per day. • Dietary fibers have 3 main mechanisms: bulking, viscosity and fermentation. 1. Increases food volume without increasing caloric content to the same extent as digestible carbohydrates, providing satiety which may reduce appetite. 2. Attracts water and forms a viscous gel during digestion, slowing the emptying of the stomach and intestinal transit, shielding carbohydrates from enzymes, and delaying absorption of glucose, which lowers variance in blood sugar levels. 3. Lowers total and LDL cholesterol, which may reduce the risk of cardiovascular disease. 4. Regulates blood sugar, which may reduce glucose and insulin levels in diabetic patients and may lower risk of diabetes. 5. Speeds the passage of foods through the digestive system, which facilitates regular defecation. As it adds bulk to the stool, it alleviates constipation. 6. Balances intestinal pH, which may reduce risk of colorectal cancer.
  96. 96. Dr. Refaat Hamed Sunday, 14 June 2015 Complementary and Alternative Medicine
  97. 97. Conditions grouped by organ/body system 1 Allergy 2 Respiratory System 3 Heart& Vascular Disorders 4 Blood& Circulation 5 Central Nervous System 6 Digestive System 7 Endocrine System 8 Musculoskeletal System 9 Reproductive System 10 Others
  98. 98. Central Nervous System: Dementia and Alzheimer's Disease • Dementia, a loss of brain function, can occur with a variety of diseases. One of these is Alzheimer's Disease (AD), which affects memory, thinking and behavior and gradually gets worse as the disease progresses. • AD is a progressive neurodegenerative disorder that causes irreversible damage to brain cells and loss of brain tissue leading to dementia and ultimately death. • It is characterized by formation of amyloid plaques and neurofibrillary tangles in the brain. Currently, it is primarily diagnosed by exclusion of other known causes of dementia. • You are more likely to get AD if you are old, have a relative with AD, have a history of head trauma, chronic high blood pressure, or have a genetic predisposition. Women tend to be at higher risk.
  99. 99. Central Nervous System: Dementia and Alzheimer's Disease • There are two types of AD: 1. Early onset where symptoms become evident before the age of 60. Several genes have been identified with Early onset and, as expected, this tends to run in certain families. 2. Late onset (most common) occurs in people older than 60. • In both types, genes and environmental factors seem to play a role. • Alzheimer's presents some challenging issues such as misplacing things, personality changes, getting lost in familiar settings, mood changes, difficulty recalling the names of familiar objects, or finding it challenging to accomplish tasks that used to be easy. • As the disease progresses, the individual may experience hallucinations, violent behavior, forgetting current events, poor judgment, depression, wakefulness at night, confusion in communication or forgetting ones' life history.
  100. 100. Central Nervous System: Dementia and Alzheimer's Disease • Once the disease reaches a severe stage, family members are not recognized, and it becomes very difficult to perform basic activities in daily life. • The only way to unambiguously positively diagnose AD is to assess a brain tissue sample after death, looking for neurofibrillary tangles, and senile plaques. • Calcium-dependent potassium channels have been found to be implicated with AD. Abnormalities of potassium (K+) channel function have been reported in cultured cells in AD.
  101. 101. Central Nervous System: Dementia and Alzheimer's Disease  Alzheimer's disease leads to nerve cell death and tissue loss throughout the brain. Over time, the brain shrinks dramatically, affecting nearly all its functions.  These images show: 1. A brain without the disease. 2. A brain with advanced AD. 3. How the two brains compare. 1 2 3
  102. 102. Central Nervous System: Dementia and Alzheimer's Disease
  103. 103. Central Nervous System: Dementia and Alzheimer's Disease Illustration of how Alzheimer's Disease spreads through the brain as the disease progresses. • Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.
  104. 104. Central Nervous System: Dementia and Alzheimer's Disease • The brains of AD patients have a buildup of two types of proteins. 1. Clumps of abnormal masses called plaques, made of beta-amyloid protein. These plaques build up between neurons and may stop them from communicating with each other. 2. Inside nerve cells are tangles, made of twisted tau protein. The brain needs tau protein to function, but in AD the protein gets twisted, which may cause damage to brain cells. • Amyloid beta peptides stick together as groups of protein aggregates known as amyloid plaques. These plaques are commonly found in the brains of AD patients, as well as those with other kinds of dementia disorders.
