Category Archives: Integrative Medicine

Introduction

Lumbar spinal stenosis (LSS) is a disease that involves narrowing of the spinal cavity due to hyperplasia of the spine and adjacent tissues. LSS is primarily an acquired degenerative stenosis associated with diminished space in the lumbar spinal canal or neural foramen causing neural or vascular compression. It affects over 100 million patients.1,2 Degenerative LSS can cause neurogenic claudication and other neurological symptoms, with or without pain, in the lower back and lower extremities.3 The symptoms of LSS are posture-dependent, exacerbated by walking, and are relieved by rest.

Although the underlying mechanism of LSS remains unclear, the main symptoms affecting the lower extremities include neurogenic claudication, radiating pain, paresthesia, and hypotonia.4 This chronic degenerative illness is newly diagnosed in five out of 100,000 people each year, and its prevalence increases with age.5 The anatomical deterioration of LSS and the symptoms experienced by patients are often inconsistent.6,7 Although its clinical symptoms improve through conservative care, the difference in efficacy in terms of symptom improvement between surgical and non-surgical treatments is not evident.8 In addition, considering the economic utility of surgical intervention and the risk of adverse reactions, conservative care is recommended first for the treatment of LSS, and surgery is only conducted if pain persists or neurogenic claudication occurs after conservative care.9 Despite this, LSS remains one of the most common indications for spinal surgery.10

The major treatment goals of non-surgical care of LSS include pain improvement, increased walking distance, and alleviated LSS-specific symptoms, such as neurological symptoms. Rehabilitation, including physiotherapy and kinesiotherapy, is currently considered as the most effective intervention.11 Various other interventions often focus on pharmacotherapy, including massage, exercise, thermotherapy, and acupuncture.12 Although effective non-surgical conservative care is recommended for the clinical improvement of LSS, no particular treatment has been established as a superior intervention.

Pharmacopuncture is a traditional integrative intervention used in East Asian countries, including the Republic of Korea and China. Pharmacopuncture aims to maximize treatment effects by injecting pharmacopuncture solutions extracted, purified, diluted or mixed from herbal medicines at various acupuncture points, including Ah-shi points and cutaneous and muscle meridians using a solution injection syringe. The most representative pharmacopuncture solutions are bee-venom, placenta, and plant extract. In a previous study conducted among Korean medicine clinics, 98.6% of 33,145 inpatients and 77.6% of 373,755 outpatients received pharmacopuncture over a 4-year period, thus indicating that it is a commonly used medical procedure.13 It is recommended by the Korean Medicine Clinical Practice Guidelines for alleviating pain and promoting functional recovery in patients with lumbar herniated intervertebral discs.

Several clinical studies have reported on the active use of various pharmacopuncture treatments for medical ailments and paralytic diseases. Major diseases treated with pharmacopuncture include musculoskeletal pain disorders, such as neck pain, degenerative knee arthritis, and lumbar pain. According to a survey conducted with the aim of clinical practice guideline development, 94.3% of Korean medicine doctors reportedly use pharmacopuncture to manage LSS.14 Pharmacopuncture is a safe intervention that rarely produces adverse reactions, which are at most mildly severe and do not develop sequelae or require rescue interventions.15 Therefore, we plan to conduct a clinical study to compare the efficacy of pharmacopuncture and conventional non-surgical treatment for lumbar spinal pain.

This study is a multi-centered, pragmatic, randomized, controlled clinical trial involving seven hospitals (Jaseng Hospital of Korean Medicine, Daejeon Jaseng Hospital of Korean Medicine, Bucheon Jaseng Hospital of Korean Medicine, Haeundae Jaseng Hospital of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Kyung Hee University Korean Medicine Hospital, and Dongguk University Bundang Oriental Hospital) distributed across the Republic of Korea. Pragmaticity was determined prior to study initiation, according to the Pragmatic Explanatory Continuum Indicator Summary tool, version 2 (PRECIS-2).16 Eligibility and recruitment are explanatory, but settings, delivery of intervention, and adherence are more pragmatic. Ninety-eight patients with LSS who voluntarily consent to participate will be randomly assigned to the pharmacopuncture group or the conservative care group, in a 1:1 ratio.

This study is an investigator-initiated clinical trial and has been approved by the institutional review board of each site (JASENG 2021-12-019, JASENG 2021-12-008, JASENG 2021-12-003, JASENG 2021-12-017, KHNMCOH 2022-01-001, KOMCIRB 2021-12-002, DOBUH 2022-001) prior to patient enrollment. All study procedures will be carried out by the investigators according to the Declaration of Helsinki and the Korean Good Clinical Practice Guidelines. Version 2.0 of the study protocol has been registered and will be updated at Clinicaltrials.gov (NCT05242497) and the Clinical Research Information Service, the South Korean registration service for clinical trials (KCT0007145). The study protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines and checklist and partially follows the Consolidated Standards of Reporting Trials (CONSORT) extension for pragmatic clinical trials. While the assessor will be blinded to group allocation and patient information throughout the study period, researchers and patients will not be blinded.

Inclusion criteria comprise the following: 1) diagnosis of LSS (L1-S1) using radiology (computed tomography or magnetic resonance imaging) by radiologist, 2) neurogenic claudication, 3) symptoms (lumbar back pain or radiating pain) with severity of the dominant pain rated at 5 or more on the numeric rating scale (NRS), and 4) age 1969 years. Every participant will have to understand and agree to the study protocol. Written informed consent will be obtained; no alternative consent process will be allowed.

Patients with the following conditions or situations will be ineligible: vascular claudication; pathologies of non-spinal origin; soft tissue pathologies or other systemic illnesses that may cause lumbar back pain or radiating leg pain, such as spinal tumors and fractures; any other chronic comorbidity that may interfere with interpretation of the results, such as dementia or stroke; prescribed medicine that may interfere with interpretation of the results, such as corticosteroids, immunosuppressants, or psychotropic drugs; treatment in the past 7 days involving any medication that may influence pain, such as non-steroidal anti-inflammatory drugs (NSAIDs), pharmacopuncture, or physical therapy; pregnant or planning to become pregnant during the study period; spinal surgery within the past 3 months; previous participation in other clinical trials within 1 month of enrollment; plans to participate in other clinical trials during the study; inability to fill out the informed consent form; and being deemed unsuitable for participation as assessed by the researchers.

Eligible participants who have signed the informed consent form will be randomly assigned to the pharmacopuncture group or the conservative care group in a 1:1 ratio. A random sequence has been generated by an independent statistician prior to the first enrollment. Random sequence generation was based on permuted block randomization with a random number table, which was generated using R 4.1.1 software (the R Foundation for Statistical Computing, Vienna, Austria). Block sizes of 2, 4, and 6 were randomly selected. The generated random sequence has been sealed in an opaque envelope and stored in a double-locked locker. Only the statistician is aware of the full randomization sequence. The delegated research coordinator in each institution will open a randomization envelope for each patient and assign the patient to the appropriate group.

Both the pharmacopuncture and control interventions will be performed biweekly for 12 weeks to account for the chronic nature of LSS. The roles of the physician and the researcher are distinct. The researcher did not act as a physician and did not get involved in the treatment process. In the pharmacopuncture group, the Korean medicine doctor served as a physician, whereas in the conservative treatment group, the conservative medicine doctor served as a physician in order to provide the most effective treatment. The physicians will decide on the prescribed medication, treatment, and perform the procedure according to the medical strategy for each intervention group. The researchers will record treatment details on the electronic case report form in a timely manner. In the pharmacopuncture group, the physicians will decide on the details related to the depth, location, and the inserted pharmacopuncture content according to their medical decisions. In the conservative care group, the physicians will decide on the details of conservative care, including physiotherapy, and will prescribe medications according to their medical decisions. Any medications or physiotherapy procedures that relieve symptoms in the lower back and lower extremities, or that improve LSS, will be recorded in the electronic case report form in a timely manner. Follow-up surveys and assessments will be performed at weeks 25 and 53, respectively.

Patients will be allowed to receive rescue medicine (including analgesics) for reasonable conditions, based on medical decisions by the physicians. The adherence rate will be calculated after excluding those who meet the dropout criteria. We set our benchmark rate at 70% to encourage participation; however, patients who fail to meet an adherence rate of 70% will not be excluded from the study. Specific details on the use of rescue medicine and the adherence rate of each patient will be recorded in an electronic case report form in a timely fashion.

Patients will be excluded from the study due to the following: (1) a significant disease develops during the study period that may interfere with the interpretation of the results; (2) request for discontinuation or withdrawal of consent; (3) pregnancy occurs during the study period; (4) performance status is too poor to allow administration of an intervention; and (5) any other reason for which discontinuation is deemed to be better for the patient based on medical decisions.

