Some Frequently Asked Questions, first published in SAGA Magazine (10)
Professor George Lewith
I’ve just seen on the news about how acupuncture can help arthritis. How do I get this treatment and can you tell me what’s involved and how long it takes, please?
Acupuncture is a treatment that involves inserting very fine, single use, sterile needles into acupuncture points on the body. In arthritis the points chosen are in or around the joint, and will often involve some of the local, very tender areas that may be present around the affected joint such as knee, hip or shoulder. Several treatments are usually needed. The evidence suggests that a minimum of 6 treatments will tend to produce a cumulative effect, although some people may need up to 12 or 14 treatments. People receiving acupuncture usually receive no, or very limited, benefit on the first 1 or 2 treatments, and then, gradually, treatment benefit accumulates. A course of treatment can last for between a few months to many years. If, for instance, you have a very bad arthritis in the knee, you may be able to avoid joint replacement for a few years with repeated acupuncture, but because the damage is still present the pain in your knee may return. If you have a bad neck or back then the acupuncture may serve to improve the condition so that it doesn’t recur for a very long period of time. Acupuncture usually works better if there isn’t any major or permanent damage in the affected area. Acupuncture is available in Germany and other European countries on their equivalent of the NHS, but its availability in the United Kingdom on the National Health Service is limited, in spite of good evidence that it is both effective and cost effective. There are about 3,000 general practitioners and specialists who have had acupuncture training and, if you are lucky enough to be registered with one of them, they may well be able to provide you with acupuncture, or refer you to a colleague who may be able to do that. About 25% of physiotherapists have acupuncture training, but physiotherapy services within NHS hospitals are rapidly declining, so whether physiotherapists would be able to provide you with acupuncture on the NHS is a moot point at the moment. Professional acupuncturists are members of the British Acupuncture Council and largely work in the private sector. They would also be able to provide effective treatment and their premises need to be registered with the local Health Authority, to make sure they are safe and the needles are disposed of appropriately. All of these qualified acupuncturist can and do treat people privately and can usually be found in Yellow Pages. For further information in relation to the British Medical Acupuncture Society look at http://www.medical-acupuncture.co.uk/; for information about the Acupuncture Association of Chartered Physiotherapists see http://www.aacp.uk.com/, and for further information about the British Acupuncture Council and its membership list see http://www.acupuncture.org.uk/ .
Is it true that chromium supplements can help stabilise blood sugar in people with diabetes? And are they safe – wasn’t there a scare about this some while ago?
All practising nutrionalists will know that there is considerable data in relation to the positive effects of chromium and blood sugar levels. Chromium has been implicated, along with zinc, in some of the damage to blood vessels that can occur with diabetes. It is certainly an important micronutrient for the pancreas, which produces insulin. Low levels of chromium tend to result in hypoglycaemia (low blood sugar) and instability in controlling the glucose in the blood. A good stable blood sugar will help substantially with diabetes control and in particular with the long term damage to all the organs that may occur with diabetes. Chromium is certainly safe in the levels in which it is found in food, and an adequate intake would be between 20 and 50 mcg a day. Sometimes supplements have up to 200 mcg, but really shouldn’t contain more. There was a scare about the use of very high doses of chromium picolinate, when up to 1000 mcg was used each day over very long periods of time. There was some suggestion that this might predispose to cancer however there was no hard evidence that this was the case. Nevertheless it certainly wouldn’t be wise to take very large doses of chromium over a long period of time. It is important to emphasise that there have been clinical trials using chromium in diabetes, and while these are certainly suggestive, and chromium appears to be harmless in the relatively small doses used, the clinical trial evidence is not yet completely definitive.
After a bad cold a month ago, I feel as if my nose and sinuses are still blocked. Can I take or do anything to clear them?
Your nose should really have cleared after a month, you wouldn’t expect a cold to last this long. Have you ever had any other problems with your sinuses before? Are you allergic to anything? Have you been to see your GP about this?
It is probable that you are just a bit congested, and in all likelihood things will settle down relatively quickly. If your nose is feeling just a bit stuffy, then some of the simple homeopathic remedies that you can buy over the counter might be useful. I would suggest that you might consider Kali Bic, and use a 30C potency perhaps twice a day for a couple of weeks. Inhalations can sometimes help, these can be done either with steam or simple aromatherapy oils, such as lavender, which could have a soothing and healing effect on the inside of the nose and all the inflamed tissues in the sinuses. Acupuncture is also quite good at unblocking the inflamed and rather sensitive lining of the nose. A couple of visits to an acupuncturist might also help you get rid of the congestion. My advice is to first be certain that you don’t have a small growth like a polyp, and if you don’t then try some simple inhalations and/or some homeopathy to try to clear it.
I’m worried about the dangers of fats. I know saturated fats are bad, and now trans fats, but what about other spreads – is it worthwhile switching to the ones that claim to reduce cholesterol?
The evidence for some of the cholesterol reducing spreads, yogurts and drinks is actually very positive. There have been large studies involving lots of people and there do seem to be small but powerful effects from these products. These products are based on plant sterols and stanols, which are naturally present in the diet, but the amounts in these ‘foods’ are clearly much greater than they would be in normal foods. They are what we call a “functional food” and they very definitely lower both total cholesterol and the dangerous fats that deposit in the artery walls; these ‘nasty fats’ are called low density lipoproteins. There is no doubt that the stanols and sterols are effective in lowering marginally raised total cholesterol by between 10 and 15%, but should be used carefully and with an appropriate diet. There is no point in taking them if your cholesterol is normal, but if it raised, or if you have raised low density lipoproteins (LDL – the dangerous ones), as opposed to the protective high density lipoproteins (HDL) then taking some of these functional foods can be of help over the long term. The only danger is that you shouldn’t eat too much of them, because they themselves can be fattening!
I used to take black cohosh for menopausal symptoms till I read it could cause liver damage – is this true? If so, what is a safer alternative?
Black cohosh is used by many herbalists in the treatment of menopausal symptoms. There are some preliminary clinical trials that suggest it may be of real value, but unfortunately no definitive studies. This is much the same for all the herbal products that have been used for the treatment of menopausal symptoms. By and large there is an absence of evidence, it is simply the fact not enough proper trials have been done. As far as side effects are concerned for black cohosh, it can cause an upset tummy, and some patients who have taken an overdose have found they have had vomiting, visual disturbance, a reduced heart rate and perspiration. As far as I understand it from the available literature, there are no reports that black cohosh has caused liver damage. I wonder where you got this information? It certainly doesn’t seem to be a well-reported or common problem; in fact a recent systematic review suggests that any adverse events as a consequence of black cohosh are rare, mild and entirely reversible. I would go back to the black cohosh, if you find it effective, and don’t be put off by ill informed scare stories.
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