  105. 105. Central Nervous System: Dementia and Alzheimer's Disease Role of tau proteins • Abnormalities in tau in the brain cause amyloid proteins to accumulate as sticky plaque aggregates inside neurons. • While the cells attempt to force these protein clumps out, any amyloid proteins that remain in the cell, along with any tau proteins that are not functioning, become responsible for cell death. • Malfunctioning tau proteins prevent brain cells from clearing out toxic waste and lead to amyloid plaque build-up.
  106. 106. Diagnosis of Alzheimer's Disease • Apamin is an 18 amino acid cyclic peptide neurotoxin found in apitoxin (bee venom). Dry bee venom consists for 2-3% of apamin. • One method for early diagnosis of Alzheimer’s disease uses human blood platelets. The presence or absence of functioning calcium-dependent potassium channels in blood platelets are determined by employing potassium channel blockers such as apamin, the absence of functioning calcium-dependent potassium channels indicates a positive diagnosis for Alzheimer's disease.
  107. 107. Drug TTT of Alzheimer's Disease • Acetylcholinesterase inhibitors: Reduction in the activity of the cholinergic neurons is a well-known feature of AD. • Acetylcholinesterase inhibitors (e.g. Donepezil, Tacrine, Rivastigmine) are employed to reduce the rate at which acetylcholine (ACh) is broken down, thereby increasing the concentration of ACh in the brain and combating the loss of ACh caused by the reduction in the activity of cholinergic neurons. Memantine • N-Methyl-D-aspartate receptor antagonists: Memantine has been shown to be moderately efficacious in the treatment of moderate to severe AD.
  108. 108. Drug TTT of Alzheimer's Disease • Solanezumab is a monoclonal antibody, being investigated by Eli Lilly as a neuroprotector for patients with AD, which binds to the amyloid-β peptides that make up the protein plaques seen in the brains of people with the disease. • Bexarotene reduced amyloid plaque and improved mental functioning in a small sample of mice engineered to exhibit Alzheimer's-like symptoms. • Drugs being used in treatment of cognitive impairment and dementia have a very limited therapeutic value, suggesting the necessity to find new strategies to prevent/ slow down the progression of dementia. Bexarotene
  109. 109. TTT of Alzheimer's Disease: Life style and Diet • Cardiovascular risk factors: hypercholesterolaemia, hypertension, diabetes, and smoking, are associated with a higher risk of onset and course of AD. • People who eat a healthy diet have a lower risk of AD. Diet high in saturated fats and simple carbohydrates lead to a higher risk of AD. • Long-term usage of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with a reduced likelihood of developing AD. NSAIDs can reduce inflammation related to amyloid plaques. • People who engage in intellectual activities such as reading, completing crossword puzzles, playing musical instruments, or regular social interaction show a reduced risk for AD.
  110. 110. TTT of Alzheimer's Disease: Life style and Diet • Calming music may reduce restlessness, boost brain chemicals, and improve behavior. Relaxation training and other exercises that require focused attention may help boost social interaction and make it easier to do tasks. • The Safe Return Program: uses identification bracelets, wallet cards, and clothing labels for people with AD. • People with AD may need help with their diet. They often forget to eat and drink and can get dehydrated. • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables. Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains, dark leafy greens (such as spinach).
  111. 111. TTT of Alzheimer's Disease: Life style and Diet • Eat more high-fiber foods, including beans, oats, and root vegetables (such as potatoes). Avoid refined foods (e.g. white breads, pastas, and esp. sugar). • Eat fewer red meats and more lean meats and cold-water fish. Use healthy oils in foods, such as olive oil. Reduce or eliminate trans-fats, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine. • Don’t smoke. Drink 6 - 8 glasses of filtered water daily. Exercise at least 30 minutes daily, 5 days a week.
