Qi Spot

I can’t wait to see how the skeptics and drug company gomers will try to suppress this.  Important to any industry is repeat business.  Hence, drug companies don’t want to cure you, they want to keep you on drugs for life.  Imagine using breathing exercises, or Qi Gong, to control diabetes!  No repeat business there, eh?

A Bastyr University study (http://www.clinicaltrials.gov/ct2/show/NCT00885846?term=NCT00885846&rank=1 and reported on http://www.wtvq.com/health/1698-qigong-for-diabetes-) has shown that Qigong use in diabetics not only lowers blood sugar, it also decreases insulin resistance and even allows them to lose weight!  (I have GOT to do this.)  Here are excerpts:

Qigong for Diabetes
Written by Kristi Runyon
Wednesday, 06 January 2010 11:45

Millions of Americans have type 2 diabetes and fluctuating sugar levels can cause major health problems. New research shows there could be a more natural way to combat the disease with ancient Chinese medicine.

Type 2 Diabetes
Diabetes is a condition which affects the body’s ability to use glucose for energy. When we eat, the body breaks down carbohydrates into glucose, a form of sugar. Normally, specialized cells in the pancreas release insulin, a hormone needed to unlock cell walls and enable the glucose to be used as fuel. In people with type 2 diabetes, the body is unable to effectively use insulin. Eventually, insulin production declines. Symptoms include: weight loss, fatigue, increased hunger and thirst, frequent urination, weight loss, vision problems and slow wound healing.

According to the Centers for Disease Control and Prevention, about 24 million Americans have diabetes. Type 2 is the most common form, accounting for 90 to 95 percent of all cases. Most people with type 2 diabetes are overweight, sedentary and have a family history of the condition.

Qigong
Qigong is a traditional Chinese practice that emphasizes posture (positions), movement, breathing techniques and mental focus. It comes from two words: Qi (meaning life force) and Gong (accomplishment or skill gained through steady practice). The theory behind Qigong is that the body can be trained to move Qi, restoring harmony and health. The techniques can be adapted for people of different abilities and health conditions.

Researchers estimate about a half-million Americans use Qigong. The techniques reportedly relax the body and improve respiration, blood flow, heart rate and digestion.

Qigong for Diabetes
Investigators at Bastyr University in Seattle recently performed a pilot study to compare the effects of Qigong against progressive resistance therapy or placebo on 32 people with type 2 diabetes. Participants assigned to the Qigong group practiced the therapy for 30 minutes at a time, two times a week for 12 weeks. In addition, once each week, they met with a certified instructor for one hour to ensure the Qigong was being done correctly. Those in the progressive resistance training group used resistance exercises for the same amount of time as those in the Qigong group. A third group (placebo) received no intervention. The researchers measured levels of blood sugar, hemoglobin A1c, insulin, fasting C-peptide, cortisol and psychological stress before, during and at the end of the study.

Here’s a significant anectode: the Qigong was quality controlled.  I remember a study at our university (before I was brought on) where ear acupuncture for weight loss was studied.  It was epic fail.  I asked later on, “did we just stick the seeds on the points or did we teach them how to use them properly?   Did we make sure someone ensured compliance?”

And not just one, not two, but several blood exams!

Researcher, Amy Putiri, M.S., says the investigators found participants in the Qigong group had significantly lower levels of fasting blood glucose, improved ability to use insulin (less insulin resistance) and reduced stress. They also lost weight. Participants in progressive resistance training had some decreases in blood glucose, but the results were inconsistent and not significant. Those in this exercise group were also more likely to gain weight.

They gained weight because they gained muscle mass.

Researchers don’t know exactly how Qigong may help lower some of the markers associated with type 2 diabetes. Putiri believes meditation, slowed movement and breathing exercises promote relaxation and reduce stress, which may improve how the body functions. In addition, she says Qigong restores the mind-body connection and the harmony between the pancreas, kidneys and liver. The findings from the Bastyr study are expected to be published in the January 2010 issue of Diabetes Care. Other small studies suggest that Qigong may also be beneficial as a complimetary therapy for patients with metabolic syndrome and elevated glucose levels.

