herbal medicine
The aim of this recent review was to investigate the efficacy of non-surgical and non-interventional treatments for adults with low back pain compared with placebo. It included all randomised controlled trials evaluating non-surgical and non-interventional treatments compared with placebo or sham in adults (≥18 years) suffering from non-specific low back pain.
Random effects meta-analysis was used to estimate pooled effects and corresponding 95% confidence intervals on outcome pain intensity (0 to 100 scale) at first assessment post-treatment for each treatment type and by duration of low back pain—(sub)acute (<12 weeks) and chronic (≥12 weeks). Certainty of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.
A total of 301 trials (377 comparisons) provided data on 56 different treatments or treatment combinations. One treatment for acute low back pain: (non-steroidal anti-inflammatory drugs (NSAIDs)), and five treatments for chronic low back pain:
- exercise,
- spinal manipulative therapy,
- taping,
- antidepressants,
- transient receptor potential vanilloid 1 (TRPV1) agonists)
were found to be efficacious. However, effect sizes were small and of moderate certainty. Three treatments for acute low back pain (exercise, glucocorticoid injections, paracetamol), and two treatments for chronic low back pain (antibiotics, anaesthetics) were not efficacious and are unlikely to be suitable treatment options; moderate certainty evidence. Evidence is inconclusive for remaining treatments due to small samples, imprecision, or low and very low certainty evidence.
The authors concluded that the current evidence shows that one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, providing only small analgesic effects beyond placebo. The efficacy for the majority of treatments is uncertain due to the limited number of randomised participants and poor study quality. Further high-quality, placebo-controlled trials are warranted to address the remaining uncertainty in treatment efficacy along with greater consideration for placebo-control design of non-surgical and non-interventional treatments.
This is an important analysis, not least because of the fact that the research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The methodology is sound and the results thus seem reliable.
The findings are in keeping with what we have been discussing at nauseam here: no treatment works really well for back pain. For acute symptoms no so-called alternative medicine (SCAM) at all is efficacious. For chronic pain, spinal manipulation therapy (SMT) have small effects. As SMT is neither cheap nor free of risks, excercise is much preferable.
Considering that most SCAMs are heavily promoted for low back pain (e.g. acupuncture, Alexander technique, cupping, Gua Sha, herbal medicine, homeopathy, massage, mind-body therapies, reflexology, Reiki, yoga), this verdict is sobering indeed!
I don’t know whether you noticed but everyone seems to be going on about the new wonder SCAM (so-called alternative medicine) ‘BLACK SEED OIL’ (BSO). If you go on the Internet, you’ll find all sorts of health claims for it, e.g.:
- -Reduces Inflammation
- -High in Antioxidants
- -Can Lower Cholesterol
- -Helps to Fight Cancer
- -Can Kill Off Bacteria
- -Balances Blood Sugar
- -Helps to Lower Blood Pressure
Interesting?
I am – as always – doutful. Nonetheless, I had a look at BSO to find out more.
BSO (also known as black caraway, black cumin or kalonji oil) is derived from the tiny black seeds of Nigella sativa (N. sativa) that grows in hot areas like Eastern Europe, Northern African, and Southwestern Asia, etc. The Wikipedia entry states that “despite considerable use of N. sativa in traditional medicine practices in Africa and Asia, there is insufficient high-quality clinical evidence to indicate that consuming the seeds or oil can be used to treat human diseases”.
But Wiki is often not up-to-date, and I therefore looked into Medline. To my surprise, I found research to be extraordinarily active.
Nigella sativa contains several phytochemical compounds, such as thymoquinone, p-cymene, α-thujene, longifolene, β-pinene, α-pinene, and carvacrol. They confer an antioxidant effect to the seeds, leading to a potent anti-inflammatory effect. Particularly, thymoquinone increases the levels of antioxidant enzymes that counter oxidative stress in the liver. Additionally, the essential oil in N. sativa seeds effectively inhibits intestinal parasites and shows moderate activity against some bacteria, including Bacillus subtilis and Staphylococcus aureus. Thymoquinone exhibits minimum inhibitory concentrations (MICs) of 8-16 μg/mL against methicillin-resistant Staphylococcus aureus (MRSA) and exhibits MIC 0.25 µg/mL against drug-resistant mycobacteria. Similarly, quercetin shows a MIC of 2 mg/mL against oral pathogens, such as Streptococcus mutans and Lactobacillus acidophilus. Furthermore, endophytic fungi isolated from N. sativa have demonstrated antibacterial activity. Further mechanisms involve inducing apoptosis, and inhibiting migration and invasion. N Sativa supplementation significantly decreases serum C-reactive protein, tumor necrosis factor-alpha, and malondialdehyde levels. It also improves total antioxidant capacity and superoxide dismutase levels.