  112. 112. TTT of Alzheimer's Disease: Alternative medicinal approaches • Phosphatidylserine (Pps) is an important phospholipid membrane component. • It may raise levels of brain chemicals that deal with memory, according to several studies. • It may work best in people with mild AD. • Consumption of Pps may reduce the risk of dementia and cognitive dysfunction in the elderly. • Bovine brain contains 713 mg Pps/100 g. • Do not take Pps if you are taking blood thinners such as warfarin or aspirin. Use caution if taking it with ginkgo.
  113. 113. TTT of Alzheimer's Disease: Alternative medicinal approaches • Caffeine, flavonoids and generally antioxidants (e.g. vitamin E and coenzyme Q10) may decrease the risk of AD. • Zinc (30 - 50 mg per day) is often low in elderly people, and may help improve memory. • Ginkgo (Ginkgo biloba) shows some evidence for treating early AD. The pharmacological actions of G. biloba extracts are well documented and include anti-apoptosis, anti-inflammatory effects, neuroprotection, anxiolysis, MAO-inhibitory effects, and antioxidant effects. • Huperzine A, an alkaloidal constituent of Huperzia serrata, may improve memory in AD. Huperzine A • Huperzine A is a potent and selective AChE inhibitor. It may slow your heart rate and can interact with many medications. Do not take huperzine A if you have a liver disease or if you are about to have anesthesia.
  114. 114. TTT of Alzheimer's Disease: Alternative medicinal approaches • American ginseng (Panax quinquefolium) improves blood flow to the brain. • Lemon balm (Melissa officinalis) helped improve mental function in people with mild-to-moderate AD. Lemon balm may act like a mild sedative. • vincamine (isolated from Vinca minor) and its synthetic derivative vinpocetine increase cerebral blood flow, reduce cerebral insufficiency due to ischaemia and are associated with improvement in short-term memory. • Vinca-derived alkaloids stimulate cerebral metabolism, modulate neurotransmitter release and are neuroprotective in nature. vinpocetine
  115. 115. TTT of Alzheimer's Disease: Alternative medicinal approaches • Several cannabinoids (e.g. cannabidiol) occurring in Cannabis sativa and some synthetic derivatives are neuroprotective in nature. • Cannabidiol also inhibits hyperphosphorylation of tau in neuronal cells, and it is antipsychotic and anxiolytic. Cannabidiol • A lower prevalence of AD in some populations is associated with a curcumin- rich diet, and improved cognitive function has been linked with consumption of curry, a food that frequently consists of turmeric (Curcuma longa), a source of curcumin (antioxidant). Curcumin
  116. 116. TTT of Alzheimer's Disease: Alternative medicinal approaches • S-adenosylmethionine (SAM): Brain SAM levels are severely decreased in AD. SAM can exert a direct effect on glutathione S-transferase (GST) activity. • AD is accompanied by reduced GST activity, diminished SAM, and increased S-adenosyl homocysteine (SAH), the downstream metabolic product resulting from SAM-mediated trans- methylation reactions. SAM supplementation improves cognitive ability and reduces amyloid production. These findings underscore the critical role of SAM as a neuroprotective dietary supplement in AD. B vitamin deficiency could induce hyper-homocysteinemia. SAM
  117. 117. TTT of Alzheimer's Disease: Alternative medicinal approaches • Dietary omega-3 PUFA, SAM and B vitamin supplementation is recommended for AD patients. • β-carotene and Vitamin A: The levels of vitamin A and its precursor, β- carotene, lower in AD compared to healthy individuals. • Vitamin B9 (Folate) and Vitamin B12: Decreased levels of both folate and vitamin B12 have been found in people with AD. • Dietary omega-3 PUFA, SAM and B vitamin supplementation is recommended for AD patients.