Both the NRS and visual analog scale (VAS) will be used to assess the severity of lower back pain and radiating pain in the lower extremities. The NRS is a pain scale on which the patients express their subjective perception of pain as a whole number from 0 to 10, where 0 denotes no pain or discomfort and 10 indicates the most severe pain and discomfort imaginable. The VAS score, in terms of lower back pain and radiating leg pain, will be reported. In the VAS, the patient indicates the pain severity on a line, ranging from a minimum of 0 mm to a maximum of 100 mm, where a higher score suggests worse severity.

The claudication-free walking distance and maximal walking distance will be assessed to evaluate functional impairment. The Zurich Claudication Questionnaire (ZCQ), an LSS-specific questionnaire, will also be used to evaluate patient-centered improvements. The ZCQ is a patient-reported outcome measure that evaluates disease severity, function, and satisfaction with treatment in patients with LSS. The ZCQ was translated into Korean and validated in 2018.17 The Oswestry Disability Index is a validated, functional disability questionnaire for assessing lower back pain.18 The possible range of each item score is 0 to 5. The total score range is 0 (a better outcome) to 100 (a worse outcome). Short-Form 12 for Health-Related Quality of Life (SF-12 v2) consists of 12 questions across 8 domains, with higher scores indicating better health-related quality of life.19 Cost analysis will be performed using a structured questionnaire covering the following areas: official/unofficial medical costs, non-medical expenses, and time and productivity loss.

The Patient Global Impression of Change will be used to assess a patients impression of their improvements. Patients will rate improvement after treatment on a 7-point Likert scale, ranging from very much improved to very much worse. The EuroQoL 5 Dimensions 5 Levels will be used to assess effects on patients quality of life. The questionnaire consists of questions in five areas (mobility, self-care, usual activities, pain, and anxiety/depression) that ask about the patients current state of health. Answers are provided on a 5-point Likert scale.

Any adverse events will be recorded using the Medical Dictionary for Regulatory Activities. Causality will be evaluated using the World Health OrganizationUppsala Monitoring Center causality assessment system. Treatment-related adverse events will be recorded independently. The severity of adverse events will be assessed using the Spilker method.

Patients will be recruited nationwide through social media and flyers that will be handed out locally. Broadcast notifications will also be posted on hospital boards and electronic posts on the online webpage. Recruitment began in May 2022.

The researchers designed a data dictionary according to the protocol prior to establishing the database for the study. Data will be recorded in a web-based electronic database (MyTrials, Bethesda software, Seoul, Republic of Korea). The authorized clinical research coordinator will record data, and the data safety monitoring committee will be able to access the database to monitor, audit, and lock or release data. Automatic queries are generated in a timely manner in response to recorded data according to predefined algorithms. Initial and interim meetings will be held periodically to monitor integrity and consistency, to coordinate data collection and address concerns, and to determine whether the study should be continued or halted. Independent data monitoring will occur at a minimum of three timepoints: prior to enrollment of the first patient, after a third of the planned dataset is collected, and after every piece of data is recorded and determined to be locked. Although the interim monitoring interval is planned to occur bimonthly, it can be changed according to the risk of each study site.

The total planned sample size is 98 patients. This sample size was determined to provide 80% power, assuming a significance rate of 0.05, an optimal difference between the two groups of 1.75, with a mean standard deviation of 2.75.20,21 Based on this equation, there were 38.8 participants in each group, and the sample size was calculated to be 98 people, since the study was done in seven hospitals and 20% of the participants dropped out.

The primary analysis will be intention-to-treat analysis. A per-protocol analysis will also be performed for patients who adhere to more than 70% of the intended treatment schedule. Missing values will be analyzed with a mixed model for repeated measures. Sensitivity analysis will be carried out based on multiple imputations and the last-observation-carried-forward method. For survival analysis, patients who dropped out during the treatment period will be right-censored, and if intermittent censoring occurs, the event will not occur within the intermittent censored period. Sociodemographic characteristics and treatment expectancy will be described per group using descriptive statistics. Each continuous variable will be presented as a mean and standard deviation, or a median and interquartile range. The differences between the two groups will be assessed using Students t-test or Wilcoxons rank-sum test, according to their distribution. Categorical variables will be presented as the frequency and percentile (%) and will be assessed using the chi-square test or Fishers exact test.

The primary outcome will be the change in the severity of the dominant lower back pain and radiating pain in the lower extremities at the end of treatment. This severity will be compared with that at baseline. A linear mixed model will be used, mainly the random intercept model. The random effects of the patients will be included in the random intercept model, and the baseline outcomes and covariant factors will be addressed using covariates as fixed effects. Changes over time between groups will be analyzed using this method by including time, group, and the interaction in the model. Sensitivity analysis will be assessed through analysis of covariance (ANCOVA), considering the group as a fixed factor.

The area under the curve (AUC) will also be analyzed to determine cumulative effectiveness. The AUC will be cumulatively evaluated using ANCOVA with multiple imputations. The minimal clinically important difference (MCID) achieved will be determined according to the NRS score for severity of lower back pain. MCID achievement will be estimated using KaplanMeier survival analysis, and statistical significance will be assessed using the log rank test. Hazard ratios will be assessed using Cox proportional hazard ratio models.

All analyses will be performed using SAS v.9.4 (SAS Institute, Inc., Cary, NC, USA) or R v.4.1.1 (the R Foundation for Statistical Computing, Vienna, Austria). Differences will be considered statistically significant at a p-value < 0.05.

If we fail to achieve a statistical difference of superiority regarding the hypothesis of intervention, non-inferiority analysis will be conducted as an alternative. A pre-specified, non-inferiority margin will be set at 50% of the MCID for lower back pain (0.9). If the difference in the change in pain severity between the two groups does not exceed the lower limit of the 95% confidence interval, pharmacopuncture will be considered non-inferior to conventional care, including physiotherapy and medication.

Although surgery is considered the gold standard for LSS patients, non-surgical interventions are recommended as the first line of treatment.22 Surgical intervention, including laminectomy for patients with symptomatic and progressive LSS, spinal instability, and other conditions can lead to re-operation within the first year.23 Since LSS is a degenerative disorder and aging patients tend to have more comorbidities, the risk of major complications associated with surgery is also considerable.24 Known major complications within a month after surgery include a 0.4% mortality rate, which increases with age. The rate of adverse events, including perioperative and post-operative complications, is 10%24%.25,26

Non-surgical interventions are non-inferior to surgical interventions, are patient-centered, and lead to fewer complications. The Spine Patient Outcome Research Trial (SPORT) has compared surgical and non-surgical interventions pragmatically, and sheds light on their effectiveness and cost-effectiveness based on real-world data.27,28 The SPORT did not identify specific non-surgical interventions, but rather non-operative interventions as per usual recommended care, including physiotherapy, education, and instructions regarding home exercise and use of NSAIDs.

Conservative treatment methods for LSS are not yet standardized.22 Several options have been suggested, including pharmacotherapy (both oral medication and injection) and physiotherapy. The Finnish lumbar spinal research group used non-operative interventions, including assessment for individual treatment, prescribed analgesics, individualized physiotherapy, and active back exercises. It also provided education with a paper brochure that included the principles of activation and physical training, maintaining pain-relieving body postures, and basic ergonomics.29,30 Another study described conservative treatment as involving an orthosis and a rehabilitation department program that included daily physiotherapy; however, regular physiotherapy was not provided.31

Comprehensive conservative care for LSS typically includes physiotherapy and analgesics.20,22,27 Specific methods are yet to be identified, but physiotherapy includes physical exercises and manual therapy.32 Pharmacotherapy is recommended only to a limited extent. Acetaminophen and NSAIDs are effective, but neither are significantly more effective than the other.7 Analgesics, including opioids and muscle relaxants, are not more effective than acetaminophen or NSAIDs.33 Prostaglandins, pregabalin, and other medications have shown positive outcomes, with or without statistical significance, but none have been predominantly recommended.3437 Since no specific intervention is currently recommended as the first-line treatment, conservative approaches should be multi-modal and patient-centered on an individual basis, and specific decisions should be made by physicians.

