complementary and alternative therapy

apple cider vinegar

MOA: delays gastric emptying in patients with DM=lowered glucose levels, feeling of satiety that comes with delayed emptying likely has a role in weigh loss.

USE: weight loss; glucose control in DM; disinfectant and wound cleansing; in raw unfiltered state, it can be used to support digestion and healthy microbiota

PK: raw unfiltered with a cloud “mother” consisting of yeast, bacteria or as supplements in a tablet form

effectiveness: decrease plasma glucose and HGBa1c, weigh loss when taken before meals; decrease of lipids

AE: damage to tooth enamel and throat irritation (dilute 1-2 tablespoons in 8oz h2o will help decrease these effects); high acidity can exacerbate gastritis, PUD and other GI s/s; decreases K+ level, hypokalemia with thiazide and loop diuretics and insulin; taking with digoxin, hypokalemia can increase the risk of digoxin toxicity

ashwagandha: withania somnifera

MOA: biological activity similar to steroids; stress modulating effects may be due to activation of GABA receptors

USE: relieve stress, anxiety, insomnia; taken to boost fertility and athletic prowess

EFFECTIVENESS: efficacy for treatment of insomnia and stress; increase testosterone levels and sperm quality

AE/DI; sedation and GI distress; effects like alcohol intoxication; high doses can induce abortion; additive effects when taken with CNS depressants

CI: pregnant patients; breastfeeding

Black Cohosj (Cimicifuga recemosa)

USE: menopause symptoms: hot flashes, vaginal dryness, palpitations, depression, irritability, and sleep disturbances

**should NOT be used to reduce hot flashes caused by tamoxifen and other SERMs

ACTIONS: unknown

AE: liver inflammation—> liver failure; rash, headache, dizziness, abdominal discomfort

DI: potentiate insulin and antihypertensive drugs and effects of estrogens used for hormone therapy; increase the risk for liver damage when taken with other drugs that hurt the liver

L: monitor liver function panel

** limit use for 6 months

clinical pearl for black cohosh with blue cohosh

black and blue cohosh are two different things; if you want black cohosh only avoid the combination of the two preparation

butterbur

USE: migraine, headaches, allergies and asthma

MOA: antiinflammaotru, antispasmidic, vasodilatory effects (believed to work like a calcium channel blocker and inhibition of lipoxygenase [an enzyme that helps with leukotrienes and other inflammatory substances])

+: does work as an antihistamine, helps with migraines (PROVEN)

AE: belching, headache, and fatigue; liver injury ! (maybe 2/2 pyrrolizidine alkaloids [PA])

CI: pt allergic to daisies, marigolds, chrysanthemums may have allergic reactions to butterbur

DI: CYP3a4 inducers: carbamazepine, phenobarbital, phenytoin + echinacea, garlic and st johns wort

**safe for short term use less than 4 months when taken at recommendation doses.

CBD oil

comes from hemp that is why it is legal

USE: anxiety, chronic pain, insomnia; epidiolex approved seizures 2/2 Lennox-gastaut and Dravet syndrome and for TB

MOA: CBD activates cannabinoid receptors in the brain, endocrine and immune function

PK; inhaled, eaten or topically

+: helps with nausea, seizures and muscle spasms; improve fibromyalgia

AE: sleepiness, dizziness, nausea, diarrhea, dry mouth ; rare livery injury

DI: metabolized by CYP2C10,CYP23A4, UGT1A7, UGT1A9, UGT2b7 in the liver and intestine; dangerous interactions: amiodarone, levothyroxine, warfarin, and some meds that prevent seizures; may have an additive effect when given with drugs that cause sedation

Coenzyme q-10

antioxidant that plays a role in cellular energy production

USE: heart failure, muscle injury from statins, mitochondrial encephalomyopathies (muscle and nervous system injury caused by deranged mitchochondroal metabolism)

MOA: potent antioxidant; takes part in metabolic pathway esp in production of ATP

+: improved cardiac function, faster recovery after heart sx, improve sperm count and same quality

AE: high does can cause GI disturbance, gastritis, reduced appetite, nausea and diarrhea; liver enzyme may increase

DI: this med is similar to vitamin k2, and may antagonize effects of warfarin; statin

CI: pregnant or breastfeeding bc (?) yet

Cranberry Juice

USE: prevent UTI and decrease urine odor in patients with urinary incontinence

ACTIONS: proanthocyanidins, a group of compounds that prevent bacteria from sticking to the urinary tract wall; but bacteria that is already attached are not affected

+: daily consumption of cranberry juice can prevent UTIs only in older adult women and women in their teens or 20s ;can reduce unpleasant odor in urinary incontinence

AE: more than 1l/day = risk for gi upset and formation of kidney stones

DI: increase risk of bleeding in patients taking warfarin

Echinacea

PK: oral [stimulates immune function, suppress inflammation and treat viral infection (flu and common cold) and topical (treat wounds, burns, eczema, psoriasis and herpes simplex infections

Actions: active ingredient cichoric acid, polysaccharides, flavnoids, essential oils have been throught to have antiviral, antiinflammaotry and immunostimulant effects thru mobilization of phagocytes, stimulation of t-lymphocyte profileration, stimulation of interferon and TNF production and inhibition of hyaluronidase (pro infallatory enzyme)

AE: unpleasant taste, fever, nausea, vomiting; allergic reactions (+ acute asthma, urticaria, angioedema, and anaphylaxis; long term therapy can suppress immune function

