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Adam Rindfleisch, MPhil, MD Associate Professor, University of Wisconsin Department of Family Medicine Making Your Practice More Integrative: Some Tips and Tricks

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Objectives Help you make your practice more Integrative 1.Define what IM is 2.Suggest a tool for evaluating therapies 3.Apply this technique to several tools you can bring into your practice supplements, CAM, and beyond 4.Offer tips and resources along the way

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Integrative Medicine at UW

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UW Health Arboretum Family Medicine

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A Key Web Resource: www.fammed.wisc.edu/integrative www.fammed.wisc.edu/integrative

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Some Disclosures

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NCCIH and ACIHM National Center for Complementary and Integrative Health Originally created as Office of Alternative Med October 1991 Renamed 1998 under Clinton as NCCAM 2015: Became NCCIH https://nccih.nih.gov/ Academic Consortium for Integrative Medicine and Health www.imconsortium.org www.imconsortium.org 69 members

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What is Integrative Medicine (IM)? Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

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What is Integrative Medicine (IM)? Bottom line Based on respect for communication and individuality Evidence-based Prevention and health-focused Enlists CIM approaches

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Our Medical Culture 68,000 Codes (ICD-9 has 13,000) W6162XA = V9107XA = Struck by a duck Burn due to water skis catching on fire

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ECHO Gauging an Approach

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The ECHO Mnemonic for choosing therapies Efficacy Cost Harms Opinions 13

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ECHO: Using it with Turmeric (Curcuma longa) https://naturalmedicines-therapeuticresearch-com https://naturalmedicines-therapeuticresearch-com Efficacy Possibly effective for knee OA 500 mg BID improved functionality Costs (variable) $3 for 140 doses of powdered $35 for 120 high-end caps Harms Likely safe, up to 8 months 6 g/day caused some flatulence and stool changes NO reports of bleeding risk Opinions My patients love it about 80% of the time Good to avoid NSAID adverse effects My Conclusion: A potentially good choice 14

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Other supplements and ECHO in brief SupplementE fficacy C ost H arms O pinions L-theanine (anxiety) Less clear$$MinimalUsually Positive Red rice yeast (cholesterol) Good$$$Moderate Ashwagandha (adaptogen) Less clear$MinimalModerate Grape seed extract (venous insuff.) Good$$MinimalLess familiar to people St. Johns wort (depression) Good$$RiskyVaried Rhodiola (adaptogen) Less clear$$MinimalUsually positive 15

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Darbinyan V, et al. Clinical trial of Rhodiola rosea L. extract SHR-5 in the treatment of mild to moderate depression. Nord JPsychiatry 2007;61:343348. Rhodiola Rosea (Arctic or Golden Root)

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VETERANS HEALTH ADMINISTRATION The Microbiome

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Ridaura, V.K., et al., Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science, 2013. 341(6150)

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VETERANS HEALTH ADMINISTRATION Probiotics Improve IBS Bifidobacterium bifidum MIMBb75 Improved global symptom score, pain, distension/bloating and stool urgency. Adequate relief reported in 47% Tx group and 11% in placebo.(P