Pharmacopuncture is officially accepted and practiced in South Korea and is commonly used in patients with LSS.10,11 Pharmacopuncture for stenosis tends to be combined with acupuncture and Chuna manual therapy. In one study, when integrated Korean medical treatment was administered to patients with LSS, 93.6% of patients admitted to the clinic received pharmacopuncture and 14.0% received bee venom acupuncture,38 illustrating the active practice of pharmacopuncture for stenosis. Another retrospective chart review with a follow-up survey also reported the efficacy of multimodal Korean medicine therapy, including Hwangryunhaedoktang pharmacopuncture in patients with LSS.39 However, specific forms of pharmacopuncture cannot be prioritized for patients with LSS, since the effect of acupuncture cannot be understood solely based on the ingredients of the subcutaneously injected drug. Pharmacopuncture is a far-reaching treatment when considering the local effect of acupuncture; the distant effect of stimulating acupoints and the composition of herbal medicine are comprehensively understood.

Thus, to collect real-world data for investigating optimal non-surgical interventions for stenosis, we have designed this clinical study to compare the effectiveness of pharmacopuncture with optimal conservative care, including physiotherapy and pharmacotherapy (the control group), as determined by physicians. Due to the pragmatic nature of the research design, it may not be sufficient to validate the experimental efficacy of the pharmacopuncture. However, in clinical settings, the efficacy identified in a fully controlled experimental design does not always appear. By structuring the study to resemble a clinical setting, we were able to compare the effectiveness of the use of pharmacopuncture with that of conservative treatment approaches and demonstrate the effectiveness in real world. In assessing the domains of the PRECIS-2, our clinical study will adopt an approach that allows pragmaticity for delivery, while taking a somewhat conservative explanatory approach to collection, to evaluate the overall effectiveness in a real-world setting. We will allow for combinatory interventions with a pragmatic perspective and will analyze the therapeutic interventions and strategies used for stenosis in the actual clinical environment with immediacy.

However, our study is limited by the fact that neither the physician nor the patient could be blinded. To compensate for these limitations, however, we employed a blinded assessor when evaluating the outcome.

Our study outcomes reflect the treatment goals for patients with stenosis, which include alleviating symptom intensity, decreasing claudication, increasing walking distance, temporarily delaying the onset of neurological defects, reducing the need for surgery, and ensuring post-operative treatment satisfaction. The primary outcome is the change in the severity of the dominant pain, between lower back pain or pain in the lower extremities. The blinded assessor evaluated walking distance and physical examination as outcomes. Patient-reported outcomes include the ZCQ, SF-12 v2, and other questionnaire scores.

This pragmatic, randomized, controlled, parallel-group clinical study will compare the effectiveness of pharmacopuncture to that of conservative care, including physiotherapy and pharmacotherapy. The study results will inform treatment planning and the selection of appropriate non-surgical treatment for individual patients with LSS.

ANCOVA, analysis of covariance; AUC, area under the curve; CONSORT, Consolidated Standards of Reporting Trials; LSS, lumbar spinal stenosis; MCID, minimal clinically important difference; NRS, numeric rating scale; NSAIDs, non-steroidal anti-inflammatory drugs; PRECIS-2, Pragmatic Explanatory Continuum Indicator Summary tool, version 2; SPIRIT, Standard Protocol Items: Recommendations for Interventional Trials; SF-12 v2, Short-Form 12 for Health-Related Quality of Life; SPORT, Spine Patient Outcome Research Trial; VAS, visual analog scale; ZCQ, Zurich Claudication Questionnaire.

Availability of data and materials: The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

This study was approved by the institutional review board of each site (JASENG 2021-12-019, JASENG 2021-12-008, JASENG 2021-12-003, JASENG 2021-12-017, KHNMCOH 2022-01-001, KOMCIRB 2021-12-002, DOBUH 2022-001) prior to patient enrollment. All patients will provide written informed consent.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HF21C0099).

The authors report no conflicts of interest in this work.

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The effectiveness of pharmacopuncture in patients with LSS | JPR - Dove Medical Press

Based on a systematic review of 17 medical studies, a recently published paper has raised questions and sparked debate about the chemical imbalance theory of depression. Although the study did not perform additional research, after synthesizing and evaluating evidence in the principal relevant areas, the authors conclude the longstanding theory is unproven.

Serotonin is a monoamine neurotransmitter, a chemical that regulates mood, sleep, appetite, and sexual desire. The chemical imbalancetheory suggests that depression is caused by lowered serotonin levels in the brain.

The paper, published July 20 in the journal Molecular Psychiatryby a multi-national team of researchers, is entitled The serotonin theory of depression: a systematic umbrella review of the evidence. The paper questions the chemical imbalance theory that began in the 1960s, based on the premise that reduced serotonin activity causes depression. This hypothesis was derived from the fact that the first two specifically antidepressant drugs, discovered in the 1950s, were both shown to increase brain levels of serotonin. Therefore, early experiments assumed a causal relationship between serotonin and depression.

Subsequently, a variety of antidepressants often referred to as happy pills were developed, promoted around, and reinforced this theory.

Although many professionals and the public still accept the serotonin theory of depression, the authors of the paper said they found no conclusive evidence that depression is associated with, or caused by, reduced serotonin concentration or activity in the brain. The study also calls into question whether raising serotonin levels via antidepressants is a reliable treatment for depression.

Although clinical experts have determined that antidepressants help in the treatment of severe depression, their mechanism is not entirely understood.

Expert reaction to the study was immediate and vigorous. The day the paper was published, BritainsScience Media Centre published a round-up of various experts and their responses.

Among them was Michael Bloomfield, Ph.D., psychiatrist and researcher at University College, London. While Bloomfield said that the hypothesis that depression was caused by a chemical imbalance in serotonin was a really important step forward in the middle of the 20thcentury, he called the review unsurprising. He noted, I dont think Ive met any serious scientists or psychiatrists who think that all causes of depression are caused by a simple chemical imbalance in serotonin.

Phil Cowen, a professor of psychopharmacology at Oxford University, has studied the effects of serotonin on depressed patients for 30 years. He believes no mental health professional today would support the view that a complex disorder like depression stems from a deficiency in a single neurotransmitter.

Professor Gitte Moos Knudsen, head of the Department of Neurology and Neurobiology Research Unit at Denmarks University Hospital of Copenhagen, said the study is based on a misconception, namely that depression is a single disease with a single biochemical deficit. Today, Knudsen notes, it is largely accepted that depression is a heterogeneous disorder with potentially multiple underlying causes.

Although the July 20 paper did not focus on the pros and cons of using antidepressants, their mechanism of action in treating depression has become the focus of discussion. This is because most of the antidepressants used today have roots in the questionable chemical imbalance theory.

In response to the study, Frederick Sundram, deputy head of psychological medicine at the University of Auckland, New Zealand, wrotethat the mechanism of action for antidepressants is not yet fully understood. He believes there may be other mechanisms at work, such as neuroplasticity. In addition, he wrote, 30 to 40 percent of the efficacy of antidepressants is due to a placebo effect.

Sundram claimed the brain chemical imbalance theory takes a simplified approach to a very complex human condition, an approach that is not shared by most psychiatrists. For example, he said, if someone has a history of personal trauma and lives under the constant stress of social isolation, unemployment, economic problems, leading to depression, antidepressants are unlikely to solve the problem.

In March, the World Health Organization (WHO) published a report that mirrors Sundrams view. The report noted that the global prevalence of anxiety and depression rose 25 percent in 2020, during the COVID-19 pandemic. The WHO said that peoples anxiety and depression were exacerbated by feelings of isolation under lockdowns, financial worries, and fear of illness or death for themselves and their loved ones. All of these are issues for which an antidepressant alone may be insufficient.

The Royal College of Psychiatrists, a British mental health authority, responded to the study by citing its position paper on antidepressants (pdf), which states that although the idea of using antidepressants to correct a chemical imbalance in the brain is too simplistic, they do have early physiological and psychological effects.

The Royal College suggests that antidepressants treat the symptoms of depression but do not directly address any underlying psychosocial causes, so medication is often combined with psychotherapy that can improve the patients ability to cope with difficult life situations.

Dr. Jing-Duan Yang is a psychiatrist and founder of the Yang Institute of Integrative Medicine. In a video presentation on Aug. 20, Yang explained why the chemical imbalance theory has become so prevalent. Yang said that once a theory developed by science becomes tied to a product, its promotion and subsequent researchers tend to exaggerate or embellish the original scientific evidence.

Drawing from his 20 years of clinical experience, Dr. Jing-Duan Yang believes antidepressants do work for some patients. However, it remains to be seen if [they work] in the way that was originally hypothesized, he said.

Dr. Yang believes antidepressant drugs have helped to reduce inflammation in the brain, and some studies suggest depression is related to the inflammatory response in the brain. Therefore these drugs may improve serotonin function but by some other mechanism.

Yang said although antidepressants are clinically proven and effective for many people, most have a variety of side effects, so patients should be cautious when using them.