  118. 118. TTT of Alzheimer's Disease: Alternative medicinal approaches • Acupuncture may improve memory and daily living skills in people with AD. • Several studies have found compelling evidence that certain aromatherapy oils have a positive effect on the mood, behavior, and even on the cognitive functioning of people with dementia. • Bright lights have been found to be beneficial as a treatment for sleep disturbances associated with dementia. In bright light therapy, a person sits in front of a light box that provides about 30 times more light than the average office light, for a set amount of time each day. the light/dark cycle and other environmental stimuli help maintain the circadian rhythm so that it stays synchronous with the 24-hour day. SharpMind™ Ginkgo, L- Dopa, Phosphatidylserine, Huperzine A, Vinpocetine & more
  119. 119. Dr. Refaat Hamed Sunday, 14 June 2015 Complementary and Alternative Medicine
  120. 120. Conditions grouped by organ/body system 1 Allergy 2 Respiratory System 3 Heart& Vascular Disorders 4 Blood& Circulation 5 Central Nervous System 6 Digestive System 7 Endocrine System: Dr. Lourine 8 Musculoskeletal System 9 Reproductive System 10 Others
  121. 121. Digestive System: Constipation Constipation can be caused by a low fiber diet, low liquid intake, or dieting. Nutrition and Dietary Supplements: • The main treatment of constipation involves the increased intake of water and fiber (either dietary or as supplements). • Fiber relieves constipation by adding bulk to stool and speeding its transit through the digestive tract. Psyllium (mucilage) is an example of a soluble fiber used standardly as a laxative. • Castor oil is used orally to clean out the intestines 6-12 hours before a bowel examination/surgery. Castor oil is known as a stimulant laxative. It works by increasing the movement of the intestines, helping the stool to come out. • Stimulant laxatives, contact laxatives, act on the intestinal mucosa or nerve plexus, altering water and electrolyte secretion.
  122. 122. Digestive System: Constipation • They also stimulate peristaltic action and can be dangerous under certain circumstances. They are the most powerful among laxatives and should be used with care. • Almond oil has a mild laxative effect. Consume 2 tbsp. of almond oil daily to relieve constipation. Almond oil also has been found to lower LDL levels while raising HDL levels. • Aloe (Aloe vera/Aloe barbadensis/Aloe ferox): Aloe juice contains anthraquinones. Although Aloe latex is a powerful laxative, it is not used frequently because it can cause painful cramping. Other gentler, herbal laxatives (such as Cascara and Senna) are generally recommended first. • Flaxseed (Linum usitatissimum) : F. O. and mucilage. • Rhubarb (Rheum palmatum): anthraquinones. • Foenugreek: mucilage. • The routine use of laxatives is discouraged.
  123. 123. Digestive System: Diarrhea • Diarrhea is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. • The most common cause is an infection of the intestines due to either a virus, bacteria, or parasite; a condition known as gastroenteritis. These infections are often acquired from food or water that has been contaminated by stool, or directly from another person who is infected. • Short duration bloody diarrhea is known as dysentery. • Prevention of infectious diarrhea is by improved sanitation, clean drinking water, and hand washing with soap. • Oral rehydration solution, which is clean water with modest amounts of salts and sugar, is the treatment of choice. Zinc tablets are also recommended. Probiotics reduce the duration of symptoms.
  124. 124. Digestive System: Diarrhea • Bile acid sequestrants such as cholestyramine can be effective in chronic diarrhea due to bile acid malabsorption. Nutrition and Dietary Supplements • Avoid chocolate, dairy products , strong spices. • The following are recommended: Rice or barley water, fresh vegetable juices (especially carrot and celery). • Swelling reducers: quercetin (250 to 500 mg two to four times per day) and chamomile. • Infection fighters: goldenseal (250 to 500 mg three times per day) and licorice root (unless you have high blood pressure). • Antidiarrheal herbs: Herbs containing tannins as Tea, Coffee, Hamamilis, and Galls. • Antispasmodic herbs: especially those containing atropine and hyoscyamine.
  125. 125. Prebiotics • Prebiotics is a general term that refers to chemicals that induce the growth and/or activity of commensal microorganisms (mainly healthy bacteria = Probiotics) that contribute to the well-being of their host. The most common example is in the gastrointestinal tract, where prebiotics can alter the composition of organisms in the gut microbiome. • Certain hand moisturizers have been proposed to act as prebiotics to improve the activity and/or composition of the skin microbiota. • prebiotics are typically non-digestible fiber compounds that pass undigested through the upper part of the gastrointestinal tract and stimulate the growth and/or activity of advantageous bacteria that colonize the large bowel by acting as substrate for them. • Like probiotics, prebiotics are conceptually intermediate between foods and drugs.
