Meta analysis – more research jargon I’m sorry but its not really tricky to understand.
Basically a meta analysis can be done when you have a number of studies that look at treatment of the same condition. So if you have a group of clinical trials on childhood diarrhea for example you can then conduct an analysis to see if it was effective across all the groups. This can be useful when the original groups were quite small (a common criticism of natural medicine trials).
There have been seven meta-analysis conducted of homeopathic trials of which six have shown homeopathy to be more useful than placebo. One of the older studies is on childhood diarrhea where there were three studies analysed. Basically what the meta analysis showed was that homeopathy reduced the average duration from 4.1 to 3.3 days as measured by the number of loose stools (1) . Most people when they have some form of gastro bug are happy for a reduction in the time they spend suffering.
The major homeopathic medicines used in those trials were Podophyllum, Arsenicum album, Sulphur, Chamomilla and Calcarea carbonica – which were used for 78% of cases.
So what other conditions have been shown in meta analysis to be effectively treated by homeopathy? Meta analysis have been conducted for conditions such as allergies, hay fever and upper respiratory tract infections showing homeopathy to be more effective than placebo. Most people who have used homeopathy for those conditions would happily confirm that this is the case.
How do you find out which homeopathic medicine to use to treat acute conditions? I run regular Homeopathic Workshops at my practice in St Ives so come along to a short two hour workshop on May 1 , 2014 from 10-30-12.30 if you are interested. The cost is $99 and you can book in on (02) 8084 0081. Alternatively if you aren’t local I find the book Homeopathic Self Care a great resource and the author is Reichenberg Ullman – you normally need to order it online from Amazon, but it does cover how to prescribe and up to 70 conditions with self naturopathic suggestions as well.
A recent press release by the National Health and Medical Research Council (NHMRC) stated that where there was evidence to support the use of homeopathy the trials were too small and not well designed. Its kind of damning with faint praise isn’t it?? By the way most of the headlines were a lot less favourable but I read the detail of the report.
So I decided to write about research and try and explain what is contained in the report and perhaps shed a little light on the whole process. I did try and avoid a lot of maths in this discussion but this is going to be a little longer than my usual blog as it covers a fair amount of information.
Research – hierachy and different types
First up there is a hierachy in terms of research evidence in western medicine. At the top of the research hierachy is the randomised controlled trial (RCT) , which is regarded as the gold standard of evidence. Unfortunately it takes a lot of gold to meet the gold standard and it will always be more difficult with natural medicine which can’t really patent its findings to generate the types of revenues that fund this standard of research.
How much of western medicine is based on the gold standard of RCT’s? Surprisingly a lot less than you would think. Back in the 1980’s when the Cochrane Collection was established only 10- 15% of drugs in use had been subject to this research. The rest of the time they relied on long term clinical use (kind of like a lot of natural medicine). That number has at least doubled in part due to the efforts of the Cochrane Collection which is an independent research body promoting the use of evidence based research in clinical decision making.
Before you get to the RCT however there are other forms of research which contribute to the picture , this can include case study reports, in vitro research (cells in a test tube), animal studies and cohort studies, case control studies and clinical use. A case study report is usually a report which can highlight problems with an existing treatment or a way of dealing with a case which yields some new information. Studies on cells in test tubes or animals may be done at the start of research. They are not considered as reliable as human trials as humans may react differently to animals.
Case control studies try to identify what is different between a group who have developed a condition and those who didn’t. They tend to be more cost effective but not always as reliable as a Cohort study where participants are tracked over a long period of time. Try remembering what you were eating like ten years ago? See? Its really not that easy. A Cohort study that tracks it over time can document what you were eating at different times in your life and see if the group who develop a condition were eating differently or eating more of a particular food group.
How do we design an RCT?
Whilst the RCT is the gold standard its fairly hard to find any RCT that is perfect. Typically an RCT is set up to compare one treatment against another or against placebo. You then recruit a group of people to your trial who need treatment for that condition – therefore you need to make sure they have the type of condition that will respond to your drug. To avoid complications you try to exclude people in the research who have other conditions as well. In the US students are often happy to participate in those trial’s as its a good way to earn some extra money.
So is that group of people you have just recruited to your study the same as the group of people who will ultimately take your drug? Quite often people as they get a little older are on multiple medications and they aren’t as robust as the group of students who did the trial.
So in your analysis you have just looked at the recruitment of participants and already you may not be that happy with the design.
See how easy it is to start to poke holes in the design of any trial and I haven’t even looked at numbers of participants yet?
Size of trial
To determine how many people you need in a trial you need to look at what the size of the treatment effect is and then a calculation is done (called a power calculation) to determine how many participants you need in your trial at the end to be able to see that the treatment effect is actually statistically significant.