Yang gave the example of a patient he treated for nearly twenty years. The patient used the common drug Cymbalta for about ten years to improve her serotonin and norepinephrine function against anxiety and depression. The patient reported side effects such as weight gain and increased blood pressure.

After switching the patient to Lexapro, a drug that simply improves serotonin function, her anxiety and depression improved once again. But it wasnt long before she started gaining weight again. She began having other disturbing side effects such as decreased libido, blurred vision, and a feeling that ants and bugs were crawling over her body.

Yang said the most serious concern about this and other common antidepressants is their black box warning, which warns that teens and young adults are prone to more suicidal thoughts and tendencies in the first few weeks of taking the drug. In addition, for some people, anti-depressants increase symptoms of depression.

Dr. Dong Shidao, a traditional Chinese medicine (TCM) doctor living in New Zealand, told The Epoch Times that TCM believes depression is strongly linked to the liver and its response to human emotions.

Chinese medicine believes the liver plays a key role in controlling the flow of qiusually translated as vital energy through the body. When the liver is free of emotional turmoil, qi flows smoothly, and depression is avoided. Depression occurs when negative emotions disrupt the livers functioning, and the flow of qi becomes stagnant or blocked.

Dong believes people become prone to liver qi stagnation when they allow worries and anxiety to remain unchecked. Instead of learning to care for themselves by developing support systems and good relationships, people today spend too much time on their cell phones and computers, says Dong. They dont know how to calm their worries in a healthy way, in order to avoid liver-related depression.

Dong believes the stress of modern society only makes depression worse. To make his point, he uses a famous Chinese saying: If the righteousness exists within, the evil will not enter. He predicts that the more society devolves, the more vulnerable people will be to depression.

Chinese medicine also has medication to treat liver qi stagnation, said Dong. But medication and acupuncture focus on unblocking and adjusting the whole body. TCM frequently uses a botanical formulation called Xiao Chi Hu Tang. The seven-herb formula was developed 1,800 years ago in China by Dr. Zhang Zhongjing and is still relied upon today to treat liver and gastrointestinal disorders.

Read more:
Study Reignites Debate on the Chemical Imbalance Theory of Depression - The Epoch Times

Sharon calls herself a universal reactor. In the 1990s, she became allergic to the world, to the mould colonising her home and the paint coating her kitchen walls, but also deodorants, soaps and anything containing plastic. Public spaces rife with artificial fragrances were unbearable. Scented disinfectants and air fresheners in hospitals made visiting doctors torture. The pervasiveness of perfumes and colognes barred her from in-person social gatherings. Even stepping into her own back garden was complicated by the whiff of pesticides and her neighbours laundry detergent sailing through the air. When modern medicine failed to identify the cause of Sharons illness, exiting society felt like her only solution. She started asking her husband to strip and shower every time he came home. Grandchildren greeted her through a window. When we met for the first time, Sharon had been housebound for more than six years.

When I started medical school, the formaldehyde-based solutions used to embalm the cadavers in the human anatomy labs would cause my nose to burn and my eyes to well up representing the mild, mundane end of a chemical sensitivity spectrum. The other extreme of the spectrum is an environmental intolerance of unknown cause (referred to as idiopathic by doctors) or, as it is commonly known, multiple chemical sensitivity (MCS). An official definition of MCS does not exist because the condition is not recognised as a distinct medical entity by the World Health Organization or the American Medical Association, although it has been recognised as a disability in countries such as Germany and Canada.

Disagreement over the validity of the disease is partially due to the lack of a distinct set of signs and symptoms, or an accepted cause. When Sharon reacts, she experiences symptoms from seemingly every organ system, from brain fog to chest pain, diarrhoea, muscle aches, depression and odd rashes. There are many different triggers for MCS, sometimes extending beyond chemicals to food and even electromagnetic fields. Consistent physical findings and reproducible lab results have not been found and, as a result, people such as Sharon not only endure severe, chronic illness but also scrutiny over whether their condition is real.

The first reported case of MCS was published in the Journal of Laboratory and Clinical Medicine in 1952 by the American allergist Theron Randolph. Although he claimed to have previously encountered 40 cases, Randolph chose to focus on the story of one woman, 41-year-old Nora Barnes. She had arrived at Randolphs office at Northwestern University in Illinois with a diverse and bizarre array of symptoms. A former cosmetics salesperson, she represented an extreme case. She was always tired, her arms and legs were swollen, and headaches and intermittent blackouts ruined her ability to work. A doctor had previously diagnosed her with hypochondria, but Barnes was desperate for a real diagnosis.

Randolph noted that the drive into Chicago from Michigan had worsened her symptoms, which spontaneously resolved when she checked into her room on the 23rd floor of a hotel where, Randolph reasoned, she was far away from the noxious motor exhaust filling the streets. In fact, in his report Randolph listed 30 substances that Barnes reacted to when touched (nylon, nail polish), ingested (aspirin, food dye), inhaled (perfume, the burning of pine in fireplace) and injected (the synthetic opiate meperidine, and Benadryl).

He posited that Barnes and his 40 other patients were sensitive to petroleum products in ways that defied the classic clinical picture of allergies. That is, rather than an adverse immune response, such as hives or a rash where the body is reacting to a particular antigen, patients with chemical sensitivities were displaying an intolerance. Randolph theorised that, just as people who are lactose-intolerant experience abdominal pain, diarrhoea and gas because of undigested lactose creating excess fluid in their gastrointestinal tract, his patients were vulnerable to toxicity at relatively low concentrations of certain chemicals that they were unable to metabolise. He even suggested that chemical sensitivity research was being suppressed by the ubiquitous distribution of petroleum and wood products. MCS, he believed, was not only a matter of scientific exploration, but also of deep-seated corporate interest. Randolph concludes his report with his recommended treatment: avoidance of exposure.

In that one-page abstract, Randolph cut the ribbon on the completely novel but quickly controversial field of environmental medicine. Nowadays, we hardly question the ties between the environment and wellbeing. The danger of secondhand smoke, the realities of climate change and the endemic nature of respiratory maladies such as asthma are common knowledge. The issue was that Randolphs patients lacked abnormal test results (specifically, diagnostic levels of immunoglobulin E, a blood marker that is elevated during an immune response). Whatever afflicted them were not conventional allergies, so conventional allergists resisted Randolphs hypotheses.

Randolph was in the dark. Why was MCS only now rearing its head? He also asked another, more radical question: why did this seem to be a distinctly American phenomenon? After all, the only other mention of chemical sensitivities in medical literature was in the US neurologist George Miller Beards 1880 textbook A Practical Treatise on Nervous Exhaustion (Neurasthenia). Beard argued that sensitivity to foods containing alcohol or caffeine was associated with neurasthenia, a now-defunct term used to describe the exhaustion of the nervous system propagated by the USs frenetic culture of productivity. Like Beard, Randolph saw chemical sensitivities as a disease of modernity, and conceived the origin as wear-and-tear as opposed to overload.

Randolph proposed that Americans, propelled by the post-second world war boom, had encountered synthetic chemicals more and more in their workplaces and homes, at concentrations considered acceptable for most people. Chronic exposure to these subtoxic dosages, in conjunction with genetic predispositions, strained the body and made patients vulnerable. On the back of this theory, Randolph developed a new branch of medicine and, with colleagues, founded the Society for Clinical Ecology, now known as the American Academy of Environmental Medicine.

As his professional reputation teetered, his popularity soared and patients flocked to his care. Despite this growth in interest, researchers never identified blood markers in MCS patients, and trials found that people with MCS couldnt differentiate between triggers and placebos. By 2001, a review in the Journal of Internal Medicine found MCS virtually nonexistent outside western industrialised countries, despite the globalisation of chemical use, suggesting that the phenomenon was culturally bound.

MCS subsequently became a diagnosis of exclusion, a leftover label used after every other possibility was eliminated. The empirical uncertainty came to a head in 2021, when Quebecs public health agency, the INSPQ, published an 840-page report that reviewed more than 4,000 articles in the scientific literature, concluding that MCS is an anxiety disorder. In medicine, psychiatric disorders are not intrinsically inferior; serious mental illness is, after all, the product of neurological dysfunction. But the MCS patients I spoke to found the language offensive and irresponsible. Reducing what they felt in their eyes, throats, lungs and guts to anxiety was not acceptable at all.

As a woman I will call Judy told me: I would tell doctors my symptoms, and then theyd run a complete blood count and tell me I looked fine, that it must be stress, so theyd shove a prescription for an antidepressant in my face and tell me to come back in a year. In fact, because MCS is so stigmatising, such patients may never receive the level of specialised care they need. In the wake of her treatment, Judy was frequently bedbound from crushing fatigue, and no one took her MCS seriously. I think a lot of doctors fail to understand that we are intelligent, she said. A lot of us with chemical sensitivities spend a good amount of our time researching and reading scientific articles and papers. I probably spent more of my free time reading papers than most doctors.