CI; if allergic to ragweed, asters, chamomile, chrysanthemums may have an increased risk for reacting to echinacea; autoimmune (SLE, RA); prolonged therapy should avoided in TB, immunocompromised pts like HIV and other chronic infections that need a good immune system

DI: immunosuppresant drugs (can oppose effects of immunosuppressants); can compromise drugs for TB, CA, HIV; can increase effects of drugs that are metabolized of CYP3a4 (inhibitor): alprazolam, amlodipine , atorvastatin, cyclosporine

elderberry

USE: treat cold and flu symptoms and promote immune responses; can decrease cholesterol levels and treat constipation

actions: stimulates inflammatory cytokines; decreased H1N1 activity by binding to H1N1 influenza

+: good for cold and flu

AE: n/v, dizziness and weakness

CI: pregnant and breastfeeding

fever few

USE: prophylaxis of migraine; allergies, asthma, RA, psoriasis

ACTION: parthenolide; inhibition of vasoconstriction in the brain, suppression of serotonin release form platelets and leukocytes and suppression of inflammation 2/2 inhibition of arachidonic acid release .

+: good for migraine

AE: abdominal pain, indigestion, diarrhea, farting, n/v: oral route: oral ulcers, tongue irritation, swollen lips; post fever few syndrome= nervousness, fatigue, insomnia, tension headache and joint pain or stiffness; may decrease platelet aggregation (2/2 suppressing release of arachidonic)= bleeding; dc 2 week before elective surgery

CI: if allergies to ragweed, chrysanthemums, daisies, marigolds may be allergic to fever few; pregnant (2/2 uterine contractions)

DI: risk for bleeding for pts taking anti platelet drugs like aspirin or anticoagulants (warfarin and heparin)

fish oil (contains omega 3 fatty acids)

use: prevention of heart disease and stroke; decrease severity of AI: RA and SLE; decrease risk of cancer

ACTION: when metabolized omega 3 fatty acids produce substances that inhibit platelet aggregation=prevents thrombosis; promote stable cardiac rhythms

+: preventing prostate cancer and decreasing top 2 dm in at risk people; reduces the risk of alzheimer's but does not slow cognitive decline

AE: unpleasant tase, halitosis, nausea, indigestion, diarrhea; may increase LDL;

DI: can potentiate effects of drugs that inhibit thrombosis

CI: seafood allergy

flaxseeds

use: constipation and dyslipidemias; hot flashes (2/2 phytoestrogen) [represents as omega 3 fatty acids for vegetarians]

actions: reduce serum cholesterol; phytoestrogen have lignan that convert to enterolactone and enterodiol = mild estrogenic and antiestrogenic actions=decrease cellular proliferation in breast tissue

'+: decease plasma cholesterol and LDL; acts like bulk forming laxative

AE: bloating, flatulence, abdominal discomfort

DI:may reduce absorption of meds take 1 hr before or 2 hrs after drugs

garlic

USES: effects cardio system; reduce LDL, triglycerides and raise HDL; reduce BP, suppresses platelet aggregation, increases arterial elasticity and decrease plaque; antimicrobial and anticancer effects

actions: allicin from garlic is what is believed that’s beneficial + ajoenes;

+: can lower bp can decrease plaque; may prevent cancer; may have some antibacterial and antifungal properties

AE: bad breath, body odor; heartburn, flatulence, n/v, diarrhea, burning sensation in the moist

CI: infectious or inflammatory GI disorders should avoid raw garlic 2/2 gi irritation

DI: increase risk of bleeding when taking antiplatelet drugs (ASA) or anitcoagulants (warfarin, heparin); can reduce levels of cyclosporine and saquinavir

ginger root

uses: vertigo and suppress nausea and vomiting 2/2 motion sickness, morning sickness, sea sickness and general anesthesia + antiinflammatory and analgesics for arthritis and chronic infllammatory dx.

actions: unclear; blocked of serotonin on CTZ of the medulla on afferent vagal neurons in the GI tract. activation of the receptors triggers emesis ; blocking it stop emesis; also may help with the anticholinergic effects and antihistaminic actions (by blocking serotonin) +antiinflammtoru effects 2/2 inhibits prostaglandins and leukotrienes

+:reduce pain, swelling and improve joint mobility in RA; ginger root for prevention of morning sickness; does help with morning sickness

AE: CNS depression, cardiac dysrythsmia; excessive doses can cause GI disturbances

CI: caution in pregnancy despite it being ok for morning sickness; high doses can stimulate the uterus; can increase bleeding for pts on anti platelet drugs or anticoagulants or drugs that inhibit clotting like direct thrombin and factor xa; can lower BG so it may potential hypoglycemic effects when on insulin and other drugs for DM

DI: can suppress platelets aggregation

gingko biloba (ginkgo biloba extracts/GBEs)

USE: improve memory; stop progression of dementia, decrease intermittent claudication; ED and others 2/2 deceased function

action: improved blood flow 2/2 gingko-induced vasodilation; suppresses platelet activating factor (PAF) a mediator of platelet aggregation, bronchospasm; reduced PAF= help protect against thrombosis + bronchospasm and other allergic dx.

+: small effects on intermittent claudication;

AE: stomach upset; headache; dizziness or vertigo (can decreases by avoiding rapid increases in dosages); spontaneous bleeding; eating raw or roasted ginkgo seeds, the seeds have a lot of toxins and can cause seizures and fatalities