Integrative medicine

Integrative medicine, a combination of evidence-based medical practices and alternative therapies such as nutritional counseling, vitamin and mineral supplementation, herbalism, and mindfulness meditation, has gone mainstream.

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As long ago as 2007, more than a third of U.S. adults visited an integrative medicine practitioner, purchased an alternative medicine product, or took a class. This activity accounted for $33.9 billion in out-of-pocket expenditures, according to the 2007 National Health Interview Survey, conducted by the CDC’s National Center for Health Statistics.

Lynn LaffertyAt the Nova Southeastern University (NSU) Pharmacy Wellness and Integrative Practices Clinic, Fort Lauderdale, Fla., the focus is on health, wellness, and prevention, according to collaborators Goar Alvarez, PharmD, CPh, FASCP, and Lynn Lafferty, PharmD, MBA, ND, CNC.

“Integrative medicine has been a consumer-driven phenomenon for many years,” said Alvarez, assistant dean of pharmacy services at NSU's College of Pharmacy and an expert on integrative therapies such as homeopathy, herbal and vitamin supplementation, and nutrition, for more than 25 years. “In our practice, we want to be sure the individual seeking care is getting information from the best sources, such as pharmacy.”

The right supplements

Alvarez and Lafferty make sure that the patients who seek care at the clinic are taking the right supplements, after they determine that there is scientific evidence for their use and that they produce positive outcomes. Collaboration with the patients’ physicians is a priority.

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For example, supplementation with probiotics can help build the patient’s immune system, said Lafferty, a pharmacist, certified nutritional counselor, herbalist, researcher, and assistant professor, Integrative and Complementary Medicine, at NSU's College of Osteopathic Medicine.

“There are many studies that show giving a probiotic when someone is on an antibiotic reduces diarrhea. We also know that 80% of your immune system is in your gut and how important the bacteria in there are for the immune system,” she said. “So if someone’s immune system is weak, we will recommend probiotics to strengthen it.”

Supplements also can be used where there are deficiencies or nutrient depletion resulting from traditional drug therapy or disease states. “Medications will have, from time to time, a negative effect on the body function or body balance,” Lafferty said. “Our goal is to replenish that nutrient that is needed in normal biochemical processes in the body.”

Practicing collaboratively with osteopathic and allopathic physicians, Lafferty and Alvarez have offered solutions to help patients discontinue the use of proton pump inhibitors (PPIs), which should be used only short-term, as they increase risk of bone fractures and Clostridium difficile infections when used long-term. “A lot of people have been on them for six to eight years,” Lafferty said. “The doctors will agree that they don’t want to continue PPIs, but want to know what to use in their place.”

She has suggested digestive enzymes can be used to help patients with digestion, thus avoiding bloating and constipation. “The studies show that as you age, your digestive enzymes decrease, so you can’t digest your food,” Lafferty said.

Other therapies

Lafferty became interested in learning about herbal remedies and nutrition following a debilitating illness - endometriosis that had spread to her intestine. Despite treatment with bioidentical hormones and birth control pills, she became sicker and depressed. When she turned to herbal therapy and a specialized diet for three months, their effectiveness astounded her. She decided to study naturopathy to learn about the pharmacology of herbs and also studied nutrition and functional nutrition.

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“I learned that different parts of the body use different elements more. For example, the pancreas uses more zinc. You can be zinc-deficient and a type 1 diabetic. You need zinc to make insulin,” she said. “You need selenium to make the active component of thyroid T3 and vitamins C and B12 for your adrenals. You need all the vitamins, but some organ systems use them more.”

In addition to supplementation and nutritional counseling, the clinic trains patients in mindfulness meditation as adjunctive therapy for stress reduction. “There are a number of studies that show how stress adversely affects the immune system,” Lafferty said. “We try to show patients as well as medical and pharmacy students that they can handle stress and see it in a different way.”

Additional resources

For pharmacists who want to learn more about integrative medicine, Lafferty and Alvarez recommend the journals Clinical Nutrition and the Journal of Ethnopharmacology. They also suggest the book Principles and Practices of Phytotherapy: Modern Herbal Medicine, by Australian authors Kerry Bone and Simon Mills.

Nova Southeastern University also offers a Masters of Science in Nutrition, a certification program in herbal medicine, and continuing education activities. For more information, visit http://www.nova.edu/graduate/index.html.