Medications, Placebo, the Right Word: What works best?

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Have you ever considered the value of your doctor’s words and demeanor when it comes to healing disease? Have you ever entertained the possibility that they could even have as great an effect on pain-management as an actual drug? In light of new research, the way a doctor conducts himself in the presence of a patient might have a greater impact on health then anyone ever thought possible. The credit for this discovery goes out to a branch of science that was only recently legitimized: Placebo studies. 

According to WebMD, a placebo is something that appears to be a medical treatment, but actually does not contain any active ingredient meant to affect health. The placebo effect, then, is the response a person can sometimes have to a placebo, e.g. symptom improvement, or even negative side effects.

Ted Kaptchuk, the current leading researcher in Placebo studies, has seen both kinds of effects. His first clinical drug trial involved comparing acupuncture and pain pills as treatments for tendinitis and elbow pain. Some patients called in reporting negative side effects from both treatments: debilitating lethargy from the pills and painful swelling and rashes from the needles. However, many patients also reported feeling a lot better after treatment, with patients who received acupuncture experiencing the greatest relief. The catch is that none of the patients actually took real pain-reducers or had real needles stuck in them. The pills were made of cornstarch and the needles had retractable tips that were unable to pierce skin (Knox).

This is only one of several studies done by Kaptchuk that shows patients having a real physical response in the absence of active medical ingredients. In another study, Kaptchuk gathered 66 volunteer migraine patients and tracked seven migraine attacks in each (495 attacks in total). He compared four different “treatments” in his patients: Maxalt (a common migraine medicine), labeled as such; a placebo, labeled as Maxalt; and a mystery pill, labeled as being either Maxalt or a placebo, and; simply taking no pills at all. Subjects were asked to rate their pain level after each attack and accompanying treatment (Feinberg).

Subjects who took no pills reported a 15% increase in migraine pain.

Subjects who took a placebo labeled as such reported experiencing 26% less pain.

Subjects who took a Maxalt pill labeled as such reported a 40% decrease in pain.

And finally, when subjects took the “mystery pill” that could have been either Maxalt or a placebo, they also reported a 40% decrease in pain (Feinberg).

Two important conclusions we can draw from this study is that 1) even when patients know they are taking a placebo, they still produce a physical response, and 2) that a placebo has the power to reduce a migraine patient’s pain as much as a scientifically proven drug!

Mind you, this is not to say that Maxalt is a completely impotent drug. While patients taking Maxalt and Placebos both reported a 40% decrease in pain in the short term, it turns out that 2.5 hours after taking the pills, the patients taking Maxalt were four times likelier to report being pain-free than those who had taken placebos (Feinberg). 

Still, Kaptchuk’s groundbreaking work has allowed researches to conclude that a whopping half of a drug’s effect comes merely from our expectations of it! (Feinberg).

This is because, as it turns out, Placebos have the power to influence a patient’s brain using the exact same biochemical pathways as a drug. Studies have proven that placebos increase dopamine (the chemical associated with feelings of pleasure) in the brains of those suffering from both Parkinson’s and depression. In fact, besides Parkinson’s and depression, patients afflicted with sleep disorders, IBS, migraines and other pains, and menopause are all in the running to enjoy these same benefits from mere placebos ("What Is the Placebo Effect?").

But sham medicine in itself is not the only way a health care professional can manipulate a patient’s response.  

Kaptchuk is actually an acupuncturist by training, and a very successful one. While he never questioned the beneficial effects of acupuncture, he couldn’t help but notice that many of his patients started showing improvement before being touched by a single needle. He began to hypothesize that the nature of his interactions with his patients, essentially the act of caring itself, was the explanation behind their sudden improvement (Knox).

He put his hypothesis to the test in the early 2000s. In collaboration with gastroenterologists studying Irritable Bowel Syndrome, Kaptchuk was able to measure the effect of a doctor’s words and behavior on 262 adults with IBS. The patients were split into three groups. Group 1 received no treatment, group 2 received sham acupuncture from a detached and somewhat absent practitioner, and group 3 received sham acupuncture from a practitioner who offered copious amounts of attention and sympathy to the patients. Care lasted at least twenty minutes and included a form of physical comfort, like hand-holding. Kaptchuk was not surprised to see that the patients who experienced the most care fared the best (Knox).

Yet another significant study done by Kaptchuk, researchers learned that the Placebo effect actually consists of many components, including the way in which the doctor delivers the placebo. This was also the first study to show a dose-dependent response for a placebo, the placebo being, in this case, the level of care and nurture given by the practitioner during treatment (Knox). 

However, it should be pointed out that the patient’s own subjective measure of symptom improvement does not necessarily reflect a real change in health. In another of Kaptchuk’s experiments, patients suffering from Asthma were given placebo medication and then examined to see if their airways had in fact opened. Unfortunately, the placebo didn’t yield effective results. But, fascinatingly, the patients still reported symptom improvement. This serves as an important reminder that while mentality can indeed have a large affect on physical health, it is not necessarily always a reliable healing tool (Feinberg).