But these effects do not neccessarily mean that BSO is clinically effective for any condition, particularly in view of its low bioavailability. So, what does the clinical evidence tell us? Here are just 9 of the most recent studies and reviews:
- This study aimed to investigate the possible beneficial cardioprotective effect of Nigella sativa in pediatric patients with type 1 diabetes mellitus. Sixty children and adolescents with type 1 diabetes were randomized into two groups: group I (n = 30) who received Nigella sativa seed oil 450 mg twice daily after meals for 3 months in addition to insulin, and group II (n = 30) who received insulin alone. Echocardiographic examinations were performed before and after the treatment. The lipid profile, malondialdehyde, nitric oxide, tumor necrosis factor-α, transforming growth factor-β, and troponin I were also measured before and after Nigella sativa treatment. After 3 months of Nigella sativa administration, group I had significantly lower cholesterol and low-density lipoprotein-cholesterol, malondialdehyde, nitric oxide, tumor necrosis factor-α, transforming growth factor-β, and troponin I levels compared with their pretreatment levels and compared with group II. In addition, group I had a significantly higher left ventricular E’/A’ ratio and two-dimensional left ventricular global longitudinal strain (2D-LV GLS) compared with baseline values and compared with group II after treatment. Conclusions: Nigella sativa can improve subclinical left ventricular dysfunction in pediatric patients with type 1 diabetes mellitus.
- This study evaluated the effects of Nigella sativa L. extract on glycemia among adolescents with PCOS. This secondary analysis used data from a randomized controlled trial conducted between March 2022 and March 2023. One hundred sixteen adolescent girls aged 12-18 years with PCOS were randomized into two groups. The intervention group received 1000 mg/day of Nigella sativa extract for 16 weeks, while the control group received 10 mg/day of medroxyprogesterone for 10 days per menstrual cycle over the same period. Fasting plasma glucose (FPG) and one- and two-hour post-prandial glucose levels were measured at baseline and after the intervention. 103 completed the study (50 in the Nigella sativa group and 53 in the control group). At baseline, there were no significant differences in FPG (p = 0.294), though the control group had higher one-hour (p = 0.002) and two-hour (p = 0.006) post-prandial glucose levels. Post-intervention, significant interaction effects were observed for FPG (p = 0.004) and two-hour post-prandial glucose (p = 0.023), indicating more significant reductions in the Nigella sativa group compared to the control group. Conclusions: Considering the observed effect of Nigella sativa supplementation on FPG and two-hour post-prandial glucose, it may offer a complementary approach to managing glycemia in adolescent PCOS. However, further research is warranted.
- This systematic review and meta-analysis of randomized controlled trials (RCTs) sought to evaluate the effects of Nigella sativa (N. sativa) consumption on glycemic index in adults. A systematic literature search up to December 2023 was completed in PubMed, Scopus, and Web of Science, to identify eligible RCTs. Random effects models were assessed based on the heterogeneity tests, and pooled data were determined as weighted mean differences with a 95 % confidence interval. Finally, a total of 30 studies were found to be eligible for this meta-analysis. The pooled results using random effects model indicated that N. sativa supplementation significantly reduced FBS (SMD: -1.71; 95 % CI: -2.11, -1.31, p <0.001; I2= 92.7 %, p-heterogeneity <0.001) and HA1c levels (SMD: -2.16; 95 % CI: -3.04, -1.29, p <0.001; I2= 95.7 %, p-heterogeneity <0.001) but not effect on insulin (SMD = 0.48; 95 % CI: -0.53, 1.48, P = 0.353; I2= 96.1 %, p-heterogeneity <0.001), and HOMA-IR (SMD: -0.56; 95 % CI: -1.47, 0.35, p=0.229; I2= 95.0 %, p-heterogeneity <0.001). Conclusion: the evidence supports the consumption of N. sativa to reduce FBS and HA1c levels. Additional research, featuring extended durations and robust study designs, is necessary to determine the ideal dosage and duration of N. sativa supplementation for achieving a positive impact on glycemic markers.
- In this systematic review, the objective is to assess the effects of Nigella Sativa on parameters that reflect metabolic syndromes, such as lipid profile, blood pressure, blood glucose, and anthropometry indices. Six out of 8 randomised controlled trials (n:776) demonstrated a significant improvement in lipid profile (p <0.05), 5 out of 7 trials (n:701) showed a significant reduction in glycaemic indices (p <0.05), 1 out of 5 trials (n:551) demonstrated significant improvements in blood pressure (p <0.05), and 2 out of 7 trials (n:705) showed a significant reduction in anthropometric measurements (p <0.05). Conclusion: Nigella Sativa has proved to have a significant positive effect on lipid profile and glycaemic index. The results showed in the parameters of blood pressure and anthropometric indices are less convincing, as results were inconsistent across studies. Nigella Sativa can therefore be recommended as an adjunct therapy for metabolic syndrome.
- This study was designed to investigate the effect of Nigella sativa supplementation on polycystic ovary syndrome (PCOS) symptoms and their severity in adolescents. The current randomized clinical trial was conducted on 114 adolescents with PCOS who were referred to gynecologist offices and clinics in Gonabad, Iran from March 2022 to March 2023. Participants were randomly allocated to the intervention (Nigella sativa 1000 mg/day) and control (10 mg/day medroxyprogesterone from the 14th day of the cycle for 10 nights) groups. The study duration was 16 weeks. Ovarian volume (measured by ultrasound), anthropometric and blood pressure; serum testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), hirsutism severity (Ferriman-Gallwey score) levels were evaluated before and after the study. Data from 103 participants (control group = 53, intervention group = 50) were analyzed. The mean age of participants was 17.0 (Interquartile range [IQR]:2.0). The mean difference in hirsutism score changes (p < 0.001), right (p = 0.002), and left (p = 0.010) ovarian volume, serum LH (p < 0.001) and testosterone (p = 0.001) were significantly higher in the intervention group compared to the control group. The frequency of oligomenorrhea, menometrorrhagia, and amenorrhea, were significantly reduced after the study in the intervention group compared to the control group (ps < 0.001). Conclusions: Short-term Nigella sativa supplementation may be effective in reducing ovarian volume and improving hormonal balance, and menstrual irregularities in adolescents with PCOS. Further research and long-term studies are warranted to validate the potential therapeutic effects of Nigella sativa in adolescents with PCOS.