This means a bigger group doesn’t add up to better research. It tends to mean that the smaller benefit someone gets from treatment the larger the group you need to show that it was statistically significant and didn’t just occur by random chance. When newer drugs are being trialled against older drugs you often see only small improvements in the treatment so large scale trials will be needed.
Most natural medicine trials are quite small as funding is usually restricted however there are processes in place to ensure that the size of the group is adequate to measure the treatment effect. The NHMRC was generally negative about the fact that so few of the homeopathic trials had in excess of 500 participants but neglected to explain why that may not be necessary. They completely omitted the explanation of power calculations or whether in fact these indicated that smaller studies were still reliable evidence. Sometimes its not all about size!
Natural Medicine and RCT’s
In the next blog I will look at some of the reasons why natural medicine doesn’t fit well into the world of RCT’s. I was going to cover it here but its already a bit long!! Would love to hear your thoughts so please feel free to comment.
Does everyone you know seem to have a food intolerance, allergy or asthma? Why is this so much more common than 20 years ago? I remember at school only one child having an asthma puffer but now it seems that schools need to keep a spare in the first aid kit as so many children have asthma.
One of the reasons there are so many allergies is that our “microbiome” or the bacteria in our intestine has changed a lot due to the food we are eating. Candida for example thrives on sugar and the highly refined diet that many people eat feeds it beautifully. Not only does it feed it but candida is smart and basically causes you to crave sugar as well making it harder to treat.
Some recent research on rats found that a common bacteria, E. coli , increased inflammation to gluten (the protein in wheat, barley and rye) , prompting what’s sometimes called a “leaky gut”. However a beneficial bacteria called bifidobacteria protected the intestinal barrier. Your gut bacteria may influence the immune response to gluten. How many other intolerances to food are being created by the balance of “good” and “bad” bacteria ? Certainly significant research is being directed at understanding the roles of these bacteria and how they can support your health or undermine it.
An easy way to support good gut health is to include small amounts of fermented food or drinks in your diet. Ideally you need a range of good bacteria as they all seem to have different functions.
Traditional diets always included a form of fermented food to support good gut health as well as ensuring you could extract the maximum in nutrients from your food. Have a look at keffir, kombucha and other forms of ferments with vegetables such as sauerkraut and kim chi. Sites such as Pinkfarm and Kitsa’s kitchen on facebook have lots of information about how you can easily incorporate these foods into your diet.
Stress often adds a range of physical symptoms to its load, as it if wasn’t bad enough that you were on a tight deadline now its adding its own load of odd stomach problems, headaches, muscle aches and pains and insomnia! Or you get to sleep and you can’t stay asleep waking up at 2am thinking about everything you need to do tomorrow.
Where do all these physical symptoms come from? First up think about your breathing. Typically when you are stressed you breathe from the top of your chest and you really don’t get enough oxygen where it’s needed. Blood flow to some areas is reduced by up to 75%. Muscles and joints tighten up and you start feeling cramps, plus aches and pains. Notice how when you are stressed your shoulders start to head up towards your ears. Sit up, let your shoulders soften and take a few deep breaths with your hand on your belly. Notice the difference. If you are feeling really overwhelmed try doing the breathing with one hand on your forehead it may help calm the brain as well.
Then there are all the stomach problems, you are either going to the bathroom too often or not at all. The same neurotransmitters that are in our head are also well represented in our stomachs (approx 70%). Not surprisingly when we are running on adrenaline or cortisol is staying high our stomachs start to act out.
If stomach problems are your dominant symptom and you weren’t feeling stressed before they started then there may well be other causes. Often Irritable Bowel type symptoms can be related to an earlier infection with a parasite, anything from giardia to blastocyst hominis. If you had a bad gastro type infection and have never really been the same since, its well worth getting a 3 day parasitology done to check what it really happening. Try and do it during a period when symptoms are bad as frequently these bugs are cyclical.
Managing stressors will help you with all the physical symptoms as well. Make sure your diet is well balanced, favouring small amounts of good quality protein and lots of vegetables. In addition think about adding a good quality magnesium with between 400-800mg a day, particularly if you are getting cramps and having trouble sleeping or staying asleep. Consider getting some supportive physical therapy such as massage or osteopathy to help keep your shoulders where they belong.
What does it really mean when someone says I’m fine through gritted teeth – well usually the complete opposite. My acronmyn for F I N E is F—–ed up Insecure, Neurotic and Emotional. So how do we end up getting ourselves into that state?
Well if you are female you often blame your hormones and sometimes they can be the culprit, particularly when you are pre menstrual. Other times though its not so easy to find something external to blame so we need to think about how we keep ending up feeling like this.