Qigong works not by suppressing the markers, but by promoting proper body function by ensuring smooth flow of Qi.  In Chinese medicine, diabetes may result from problems with the Lungs, Kidneys, Spleen or a combination thereof.  Diabetes in TCM is seen as a problem with Body Fluids.  The Lungs and Kidneys also have an intimate relationship with Qi, the Lungs receiving Qi and the Kidneys holding Qi.  Can we presume that by ensuring proper Qi flow the Lungs and Kidneys then are freer to control Fluids, and thus, Diabetes?

It has been reported in the media that Dr. Andrew Weil, MD has been critiqued by the US Food and Drug Administration for promoting astragalus root (huang qi) in general and his “Immune Booster” formula against Swine Flu.  My opinions on Whine, er Swine Flu aside, I would like to take this opportunity to discuss Huang Qi in general and it’s use against flus in particular.

But first I have to correct the online article as it showed the astragalus stem and leaves on the page.

Leaves of the astragalus plant

Actually the Huang Qi often used is the astragalus ROOT

Astragalus root sliced and ready for use

Some excerpts from the article:

In a stern warning letter, the Food and Drug Administration and Federal Trade Commission told Weil Lifestyle LLC to stop marketing a dietary supplement called “Immune Support Formula” as a product that could “diagnose, mitigate, prevent, treat or cure the H1N1 Flu Virus in people.”

…The regulators go on to call out several other statements on the Web site about studies and scientific evidence to back the antiviral and immune-boosting power of the herb astragalus, an ingredient in Immune Support Formula.

…The NIH’s National Center for Complementary and Alternative Medicine says, “The evidence for using astragalus for any health condition is limited.” Data from small and preliminary studies suggest the herb may help the immune system fight infections, the NCCAM says, and researchers funded by the center are studying astragalus’s effects on the immune system.

…On “Larry King Live” last month, Weil recommended some “interesting strategies” to combat swine flu, including taking capsules of astragalus, which he called “perfectly safe.”

Offhand, I must say that while I admire Dr. Weil for having the courage to stand up for traditional medicine, I believe it is irresponsible to call astragalus, or any other medicinal plant “perfectly safe” and on Larry King Live yet!

I know that what he probably meant was that the amount of astragalus in his formulations were within accepted safety levels, but I believe that ordinary laymen who hear such statements as “perfectly safe” would interpret that to mean “I can take it like candy.”  Not the case.  Sure, it has a high theapeutic index, with a dosage range from 9-30 grams (relatively high) but still there is an UPPER LIMIT.

But what is Astragalus Root all about?  It’s common english name is milkvetch and it’s scientific name is Astragalus propinquus or Astragalus membranaceus according to some.  The component used in Chinese Medicine is the root and thus the herbal component is called Radix Astralagi.

It is considered one of the 50 fundamental herbs in Chinese medicine.  According to tcm-healthinfo.org it can be used:

Orally, Huang Qi/Astragalus is used for treating the common cold and upper respiratory infections; to strengthen and regulate the immune system; and to increase the production of blood cells particularly in individuals with chronic degenerative disease or in individuals with cancer undergoing chemotherapy or radiation therapy. It is also used orally for chronic nephritis and diabetes. Astragalus is also used orally as an antibacterial and antiviral; a tonic; liver protectant; anti-inflammatory; antioxidant; and as a diuretic, vasodilator, or hypotensive agent.
Topically, Huang Qi/Astragalus is used as a vasodilator and to speed healing.
In combination with Ligustrum lucidum (glossy privet), astragalus is used orally for treating breast, cervical, and lung cancers.

