Evidence schmevidence

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Why are Western doctors so resistant to complementary alternative medicine and supplementation? When you mention this, no matter how evidence-based, they look at you as if you just said, "Hey, let's get a naked, chanting shaman in here waving clucking chickens over your patient's head."

 Yes, I know those two don't go together … I'm just saying how they look at you.

I feel like saying, "Um, hello, are you aware that the Institute of Medicine of the National Academy of Sciences and the Bravewell Collaborative recently convened a summit on Integrative Medicine and the Health of the Public?”

And that the summit looked critically at the evolution of integrative medicine — which is a holistic approach to healthcare that uses the best of conventional and alternative therapies such as acupuncture, Reiki and advanced nutritional (nutraceutical) remedies.

The conclusion is that many of these therapies are scientifically proven to be medically and cost effective. Yes, scientifically documented and not in Witch Doctor's Weekly, either!

So why do we nurses need to be advocates for complementary and alternative medicine? Let's break it down “Nurse Jackie” style … (This means I'm about to get really “real” again.)

A report by the Commonwealth fund, “Quality of Health Care in the United States” looked at the state of healthcare in our nation and showed some pretty serious gaps, particularly in preventive care. Big deal, right? Uh-uh, because we wind up spending a lot of money (way too much) “after the fact.”

Did you know that in 2009, $2.5 trillion (or 16.5% of the U.S. Gross National Product) was spent on healthcare … and of that, 95 cents of every dollar was spent on treating a disease after it occurred? (Source: CMS data base)

And most of that money was spent on treating chronic diseases, such as heart disease and type II diabetes, which by the way are preventable and even reversible. Yup, I'm not making this stuff up. (It would be waaaay funnier if I were!)

Many healthcare practitioners don't tend to think of breakthroughs in medicine such as nutraceuticals. Some people have a hard time believing giving nutraceuticals can be as powerful as drugs. But they really can be and in many instances, they're even more powerful because they can prevent the problem in the first place

So why the resistance? Well, in reality, our "health-care" system is a “disease-reactive” system. Nurses are at an advantage here over doctors because we are trained on health and wellness while doctors are trained on sickness.

I've asked this question of wellness versus sickness to dozens of doctors. Almost all tell me they are generally trained under the presumption that when someone gets “sick,” they were well to begin with but most likely they aren't (young or old so this applies to you, too, kids)! 

Ask a doctor to take 100 patients' vitamin D levels and I can pretty much guarantee that 98 of them are way below therapeutic level and 1 of the 2 that is in range is someone who lies naked outside at noon every day for a half hour. Hey, their 25(OH)D level is great … they'll just get skin cancer!

OK, so maybe there are doctors out there who will agree that nutrition is important in prevention, but so many are suspicious about supplements. But "eating well" isn't necessarily going to get us where we need to be.

To be honest, gang, unless you are supplementing with good non-synthetic advanced nutritional supplements, you're not "well.” Even if you live at Whole Foods, you're not going to be nutritionally sound. It's a couple of weeks from harvest to shelf. Do you grow your own? Great, except that in this country we have depleted so many nutrients from our soils, and our ground soil is so exposed to pollutants, it's just not as nutritious as what our grandparents grew.

Do you microwave your food? Fabulous little invention, right? Except now all you have is empty calories because you've nuked out all nutritious content. So eating healthy isn't as easy as it sounds.

But “Dr. X” will say, “Show me the clinical trial.” Well, I can show you. For example, you can find major meta-analyses on coenzyme Q 10 (Co-Q 10) being beneficial to the heart, brain, kidneys and other tissues and show that it is low in persons with chronic diseases such as heart conditions, muscular dystrophies, Parkinson's disease, cancer, diabetes and with persons on statins (statins just suck out whatever Co-Q 10 you have left in your body) and that supplementation improves these conditions in various ways.

I can show you peer-reviewed journal evidence on the benefits of stabilized rice bran (SRB) on chronic diseases such as diabetes, high cholesterol, liver abnormalities, irritable bowel disease, inflammatory bowel disease, and cardiovascular disease. I can show you that SRB is one of the most potent and accessible sources of a complex mix of phytonutrients, beta-sitosterols and antioxidants and because of that, it has been shown to enhance the immune function.

We can look at studies on Methylsulfonylmethane (MSM), a natural Cox2 inhibitor that does not have the side effects of the synthetic ones and that are used clinically to treat pain in conditions such as osteoarthritis, scleroderma, fibromyalgia, lupus erythematosus, and stress injuries-repetitive type.

We can talk for hours about good liquid non-synthetic vitamins and minerals (no need for mega doses when it's pure sources) and their benefits. But, many of these studies are in journals such as the Journal of Alternative Medicine, the Journal of Medicinal Plants Research, American Journal of Nutrition, Journal of Nutritional Biochemistry, Journal of Herbal Pharmacotherapy, etc. 

I can show you all of this and it will still be met with major skepticism. I just don't get it. This isn't snake oil!

But there are studies in journals the average doctor would recognize, such as the International Journal of Immunopharmacology, Atherosclerosis, International Journal of Molecular Medicine, and the Journal Human Hypertension (and no chicken-wielding shamans!)

And just wait until you see the new research being conducted relating micronutrient deficiencies in nursing home patients with comorbid problems.  Your residents need selenium, copper, iron, zinc, iodine, phosphorus, magnesium, plus liquid protein amino acids, and just check out what the vitamin B supplementation does.

Oh, and Flintstones chewables DO NOT COUNT! But how many docs pooh-pooh multivitamin-multimineral supplementation? OK, so blind stubbornness upsets me.

But do you know how much we could help our residents by advocating for good evidence-based supplementation with nutraceuticals? Think about it: boosting the immune system; decreasing constipation; lowering LDL and triglycerids; lowering blood pressure; lowering risk of stroke; stabilizing blood sugar; enhancing cognition, energy and stamina; decreasing pain; improving function; all while getting rid of that nine-or-more meds problem while getting people healthy and saving precious Medicare dollars. I've seen this work.

OK, I'm climbing down off of my soapbox for now. But — and I know I sound like Joan Rivers here — can we talk? Seriously.

Just keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC — a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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