- This study evaluates the efficacy of a novel mucoadhesive patch containing Nigella sativa 10% extract compared to triamcinolone 0.1% in alleviating symptoms and reducing lesion severity in patients with erosive-atrophic oral lichen planus. A pilot study comprising two groups, each with 10 patients, was conducted. The intervention group received mucoadhesive patches containing N. sativa 10% extract, while the control group received triamcinolone acetonide 0.1% patches. Pain and burning intensity, measured through visual analog scale, and lesion severity based on the Thongprasom scale were assessed weekly for 4 weeks. Descriptive records were kept for side effects and patient satisfaction. Pain and burning intensity decreased in both groups throughout the sessions, with the N. sativa group showing a greater reduction than the triamcinolone group. The reduction in burning intensity within each group was significant (p < .001), and there was a significant difference between groups only in the second session (p = .045). The overall difference between groups was not significant (p > .05). Lesion severity also decreased significantly in both groups (p < .001), with a significant difference between groups observed in the third session (p = .043) and overall throughout the study (p = .006). Conclusion: The use of N. sativa extract in mucoadhesive patches was as effective as corticosteroids in reducing pain, burning, and lesion severity in patients with oral lichen planus, with N. sativa showing superior results in some sessions. Notably, no significant complications were observed with N. sativa use, making it a promising treatment option for lichen planus.
- This study aimed to explore the impact of N. sativa supplementation on the lipid profile of adult participants. We searched Scopus, Web of Science, PubMed, Cochrane, and Web of Science databases until December 2022. Random effects models were used, and pooled data were determined as standardized mean differences with a 95% confidence interval. The findings of 34 studies with 2278 participants revealed that N. sativa supplementation significantly reduced total cholesterol (TC) (SMD: -1.78; 95% CI: -2.20, -1.37, p < 0.001), triglycerides (TG) (SMD: -1.2725; 95% CI: -1.67, -0.83, p < 0.001), and low-density lipoprotein cholesterol (LDL-C) (SMD: -2.45; 95% CI: -3.06, -1.85; p < 0.001) compared to control groups. However, a significant increase was found in high-density lipoprotein cholesterol (HDL-C) (SMD: 0.79; 95% CI: 0.38, 1.20, p < 0.001). Conclusion: N. sativa has improved effects on TG, LDL-C, TC, and HDL-C levels. Overall, N. sativa may be suggested as an adjuvant anti-hyperlipidemic agent.
- In this double-blind clinical trial, 70 nulliparous pregnant women referred to Hajar Hospital and Imam Ali clinics of Shahrekord and had missed abortion before the 12-week gestational age were selected and randomly divided into two interventions and control groups. The intervention group received 5 g of Nigella sativa oil alone daily for up to 3 days and the control group received a placebo. In case of nonresponse, 3 days after the last dose of medication or placebo, 800 μg of misoprostol (vaginal) were used. Data were analyzed by SPSS software. The chi-square test, Fisher’s exact test, independent t-test and paired t-test were used for analytical statistics. According to the results, 18 cases (51.4%) in the intervention group and seven cases (20%) in the control group showed complete evacuation of uterine contents which had a significant difference (p < 0.05). The frequency of vagina physical examination and type of hemorrhage did not show any significant difference between the two groups before and after the intervention. After the intervention, human chorionic gonadotropin (HCG) was significantly decreased in the intervention group but did not change in the control group (p < 0.05). The frequency of adverse events in the intervention group was three (8.6%) and in the control group was one (2.9%) which had no significant difference. Conclusion: Nigella sativa improves the outcome of missed abortion by reducing HCG and facilitating cervix dilatation and delivery of uterine contents.
- This systemaatic review evaluated the role of Nigella spp in managing allergic rhinitis (AR), a comprehensive review through systematic reviews and meta-analyses was conducted. To carry out a meta-analysis of clinical trials that used Nigella spp in treating AR based on current data. A meta-analysis of randomized controlled trials (RCTs) was performed. Various databases, including PubMed, Web of Science, Embase, Science Direct, Springer Link and the Cochrane Library, were searched until October 2023 to obtain RCTs assessing impact of Nigella spp in the control of AR. The current meta-analysis was carried out with a random-effects model. There were 8 studies enrolled, and our meta-analysis findings revealed that, relative to the control group, observation group exhibited the markedly increased total effective rate for allergic rhinitis treatment (odds ratio [OR] = 4.24, 95% confidence interval [CI] (2.57, 7.27), and p < 0.00001); three studies showed that the effect of Nigella spp for nasal symptoms treatment among patients with allergic rhinitis was superior in observation group to control group [mean difference = -2.60, 95% CI (-2.82, -2.38), p < 0.00001]; adverse effects occurred in five studies, all of which were transient, did not require medical intervention, and were not statistically significant between the two groups [OR = 1.01, 95% CI (0.59, 1.73), p = 0.98]. Conclusion: The observation group demonstrated relative safety and had an enhanced effect on allergic rhinitis treatment and total nasal symptom improvement than the control group. The inclusion of fewer studies and the lower quality of trial design might affect the stability of the results. However, the evidence-based findings that Nigella spp for allergic rhinitis treatment is more accurate should be validated in future large-scale, multicenter, and well-designed RCTs.
