MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Acupressure is the stimulation of acu-points by using pressure instead of needles, as in acupuncture. The evidence for or against acupressure mirrors that of acupuncture, except there is far less of it. This is why this new trial might be important.

The aim of this RCT was to determine the effect of self-acupressure on fasting blood sugar (FBS) and insulin level in type 2 diabetes patients. A total of 60 diabetic patients were selected from diabetes clinic in Rafsanjan in Iran, and  assigned to 2 groups, 30 in the acupressure and 30 in the control-group. The intervention group received acupressure at ST-36, LIV-3, KD-3 and SP-6 points bilaterally for 5 minutes at each point in 10 seconds pressure and 2 seconds rest periods. Subjects in the control group received no intervention. The FBS and insulin levels were measured before and after the intervention for both groups.

There were no significant differences between the acupressure and control group regarding age, sex and level of education. The insulin level significantly increased after treatment in the acupressure group (p=0.001). There were no significant differences between the levels of insulin in study or control groups. Serum FBS level decreased significantly after intervention in the acupressure group compared to the control group (p=0.02).

The authors concluded that self-acupressure as a complementary alternative medicine can be a helpful complementary method in reducing FBS and increasing insulin levels in type 2 diabetic patients.

I do not want to go into the methodological details of this study; suffice to say that it was less than rigorous and that its findings are therefore not trustworthy (never mind the fact that the results are biologically implausible). Even if that had not been the case, a single study would certainly not be sufficient reason to reach the conclusion that acupressure is helpful to control diabetes. For that, I am sure, we would need at least half a dozen independent replications.

Like most people, I have several non-medical friends who suffer from diabetes. They would love nothing better than having a simple, safe and effective method applying pressure to their skin in order to manage their disease. If they read this paper, some of them might conclude that acupressure is the answer to their problems and use it to control their condition. One does not need all that much imagination to see that this could seriously harm them, or even cost several lives.

Acupressure might be virtually free of risks, but with a bit of ill advice, even seemingly harmless treatments can kill.

5 Responses to Acupressure: you thought it was harmless? Read this, it might change your mind!

  • “Since we did not find any controlled clinical trial regarding the specific effect of self-acupressure on the level of fasting blood sugar and insulin in diabetes type 2 patients, the current study was designed with the aim of “determining the effect of self-acupressure on FBS and insulin levels in type 2 diabetes patients”, in order to provide an easy to implement, cost-effective, and free of side effects therapeutic CAM to control diabetes symptoms and complications, and enhance the quality of life in such patients.”

    No other trials to directly compare their results with and no placebo/sham control. The correct conclusion to draw from this small trial is that it is not known whether self-acupressure for type 2 patients is more effective than similar self-relaxation techniques or placebo/sham.

    Easy to implement, cost-effective, free of side effects solutions for serious medical problems are not two-a-penny. Careless conclusions in trials like this one are.

  • I would also conclude that the authors of the study do not know very much about type 2 diabetes. In this condition (quite distinct from type 1 which is a totally different disease) the body loses its sensitivity to the hypoglycaemic effects of insulin, and has an exaggerated insulin response to a glucose load. The chronically high insulin level has other, undesirable metabolic effects that are not directly connected with glucose. I would not, therefore, regard a rise in insulin to be a desirable response to treatment.

    In fact there is an easy-to-implement, cost-effective solution to type 2 diabetes which is free of side-effects, and that is exercise. Strenuous exercise (even in short bursts) alters the way that the muscles metabolise glucose and is a very effective way of bringing the disease under control, particularly when combined with weight loss and sensible eating (any diabetes dietician will be able to explain what is necessary).

    There are also drugs such as metformin, which has clearly been shown to prolong life and reduce the risk of cardiovascular and cerebrovascular disease in diabetics, and which is cheap and well-tolerated in most people (and currently being investigated in cancer-prevention trials).

    When none of this works, there are other drugs, including insulin, which can bring the sugar down, but insulin is a treatment of last resort in type 2 diabetes (as opposed to type 1 where lack of insulin is rapidly fatal).

  • “If they read this paper, some of them might conclude that acupressure is the answer to their problems and use it to control their condition.”

    I don’t think you have a lot to worry about. As you point out, “CONCLUSION: Self-acupressure as a complementary alternative medicine can be a helpful complementary method…”.

    Those of us who aren’t very familiar with reading studies would figure that means some acupressure might be helpful in addition to (not in replacement of) standard care.

    It would be helpful to me and other non-experts to understand how “helpful complementary method” translates to “the answer to their problems” (as you put it), or a “solution” (as Leigh calls it).

  • An interesting pastime, pressing yourself at various places… There is virtually no need to call local massage by a special name and specific locations by pre-designated code names. But, of course, it lends plausibility to the practice, like it’s systematic, when in fact, it’s based on wishful thinking.

    The distance between the effectiveness of acupressure on diabetes and actually effectively treating diabetes (all types) is on the order of a light-year, just to put it in perspective. It is not only NOT a helpful complementary method (“a complementary alternative medicine“), it is not even remotely capable of producing helpful results. The bad thing about this trial is that there was no reason to perform it anyway as the pathophysiology of diabetes mellitus Type 2 has been so extensively studied, that it is a disgrace to even consider that localized massage can affect pancreatic beta cells in any meaningful manner.

