LMCC/Complementary and Alternative Medicine

Epidemiology

Approximately 50-75% of Canadians use CAM at some point in their lives.
CAM use is highest in Western provinces and lowest in Atlantic provinces.
CAM is more likely to be used by younger patients, as well as those with higher education and higher income.
Examples of CAM: chiropractice, acupuncture, massage, naturopathy, homeopathy, Traditional Chinese Medicine, Ayurveda
Most commonly used for chronic diseases, such as back/neck problems, gynecological problems, anxiety, headaches, and digestive problems.
More than half of Canadians do not disclose CAM use to their physicians.

Herbal Products

Over 50% of Canadians use natural health products.
Most herbs have not yet been shown to be effective in clinical trials.
Many patients believe herbal products are inherently safe and are unaware of potential side effects and interactions with conventional medicines.
All natural health products must be regulated under the Natural Health Products Regulations; these products include herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids and essential fatty acids.
Questions to ask patients who may be taking herbal products:
- Are you taking an herbal products, supplement or other natural remedy
- Are you taking any prescription or non-prescription medications for the same purpose as the herbal product?
- Are you allergic to any plant products?
- Are you pregnant or breast-feeding?

Common Herbal Products

Common Name	Reported Uses	Possible Adverse Effects	Possible Drug Interactions
Chamomile	mild sedative, anxiolytic, GI complaints, common cold	allergic/contact dermatitis, anaphylaxis	anxiolytics, sedatives
Echinacea	Common cold, flu, wound treatment, urinary tract infections, cancer	hypersensitivity, hepatotoxicity with prolonged use, avoid use if immunosuppresed	potentiates warfarin
Evening primrose	Dysmenorrhea, menopausal Sx, inflammation, allergies, eczema, arthritis, MS	Headache, restlessness, nausea, diarrhea, may decrease seizure threshold	anticoagulants, antiplatelets
Feverfew	Migraine prevention, rheumatoid arthritis, anti-inflammatory	Edginess, upset stomach, skin rash, miscarriage	Anticoagulants, antiplatelets
Garlic	Elevated lipids, hypertension, hyperglycemia, antimicrobial	GI irritation, contact dermatitis, may increase post op bleeding	anticoagulants, potentiates antihypertensives
Ginger	Nausea, motion sickness, dyspepsia, antiinflammatory	heartburn, not to be used for morning sickness	none known
Ginkgo biloba	Increases peripheral circulation (AD, dementia, intermittant claudication), premenstrual syndrome, vertigo	headache, cramping, bleeding, mild digestive problems, reports of intracranial hemmorage	anticoagulants, thiazide diuretics, MAO inhibitors
Ginseng	Energy enhancer, decreases stress, adjunct support for chemotherapy/radiation	Hypertension, nervousness, insominia, breakthrough bleeding, palpitations	Stimulant medications, antihypertensives, hormonal therapies
Glucosamine	osteoarthritis	GI distress, headache, drowsiness, palpitations	none known
Saw palmetto	BPH, adjunct to finasteride	Mild GI distress	a-adrenergics
St. John's Wort	Mild to moderate depression	Photosensitivity, increased liver enzymes, drowsiness, dizziness, nausea, headaches	CNS depressants
Valerian	Sedative, anxiolytic, muscle relaxant, PMS	Drowsiness, headache, digestive problems, paradoxical insomnia	CNS depressants

References

Toronto Notes 2005