Yes, I know: the evidence is not perfect for any of the indications. In addition, there is a problem with low bioavailability. And I am suspicious of any SCAM that seems to be effective for an incredibly long list of conditions.
At the same time, I have to admit that, collectively, the research on BSO is impressive. As BSO has been used for centuries (as a spice etc.), serious adverse effects seem unlikely. The evidence regarding its effectiveness might not be fully convincing but, in my book, it is encouraging.
This study was aimed at investigating how Spanish media reinforce a positive image of dietary supplements in the treatment of children, potentially leading to harmful health attitudes and behaviors.
The researchers conducted a quantitative content analysis of 912 news articles published between 2015 and 2021 in Spanish media outlets discussing dietary supplements for children. They used a frequency analysis and a proportion comparison to analyze variables such as the reach of news, tone of news, mentions of health professional consultation, association with natural products, media specialization, intertextuality, and headline mentions.
The study found a 60% increase in publications discussing dietary supplements for children during the study period. The content analysis indicates that these articles predominantly present dietary supplements in a positive light, often without robust scientific evidence. Furthermore, many do not emphasize the need for medical consultation, which may contribute to unsupervised consumption of supplements, particularly among minors. This highlights the critical importance of professional guidance when considering dietary supplements for children. Additionally, the frequent emphasis on the “natural” attributes of these products raises concerns regarding consumer perceptions and potential safety risks.
The authors concluded that their study reveals a problem regarding the portrayal of dietary supplements for children in Spanish media. The overly optimistic image, lack of scientific basis, and failure to recommend medical supervision may contribute to unsupervised consumption among minors, risking their health due to misinformed decisions influenced by media portrayal.
I would add that this problem exists not just for children and not just in Spain. It has long been noted to put consumers of all ages and from all countries at risk. The authors kindly cite our own study from 2006 that concluded: “UK national newspapers frequently publish articles on CATs for cancer. Much of this information seems to be uncritical with a potential for misleading patients.”
Even several years before that, my late friend Thomas Weimayr and I published this study in the BMJ:
The media strongly influences the public’s view of medical matters.1 Thus, we sought to determine the frequency and tone of reporting on medical topics in daily newspapers in the United Kingdom and Germany. The following eight newspapers were scanned for medical articles on eight randomly chosen working days in the summer of 1999: the Times, the Independent, the Daily Telegraph, and the Guardian in the United Kingdom, and Frankfurter Allgemeine Zeitung, Süddeutsche Zeitung, Frankfurter Rundschau, and Die Welt in Germany. All articles relating to medical topics were extracted and categorised according to subject, length, and tone of article (critical, positive, or neutral).
A total of 256 newspaper articles were evaluated. The results of our analysis are summarised in the table. We identified 80 articles in the German newspapers and 176 in the British; thus, British newspapers seem to report on medical topics more than twice as often as German broadsheets. Articles in German papers are on average considerably longer and take a positive attitude more often than British ones. Drug treatment was the medical topic most frequently discussed in both countries (51 articles (64%) in German newspapers and 97 (55%) in British). Surgery was the second most commonly discussed medical topic in the UK newspapers (32 articles; 18%). In Germany professional politics was the second most commonly discussed topic (11 articles; 14%); this category included articles about the standing of the medical profession, health care, and social and economic systems—that is, issues not strictly about treating patients.
Because our particular interest is in complementary medicine, we also calculated the number of articles on this subject. We identified four articles in the German newspapers and 26 in the UK newspapers. In the United Kingdom the tone of these articles was unanimously positive (100%) whereas most (3; 75%) of the German articles on complementary medicine were critical.
This analysis is, of course, limited by its small sample size, the short observation period, and the subjectivity of some of the end points. Yet it does suggest that, compared with German newspapers, British newspapers report more frequently on medical matters and generally have a more critical attitude (table). German newspapers frequently discuss medical professional politics, a subject that is almost totally absent from newspapers in the United Kingdom.
The proportion of articles about complementary medicine seems to be considerably larger in the United Kingdom (15% v 5%), and, in contrast to articles on medical matters in general, reporting on complementary medicine in the United Kingdom is overwhelmingly positive. In view of the fact that both healthcare professionals and the general public gain their knowledge of complementary medicine predominantly from the media, these findings may be important.2,3
25 years later, the call on journalists to behave more responsibly when reporting about so-called alternative medicine (SCAM) is as loud and clear as it is neglected and ignored.
In 1993, I was appointed Professor of Complementary Medicine at the University of Exeter. After settling in, I started to wonder what a suitable initial research project would be. Someone alerted me to some funds made available by the University for small projects – if I remember corretly, the amount was less that £30 000. Apparently, the grant was to be unbeaurocratic and, as I was newly appointed and everyone was wondering what I might get up to, I decided to go for it.