Judy grew up in Texas, where she developed irritable bowel syndrome and was told by doctors that she was stressed. Her 20s were spent in Washington state where she worked as a consultant before a major health crash left her bedbound for years (again, the doctors said she was stressed). Later, after moving to Massachusetts, a new paint job at her home gave her fatigue and diarrhoea. She used to browse the local art museum every Saturday, but even fumes from the paintings irritated her symptoms. She visited every primary care doctor in her city, as well as gastroenterologists, cardiologists, neurologists, endocrinologists and even geneticists. Most of them reacted the same way: with a furrowed brow and an antidepressant prescription in hand. Not one allopathic doctor has ever been able to help me, Judy said.

Morton Teich is one of the few physicians who diagnoses and treats patients with MCS in New York. The entrance to his integrative medicine private practice is hidden away behind a side door in a grey-brick building on Park Avenue. As I entered the waiting room, the first thing to catch my eye was the monstrous mountain of folders and binders precariously hugging a wall, in lieu of an electronic medical record. I half-expected Teichs clinic to resemble the environmental isolation unit used by Randolph in the 1950s, with an airlocked entrance, blocked ventilation shafts and stainless-steel air-filtration devices, books and newspapers in sealed boxes, aluminium walls to prevent electromagnetic pollution, and water in glass bottles instead of a cooler. But there were none of the above. The clinic was like any other family medicine practice I had seen before; it was just very old. The physical examination rooms had brown linoleum floors and green metal chairs and tables. And there were no windows.

Although several of Teichs patients were chemically sensitive, MCS was rarely the central focus of visits. When he introduced me, as a student writing about MCS, to his first patient of the day, a petrol-intolerant woman whose appointment was over the phone because she was housebound, she admitted to never having heard of the condition. You have to remember, Teich told me, that MCS is a symptom. Its just one aspect of my patients problems. My goal is to get a good history and find the underlying cause. Later, when I asked him whether he had observed any patterns suggesting an organic cause of MCS, he responded: Mould. Almost always.

Many people with MCS I encountered online also cited mould as a probable cause. Sharon told me about her first episode in 1998, when she experienced chest pain after discovering black mould festering in her familys trailer home. A cardiac examination had produced no remarkable results, and Sharons primary care physician declared that she was having a panic attack related to the stress of a recent miscarriage. Sharon recognised that this contributed to her sudden health decline, but also found that her symptoms resolved only once she began sleeping away from home.

She found recognition in medical books such as Toxic (2016) by Neil Nathan, a retired family physician who argued that bodily sensitivities were the product of a hyper-reactive nervous system and a vigilant immune system that fired up in reaction to toxicities, much as Randolph had said. The conditions that Nathan describes are not supported by academic medicine as causes of MCS: mould toxicity and chronic Lyme disease are subject to the same critique.

Sharon went to see William Rea, a former surgeon (and Teichs best friend). Rea diagnosed her with MCS secondary to mould toxicity. Mould is everywhere, Teich told me. Not just indoors. Mould grows on leaves. Thats why people without seasonal allergies can become chemically sensitive during autumn. When trees shed their leaves, he told me, mould spores fly into the air. He suspected that American mould is not American at all, but an invasive species that rode wind currents over the Pacific from China. He mentioned in passing that his wife recently died from ovarian cancer. Her disease, he speculated, also had its roots in mould.

In fact, Teich commonly treats patients with nystatin, an antifungal medication used to treat candida yeast infections, which often infect the mouth, skin and vagina. I have an 80% success rate, he told me. I was dubious that such a cheap and commonplace drug was able to cure an illness as debilitating as MCS, but I could not sneer at his track record. Every patient I met while shadowing Teich was comfortably in recovery, with smiles and jokes, miles apart from the people I met in online support groups who seemed to be permanently in the throes of their illness.

However, Teich was not practising medicine as I was taught it. This was a man who believed that the recombinant MMR vaccine could trigger acute autism traditionally an anti-science point of view. When one of his patients, a charismatic bookworm Ill call Mark, arrived at an appointment with severe, purple swelling up to his knees and a clear case of stasis dermatitis (irritation of the skin caused by varicose veins), Teich reflexively blamed mould and wrote a prescription for nystatin instead of urging Mark to see a cardiologist. When I asked how a fungal infection in Marks toes could cause such a bad rash on his legs, he responded: We have candida everywhere, and its toxins are released into the blood and travel to every part of the body. The thing is, most people dont notice until its too late.

Moulds and fungi are easy scapegoats for inexplicable illnesses because they are so ubiquitous in our indoor and outdoor environments. A great deal of concern over mould toxicity (or, to use the technical term, mycotoxicosis) stems from the concept of sick-building syndrome, in which visible black mould is thought to increase sensitivity and make people ill. This was true of Mark, who could point to the demolition of an old building across the street from his apartment as a source of mould in the atmosphere. Yet in mainstream medicine, diseases caused by moulds are restricted to allergies, hypersensitivity pneumonitis (an immunologic reaction to an inhaled agent, usually organic, within the lungs) and infection. Disseminated fungal infections occur almost exclusively in patients who are immunocompromised, hospitalised or have an invasive foreign body such as a catheter. Furthermore, if clinical ecologists such as Teich are correct that moulds such as candida can damage multiple organs, then it must be spreading through the bloodstream. But I have yet to encounter a patient with MCS who reported fever or other symptoms of sepsis (the traumatic, whole-body reaction to infection) as part of their experience.

Teich himself did not use blood cultures to verify his claims of systemic candidiasis, and instead looked to chronic fungal infection of the nails, common in the general population, as sufficient proof.

I dont need tests or blood work, he told me. I rarely ever order them. I can see with my eyes that he has mould, and thats enough. It was Teichs common practice to ask his patients to remove their socks to reveal the inevitable ridges and splits on their big toenails, and thats all he needed.

Through Teich, I met a couple who were both chemically sensitive but otherwise just regular people. The wife, an upper-middle-class white woman I will call Cindy, had a long history of allergies and irritable bowel syndrome. She became ill whenever she smelled fumes or fragrances, especially laundry detergent and citrus or floral scents. Teich put both her and her husband on nystatin, and their sensitivities lessened dramatically.

What struck me as different about her case, compared with other patients with MCS, was that Cindy was also on a course of antidepressants and cognitive behavioural therapy, the standard treatment for anxiety and depression. It really helps to cope with all the stress that my illness causes. You learn to live despite everything, she said.

In contemporary academic medicine, stress and anxiety cause MCS, but MCS can itself cause psychiatric symptoms. Teich later told me, unexpectedly, that he had no illusions about whether MCS is a partly psychiatric illness: Stress affects the adrenals, and that makes MCS worse. The mind and the body are not separate. We have to treat the whole person.

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To understand this case, I also spoke to Donald Black, associate chief of staff for mental health at the Iowa City Veterans Administration Health Care. He co-authored a recent article on idiopathic environmental intolerance that took a uniform stance on MCS as a psychosomatic disorder. In 1988, when Black was a new faculty member at the University of Iowa, he interviewed a patient entering a drug trial for obsessive-compulsive disorder. He asked the woman to list her medications, and watched as she started unloading strange supplements and a book about environmental illness from her bag.

The woman had been seeing a psychiatrist in Iowa City a colleague of Blacks who had diagnosed her with systemic candidiasis. Black was flummoxed. If that diagnosis was true, then the woman would be very ill, not sitting calmly before him. Besides, it was not up to a psychiatrist to treat a fungal infection. How did he make the diagnosis? Did he do a physical or run blood tests? No, the patient told him, the psychiatrist just said that her symptoms were compatible with candidiasis. These symptoms included chemical sensitivities. After advising the patient to discard her supplements and find a new psychiatrist, Black made some phone calls and discovered that, indeed, his colleague had fallen in with the clinical ecologists.

Black was intrigued by this amorphous condition that had garnered an endless number of names: environmentally induced illness, toxicant-induced loss of tolerance, chemical hypersensitivity disease, immune dysregulation syndrome, cerebral allergy, 20th-century disease, and mould toxicity. In 1990, he solicited the aid of a medical student to find 26 subjects who had been diagnosed by clinical ecologists with chemical sensitivities and to conduct an emotional profile. Every participant in their study filled out a battery of questions that determined whether they satisfied any of the criteria for psychiatric disorders. Compared with the controls, the chemically sensitive subjects had 6.3 times higher lifetime prevalence of major depression, and 6.8 times higher lifetime prevalence of panic disorder or agoraphobia; 17% of the cases met the criteria for somatisation disorder (an extreme focus on physical symptoms such as pain or fatigue that causes major emotional distress and problems functioning).