Given the evidence, in the end the patients who will fare the best will probably receive a harmonious balance of drug and non-drug treatment including, but not limited to, proper nurturing and words of hope from a doctor. If nothing else, Kaptchuk’s studies will hopefully encourage more and more doctors to treat their patients with care and respect. If a doctor’s attitude toward his patients can elevate the effects of sham medicine, then just imagine the potential benefits for a patient who receives a genuine treatment and exceptional care from his/her doctor!

Please call 734-726-0153 to schedule a free consultation and evaluation. At Digestive Health Ann Arbor we are known for providing professional and compassionate care. We strive to guide people towards a comprehensive and holistic healing strategy. Restoring your body to health will restore the quality of your life.

Dining with IBS: An Uncomfortable Date Indeed

For those with Irritable Bowel Syndrome (IBS), eating out can be a jungle expedition, fraught with danger, unexpected twists, and improvised back up strategies. The sufferer calls ahead to ensure there are suitable food options, ingests caustic medications with potential side effects that range from extreme constipation to heart attack, and drives a separate car that can serve as a getaway vehicle. At the restaurant they must nonchalantly nudge the dining party towards a table near a bathroom, and pounce on the seat with easiest entry and exit path. During the meal they must be vigilantly self-aware, constantly assessing their evolving physical state as the food digests. Only when the meal is over and the bill is paid can an IBS sufferer breathe a sigh of relief. A leisurely dining experience is never so simple for a person with IBS.

IBS is not restricted to digestive discomfort- it affects the way we live. The stress of IBS can lead to physical and emotional debilitation. However, we do not have to passively accept IBS or merely numb the symptoms. It is possible to combat IBS at its root and completely eradicate it from our lives. This month’s blogs will offer a simple 3-step solution for dealing with Irritable Bowel Syndrome.

Please call 734-726-0153 to schedule a free consultation and evaluation. At Digestive Health Ann Arbor we are known for providing professional and compassionate care. We strive to guide people towards a comprehensive and holistic healing strategy. Restoring your body to health will restore the quality of your life.

Gluten Sensitivity & Celiac Disease: Different Name, Same Game

Celiac disease and gluten sensitivity sound like two totally different entities. Celiac disease sounds severe while gluten sensitivity seems pretty harmless. Unfortunately, both are very serious digestive conditions and are actually much more similar than their names would indicate.

Both celiac disease and gluten sensitivity are forms of gluten intolerance. Gluten and gliadin are proteins found in wheat, barley, and rye that give flour its elasticity. Gluten and gliadin can be found in cookies, breads, pastas, anything that uses flour and certain kinds of alcohol. An allergy to gluten can lead to both gluten sensitivity and eventually celiac disease.

Gluten sensitivity and celiac disease should be thought of as progressing points on the same continuum. Both are caused by gluten intolerances, and gluten sensitivity can quickly evolve into the more severe celiac disease.

Celiac disease sufferers are defined as those who have unhealthy, deteriorated villi. When gliadin and gluten trigger an allergic reaction, it inflames the small intestine. This inflammation flattens and destroys the lining (villi) of the small intestine, impeding nutrient absorption. Celiac disease is diagnosed through a biopsy of the small intestine which shows the villous atrophy.

Below is an image of healthy villi on the left, and villi worn down due to gluten consumption on the right. The villi are responsible for capturing and transmitting nutrients to the rest of the body. Flattened and deteriorated villi are much less functional.

Though it is well-known in the medical community that gluten sensitivity is a precursor to Celiac disease, it is often misdiagnosed or not diagnosed at all. Why? Because most doctors test only for Celiac disease. Though the villi biopsy cannot measure gluten sensitivity, it is the most common test among medical professionals. Unfortunately, many people who have Gluten Sensitivity continue to suffer for years, leading to unnecessary villi damage and pain. It's time to demand preventative measures when it comes to your health.

Love Your Bacteria: Yeast Infections and IBS

Over 100 trillion bacteria are crawling inside your body right now, the majority of which reside in your digestive system. Gross? Yes. Necessary? Yes. Without it, food could not be digested, our immune system would be underdeveloped, and all of us would have IBS. It's time to start loving our bodies’ healthy bacteria.

When our healthy bacteria is wiped out by antibiotics or overridden by an excess in yeast, IBS symptoms like diarrhea, constipation, and abdominal pain can arise. Yeast invades and irritates tissue, flourishing rapidly and stamping out the growth of beneficial bacteria. Since yeast feeds on sugars, diets rich in starch, refined carbohydrates, sweets and alcohol encourage its growth. Though eliminating these foods from your diet can help, the best offense is a good defense. Make sure you prevent yeast infections by using a probiotic to replenish friendly bacteria after using antibiotics, and avoid foods that feed yeast. Get tested for potential food allergies with an ELISA blood test, and make sure to avoid using antibiotics unless absolutely necessary. It's time to tell the whole story when it comes to healthy bacteria, yeast infections and IBS.

