Chapter 71: Complementary and Alternative Therapy

Vocabulary practice flashcards covering complementary and alternative therapies, regulatory frameworks, common herbal supplements, mechanisms of action, adverse effects, and dangerous botanicals from Chapter 71.

Complementary Health Approach

A non-mainstream practice used together with conventional medicine.

Alternative Health Approach

A non-mainstream practice that is used in place of conventional medicine.

National Center for Complementary and Integrative Health (NCCIH)

An agency within the National Institutes of Health (NIH), originally created in the late 1990s as NCCAM and renamed in 2014, responsible for promoting and funding basic research and clinical trials on the safety and efficacy of complementary and alternative medicine (CAM).

Dietary Supplement Health and Education Act of 1994 (DSHEA)

Federal legislation that classifies botanical products, vitamins, and minerals as dietary (food) supplements rather than drugs, exempting them from mandatory premarket safety and efficacy evaluations by the FDA.

Current Good Manufacturing Practices (CGMP) Ruling

Standards issued by the FDA in June 2007 to ensure dietary supplements are free of adulterants, contaminants, and impurities, and that product labels accurately state the identity, purity, quality, and strength of active and inactive ingredients.

Dietary Supplement and Nonprescription Drug Consumer Protection Act

Legislation passed in 2006 mandating that manufacturers and distributors report serious adverse events (such as deaths, hospitalizations, life-threatening experiences, persistent disabilities, and birth defects) to the FDA within $15$ days.

Standardization (Herbal Products)

A three-step manufacturing process in which a producer (1) prepares an extract from plant parts, (2) analyzes the extract for known active ingredients, and (3) dilutes or concentrates it to ensure a predetermined quantity of active chemical constituents and achieve therapeutic batch-to-batch equivalence.

Apple Cider Vinegar

A dietary supplement commonly used for weight loss and glucose control in diabetes; it delays gastric emptying to prolong satiety and reduce blood sugar levels, but chronic use can erode tooth enamel, cause throat irritation, and induce hypokalemia.

Black Cohosh (Cimicifuga racemosa)

An herbal product used to relieve menopausal symptoms (such as hot flashes, vaginal dryness, palpitations, and sleep disturbance); use is generally limited to $6$ months due to a lack of long-term data and isolated reports of liver inflammation and failure.

Blue Cohosh (Caulophyllum thalictroides)

A plant with legitimate uses in promoting labor and menstruation that is chemically distinct from black cohosh; it can elevate blood pressure, increase intestinal motility, accelerate respiration, and cause uterine contractions, making it contraindicated during pregnancy.

Ashwagandha (Withania somnifera)

An Ayurvedic botanical used primarily to alleviate stress, anxiety, and insomnia; acts in part via biological activity resembling steroids and GABA receptor stimulation, but is contraindicated during pregnancy due to potential abortifacient and testosterone-elevating effects.

Butterbur (Petasites hybridus)

A botanical possessing anti-inflammatory, antispasmodic, and vasodilatory properties; recommended as a first-choice preventive therapy (Level A rating by the AAN and AHS) for migraine headaches at doses of $50$ to $75\,mg$ twice daily.

Pyrrolizidine Alkaloids (PAs)

Toxic compounds present in unpurified butterbur and comfrey that are converted into hepatotoxic metabolites by CYP3A4 isoenzymes, posing a serious risk of liver damage and veno-occlusive disease.

Cannabidiol (CBD)

An oil derived from industrial hemp (Cannabis sativa containing less than $0.3\%$ delta-9-THC); FDA-approved as Epidiolex to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex.

Coenzyme Q-10 (ubiquinone / CoQ-10)

An endogenous antioxidant required for mitochondrial ATP production; used for heart failure and statin-induced myopathy (since statin drugs block the shared biosynthetic pathway with cholesterol).

Cranberry Juice

A beverage containing proanthocyanidins that prevent bacteria from adhering to the urinary tract wall; clinically proven to prevent recurrent UTIs in older women and women in their teens and twenties, but ineffective at treating established infections.

Echinacea (Echinacea angustifolia, E. purpurea, E. pallida)

An oral and topical botanical used to stimulate immune function and suppress inflammation; acts as a CYP3A4 inhibitor, and prolonged use can suppress immune function by blocking the CD28 signaling pathway in T cells.

Elderberry (Sambucus nigra)

A fruit supplement used to reduce the duration and severity of cold and influenza symptoms; functions by stimulating inflammatory cytokine production (IL-6, IL-8) and binding to H1N1 virions to prevent cellular entry.

Feverfew (Tanacetum parthenium)

A daisy-like herb containing parthenolide used for episodic migraine prophylaxis ($50$ to $300\,mg$ twice daily); suppresses platelet aggregation by inhibiting arachidonic acid release and must be stopped $2$ weeks prior to elective surgery.

Postfeverfew Syndrome

A withdrawal condition occurring upon discontinuation of long-term feverfew, characterized by nervousness, fatigue, insomnia, tension headaches, and joint stiffness or pain.

Fish Oil

A supplement containing essential omega-3 fatty acids that produce membrane-stabilizing properties to promote stable cardiac rhythms and suppress platelet aggregation, reducing the risk of thrombosis.

Flaxseed

A vegetarian source of alpha-linolenic acid, soluble plant fiber, and lignans (phytoestrogens) that functions like a bulk-forming laxative to treat constipation and decreases total cholesterol and LDL levels.

Garlic (Allium sativum)

A botanical used for cardiovascular benefits; lowers blood pressure by stimulating nitric oxide synthase, inhibits platelet aggregation, and contains sulfides that reduce cholesterol synthesis.