In my own review of the literature, it was clear that the most compelling evidence for MCS came from case studies of large-scale initiating events such as the Gulf war (where soldiers were uniquely exposed to pesticides and pyridostigmine bromide pills to protect against nerve agents) or the terrorist attacks on the US of 11 September 2001 (when toxins from the falling towers caused cancers and respiratory ailments for years). In both instances, a significant number of victims developed chemical intolerances compared with populations who were not exposed. From a national survey of veterans deployed in the Gulf war, researchers found that up to a third of respondents reported multi-symptom illnesses, including sensitivity to pesticides twice the rate of veterans who had not deployed. Given that Gulf war veterans experienced post-traumatic stress disorder at levels similar to those in other military conflicts, the findings have been used to breathe new life into Randolphs idea of postindustrial toxicities leading to intolerance. The same has been said of the first responders and the World Trade Centres nearby residents, who developed pulmonary symptoms when exposed to cigarette smoke, vehicle exhaust, cleaning solutions, perfume, or other airborne irritants after 9/11, according to a team at Mount Sinai.

Black, who doubts a real disease, has no current clinical experience with MCS patients. (Apart from the papers he wrote more than 20 years ago, he had seen only a handful of MCS patients over the course of his career.) Despite this, he had not only written the article about MCS, but also a guide in a major online medical manual on how to approach MCS treatment as a psychiatric disease. When I asked him if there was a way for physicians to regain the trust of patients who have been bruised by the medical system, he simply replied: No. For him, there would always be a subset of patients who are searching for answers or treatments that traditional medicine could not satisfy. Those were the people who saw clinical ecologists, or who left society altogether. In a time of limited resources, these were not the patients on which Black thought psychiatry needed to focus.

It became clear to me why even the de facto leading professional on MCS had hardly any experience actually treating MCS. In his 1990 paper, Black then a young doctor rightly observed that traditional medical practitioners are probably insensitive to patients with vague complaints, and need to develop new approaches to keep them within the medical fold. The study subjects clearly believed that their clinical ecologists had something to offer them that others did not: sympathy, recognition of pain and suffering, a physical explanation for their suffering, and active participation in medical care.

I wondered if Black had given up on these new approaches because few MCS patients wanted to see a psychiatrist in the first place.

Physicians on either side of the debate agreed that mental illness is a crucial part of treating MCS, with one I spoke to believing that stress causes MCS, and another believing that MCS causes stress. To reconcile the views, I interviewed another physician, Christine Oliver, a doctor of occupational medicine in Toronto, where she has served on the Ontario Task Force on Environmental Health. Oliver believes that both stances are probably valid and true. No matter what side youre on, she told me, theres a growing consensus that this is a public health problem.

Oliver represents a useful third position, one that takes the MCS illness experience seriously while sticking closely to medical science. As one of few MCS-agnostic physicians, she believes in a physiological cause for MCS that we cannot know and therefore cannot treat directly due to lack of research. Oliver agrees with Randolphs original suggestion of avoiding exposures, although she understands that this approach has resulted in traumatising changes in patients abilities to function. For her, the priority for MCS patients is a practical one: finding appropriate housing. Often unable to work and with a limited income, many of her patients occupy public housing or multi-family dwellings. The physician of an MCS patient must act like a social worker. Facilities such as hospitals, she feels, should be made more accessible by reducing scented cleaning products and soaps. Ultimately, finding a non-threatening space with digital access to healthcare providers and social support is the best way to allow the illness to run its course.

Whether organic or psychosomatic or something in between, MCS is a chronic illness. One of the hardest things about being chronically ill, wrote the American author Meghan ORourke in the New Yorker in 2013 about her battle against Lyme disease, is that most people find what youre going through incomprehensible if they believe you are going through it. In your loneliness, your preoccupation with an enduring new reality, you want to be understood in a way that you cant be.

A language for chronic illness does not exist beyond symptomatology, because in the end symptoms are what debilitate normal human functioning. In chronic pain, analgesics can at least deaden a patients suffering. The same cannot be said for MCS symptoms, which are disorienting in their chaotic variety, inescapability and inexpressibility. There are few established avenues for patients to completely avoid triggering their MCS, and so they learn to orient their lives around mitigating symptoms instead, whether that is a change in diet or moving house, as Sharon did. MCS comes to define their existence.

As a housebound person, Sharons ability to build a different life was limited. Outside, the world was moving forward, yet Sharon never felt left behind. What allowed her to live with chronic illness was not medicine or therapy, but the internet. On a typical day, Sharon wakes up and prays in bed. She wolfs down handfuls of pills and listens to upbeat music on YouTube while preparing her meals for the day: blended meats and vegetables, for easier swallowing. The rest of the day is spent on her laptop computer, checking email and Facebook, watching YouTube videos until her husband returns home in the evening. Then bed. This is how Sharon has lived for the past six years, and she does not expect anything different from the future. When I asked her if being homebound was lonely, I was taken aback at her reply: No.

In spite of not having met most of her 15 grandchildren (with two more on the way), Sharon keeps in daily contact with all of them. In fact, Sharon communicates with others on a nearly constant basis. Some people are very much extroverts, Sharon wrote. I certainly am. But there are also people who need physical touch and I can understand why they might need to see real people then but its very possible to be content with online friends. This is my life! The friendships that Sharon formed online with other housebound people with chronic illnesses were the longest-lasting and the most alive relationships she had ever known. She had never met her best friend of 20 years their relationship existed completely through letters and emails, until two years ago, when the friend died. That was very hard for me, Sharon wrote.

The pandemic changed very little of Sharons life. If anything, Covid-19 improved her situation. Sharons local church live-streamed Sunday service, telehealth doctor appointments became the default, YouTube exploded in content, and staying indoors was normalised. Sharon saw her network steadily expand as more older adults became isolated in quarantine.

People within the online MCS community call themselves canaries, after the birds historically used as sentinels in coalmines to detect toxic levels of carbon monoxide. With a higher metabolism and respiratory rate, the small birds would theoretically perish before the less-sensitive human miners, providing a signal to escape. The question for people with MCS is: will anyone listen?

Us canaries, said a woman named Vera, who was bedbound from MCS for 15 years after a botched orthopaedic surgery, we struggle and suffer in silence. Now, in the information age, they have colonised the internet to find people like themselves. For our part, we must reimagine chronic illness which will become drastically more common in the aftermath of the pandemic where what matters to the patient is not only a scientific explanation and a cure, but also a way to continue living a meaningful life. This calls into action the distinction between illness and disease that the psychiatrist and anthropologist Arthur Kleinman made in his 1988 book The Illness Narratives. Whereas a disease is an organic process within the body, illness is the lived experience of bodily processes. Illness problems, he writes, are the principal difficulties that symptoms and disability create in our lives.

By centring conversations about MCS on whether or not it is real, we alienate the people whose illnesses have deteriorated their ability to function at home and in the world. After all, the fundamental mistrust does not lie in the patient-physician relationship, but between patients and their bodies. Chronic illness is a corporeal betrayal, an all-out assault on the coherent self. Academic medicine cannot yet shed light on the physiological mechanisms that would explain MCS. But practitioners and the rest of society must still meet patients with empathy and acceptance, making space for their narratives, their lives, and their experience in the medical and wider world.

This essay was originally published in Aeon

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Allergic to the world: can medicine help people with severe intolerance to chemicals? - The Guardian

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All outcome studies must assess the efficacy of integrated protocols in their entirety and not of individual therapies. This is a point of crucial importance.Prof Majid AliEditor, Journal of Integrative Medicine,Professor of Medicine, Capital University of Integrative Medicine

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She knows modern medicine as a nurse practitioner. She writes about integrative medicine, which she uses as a supplemental form for medicine.

It include mantras, yoga, even acupuncture.

The book is a combination of a weekly intention which is what I call the mantra, which is a phrase that might help you in your every day and an action," Weigel explained. "That action is a yoga pose or a type of breath or maybe the use of an essential oil.

For 52 weeks and this book as your guide, Weigel hopes people with a range of medical and mental issues can find results like her patients have.

She has mainly worked with patients with multiple sclerosis, but she says she has seen integrative medicine work wonders on people with a range of problems like pain, insomnia, anxiety and others.

Weigel says her book is not a challenge. Its supposed to be easy and give you something not to do... to not stress.