  126. 126. Live probiotic cultures are available in fermented dairy products and probiotic fortified foods. However, tablets, capsules, powders and sachets containing the bacteria in freeze dried form are also available.
  127. 127. Probiotics ≠ Antibiotics • Probiotics are microorganisms that are believed to provide health benefits when consumed. They are found naturally in diet, but deplete over time with age, stress and poor diet. • They aid digestion of food, protect us from certain invasive pathogens, can produce some vitamins (vitamin B12, folate, vitamin K) and increase our immune response. • Probiotics and prebiotics, together, exert an immunomodulatory role on the epithelial barrier of gut mucosae. • Probiotics ability to produce conjugated linoleic acid (CLA) is an additive health benefit property for its known role in colon cancer mitigation.
  128. 128. Probiotics ≠ Antibiotics • Probiotics are also useful in the treatment of (1) antibiotic-associated diarrhea; (2) Lactose intolerance; (3) Irritable bowel syndrome and colitis.
  129. 129. Digestive System: Gallbladder Disease • Gallbladder disease is swelling of the gallbladder, a pear-shaped organ under the liver that secretes bile, a fluid that helps with digestion. Gallbladder disease often occurs with gallstones. Some drugs can dissolve stones, avoiding the need for surgery. • In people with recurrent gallstones, surgery may be considered. Some medication, such as Ursodeoxycholic acid (oral bile acid), and ultrasound to break down the stones may also be used. • What Causes Gallstones? The bile stored in the gallbladder contains water, bile salts, cholesterol, fats, proteins, and bilirubin. Bile salts break up the fat that is consumed in our food. Gallstones generally form because the bile is saturated with either cholesterol or bilirubin.
  130. 130. Digestive System: Gallbladder Disease Types of Gallstones: • There are two types of gallstones: cholesterol stones and pigment stones. • Cholesterol stones (hardened cholesterol, yellowish-green in color) are the most common type of gallstone to develop, occurring in approximately 80% of patients with gallstones. • Pigment stones are made of bilirubin, and are are usually small and dark in color. • Ursodeoxycholic acid reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients who want an alternative to surgery. Ursodeoxycholic acid
  131. 131. Digestive System: Gallbladder Disease Nutrition and Dietary Supplements: • Decrease total fat intake, especially saturated fats (meat and dairy products). • Eliminate food allergens. Eggs, in particular, may irritate the gallbladder. • Eat more fiber. Consider fiber supplements such as flaxmeal (1 tsp. one to three times per day). Combine 1 heaping tsp. of flaxmeal in 8 oz. of apple juice for a drink high in fiber and pectin. • Choline (1,000 mg per day) and lipase (10,000 NF units with meals) stimulate gallbladder function. Choline supplementation can be used in the treatment of liver disorders, hepatitis, glaucoma, atherosclerosis, Alzheimer's disease, bipolar disorder and possibly other neurological disorders. • Vitamin E (400 to 800 IU/day) and vitamin C (1,000 mg two to three times per day) promote bile production.
  132. 132. Digestive System: Gallbladder Disease Herbal drugs: • Choleretic herbs stimulate bile production and increase bile solubility. • Especially useful are milk thistle (Silybum marianum), dandelion root (Taraxacum officinale), and turmeric (Curcuma longa). Use these herbs singly or in combination as a tea or tincture (15 to 20 drops), two to three times per day before meals. • Sodium curcuminate, a salt of curcumin, also exerts choleretic effects by increasing biliary excretion of bile salts, cholesterol, and bilirubin, as well as increasing bile solubility. • Enteric-coated peppermint oil (Mentha piperita) may help dissolve stones (0.2 to 0.4 ml three times a day between meals).
