What does it mean to be healthy? The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” That’s more or less the philosophy underlying integrative medicine, which focuses on maintaining and improving patients’ health by combining alternative modalities, like acupuncture, homeopathy and herbal remedies, with traditional Western medicine.
But when MDs take an integrative approach to care, how does that affect treatment? Do patients still take prescription drugs? Is acupuncture the answer for every ailment? We talked to five integrative physicians, working across multiple specialties, to learn more. Here’s what they had to say.
Director of integrative medicine at the University of Tennessee Medical Center, Knoxville, TN
Our patients co-create a treatment plan annually for their health goals with our team of providers. Through this team, we include nutrition counseling (food is medicine); mind/body therapies including meditation, yoga, stress management and meaningful life classes; cognitive behavioral therapy; acupuncture, which has an array of evidence for many conditions; integrative health coaching; personal training and supplement and herb education, as well as overall primary/preventive care. These complementary therapies, along with others available in the community, can be fundamental to achieving optimal health for our patients, and are used with each patient whenever indicated based on their needs.
Our patients feel empowered in partnership with our team to be their most healthy selves in all realms — mind, body, spirit, community — utilizing all modalities that can help them realize their goals. One patient who had trigeminal neuralgia was able to come off of her anticonvulsant medication, which had been used to control her pain, with acupuncture. She no longer has pain and does not have to take medication for this. Also, several of our patients with diagnoses of irritable bowel syndrome no longer have their gastrointestinal issues due to changes in their diet and the addition of certain supplements under the supervision of our dietitian.
Integrative psychiatrist with Partners in Resilience and co-founder of Natural Mental Health, Minneapolis
Depression is not a new phenomenon, but it has reached epidemic proportions, creating a need for innovative, safe, effective and scalable treatments for large numbers of people. Recovery from depression is not all about brain chemistry, but it is partly about brain chemistry, and if that is off, then we need to start there. I begin by identifying the subtype of depression: anxious, agitated or sluggish. Recognizing these patterns allows for more intelligent, targeted strategies for support and rebalancing.
I’ll use the anxious mood subtype as an example of how I may build a treatment plan. First, I’d encourage nutrition to support mood, since diet provides the building blocks for all the brain chemicals. I suggest subtype specific diets to help balance brain chemistry — the diet for an anxious mood focuses more on serotonin-boosting foods, like healthy, complex carbs and foods rich in tryptophan.
When diet is not enough, I may suggest supplements. If the symptoms of depression aren’t too severe, I often recommend a trial of natural therapies before prescription medication. I use products that combine all the needed nutraceuticals into one or two different capsules, both to reduce cost and make it easier for patients to use. Staying with the example of the anxious mood, the focus would be on providing everything the brain needs to make serotonin, including several micronutrients like the B vitamins, along with 5HTP, the building block for serotonin. I usually combine that with high-quality magnesium, which I find very effective for improving sleep, mood and anxiety.
I think a two- to three-week trial of natural therapies is enough time to get a sense for whether they will work. If there is little to no improvement by then, I may recommend medication. I find that staying on the natural therapies often helps medications work better at the lowest possible dose, which is one of my goals for treatment.
Director of integrative medicine at Stamford Hospital and assistant professor of clinical medicine at Columbia University, Stamford, CT, and New York City
Headache is the most common neurological complaint in medicine, with 50 percent of the general population experiencing at least one headache per year. The Western approach to the different varieties of headache, such as migraine and tension headaches, includes medications for an acute attack, preventive medications, lidocaine injections into the muscle and Botox injections.
Though many patients find relief with these approaches, many patients will also explore alternative approaches to help with this chronic medical problem. Adding natural, evidence-based approaches like acupuncture to a treatment plan creates additional ways to help treat the patient, often allowing them to reduce or even eliminate medications and thereby avoid troublesome side effects.
Acupuncture, based on 5,000-year-old traditional Chinese medicine principles, is regularly used for both treatment and prevention of headaches. With acupuncture, sterile metal needles are inserted into specific acupuncture points in the head and arm, sometimes with an electrical stimulator attached to the needles to help stimulate the flow of “chi/life force” that may be blocked in the body’s energy channels, known as “meridians.” In a recent review of 22 studies that included almost 5,000 patients, acupuncture was shown to reduce the frequency of headaches by over 50 percent. Risks of acupuncture includes bleeding, infection, allergy to the needles and damage to underlying organs and tissues from incorrect needle insertion. Always have acupuncture performed by a medical acupuncturist (MD) or a licensed acupuncturist.
Kathryn A. Boling
Family medicine physician and primary care provider at Lutherville Personal Physicians, Lutherville, MD
I incorporate alternative medicine treatments because even though I’m an allopathic doctor, I don’t believe we have all the answers for everything. I’m not constrained by the belief that treatments outside traditional Western medicine can’t work for my patients. My goal is to give my patients as many options for health as I can, whether they want relief from pain or to get their mobility back.
For instance, I recommend acupuncture to some of my patients in part due to my own experience with it. In 2016, I was hit by an 18-wheeler in my car, and I was hurt pretty badly. I took pain medicine and went to physical therapy, which I also recommend for patients, but I still had a lot of discomfort. Acupuncture helped me a lot with my pain, which opened my eyes to the fact that even though I didn’t disagree with acupuncture, I didn’t necessarily refer my patients easily to it. Now if I have someone who’s trying everything Western medicine has to offer and isn’t getting relief, I’m happy to refer them to acupuncturists in the area.
I also suggest herbal supplements for some conditions. For joint pain, I’m happy to use glucosamine chondroitin sulfate, tart cherry and turmeric for its anti-inflammatory effects.
Medical director of psychosocial oncology, Memorial Care Todd Cancer Institute at Long Beach Medical Center, Long Beach, CA
There are many misconceptions that surround the term “alternative medicine.” The term is sometimes understood literally as treatments that are different from those that are verified by science as effective. This is particularly important in oncology, as some patients may seek alternative modalities and forgo potentially curative treatments or delay such treatments until the disease is very advanced.
We’ve made huge advances in cancer treatment, and now 68 percent of the 20 most common cancers are cured with what modern oncology has to offer. On the other hand, I have many patients that use complementary or integrative remedies, like acupuncture, yoga, massage, herbs and CBD oil, in tandem with conventional oncology treatments. These remedies may have beneficial effects on reducing side effects like nausea, pain or fatigue, boosting well-being and improving overall quality of life. It is important, however, to make sure that there are no undesirable interactions of these remedies with the medications taken. For example, St. John’s Wort is “natural,” but it may have many adverse interactions with commonly prescribed medications.
Also, some of the complementary interventions like cognitive behavior therapy are becoming more and more integrated in treatment, and are considered by many to be a standard of care in oncology.
Responses have been condensed and lightly edited.