You can find her book in several local stores like Rosie True boutique in Jacksonville Beach. You can also find her book on Amazon.

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Jacksonville nurse practitioner writes book on how to use integrative medicine in your daily life - FirstCoastNews.com WTLV-WJXX

CHAMPIONSGATE, Fla., Sept. 15, 2022 /PRNewswire/ --The International Academy of Oral Medicine and Toxicology (IAOMT) is raising awareness of the connection between dental conditions and whole body health with season two of its integrative health podcast and video series Word of Mouth.

Integrative health podcast and video series Word of Mouth, season two released!

"This unique podcast series focuses on the relationship between oral health and overall health, which is also known as the oral-systemic connection," explains IAOMT President Dave Edwards, DDS. "All too often, dentistry is excluded from medical care, resulting in a disconnect between the treatment of the mouth and the rest of the body. This is dangerous because oral health conditions are scientifically associated with a wide range of systemic illnesses."

In the first episode of Word of Mouth, IAOMT member and past president, Griffin Cole, DDS, NMD, interviews biochemist Boyd Haley, PhD about Emeramide, a safe and effective heavy metals chelator that is going through the FDA approval process. They discuss the risks for dental patients and dental professionals that are associated with mercury dental fillings and the many detrimental health effects from exposure to mercury.

New episodes of Word of Mouth will be released every two weeks to explore other concepts relevant to integrative health. In the second episode, IAOMT member Beth Rosellini, DDS, AIAOMT, interviews Earl Bergersen, DDS a pioneer in pediatric sleep, breathing and airway health. The third episode features IAOMT member and past president, David Kennedy, DDS, interviewing Griffin Cole, DDS, NMD, about the adverse health effects from fluoride exposure.

The IAOMT expects Word of Mouth to be a long-running series that will forge a more integrated approach to dental and medical care. "What happens in the mouth impacts the rest of the body and vice-versa," IAOMT President Edwards reiterates. "Patients can clearly benefit from an integrative approach to treating the health of their whole body. Our Word of Mouth series will spread this important message."

Episodes of Word of Mouth can be found on the Word of Mouth website, as well as Spotify, Apple iTunes, YouTube and Facebook.

The IAOMT is a non-profit organization dedicated to biological dentistry and its mission of protecting public health and the environment since it was founded in 1984.

Contact:David Kennedy, DDS, IAOMT Public Relations Chair, [emailprotected]International Academy of Oral Medicine and Toxicology (IAOMT)Phone: (863) 420-6373; Website: http://www.iaomt.org

SOURCE International Academy of Oral Medicine and Toxicology

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Integrative health podcast and video series Word of Mouth, season two released! - PR Newswire

From my vantage point in the Southwest region of the USA, the future looks bright for massage therapy. Elevated continuing education offerings, greater opportunities within allopathic care sectors, and greater acceptance amongst the general public lead me to see our industrys future as very positive.

In my opinion, continuing education is a huge factor in our industrys continued progress and growth. Encouraging therapists to participate with continuing education requirements ensures professionals will acquire updated skill sets and knowledge.

As science discovers more about the human body, it is imperative massage therapists learn these new discoveries to better understand who they treat in their practices. Therapists learn new innovative tools, techniques and approaches as they further their education.

Clients benefit from therapists who seek to advance and improve their practice of therapeutic massage. Ultimately, we attend continuing education to better serve our clientele.

It is my hope that states which do not require continuing education requirements reevaluate why they have chosen to not require this key aspect of industry growth.

In five years, I foresee many more innovations in continuing education regarding the usage of tools to aid manual therapy efforts. I also foresee a greater trend that more educators will hold courses on the integration of mental and physical health with massage therapy efforts.

As trauma informed is slowly becoming a buzzword in education, we will surely have more continuing education classes touch upon this topic. This necessitates we massage educators work with other mental health professionals to ensure our content is accurate and elevated.

Many entry level massage programs in the past decade have adopted courses traditionally reserved as continuing education:

As entry level education elevates, a wise program director will ensure the foundational skills will not be rushed in the first set of classes in order to fit the advanced content later in programs.

Therapists with advanced education with a specific focus will also have greater opportunities with allopathic care sectors.

An example is seen when therapists learn advanced education in lymphatic drainage training. Therapists completing over 60 hours of training in this field have access to work with advanced lymphedema and similar patients. These patients need an exquisite clinical treatment plan which a normal entry level program does not offer enough insight towards lending assistance.

Therapists who seek longer education programs will be able to work in hospital and clinical settings otherwise not afforded to the average massage therapist.

I see many therapists now working in hospitals. This will lend towards greater credibility of massage in the eyes of allopathic medicine. Here in Arizona, I often speak with doctors and nurses who hold a great respect for massage therapy.

In five years, I foresee many more professionals having completed longer specific programs in:

I also foresee on the eastern side of our field, more therapists becoming acupuncturists to further integrate Chinese medicine practice into massage related work.

As massage therapy makes gains in varying professional arenas, more members of the general public will garner a greater appreciation of massage therapy.

Many more people realize massage can aid in the treatment and recovery of many clinical conditions such as:

I foresee mainstream massage coverage in a more positive light as our professional gains in other health care sectors highlight our value as massage therapists. I also foresee more successful massage and integrated wellness facilities being showcased as healing havens as we heal the planet one body at a time.

The future is bright for massage therapy. Entry level education is strengthening, continuing education is broadening, more therapists are working in allopathic sectors, and more general public members are benefiting from the healing power of our work. These will only continue to trend upwards in the next five years.

Jimmy Gialelis, LMT, is a national board certified clinical practitioner passionate about clients actualizing maximum health gains. A member of the Massage Therapy Hall of Fame, he contributes to the Massage & Bodywork Licensure Exam as an exam item writer. He maintains a continuing education business, Advanced Massage Arts & Education, along with his private practice studio in Tempe, AZ.

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Where Will the Massage Industry Be in Five Years? - Institute for Integrative Healthcare Studies

If you haven't tried plogging yet, it's about time you hop on this fitness trend that's great for the environment. The incredibly popular activity of jogging while picking up trash along your route is something individuals are having fun with across the globeand for good reason. There's so much healthy goodness your body gains from plogging, and science proves it. Read on for some astounding facts and food for thought. Ready, set, let's learn the wholesome plogging habits that slow aging!

Started by Erik Ahlstrm in Sweden, "plocka upp" (which means plogging in Swedish) can be life-changing. Not only is the endeavor extraordinary for your overall mental and physical fitness, but it's also quite infectious and benefits the environment in a seriously major way. You may even be inspired to initiate a plogging event in your own community and help spread this positive effort to friends and neighbors. As you help clean up your world, take a look at the many plogging habits that slow aging.

Everyone knows that too much stressmental or physicalcan be totally detrimental to your mind and body. Stress is not simply an overwhelming feeling; it's also the cause of many serious health issues, including stroke, heart disease, dementia, and even early death.6254a4d1642c605c54bf1cab17d50f1e

Let's look at some statistics on the harmful results of stress. Individuals who maintain a stressful 55 hours or more of work every week have a 35% increased risk of suffering from a stroke and 17% increased risk of death by heart disease when compared to keeping a lighter 35 to 40-hour week, according to a study (via NPR). The ability to recover from any sort of stress on the body apparently decreases as you age. Research reveals that an 80-year-old person can take 3 times longer to bounce back from any sort of stress when compared to a 40-year-old, according to a study performed by a Singapore-based biotech company called Gero (via CNET).

The most effective ways to address stress is by performing consistent exercise, in addition to sleeping well, eating a nutritious mostly plant-based diet, being social, and meditating, according to Harvard Health Publishing. Dr. Shalu Ramchandani, an integrative medicine specialist at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, explains, "If you're practicing all these healthy habits, it helps you become more resilient and better able to adapt to life's challenging situations."

Bottom line? It's crucial for your overall well-being to get up, get going, and feed your body and your mind with exercise. A plogging routine will have you totally covered on both counts!

Related: The #1 Strength Workout To Regain Muscle Mass as You Age, Trainer Says

Your body benefits from every bit of exercise you can work into your schedule. Along with being a great mood lifter and strength builder, a solid cardio workout is proven to prevent heart disease and other chronic illnesses, Harvard Health Publishing reports. That being said, research proves that aerobic activity can help you live even longer. So what are you waiting for? Put on your sneakers, grab a garbage bag, and get on your way, because your heart will surely thank you.

Related: The Top 5 Walking Habits That Slow Aging, Fitness Expert Reveals

Your heart will beat with pride as a result of your plogging efforts, and a happy heart is a healthy one. Performing service to your community in a special way is plain old nourishing. Studies have proven that the more selfless deeds you perform, the more happiness you experienceand it will help you live longer.