I sat down and recycled an idea that I had long wanted to test by never quite has the time to realize: a simple clinical trial where patients suffering from a common, benign condition [I think I chose insomnia] would be randomized into two groups. Both groups would be treated with a mild sleeping aid [I think I chose valarian]. The only difference between the two groups was that
- the experimental group would get an empathetic consultation, while
- the control group would get a normal one.
Thus the aim of the trial was to see whether empathy would impact on the outcome. My plan was that the prescribing clinician would be trained such that he/she could behave either normally or empathetically at will.
After I had submitted the proposal it was ‘peer reviewed’ by University staff. As it happened, my reviewer was John Tooke – he later became professor and medical director of the medical school at Exeter and later again moved to London and became the ‘Head of the School of Life & Medical Sciences’ at UCL but, at the time, he was just a doctor in the local hospital (if you are interested, there is more about Tooke in my memoir). Tooke’s assessment of my proposal was, to put it mildly, not positive and, of course, I never did get the funding. His critique explained that in the English language we call it ‘sympathy’ and not ’empathy’.
So, the study outlined above never got done, and every time I hear the word ’empathy’, I am reminded of this little anecdote. Like, for instance, a few days ago when I read that Elon Musk in his infinite wisdom had pronounced that: “The fundamental weakness of Western civilization is empathy”
I have to admit: this thought scares me!
The question I ask myself is this: to what extent does a neglect of emapthy contribute to the professional success of some people?
In any case, I am jolly glad that in the English language does have a word ’empathy’. I am even more profoundly glad that many people I know do have empathy. And I agree with Hannah Arendt who once wrote that “The death of human emapthy is one of the earliest and most telling signs of a culture about to fall into barbarism”
PS
sympathy = (an expression of) understanding and care for someone else’s suffering
As we all know, the FDA cannot require that dietary supplements be proven effective before they are sold. Yet, Robert F. Kennedy Jr. once said the FDA is exhibiting an “aggressive suppression” of vitamins, dietary supplements, and other substances and that he will end the federal agency’s “war on public health”.
With Kennedy now in the driver’s seat, the supplement industry expects to make bolder health claims for its products and to get the government, private insurers, and flexible spending accounts to pay for supplements, essentially putting them on an equal footing with FDA-approved pharmaceuticals.
The day Kennedy was sworn in as secretary of Health and Human Services, Trump issued a “Make America Healthy Again” agenda instructing health regulatory agencies to “ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease prevention.” Kennedy added that dietary supplements are one key to good health. Supplement makers now want programs like health savings accounts, Medicare, and even benefits from the Supplemental Nutrition Assistance Program, or SNAP, to pay for vitamins, fish oil, protein powders, herbal remedies and probiotics.
In speeches and in a pamphlet called “The MAHA Mandate,” Emord and alliance founder Robert Verkerk said Kennedy would free companies to make greater claims for their products’ alleged benefits. Emord said his group was preparing to sue the FDA to prevent it from restricting non-pharmaceutical products.
With their ‘Mandate’ Emord and Verkerk want “to shift the healthcare paradigm towards one that restores the health of the American people through a holistic and individual-centered approach that works with, rather than against, nature”.
But do they ever question whether:
- vitamins do anything at all to people who eat a normal diet?
- fish oil is effective and safe for which conditions?
- protein powders have any effects beyond eating a steak?
- herbal remedies generate more good than harm?
- probiotics work for which conditions?
The short answer is no. To me, it seems that the MAHA are as uninterested in the evidence regarding efficacy and safety (quite possible they know how flimsy it is) as they are keen on the promotion of quackery.
Constipation is characterized by persistent difficulty in defecating. It is a common disorder in the community particularly affecting the elderly and those with intellectual disabilities and neuropsychiatric disorders. It can also be caused by numerous medications including analgesic, antidepressant, antihypertensive and anticholinergic agents. It may be asymptomatic or it may produce abdominal pain/cramps, bloating, nausea and anorexia progressing to urinary incontinence and fecal impaction, or paradoxical diarrhea due to overflow.
This review demonstrated that constipation may also kill you. A wide range of mechanisms associated with constipation may result in death including:
- bowel obstruction,
- stercoral colitis with ulceration,
- perforation and peritonitis,
- respiratory compromise,
- abdominal compartment syndrome,
- venous thrombosis with pulmonary thromboembolism.
Moreover, constipation may exacerbate pre-existing diseases and treatments such as laxative and enemas may be lethal. The autopsy examination of a case with constipation and megacolon should take into account all of the pre-existing conditions, as well as the possibility of underlying disorders such as Hirschprung disease. Review of the decedent’s medical and drug history and level of supportive care will be important. Toxicological evaluations may be useful.
____________________
Constipation is defined as having fewer than three bowel movements per week or experiencing difficulty in passing stool. The condition is common and often difficult to treat. WebMD recommends diet and lifestyle changes, such as:
- Drink an extra two to four glasses of water a day, unless your doctor tells you to limit fluids for another reason.
- Try warm liquids, especially in the morning.
- Add fruits and vegetables to your diet.
- Eat prunes and bran cereal.
- Exercise most days of the week. When you move your body, the muscles in your intestines are more active, too.