Allicin

The principal active and aromatic sulfide in garlic oil, produced when intact garlic cells are crushed and the enzyme alliinase cleaves the odorless amino acid alliin.

Ginger Root (Zingiber officinale)

A rhizome used to suppress nausea, vomiting, and vertigo; active constituents such as galanolactone block $\text{5-HT}_3$ (serotonin) receptors in the chemoreceptor trigger zone and on afferent vagal neurons.

Ginkgo Biloba

A standardized leaf extract ($24\%$ flavonoids and $6\%$ terpenoids) used to promote vasodilation and improve blood flow in claudication and dementia; suppresses platelet-activating factor (PAF) synthesis.

Ginkgo Evaluation of Memory (GEM) Study

A large NIH-sponsored, placebo-controlled trial of over $3000$ older participants ($75$ years or older) showing that $120\,mg$ of Ginkgo biloba extract twice daily for $6$ years failed to prevent dementia or Alzheimer disease.

Glucosamine and Chondroitin

Cartilage components taken for osteoarthritis; glucosamine provides a substrate for cartilage and synovial fluid synthesis while suppressing degradative cytokines, and chondroitin helps keep cartilage hydrated.

Green Tea (Camellia sinensis)

A beverage containing polyphenols, epigallocatechin-3-gallate (EGCG), and caffeine used for weight loss and mental clarity; contains small amounts of vitamin K, which can counteract the anticoagulant effects of warfarin.

Epigallocatechin-3-gallate (EGCG)

A primary active polyphenol compound found in green tea extracts credited with chemoprotective, anti-inflammatory, and antioxidant properties.

Marijuana (Cannabis sativa)

A Schedule 1 controlled substance whose primary active ingredients (THC and CBD) stimulate cannabinoid receptors in the CNS and smooth muscle; used medically for neuropathic pain, appetite stimulation, and spasticity in multiple sclerosis.

Cannabinoid Hyperemesis Syndrome (CHS)

A rare adverse condition characterized by severe, cyclical nausea and intractable vomiting occurring in long-term, daily cannabis users.

Melatonin

A hormone produced by the pineal gland in response to darkness that regulates circadian sleep-wake cycles; recommended by the AAN for insomnia and sleep disturbances in children with autism spectrum disorder (ASD).

Peppermint Oil (Mentha piperita)

An agent used for irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO); relaxes gastrointestinal smooth muscle by blocking calcium channels and activates cooling TRPM8 receptors.

Small Intestinal Bacterial Overgrowth (SIBO)

A condition linked to proton pump inhibitor use and gastric bypass surgery characterized by excess intestinal gas, cramps, and diarrhea; susceptible to the bacteriostatic and bactericidal actions of peppermint oil.

Probiotics

Preparations of beneficial bacteria (such as Lactobacilli and Bifidobacteria) or yeasts (such as Saccharomyces boulardii) that prevent colonization by enteric pathogens, produce lactic acid, and maintain gut microflora.

Resveratrol

An antioxidant compound found in grape skins, red wine, and berries that inhibits phosphodiesterases (PDEs), elevating cellular cyclic AMP (cAMP) and activating AMP-dependent protein kinase.

Saw Palmetto (Serenoa repens)

An extract derived from American palm berries taken to relieve urinary symptoms of benign prostatic hyperplasia (BPH); rigorous clinical trials and Cochrane reviews indicate it is no more effective than a placebo.

Soy Isoflavones

Phytoestrogens (specifically genistein and daidzein) converted by intestinal bacteria into equol; act as selective estrogen receptor modulators (SERMs) to relieve postmenopausal hot flashes.

St. John's Wort (Hypericum perforatum)

An herbal preparation containing hyperforin and hypericin used for mild-to-moderate depression; strongly induces CYP3A4 isoenzymes and P-glycoprotein, drastically accelerating the metabolism and excretion of conventional medications like cyclosporine, warfarin, and oral contraceptives.

P-glycoprotein

A transmembrane transport protein that pumps xenobiotic drugs out of intestinal epithelial cells into the lumen and out of renal tubular cells into urine; induced by St. John's wort to accelerate elimination of drugs like digoxin.

Turmeric (Curcuma longa)

A spice containing yellow curcumin used primarily for osteoarthritis and rheumatoid arthritis; possesses low bioavailability and theoretical risks of increasing bleeding when taken with antithrombotic drugs.

Valerian (Valeriana officinalis)

An herbal sedative used to promote sleep by increasing the availability of gamma-aminobutyric acid (GABA) at central synapses and directly stimulating GABA receptors; potentiates CNS depressants.

Comfrey (Symphytum officinale)

A dangerous herbal supplement containing pyrrolizidine alkaloids (PAs) that induce hepatic veno-occlusive disease (VOD) and severe liver damage; banned from the internal market by the FDA in 2001.

Veno-occlusive Disease (VOD)

A severe hepatic vascular obstruction characterized by the occlusion of terminal venules in the liver, leading to liver failure; caused by ingestion of pyrrolizidine alkaloid-containing botanicals like comfrey.

Kava (Piper methysticum)

An herbal product promoted as a natural alternative to benzodiazepines for anxiety and insomnia; known to cause severe hepatotoxicity, acute liver failure, and death requiring emergent liver transplantation.

Ma Huang (Ephedra)

A botanical containing ephedrine that stimulates adrenergic receptors to cause hypertension, tachycardia, and CNS excitation; banned in the United States by the FDA in 2004 due to risks of stroke, myocardial infarction, and death.