One of the most common causes of feeling ‘FINE’ is forgetting to say No. Maybe its because we don’t want to say no – after all nice girls don’t do that. So if it is hard for you to say no try this ” I’d really love to (help you move house, mind your three horrible children, etc..) but that weekend is really busy and I just need to check my diary and get back to you”. Then give yourself a chance to decide honestly if this is something you want to do. If it is go ahead, if not text or email them that you are really sorry but you just can’t do it that weekend.
Once you get comfortable with delaying your answer then think about getting really brave and just saying NO. Start with baby steps – say no to canteen duty by email, then get brave and tell your kids to catch the bus home from school. Start carving out a little more time for you.
Once you carve out that time start spending it working on nourishing your health – regular exercise should be your first step. Even just walking 30 minutes a day can help reduce those feelings of being FINE!!
Many of us gain weight when we are stressed simply because we grab a quick fix of carbs to keep us going. Over the course of days and weeks this often adds up quickly to quite a few kilos. We know what we should be eating, but often we are just too tired or too busy to prepare healthy meals and snacks.
But for some people stress adds another nasty surprise with elevated cortisol resulting in weight gain around the stomach. If you usually put it on around the hips something else may be contributing.
Cortisol levels should be highest in the morning and fall during the day, being lowest at midnight. Typically if your cortisol is high you may also have problems sleeping as well. Cortisol has a wide range of functions but for weight gain it stimulates the release of glucose to maintain blood sugar levels. So elevated cortisol through the day can result in increased appetite – stress is making you hungrier (and fatter).
Getting control of your cortisol levels isn’t as simple as just balancing blood sugar. You need to deal with triggers which are creating the stress for you. Sometimes it isn’t the situation itself but how you respond to it that makes you stressed. Often what is stressful for one person is not a problem for someone else.
So once you identify the trigger try and think about some other ways to handle the situation. Take five deep breaths before you even think about reacting. If you still aren’t feeling calmer then a thirty minute walk (before you scream at your boss) which will reduce your cortisol levels and help you stay calmer. A regular meditative practice, such as yoga or indeed meditation can also be a good way to get your cortisol levels under control.
Christine runs regular Stress Managment Workshop with Cheryl Alderman at Be Ultimate . Alternatively make an appointment with Christine on 8084 0081 , her practice is at Elemental Health at St Ives, Sydney
This month I am looking at the major “obstacles” as I believe until you deal with these issues it is really hard to successfully lose weight and keep it off.
Insulin Resistance is one of the most common problems blocking weight loss and unfortunately yo yo dieting usually makes it worse. So how do you deal with insulin resistance?
First up be clear this is the problem – usually insulin resistance presents with a craving for sweet and fatty foods as well as dips in energy if you haven’t eaten for a few hours. This then makes you crave sweet food to boost your blood glucose perpetuating a nasty cycle. Your body then releases insulin to store the elevated glucose (often as fat) and this frequent activation can cause the pancreas, which produces insulin, to become less effective.
Strategies for improving your insulin resistance;
1. A low carbohydrate diet with modest amounts of protein at every meal. Low carbs doesn’t mean no carbs it just means that you need to reduce carbohydrates (such as bread and pasta) to 2-3 serves a day and increase the nutrient density of your meals with 6 serves of vegetables a day. In addition try and eat some protein containing food every 4 hours to avoid dips in blood glucose – a handful of nuts or half a tub of yoghurt could be some easy options.
2. Regular exercise has consistently been shown to improve insulin sensitivity – 30 minutes of walking five times a week is enough to produce consistent benefit. Ideally you could add some resistance exercise to build muscle however just the walking will produce significant benefits and you don’t need special gear!
3. Supplements – this area is a little tricky as it can depend on your specific symptoms. A good base is a multi vitamin and good quality fish oil (1000mg). If sweet cravings are an issue then chromium is often indicated. Australian soils are old and depleted so it is hard to get it from your diet. The other key nutrient is magnesium and if you also get cramps or muscle aches and pains or sleep badly this is a good signal that you may require it – generally at least 400mg a day is a good level.
4. Stress less – find a way to start managing the stress in your life as this is a major trigger. It can lead to abdominal obesity and inflammation thereby aggravating your symptoms. Ideal ways to manage stress could include a regular yoga class, meditation tapes, journalling, walking on the beach or simply meeting with a friend.
5. Avoid CRAP foods – Carbonated , Refined, Additive laden and Processed foods. If you look on the back of the packet and you don’t know what things are, then basically its not food. Trans fats in particular are very damaging to your arteries and these substances are often used to preserve foods so best to avoid them!
Christine Pope is a nutritionist and homeopath based at Elemental health at St Ives. If you need help with managing your weight you can make an appointment on 8084 0081.