The 30-foot miracle: Discovering our Digestive Tract

Our digestive tract is a 30-foot-long muscular tube that begins at our mouth and ends at our anus. Its 3 main functions:

1. Transform food into absorbable nourishment.

2. Fend off invading organisms and toxins.

3. Expel waste products.

Ingested food travels down the digestive tract through a process called peristalsis, a wave-like muscle contraction. During peristalsis, different enzymes, bacteria and acids critical to digestion are secreted in a highly specialized and coordinated process. When food is completely broken down it passes through the digestive tract's tissue wall and is absorbed by the body’s cells.

Around 70% of our immune system is located in our digestive tract. Its primary role is to “ok” or “attack” a food we ingest. When our immune system doesn't like something in our tube, it uses inflammation and excess mucus as ammunition. If the immune system is constantly on the offensive, these reactions can damage our digestive tract. Inflammation deteriorates the intestinal lining, resulting in something called “Leaky Gut syndrome.”

Why do some medical professionals refuse to talk about the connection between poor health and poor digestion? Clearly our bodies have evolved a highly complex digestive immune system for a reason. Denying the fact that food plays a crucial role in our overall well-being seems misguided and potentially dangerous. It is critical that we start addressing digestion as a key element in human health.

IBD/IBS Relief: What you Need to Know about Feeling Better

“IBS symptoms in one quarter of patients may be caused or exacerbated by one or more dietary components.” This is a direct quote from a journal article in PubMed published by the Division of Gastroenterology and Hepatology at the University of North Carolina School of Medicine. Do you suffer from IBD or IBS? Do you feel sick or suffer from chronic discomforts that no one has been able to diagnose? You may have an undetected food allergy.

What is an allergy?

An allergy is the immune systems response to a protein usually found in a food, such as peanuts, eggs, wheat or milk that your system perceives as a foreign body. Most food allergies are acquired, not inherited but some people develop sensitivities due to repeated exposure. Some people react when the irritant is in large quantities, while others react to pesticides and herbicides combining with the natural chemicals in food. Whatever the cause, the result is the same - a compromised immune system and general discomfort.

Though many medical professionals speak about slight diet alterations to relieve IBS symptoms, we need to investigate whether a specific food group is a direct cause. We need to ask not only how to relieve discomfort, but how to remove it entirely.

A 3-Step Solution for Digestive Health: Testing Methods for Food Allergies

Digestive Health Ann Arbor’s 3-step method offers relief from food allergy symptoms and digestive disorders. 
1. Discover what foods  are triggers. 
2. Exclude the trigger food completely from our diet. 
3. Nourish stressed systems with supplements and enzymes.
But how do we know what foods cause us trouble? If we suspect a food allergy contributes to our poor health, must we complete a tedious elimination diet for a month? Fortunately, technology has paved the way for rapid and accurate techniques. 
RAST Blood Test
Most doctors perform RAST examinations (short for radioallergosorbent test). RAST results show only acute immune reactions to food. At Ann Arbor Holistic Health we complete this test along side the ELISA blood test for more complete results.
ELISA Blood Test 
The most comprehensive digestive diagnostic tool is the ELISA blood test, which examines your body’s reaction to 96 different food allergens including gluten, dairy, eggs, soy and peanuts, and more. This simple test also allows health professionals to efficiently check for the severity of allergies, ranging from IgE (most severe), IgA (moderate) and IgG (least severe). Sound too easy? Since 70% of the immune system is located in our digestive tract, removing trigger foods can lead to radical improvements in our well-being. It is time to transform our search for solutions and it is time for solutions that will transform us.

13 Warning Signs: Detecting Food Allergies, What Everyone Must Know

As we have seen, there is a surprising amount of evidence implicating food allergies and intolerances in digestive disorders. However, 60% of people with food allergies display symptoms that are seemingly unrelated to their digestive system.

Check out these 13 Warning Signs of possible food allergies:

1. Tiredness, drowsiness, no energy.

2. Frequent headache or migraines.

3. Stomach bloating, nausea, diarrhea, constipation, flatulence (IBD/IBS).

4. Mouth Ulcers.

5. Chronic cough, bronchitis, asthma, colds and 'flu'.

6. Eczema, psoriasis, and chronic skin problems.

7. Aching joints, backache.

8. Gradual weight change.

9. Tinea or Yeast (Candida) infections.

10. Clumsiness, lack of coordination.

11. Miscarriage, infertility.

12. Hemorrhoids and Ear pain.

13. Cravings, addictions.

Read the journal article yourself, and many others: http://www.ncbi.nlm.nih.gov/pubmed/19559137