Let’s take a sampling of research articles about the effects of Astragalus

Shen et al.  “Differential Effects of Isoflavones, from Astragalus Membranaceus and Pueraria Thomsonii, on the Activation of PPAR-alpha, PPAR-gamma, and Adipocyte Differentiation In Vitro“  American Society for Nutrition J. Nutr. 136:899-905, April 2006

Our data suggest the potential value of isoflavones, especially biochanin A and their parent botanicals, as antidiabetic agents and for use in regulating lipid metabolism. – from abstract.

Here’s an article so good I have to quote the whole thing with some points highlighted…

Could an herbal therapy that’s been used for centuries in Chinese medicine to strengthen the immune system hold the key to an effective treatment for Acquired Immune Deficiency Syndrome, better known as AIDS? A new study by scientists at the UCLA AIDS Institute says that’s possible.

The research, set to be published in the Journal of Immunology November 15th (available on-line now at http://www.jimmunol.org/cgi/content…), concludes astragalus root contains a substance that could make it a powerful weapon in the fight against the HIV virus that causes AIDS. “This has the potential to be either added to or possibly even replace the HAART (highly active antiretroviral therapy), which is not tolerated well by some patients and is also costly,” co-author Rita Effros, a professor of pathology and laboratory medicine at the David Geffen School of Medicine at UCLA and member of the UCLA AIDS Institute, said in a press statement.

So what specifically appears to make astragalus effective in treating HIV infection? The key finding in the UCLA study shows a substance in the herbal therapy prevents or slows down the progressive shortening of a part of immune system cells called telomeres.

A telomere is a region found at the end of each cell chromosome. It does not contain genes but does contain repeated DNA sequences. As immune cells age, telomeres gets shorter and shorter when the cells divide. Eventually, the cells change, can no longer divide and their ability to fight infections is compromised. This phenomenon is dubbed replicative senescence.

For a strong immune system to function correction, a great deal of cell division has to take place. For example, when a virus invades the body, killer T-cells (known as CD8 T-lymphocytes) have receptors that recognize the invader and begin to create versions of themselves to fight the virus — through division, they create more and more of an immune system “army” to knock out the virus. In most healthy people, the telomeres in cells are long enough to allow cells to divide many times without a glitch. What’s more, T-cells can switch on an enzyme called telomerase to prevent the telomeres from shortening and to boost the ability of the cells to divide.

“The problem is that when we’re dealing with a virus that can’t be totally eliminated from the body, such as HIV, the T-cells fighting that virus can’t keep their telomerase turned on forever. They turn off, and telomeres get shorter and they enter this stage of replicative senescence,” Dr. Effros explained in a statement to the press.

Previous studies have shown that injecting the telomerase gene into T-cells can keep the telomeres from shortening so they fight HIV longer than they normally would be able to. However, this complicated and expensive gene therapy isn’t a practical way to treat the millions of people infected with the HIV virus. Good news: the current study shows that treatment with a natural substance called TAT2 found in astragalus could be a far better approach.

The reason? Not only did the researchers find that the astragalus-derived TAT2 slowed the shortening of telomeres, but it also boosted the CD8 T-lymphocytes production of soluble factors called chemokines and cytokines. And these substances have been shown in other research to shown to block the replication of the HIV virus.

“The ability to enhance telomerase activity and antiviral functions of CD8 T-lymphocytes suggests that this strategy (using TAT2 from astragalus) could be useful in treating HIV disease, as well as immunodeficiency and increased susceptibility to other viral infections associated with chronic diseases or aging,” the researchers wrote in their research paper.

According to the Memorial Sloan-Kettering Cancer Center web site (http://www.mskcc.org/mskcc/html/691…), astragalus has no reported adverse effects. It has been used in traditional Chinese medicine to support and enhance the immune system and for heart disease. Currently, the herb is widely used in China for chronic hepatitis, colds and upper respiratory infections and as an adjunctive therapy in cancer. The remarkable herbal therapy has also shown promise in animal experiments as a way to prevent dementia.