- Don’t ignore the urge to poop. Listen to your body when it’s telling you it’s time to go.
- Eat foods with probiotics such as yogurt and kefir.
- Skip processed meats, fried foods, and refined carbs such as white bread, pasta, and potatoes. You can eat lean meats such as poultry and low-fat dairy products.
- Keep a food diary and make a note of any foods that constipate you.
- Adjust how you sit on the toilet. Raising your feet, leaning back, or squatting may make it easier to poop.
- Take an over-the-counter fiber supplement (Metamucil®, MiraLAX®, Citrucel® or Benefiber®). Start with a small amount at first.
- Avoid reading or using your phone or other devices while you’re trying to move your bowels.
- Drink less alcohol and caffeinated drinks, which can make you dehydrated.
- Talk to your doctor about bowel training. It can help train your body to pass stool shortly after breakfast every morning.
- Don’t rush when going to the bathroom. Give yourself time to relax, which can help your digestive muscles relax.
- Talk to your doctor about any medications that could be causing your constipation.
___________________
Because conventional options are often not as successful as hoped, many sufferers turn to so-called alternative medicine (SCAM). But is SCAM really a solution?
A recent review found that “acupuncture or electroacupuncture and herbal medicine are effective in treating
constipation, whereas findings on massage and moxibustion are inconclusive.” Our own assessment [‘Oxford Handbook…’ (2008)] of the evidence disagrees and rated as follows:
- Beneficial: Psyllium
- Likely to be beneficial: abdominal massage, biofeedback, fibre
- Unknown effectiveness: acupuncture, aloe vera, ayurvedic medicine, meditation, Padma Lax, probiotics, herbal tea.
Whichever way we turn it, constipation is a more serious condition than many of us think, and neither conventional healthcare nor SCAM are convincingly successful in helping those who suffer from it.
Hair loss is prevalent and can affect both males and females of different age groups. Despite the availability of many conventional treatment options, these might cause side effects, leading to a growing interest in natural and herbal remedies (HRs).
This review aimed to investigate the efficacy and safety of various HRs for hair loss and examine the current scientific evidence behind them. A literature search identified relevant studies published up to March 2024. The results suggested potential benefits in promoting hair growth and treating various forms of hair loss (HL). Several remedies were found to be effective in different conditions, including:
- androgenetic alopecia (AGA),
- telogen effluvium,
- alopecia areata (AA).
Various mechanisms of action (MOA) seem to be involved,
including
- 5α-reductase inhibition,
- increased microcapillary blood flow,
- antioxidant effects,
- modulation of the hair growth signaling pathways.
The authors concluded that natural and herbal remedies show promise in treating hair loss, However, many of these studies have limitations such as lack of long-term follow-up, small sample sizes, and short treatment durations. Due to this variation in the quality of evidence, further well-designed randomized trials with larger sample sizes are required to confirm the efficacy of these HRs.
The herbal remedies included in this review are:
- rosemary,
- saw palmetto,
- onion juice,
- Korean red ginseng,
- pumpkin seed oil,
- azelaic acid,
- olive oil,
- coconut oil,
- henna,
- honey,
- rice bran extract,
- Ashwagandha,
- Amla.
The authors claim that they “show promise”. Is it ‘splitting hair’ to ask: all of them? Closer inspection finds significant ‘hair in the soup’ and reveals that this statement is ‘pulled by the hair’ and based largely on wishful thinking. The truth is that evidence from rigorous clinical trials is almost totally absent.
I am tempted to say that this review is ‘hair-raising’ – alas there is not much hair left on my head to raise – even for a review as poor and misleading as this one.
It does not happen every day that the prestigeous German FRANKFURTER ALLGEMEINE ZEITUNG publishes an in-depth analysis of TCM (Traditional Chinese Medicine) and even discusses several of the themes that we, here on this blog, have often debated. Allow me, therefore, to translate a few passages from the recent FAZ article entitled “Der Fluch der alten Dinge” (The Curse of Old Things):
… TCM has countless followers in many countries. ‘TCM is a wonderful medicine that thinks ‘holistically’, that sees not just one organ but the whole person and that offers very good treatment options,’ says Dominik Irnich. He heads the German Medical Association for Acupuncture. Although there is not evidence for all indications, TCM is ‘a scientifically based option for a number of diseases, the effects of which have been proven many times over’…
Meanwhile, Beijing wants to utilise the positive image of TCM to present itself in a good light and promote exports. The current five-year plan also provides for the creation of around 20 TCM positions for epidemic prevention and control. Critics, on the other hand, see patients at risk due to insufficiently tested therapies – and medicine as a whole: many studies are hardly valid and distort the state of science…
The top leadership of the Chinese Communist Party is using the ‘old things’ to increase its global influence and utilise TCM not only in its own country, but also as an export hit. The global TCM market is estimated to be worth many billions of euros annually, but there are no reliable figures – not least because it often includes illegally traded products such as rhino horn or donkey skin, which has led to mass killings.