Research performed at Carnegie Mellon University reveals that individuals 51 years of age and over who consistently volunteered their time were at lower risk of developing high blood pressure than adults who did not. High blood pressure is a major cause of stroke, heart disease, and early mortality. Individuals who volunteered a minimum of 200 hours each year lowered their high blood pressure by as much as 40%. The research indicates that performing this kind of volunteer work could be an effective method to help you avoid hypertension.

Volunteering your time cleaning up your community while exercising is an unselfish, feel-good thing to do. You'll be accomplishing a wealth of positive things while doing it.

Your surroundings are integral to your mood and overall health. Not only is the air you breathe and the food you eat negatively compromised by pollutants, but a community that has litter scattered about can also encourage other residents and people traveling to that particular place to be litterers, too.

Aside from being a pretty unattractive sight, think about where that loose trash ends up. One spot is in storm drains, which feed into lakes, streams, rivers, and oceans, exposing fish (your seafood) and more to bacteria. Soil can also become contaminated by the harmful chemicals that come from litter. And in order to easily do away with litter, it's typically burned, which can let out a substantial amount of toxic gases and particulate matter into the earth's atmosphere, according to WorldAtlas. This can result in respiratory issues and health ailments.

Doing your bit to keep your environment clean not only inspires others to keep it that way, but also helps generate a world that is clean to live, eat, and breathe in. This is a huge golden reason why plogging makes so much sense. Think of inspiring a huge number of ploggers to get an abundance of exercise while cleaning up the earth. The activity may motivate people to be mindful of not littering in the first place!

Alexa Mellardo

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The Plogging Habits That Slow Aging, Science Reveals Eat This Not That - Eat This, Not That

Young Living, a Lehi, UT-based multi level marketing company, recently released its results on a study that centered around its antioxidant berry drink, NingXia Red. The research, conducted by The Franklin Health Research Center, was published in Advances in Integrative Medicine.

The beverage, rich in antioxidants, reduces oxidative stress, promotes wellness and immune support. The dark berry blend was linked to a boost in overall health, particularly in areas such as sleep, mental wellbeing, physical function, and immunity.

Researchers conducted the randomized clinical trial in the United States at the end of 2020 amid a pandemic to evaluate the effects of NingXia Red on multiple health outcomes. The proprietary NingXia Red Blend includes Ningxia wolfberry puree (Lycium barbarum), blueberry juice concentrate (Vaccinium corymbosum), plum juice concentrate (Prunus domestica), cherry juice concentrate (Prunus avium), aronia juice concentrate (Aronia melanocarpa), pomegranate juice concentrate (Punica granatum), along with a proprietary essential blend that contains grape (Vitis vinifera) seed extract, orange essential oil (Citrus sinensis), yuzu essential oil (Citrus junos), lemon essential oil (Citrus limon) and tangerine essential oil (Citrus reticulata).

The trial included 160 healthy adults between the ages of 18-65 were randomized to either a treatment or a control group, with data being collected at the baseline, on day 30, and on day 60 of the study. Each health outcome was measured using multiple clinically and statistically validated instruments that allow for self-reporting of signs and symptoms reflective of overall health status.

The study suggests that drinking 2oz of the blend a day can increase sleep quality, productivity, and mental wellbeing, particularly for women aged 20-49.

Data collected from the treatment group from day 60 revealed improved sleep patterns, increased time asleep by an average of 21 minutes and a decrease in time of falling asleep by an average of 6 minutes when compared to the control group. As a result of improved sleep quality, NingXia Red drinkers also experienced an average of a 37.9% increase in productivity. In addition, the study was also clinically shown to reduce daily stress by 23% and improve mental wellbeing. The effects were more significant in women compared to men, and more prevalent in adults aged 20-49 as compared to adults aged 50-65.

Compared to the control group, those who consumed NingXia Red were shown to increase physical energy levels by 34.5% and reduce physical limitations by 36%. Physical limitations due to inflammation, physical function, mental wellbeing and energy levels were measured by the bodys inability to achieve daily physical tasks such as carrying groceries, using stairs and taking walks. NingXia Red drinkers also averaged a 27% reduction in somatic symptom scores, which reflects improvement in gastrointestinal health, sleep quality, headaches, and respiratory function. Those who did not consume NingXia Red were about five times more likely to develop moderate to severe respiratory symptoms than the NingXia Red group.

Daily consumption of 60 ml of NingXia Red resulted in an increase in sleep duration when used consistently for 60 days. Length of illness was shorter in the supplement group compared to the control group. The supplement improved both immune response and overall health through a safe and healthy method of use, the authors concluded.

The authors acknowledged that certain populations could require a longer intervention time for effects to be documented. In the future, they suggest studies should examine the effects of an antioxidant beverage for periods of 46 months or longer to determine whether the benefits continue to increase.

Source: Advances in Integrative MedicineVolume 9, Issue 3, September 2022 doi.org/10.1016/j.aimed.2022.06.007Effects of antioxidant supplement on immune health and physical wellbeing: A randomized, controlled trialAuthors: J. Hawkins at al.

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Study: Dark berry blend linked to improved sleep, stress, physical health - NutraIngredients-usa.com

An unhealthy gutcan do more than cause tummy troubleswhen your microbiome is off your mood can be too. "Living inside every person are trillions of microorganisms- bacteria, fungi, parasites, and viruses-that are collectively known as the microbiome," Dr. Jessica Cho, M.D. and Integrative Medicine Specialist with Wellness at Century City tells us. She adds, "When you are healthy, your microbiome detoxifies your gut, boosts your immunity, and synthesizes specific vitamins and amino acids. Thus, several diseases including cancer, autoimmune disorders, and autism spectrum disorder-are now thought to be influenced by the gut microbiome." Recognizing the signs of a microbiome imbalance is essential to overall health and Eat This, Not That! Health spoke with experts who share what signals to look out for. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Dr. Samrat Jankar, Surgical Gastroenterologist, Gastroenterologist, Laparoscopic Surgeon and Colorectal Surgeon with Clinic Spots says, "Your gut microbiome is the collection of all the microbes (bacteria, fungi, viruses, and protozoa) that live in your digestive tract. These microbes play a crucial role in keeping you healthy by helping to break down food, synthesize vitamins, and protect against pathogens."

Dr. Jankar says, "There are several things you can do to help keep your gut microbiome healthy, including:

-Eating a diverse array of fresh fruits and vegetables

-Avoiding processed foods

-Limiting your intake of antibiotics"

Dr. Cho shares, "Environmental exposures and diet may tip the balance of your microbiome, leading to higher susceptibility to infection. Probiotics, which are foods that naturally host microbiota or supplement pills, repair your microbiome and support your digestive health."

Dr. Jankar tells us, "Poor gut health has been linked to a variety of mood disorders, including anxiety and depression. This is thought to be due to the fact that the gut and brain are connected via the vagus nerve, which allows for communication between the two. Additionally, gut microbes produce neurotransmitters that can impact mood. Therefore, maintaining a healthy gut is essential for good mental health."

Dr. Cho explains, "Your microbiota influences not only the gut, but also brain function through immune and endocrine pathways and the nervous system. The gut microbiota of individuals with mood disorders contrasts significantly with that of healthy individuals because it secrets neurotransmitters and metabolites that influence our natural neurotransmitter levels, which affects behavior and mood. Poor gut health has been linked to a myriad of mood disorders, including anxiety, depression, and bipolar disorder."6254a4d1642c605c54bf1cab17d50f1e

Dr. Cho says, "Digestion issues including IBS, constipation, diarrhea, heartburn, and bloating are a sign of an unhealthy gut. Simple carbs like glucose and lactose are easily absorbed by our own small intestine, but we rely on our gut microbiome to help digest more complex structures. With a malfunctioning gut microbiome, we may experience digestive problems."

According to Dr. Cho, "Autoimmune diseases such as thyroid conditions, rheumatoid arthritis, and type 1 diabetes. Some microbes occupy niches in our gut that might otherwise host harmful bacteria, so without a robust microbiome, we may be more susceptible."

"Your gut microbiome influences inflammatory markers, which contributes to weight management," Dr. Cho explains.

Dr. Cho states, "there is a bi-directional relationship between gut microbiome and heavy metal toxicity. Heavy metals may contribute to the progression of various metabolic diseases due to perturbations of the gut microbiota by altering the pH, oxidative balance, and concentrations of detoxification enzymes in heavy metal metabolism and compromised integrity of intestinal barrier."

Heather Newgen

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Signs There is Something Wrong With Your Gut Eat This Not That - Eat This, Not That