    We have been through this before and quite persistently. As such, I was only tempted to check this study in more detail. Some excerpts are quite telling:

    Given that in this study, the sampling was done by convenience method, the control group was nonequivalent and the intervention was combined, so that the results cannot clearly be attributed to acupressure alone.

    But it is not exactly clear that FBS decrease can be solely attributed to the increase of insulin level or FBS reduction, despite influencing by insulin, is driven by other independent mechanisms. Hence, it is not easy to comment on such interventions for patients with insulin-resistance. In addition, among the studies conducted in this regard, a large variety is observed on the employed methods (acupuncture or acupressure), intervention protocols, pressure points, and targeted populations, which can affect the results of the intervention.

    And the award winning:

    However, according to the results of the studies, acupressure, as a complementary medicine, could control complications and prevent symptoms of diabetes mellitus. Therefore, the intervention can be employed as a complementary treatment for patients with diabetes, to prevent diabetes in high-risk patients, control hyperglycemia of non-pancreatic origin such as stress-induced hyperglycemia, control blood sugar in patients who use drugs that increase blood glucose, and patients with adrenal dysfunction, and to treat morbid obesity.

    Yes, I would definitely agree with Dr. Ernst. This paper really does give some dangerous suggestions!

    The conclusions really could not begin in any better manner:

    The Results of this study indicated that self-acupressure can be considered as an effective, suitable, and cost-effective complementary medicine to control the blood glucose level in patients with type 2 diabetes, and can be easily implemented by the patient without the need to refer to a health care center.

    And it gets even better:

    This manuscript is derived from a master’s degree thesis.

    This is actual work by an actual student, in an actual research setting in an actual research center/university. If such research is carried out in a university, I would argue that it is totally in the interest of the public to consider a good external assessment or, potentially, shut it down, because it does not apply science.

    For hard-core readers that would really bother with the credibility of this, however, I find it very important to put it in some perspective, though. The main results are the following (the only results in the paper, really):

    Serum Fasting Blood Sugar level:
    BEFORE INTERVENTION: 128.30±35.73
    AFTER INTERVENTION: 122.23±30.93
    (p-value: 0.10)

    Serum Insulin Level:
    BEFORE INTERVENTION: 11.52±7.58
    AFTER INTERVENTION: 14.49±10.02
    (p-value: 0.001)

    For any even moderately knowledgeable on the field, this translates to a reduction ~6 mg/100mL. A simple but telling chart can put this into perspective. Now, I did start going on about how this is not even meaningful (it’s about ~5%) but another thing occurred to me:

    The internal and external variation coefficient at 37 °C for glucose kits was 41.1% and 74.1%, and for insulin 6.91 and 6.23, respectively, and the sensitivity of glucose and insulin kits was 5 mg/100 Ml and 1.76 micro units per milliliter.

    Ok, there is no need to comment on a difference that is that close to the margin of the instrument precision. The p-value is 0.1 anyway, which is terrible, even after viewing all numbers in the proper perspective.

    Now on the insulin level difference, which appears to be more significant…besides, this is a 0.001 p-value. The authors should know that the fasting insulin level is not a very meaningful test in the absense of pathology or when it is already known that participants suffer from diabetes mellitus type II. The units are not even mentioned, so I have to interpret them as μU/mL, as this is the unit used for the instrument precision, not to mention that they only make sense in these units as they stand in the paper. A quick search for the proper ranges shows that 5-20 μU/mL is a reasonable range for fasting insulin (hoping that the U actually refers to the same units and that their enzyme U is equal to the corresponding IU, it’s somewhat complicated anyway). I don’t see whether there is a lot to comment on such a result, 3 μU/mL is a tremendously meaningless difference when measures are within normal range anyway.

    As a special, here, after trying to see who would bet too much on fasting insulin levels, I got this diamond, from which I quote:

    People often keep close watch on their glucose numbers. But how many of us know our insulin level? Dr. Joseph Mercola says fasting insulin is “the number that may best predict your sudden death.” Sounds important. But what does it mean?

    I take the liberty to answer the question independently. It means that you should also get a glucose tolerance test as a free bonus, if you want a reliable diagnosis.

    In the inclusion criteria, I read:

    normal body mass index (BMI) within the range of 20 to 30 kg/m2

    .
    Not quite “normal”, unless you are trying to be nondiscriminatory, instead of professional.

    In the exclusion criteria, I read:

    discontinuation of anti-diabetics

    .
    Does this mean that people on anti-diabetics were included, and those that discontinued them were not?

    The title and “coat of arms” of the Journal is very insightful:
    Electronic Physician: Excellence in Constructive Peer Review.
    I hope this is not a hoax…

    All in all, to quote the paper itself:

    […] the energy flow (qi) is increased in the body during acupressure; therefore, it can be effective in the management of diseases.

    Great!

    • Yes, if folks read the full “Free PMC Article”, there’s still no indication that acupressure should replace standard care. No “answer to their problems”, no “solution”. Nothing to worry about. It’s pretty clear.

      The only hint that you could replace standard care with acupressure is from Edzard, at the end of his post. So really, the title should read: “Blog Posts: you thought they were harmless? Read this, it might change your mind!”

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