Officially, Beijing prosecutes illegal trade and promotes science-based medicine, but the interests are intertwined. Even under Mao, traditional methods were used in China as a favourable alternative to imported medicines, and Beijing is currently increasingly allowing them to be reimbursed. At the same time, China’s leadership is trying to anchor TCM products in healthcare worldwide, for example as part of a ‘health Silk Road’ in Africa. During the Covid-19 pandemic, the state not only used TCM products en masse in its own country, Chinese foreign representatives also distributed them to Chinese people in Europe. This included a product based on gypsum, apricot kernels and plant parts called Lianhua Qingwen. According to a report published by the consulate in Düsseldorf, this was distributed even though the sale of medicines outside of pharmacies is generally punishable by law.
Beijing has also been successful at the level of the World Health Organisation (WHO), which promotes traditional medicine from China. ‘This was part of the interests and election programme of former Chinese Director-General Margaret Chan,’ says WHO consultant Ilona Kickbusch. The WHO drew up standards for acupuncture training, including knowledge of the ‘function and interactive relationship of qi, blood, essence and fluid’, as the document states.
In 2019, the WHO member states decided to add a chapter on ‘traditional medicine’ to the standard classification of diseases. Doctors can now code alleged patterns of ‘qi stagnation’ or yang deficiency of the liver. The umbrella organisation of European science academies EASAC criticised this as a ‘significant problem’: doctors and patients could be misled and pressure could be exerted on healthcare providers to reimburse unscientific approaches. Nature magazine found: ‘The WHO’s association with drugs that have not been properly tested and could even be harmful is unacceptable for the organisation that has the greatest responsibility and power to protect human health.’ …
In general, the study situation on therapies that are categorised as TCM is extremely confusing. The evidence is ‘terrible’, says the physician Edzard Ernst, who has analysed such procedures. ‘There are thousands of studies – that’s part of the problem.’ Many studies come from China, but it is known that a large proportion are invalid or falsified. It is almost impossible to report critically on TCM there: according to media reports, a doctor was imprisoned for three months in 2018 after criticising a TCM remedy. In 2020, Beijing even considered banning criticism of TCM, but refrained from doing so after an outcry.
According to Ernst, the quality of even some of the meta-analyses from the respected Cochrane Collaboration is ‘hair-raising’ due to the inclusion of unreliable studies, and according to some Chinese researchers, acupuncture works for everything. Prof. Unschuld said at an event a year ago that he was asked in China not to address critical issues.
‘In a country without the open and free critical culture that is common in democratic countries, the control mechanisms are missing,’ says Jutta Hübner, Professor of Integrative Oncology at Jena University Hospital. The inclusion of Chinese studies, which almost never report negative results, can create a much too positive image of TCM at a formally very high level of scientific evidence, without the results being reliable…
Instead of allowing the research to be carried out by proponents, it would be desirable ‘if the universities in particular remembered that they have the duty to be critical,’ says physician Edzard Ernst. However, some university clinics prefer to advertise TCM methods in order to attract patients and money.
- slightly improved BPH symptoms measured with the International Prostate Symptom Score (IPSS) at follow-ups of up to 12 months (standardized mean difference [SMD] -2.06, 95% confidence intervals [CI] [-3.22, -0.91] very low certainty evidence, 6 studies),
- reduced prostate specific antigen (PSA) levels (mean difference [MD] -0.37 ng/ml, 95% CI [-0.50, -0.23] low certainty evidence, 4 studies)
- had little effect on quality of life (SMD -0.59, 95% CI [-1.57, 0.38] very low certainty evidence, 2 studies).
The main reasons for downgrading the evidence were study limitations (studies judged to be at an unclear or high risk of bias), inconsistency (considerable heterogeneity), and imprecision (small effect sizes and wide confidence intervals around effect estimates). All six studies reported no adverse-effects.
- positive but not truly honest about the limitations of the evidence (we see this regularly on my blog);
- or they are sufficiently critical and thus arrive, like our above paper, at unequivocal (and sadly not very helpul) conclusions.
As this is so, we see very few SRs that conclude “there is sound evidence to show that SCAM xy is effective (or ineffective)”. Yet, such verdicts would be what consumers need.
The cause of the first scenario (false-positive conclusion) is that reviewers are biased and want to demonstrate that SCAM works. Such authors behave unethically, in my view, because they mislead the public and might cause untold harm. The cause of the second scenario (unequivocal conclusion) is the poor quality of the primary studies. This phenomenon too is mostly due to over-enthusiastic researchers who want to prove their SCAM instead of testing it. Conducting a clinical trial is far from easy or cheap. It is beyond me, why so many SCAM trialists do not try their best to do it well!
If you think of it, the most likely reason is that they are not really interested in finding the truth but mainly want to promote their agenda. If you don’t believe me, have a look at my ALTERNATIVE MEDICINE HALL OF FAME and the amazing men and women in it.
It is time, I think, that SCAM researcher learn the most basic principle of their profession: science is not a game where you set out to confirm what you believe. Science works by
- formulating a hypothesis,
- doing your very best to prove your hypothesis wrong,
- only if it cannot be proven wrong, assuming that it probably is correct.
To put it bluntly: investigators who use science to prove their point are not scientists but pseudo-scientists, and sadly SCAM has more than its fair share of such charlatans (drunken men using a lamp-post for support rather than enlightenment!). To put it even more bluntly: to prevent serious harm – because that sort of thing does a lot of real harm! – researchers who repeatedly show themselves to be incapable of doing unbiased science (again, see my ALTERNATIVE MEDICINE HALL OF FAME), should be banned from doing research.