WOW.  “Possibly replace HAART”.  THIS is the Huang Qi that is they doubt has an effect against a FLU?

Some other research cited by this article from the University of Maryland Medical Center website

Chen KT, Su CH, Hsin LH, et al. Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin. 2002;23(8):757-761.

Duan P, Wang ZM. [Clinical study on effect of Astragalus in efficacy enhancing and toxicity reducing of chemotherapy in patients of malignant tumor]. Zhongguo Zhong Xi Yi Jie He Za Zhi.2002;22(7):515-517.

Hao Y, Qiu QY, Wu J. [Effect of Astragalus polysaccharides in promoting neutrophil-vascular endothelial cell adhesion and expression of related adhesive molecules]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24(5):427-430.

Hei ZQ, Zhang JJ, Lin SQ, et al. [Effects of Astragalus membranaceus injection on nitric oxide and endothelin concentration of intestinal mucosa after hemorrhage shock-reperfusion in rats]. Zhongguo Zhong Yao Za Zhi. 2004;29(5):444-447.

Kim SH, Lee SE, Oh H, et al. The radioprotective effects of bu-zhong-yi-qi-tang: a prescription of traditional Chinesemedicine astragalus. J Chin Med. 2002;30(1):127-137.

Mao SP, Cheng KL, Zhou YF. [Modulatory effect of Astragalus membranaceus on Th1/Th2 cytokine in patients with herpes simplex keratitis]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2004;24(2):121-123.

Shao BM, Xu W, Dai H, et al. A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb. Biochem Biophys Res Commun. 2004;320(4):1103-1111.

Shi FS, Yang ZG, Di GP. [Effect of Astragalus saponin on vascular endothelial cell and its function in burn patients]. Zhongguo Zhong Xi Yi Jie He Za Zhi. 2001;21(10):750-751.

So the evidence IS there.  But why the need to bash it?  Like I said, if properly used, the commonly found and inexpensive Astragalus root (btw, it’s also used in contemporary asian cooking) can REPLACE expensive drugs that are money-makers for Big Pharma… maybe.

Sources:

Hensley, Scott.  “FDA and FTC Slam Swine Flu Claims For Dr. Weil Supplement” http://www.npr.org 16 October 2009.  20 October 2009 <http://www.npr.org/blogs/health/2009/10/fda_and_ftc_slam_swine_flu_cla.html>

tcm.health-info.org “Huang Qi – Astragalus Root”. 20 October 2009 <http://tcm.health-info.org/Herbology.Materia.Medica/huangqi-properties.htm>

Shen et al.  “Differential Effects of Isoflavones, from Astragalus Membranaceus and Pueraria Thomsonii, on the Activation of PPAR-alpha, PPAR-gamma, and Adipocyte Differentiation In Vitro“  American Society for Nutrition J. Nutr. 136:899-905, April 2006

University of Maryland Medical Center. 20, October 2009 <http://www.umm.edu/altmed/articles/astragalus-000223.htm>

Baker, Sherry. NaturalNews.com 13 November 2008. 20 October 2009 <http://www.naturalnews.com/024799_HIV_astragalus_AIDS.html>

Chinese Herbs

Ah yes, the sacred double blind study – the holy grail of western medicine.  It’s proponents mean well, and if used properly, it is an essential tool in the research of the effectiveness of interventions.  Again, the key phrase, as always, is “if used properly.”  The article I have cited does not use it properly. Feel free to read the whole article, as I have linked to it below, but let me quote the conclusion as follows:

“Overall the positive evidence in favour of Chinese herbal medicines for the treatment of impaired glucose tolerance is constrained by the following factors: a lack of trials that tested the same medicine, lack of details on co-interventions, unclear methods of randomisation, poor reporting and other risks of bias,”

So here are their “constraints”:

a) a lack of trials that tested the same medicine.

b) a lack of details on co-interventions

c) unclear methods of randomisation

d) poor reporting and other risks of bias

And here are my comments, first for letters b and d.

