"Alternative" Therapies

[gav]

Hi Soft Dough,

You stated earlier that the majority of alternative medicines only work due to the placebo affect. You also asked what clinically proven natural medicines would be prescribed for high cholesterol. I did not know, so I endeavoured to find out...

Policosanol - Canetti M, Moreira M, Mas R, et al. A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res 1995;15:159-65.

Artichoke - Pittler MH, Thompson CO, Ernst E. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database Syst Rev 2002;3:CD003335

Niacin (Vitamin B3) - McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705.

Blonde Psyllium - Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 2000;71:472-9.

 

[Julia]

Hi Soft Dough,

You stated earlier that the majority of alternative medicines only work due to the placebo affect. You also asked what clinically proven natural medicines would be prescribed for high cholesterol. I did not know, so I endeavoured to find out...

Policosanol - Canetti M, Moreira M, Mas R, et al. A two-year study on the efficacy and tolerability of policosanol in patients with type II hyperlipoproteinaemia. Int J Clin Pharmacol Res 1995;15:159-65.

Artichoke - Pittler MH, Thompson CO, Ernst E. Artichoke leaf extract for treating hypercholesterolaemia. Cochrane Database Syst Rev 2002;3:CD003335

Niacin (Vitamin B3) - McKenney J. New perspectives on the use of niacin in the treatment of lipid disorders. Arch Intern Med 2004;164:697-705.

Blonde Psyllium - Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr 2000;71:472-9.

Gav, those headings of trials don't allow access to them, so - whilst it's appreciated that you have found them - just the headings are pretty meaningless.

For all we know they might have consisted of a non-randomised sample of six people. We don't know what controls they used, or anything about how the trials were conducted.

Perhaps you could post again with an actual link to the methodology.

 

[Julia]

Out of curiosity I googled the first trial listed.
Here is the abstract. Doesn't exactly sing the praises of the product, does it!

Background: Policosanol, commonly derived from purified sugar cane wax, has been reported to exert lipid-lowering effects. Policosanol is available in the United States as a nutritional supplement despite no US research clinical experience. This trial was designed to rigorously establish the lipid-lowering efficacy of policosanol as monotherapy and its potential additive and possibly synergistic effects when added to statin therapy.
Methods: A randomized, parallel, double-blind, double-dummy, placebo-controlled design was used. Patients with low-density lipoprotein cholesterol (LDL-C) levels from 140 to 189 mg/dL were assigned into 1 of 4 groups to receive policosanol 20 mg, atorvastatin 10 mg, combination therapy, or placebo for 12 weeks.
Results: A total of 99 patients were examined. Baseline characteristics were similar among all treatment groups. Policosanol (20 mg/d for 12 weeks) did not significantly change plasma total cholesterol, LDL-C, high-density lipoprotein cholesterol, or triglyceride levels when compared with baseline values or with values of placebo-treated patients. Atorvastatin (10 mg/d for 12 weeks) reduced total cholesterol by 27% and LDL-C by 35%. Addition of policosanol to atorvastatin failed to produce any further reduction in lipid levels above that of atorvastatin alone. Policosanol was safe and did not affect liver enzyme or creatinine phosphokinase levels.

Conclusions: Policosanol did not reduce LDL-C or total cholesterol levels either alone or in combination with atorvastatin. This observation supports the need for systematic evaluation of available products containing policosanol to determine their clinical lipid-lowering efficacy under rigorous experimental conditions. We propose that policosanol should be added to the list of nutritional supplements lacking scientific validity to support their use.

 

[Julia]

And the second study, on Artichoke leaf extract:

REVIEWER'S CONCLUSIONS: Few data from rigorous clinical trials assessing ALE for treating hypercholesterolaemia exist. Beneficial effects are reported, the evidence however is not compelling. The limited data on safety suggest only mild, transient and infrequent adverse events with the short term use of ALE. More rigorous clinical trials assessing larger patient samples over longer intervention periods are needed to establish whether ALE is an effective and safe treatment option for patients with hypercholesterolaemia.

 

[Julia]

Although a bit vague, this one seems more valid. But still little different from the standard advice that fibre in the diet will assist in controlling cholesterol.

Although psyllium therapy does not replace diet therapy for persons with high serum cholesterol concentrations, it offers an additional dietary tool. The results of this study show that psyllium can play an important role in maintaining diet-induced reductions in serum total and LDL-cholesterol concentrations. For some people, psyllium therapy may also be a safe, acceptable, and effective alternative to drug therapy. For example, if a person is trying to reduce his or her LDL-cholesterol concentration to 3.36 mmol/L through dietary modification but can achieve a reduction to only 3.62 mmol/L, the addition of psyllium to the regimen could help the person to attain his or her goal and eliminate the need for drug therapy.

In this study, dietary change and long-term use of a standard dose of psyllium (5.1 g twice daily) resulted in {approx}5% lower serum total cholesterol concentrations and 7% lower LDL-cholesterol concentrations than did dietary changes and placebo. Because every 1% reduction in serum total cholesterol concentration results in a 2–3% reduction in risk of CHD, dietary change plus psyllium therapy could potentially reduce CHD risk 10–15% more than diet therapy alone in people with hypercholesterolemia (6).

I couldn't find anything on the Niacin suggestion.

 

[gav]

Gav, those headings of trials don't allow access to them, so - whilst it's appreciated that you have found them - just the headings are pretty meaningless.

For all we know they might have consisted of a non-randomised sample of six people. We don't know what controls they used, or anything about how the trials were conducted.

Perhaps you could post again with an actual link to the methodology.

Julia, I understand the point you are making. Those references I listed are from text books, so I can't provide links. I guess it doesn't matter if there were 5,000 random subjects in a controlled environment.. They could have thrown out 5 failed tests before publishing the successful ones - just as the drug companies are currently allowed to... More regulation is required all round...

 

[Sunder]

Excuse the coarseness, but it is really starting to sound to me like the old "polishing a turd" effect now.

When you have such a poor base as alternative treatments do, you can try to polish it with selective bits of information and misinformation, but at the end of the day, it's still a methodology with a poor base. Claiming traditional medicine also has a poor base does not make your poor base any better.

If anything, this thread has made me accept that while natural products may have some therapeutic value, it confirms in my mind alternative medicine stumbles across them by accident, not by research or design, and continues to be a dangerous, haphazard risk.