  133. 133. Digestive System: Liver Cirrhosis • Cirrhosis is the damage of liver cells and their gradual replacement with scar tissue that impairs blood flow through the liver causing hepatocyte death and loss of liver function. Hepatic fibrosis occurs in response to liver damage. • Cirrhosis is most commonly caused by alcoholism, hepatitis B and hepatitis C, and fatty liver disease, but has many other possible causes.  Medications • Antibiotics: for infected ascites (peritonitis) • Beta-blockers: typically propranolol or nadolol, reduce the heart rate and can lower the pressure in veins going to the liver. • Diuretics: as spironolactone. • Lactulose: reduces toxic levels of ammonia that cause hepatic encephalopathy, which can result in disturbances in consciousness or deep coma.
  134. 134. Digestive System: Ascites • Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis. • Ascitic fluid can have many sources such as liver disease, cancers, congestive heart failure, or kidney failure. Approximately 80% of the ascites cases are thought to be due to cirrhosis. • It is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome.
  135. 135. Digestive System: Hepatic encephalopathy • Hepatic encephalopathy is the confusion, altered level of consciousness, and coma that takes place as a result of liver failure. In advanced stages, it is called hepatic coma . It may ultimately lead to death. • It is caused by accumulation in the bloodstream of toxic substances that are normally removed by the liver. • Ammonia levels in blood may assist in the diagnosis of hepatic encephalopathy. • Hepatic encephalopathy is reversible with treatment. This relies on suppressing the production of the toxic substances in the intestine and is most commonly done with the laxative lactulose or with non-absorbable antibiotics. In addition, the treatment of any underlying condition may improve the symptoms.
  136. 136. Digestive System: Liver Cirrhosis Nutrition and Dietary Supplements • Antioxidants • Betaine: may help protect against fatty deposits in the liver, which can occur from chronic alcohol use, protein malnutrition, obesity, poorly controlled diabetes, and other causes. • Carnitine: Carnitine is a substance required for the transport of fatty acids within the mitochondria during the breakdown of lipids for the generation of metabolic energy. Betaine Carnitine • N-acetyl cysteine • ω-6 fatty acids (gamma-linolenic acid, GLA): GLA found in evening primrose oil (EPO) and borage seed oil, may help lessen cravings for alcohol and prevent liver damage. • S-adenosylmethionine (SAM): Preliminary research suggests that SAM may provide protection against liver damage and scarring and may improve survival rates in people with cirrhosis due to alcohol abuse.
  137. 137. Digestive System: Liver Cirrhosis Herbal drugs • Green Tea (Camellia sinensis): Drinking 10 cups of green tea per day is likely to protect against disorders of the liver. • Licorice root: Some preliminary data suggests that taking glycyrrhizin in combination with cysteine and glycerine may prove useful for helping reduce the risk of cirrhosis if you have hepatits C. • Milk thistle (Silybum marianum): Standardized to 70 - 80% silymarin (dose = 200-400 mg/day). • Active substances in milk thistle (particularly the flavonoid silymarin) protect the liver from damage caused by viruses, toxins, alcohol, and certain drugs such as acetaminophen. • Milk thistle improves liver function in people with mild liver disease but is less effective for those with severe liver disease such as cirrhosis.
  138. 138. Digestive System: Liver Cirrhosis • Silibinin is the major active constituent of silymarin, a standardized extract of the milk thistle seeds, containing a mixture of flavonolignans consisting of silibinin, isosilibinin, silicristin, silidianin and others. Silibinin Mechanisms of action: • Outer hepatocyte cell membrane changes induced preventing toxins from entering the cells. • Stimulates nucleolar polymerase A which leads to increased protein synthesis leading to liver regeneration via the formation of new hepatocytes. • Decreased biliary cholesterol, increase bile excretion, increase bilirubin excretion. • Silibinin has hepatoprotective (antihepatotoxic) properties, in vitro anti- cancer effects against a variet of cancers (e.g. prostate, breast, colon and lung carcinoma cells).