“lack of details on co-interventions” – I agree that this needs rectification.  Co-interventions are very important in Chinese Medicine as we believe that the human being is a microcosm of the universe.  Everything affects health – diet, lifestyle, work and play level, family relationships, etc.  What I find surprising is that western medicine is using this critique on Chinese medicine, considering how much less an emphasis western medicine puts on it.

“poor reporting and other risks of bias” – Considering that western medical studies are more often than not funded by the very companies that produce the drugs, poor reporting and bias risks is not something that we M.D.s should be throwing at our “alternative” counterparts.

And back to our main program:

Western medicine is heavily influenced by Robert Koch.  His idea was basically one pathogen per disease.  A logical corollary of that is that there is a tendency to go for one solution per problem, hence the comment “lack of trials that tested the same medicine”.  I can assume this means, in plain language, “why are there so many formulas (15 cited in the article) for diabetes? Can’t we just stick to a few and test those repeatedly?”

Also, there is the all powerful “randomisation” (or randomization in American).  Why can’t we give the same drug blindly to a group of randomly selected subjects and give a placebo to the other half?  (The essence of a double-blind study, btw, is that neither drug pusher nor drug addict to be knows they’re pushing/drinking).

The answer to these questions can be summarized in the Chinese medicine axiom: “One disease, many treatments; Many diseases, one treatment” and the idea of treating the root and not the branches of the tree.

I recall explaining this concept to a colleague of mine.  After I mentioned that “western medicine doesn’t care for the causes of migraine in terms of formulating treatment,” she replied, “but western medicine does!” and then she went on to elaborate different mechanisms of action for the pain, mostly elaborating on the dilation of cranial blood vessels.

Countering, I said, “no, what we mean by causes include: is the patient’s head constantly bombarded by wind?  Is the problem emotional? Is the problem mainly dietary?”  In other words, we’re not looking for what physiologic process leads to the pain, but what environmental or lifestyle cause is triggering the physiologic process.  The treatment must then look to treat THAT cause.  Hence, “One disease, many treatments.”

Secondly, the same cause might present as different diseases.  For example, a person who gets exposed to extreme (for that person) cold can present with a headache, or a runny nose, or the flu, or might have an old arthritic pain recur.  Treatment in Chinese medicine should look at the presentation (let’s use headache) and treat the root of that headache.  Acupuncture-wise, we might use points specific for the area of pain combined with points for treating cold.  Those points for treating cold may also be used in the other presentations, such as the runny nose, the flu, etc.  Hence, “many diseases, one treatment”.

How does that apply to our Diabetes studies?

Quite simply, Chinese medicine may recognize many causes for a patient’s high blood sugar.  The Diabetes is the branch – the presentation – which may have many roots.  Treat the root, not just the branch.  This is the essence of treatment customization in Chinese medicine.

As a western doctor, I was trained mainly to look at the blood sugar level.  As a chinese doctor, I’d ask the patient about sleep, appetite, waste management, and customize treatment appropriately.  Hence, if the patient improves after just one week, I might tweak the formula or even change the formula altogether; depending on the patient’s presentation at the time.  At the same time, the physician has in mind the root cause of the disease, so one must have both a long term and short term strategy in mind.

Given that summary, I hope the reader realizes why it is so difficult to study Chinese Medicine using double blind trials – because the very nature of Chinese medicine undermines the double blind study.

Sources:

From Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006690, as quoted by Endocrinology Update.

Corderoy, Amy. “Evidence Lacking in Chinese Medicine for Diabetes” Endocrinology Update 8 October 2009. 9 October 2009 <http://www.endocrinologyupdate.com.au/article/evidence-lacking-for-chinese-medicine-in-diabetes/501343.aspx>