Today is World Cancer Day. It is an international day observed every 4 February to raise awareness about cancer, encourage its prevention, and mobilise action to address the global cancer epidemic. Cancer and so-called alternative medicine (SCAM) are closely linked, for instance, through the fact that large proportions of desperate cancer patients use SCAM, many in the hope to cure their disease. I have therefore often tried to instill some rational thought into the debate by discussing the emerging, largely negative evidence on SCAM for cancer. Here are just a few recent examples:
- Homeopathy as a therapy for cancer? A new review from India
- Geopathic stress allegedly can cause health issues such as arthritis, multiple sclerosis and cancer – BUT, PLEASE, DON’T BELIEVE SUCH NONSENSE!
- Homeopathic Cancer Therapy? No, no and no!
- Medicinal Mushrooms for Cancer?
- Bioenergy therapies for cancer: implausible, ineffective, and an unethical waste of money
- Camel urine as a treatment for cancer patients?
- Homeopathy for cancer? Unsurprisingly, the evidence is not positive.
- When an undercover journalist tests alternative cancer healers
To mark the day, I had a look at what people post on ‘X’ about SCAM and cancer cure. Here are some of the more amazing assumptions, claims and comments that I found (warts and all):
- The Princess of Wales, Kate Middleton has been diagnosed with Cancer – there is a high probability she has Turbo Cancer, caused by COVID-19 mRNA Vaccines she took in 2021.
- Blue butterfly pea flowers (Clitoria ternatea) is one of the best CANCER KILLING and CANCER PROTECTIVE plants available to man.
- Dandelion root far more effective in fighting cancer cells than chemotherapy.
- In Kenya, research shows 76% of cancer patient who turn to traditional medicine instead of chemotherapy have drastically improved.
- I’ve just been diagnosed w cancer and will approach it with nutrition, suppl,and cont’d exercise… other alternative therapies as well. Been an RN for decades and have witnessed the horrors and pitfalls of modern medicine. Must b your own best advocate.
- I had a niece, a cousin and a friend die same week of the big C. was an eye-opener for me cause chemo did not help them at all….so looked at the alternative medicine….down in Mexico. but it was too late. cancer spread like wildfire.
- I pray to God that no one has to suffer through cancer but I agree with you 1000% alternative medicine as a matter fact we already know that there are three that can cure cancer. I ivermectin is one and I can’t remember the other two.
- Cancer has been proven to be eliminated with alternative medicine you denounce without a single study. I’m starting to think you hate the American people.
- Next time you or your loved one gets cancer, use “alternative medicine“.
- Most Doctors use drugs for treatment of symptoms because that’s how they are trained. No nutrition or alternative medicine is taught or encouraged. In cancer treat Drs are required to only recommend chemo because they could lose their license for alternative nedicine referrals.
- Spiritual causes of illness, including cancer, are often explored within alternative approaches to healing and holistic philosophies. Although traditional medicine does not recognize spiritual causes, many spiritual traditions and energetic practices.
- I pray that you look to alternative medicine, don’t listen to the current medical model as it is designed to keep people sick, western medicine does not heal. Chinese medicine does like others around the world. A primary cause of cancer is parasites. Western medicine doesn’t look.
- Chemotherapy is brutal, attacking both cancer and healthy cells. Alternative solutions do exist, but mainstream medicine often won’t offer them. Take control of your research, explore your options, and question everything.
- I cured my cancer symptoms using alternative medicine, including Ayurveda. Not drugs.
- I’m a double cancer survivor and I was in a clinical trial testing chemo in 2013-2014. Chemo is poison and big pharma. Alternative medicine is better. Changed must be made. I love that PresidentTtump has done this. And I can’t wait for RFKJr to lead HHS.
- Cancer kills you if you follow the advice of the medical establishment. There are many alternative cures for cancer and even more ways to prevent it in the first place. Do some research into naturopathic medicine if you truly want to be healthy.
- Maybe Trump should redirect that 500 billion to alternative medicine/supplement/ivermectin research that will eradicate cancer. And what is causing cancer. Don’t need a mRNA cancer vaccine. We already have the tools to stop cancer.
- Please get checked for parasites which is what cancer is. Try alternative medicine and see how that works – I bet it does.
- I have a friend who cured her own breast cancer with alternative methods. There are cures out there. Mainstream medicine just won’t recognize them.
- Everything is fake in medical field nowadays. Not only petition but also pathogen hypothesis medical academic papers about virus, cancer etc.. We need to build an alternative medicine field ASAP.
- …
- …
[I could have gone on almost for ever]
I had not expected to find much wisdom on ‘X’, but what I did find truly horrified me. For every sensible Tweet, there seem to be 10 imbecillic and dangerous ones. Imaging a desperate cancer patient reads these lies, misleading claims, nonsensical statements and conspiracy theories!
To set the record straight, let me state these two simple facts:
There is no SCAM that would change the natural history of any form of cancer.
What is more, there never ill be one! As soon as a treatment might look promising as a cancer cure, it will be investigated by mainstream scientists and – if it turns out to be helpful – integrated into conventional oncology. In other words, it will become evidence-based medicine.
You don’t believe me without evidence?
Ok, then please read my book on the subject.
PS
And yes, there are some SCAMs that might have a role in improving QoL, but that’s a different topic.