  139. 139. Digestive System: Liver Cirrhosis • Turmeric (Curcuma longa): Animal studies provide evidence that turmeric may protect the liver from a number of damaging substances such as carbon tetrachloride and acetaminophen. • Turmeric accomplishes this, in part, by helping to clear such toxins from the body and by protecting the liver from damage. • Ginger (Zingiber officinale) • Celery Seed (Apium graveolens): may have activity to help protect the liver from damaging agents such as acetaminophen. • Dandelion (Taraxacum officinale): Dandelion is a natural diuretic.
  140. 140. Digestive System: Viral Hepatitis • Hepatitis is a serious disorder in which liver cells become inflamed. The inflammation most occurs because of a virus. Viral hepatitis usually appears as type A, B, or C. It can also be caused by an overactive immune system, and from drugs, alcoholism, chemicals, and environmental toxins. • Type A, the most common form of viral hepatitis, is transmitted by contaminated food or water, or contact with a hepatitis A patient. Unlike hepatitis types B and C, there is no "carrier" state. The hepatitis A or B vaccines are effective for prevention. No vaccine against hepatitis C is available. • Hepatitis types B and C affect people of all ages transmitted through blood or sexual intercourse with infected person. An estimated 150–200 million people worldwide are infected with hepatitis C. • Many illnesses and conditions can cause hepatitis, but certain viruses cause about half of all hepatitis in people. There are several types of hepatitis viruses including types A,B, C, D, E, and possibly G.
  141. 141. Digestive System: Viral Hepatitis • Those at risk for viral hepatitis include workers in the health care profession, people with multiple sexual partners, and intravenous drug abusers. Blood transfusion is a rare cause of viral hepatitis. • All hepatitis viruses can cause acute hepatitis. • Viral hepatitis types B and C can cause chronic hepatitis. • Symptoms of acute viral hepatitis include fatigue, flu-like symptoms, dark urine, light-colored stool, fever, and jaundice; however, acute viral hepatitis may occur with minimal symptoms that go unrecognized.
  142. 142. Digestive System: Viral Hepatitis Medications • Interferons – this group of medications are natural proteins that activate immune functions in the body and have anti-viral properties. • Corticosteroids – may be used in the early stages of chronic hepatitis to enhance the effects of interferon. • Nucleoside Analogues– this class of drugs, including lamivudine and ribavirin, are used to stop replication of the virus. • These agents can be used against hepatitis B virus, hepatitis C virus, herpes simplex, and HIV. Once they are phosphorylated, they work as antimetabolites by being similar enough to nucleotides to be incorporated into growing DNA strands; but they act as chain terminators and stop viral DNA Polymerase. They are not specific to viral DNA and also affect mitochondrial DNA. Because of this they have side effects such as bone marrow suppression.
  143. 143. Digestive System: Viral Hepatitis Herbal drugs: • Milk thistle (Silybum marianum) • Licorice root (Glycyrrhiza glabra): In Japan, glycyrrhizin injections have been used as a therapeutic drug for chronic hepatitis since 1979. In one study, Japanese hepatitis C patients who received intravenous treatment with glycyrrhizin, cysteine, and glycine for an average of 10 years were significantly less likely to develop liver cancer and cirrhosis than those who received placebo. In a second study of 57 patients with hepatitis C, glycyrrhizin significantly improved liver function after only one month. These effects diminished after glycyrrhizin treatment was discontinued. • Green tea (Camellia sinensis): Catechin may help treat viral hepatitis.
  144. 144. Digestive System: Viral Hepatitis • Turmeric (Curcuma longa): in animal studies, turmeric has been shown to have a protective effect on the liver. • C. longa possesses antioxidant, anti-tumor, antimicrobial, anti-inflammatory, wound healing, and gastroprotective activities. The curcuminoid and the sesquiterpene fractions of C. longa have hepatoprotective activities. • Turmeric has been found to have a hepatoprotective characteristic similar to that of silymarin. • Turmeric hepatoprotective effect is mainly a result of its antioxidant properties, as well as its ability to decrease the formation of pro- inflammatory cytokines. • Astragalus (Astragalus membranaceus): This herb is also used for its immune enhancing properties, especially for the prevention and treatment of the common cold and chronic hepatitis.

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