A recording of this presentation is available HERE.
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Many thanks to Dr. Gabriela Meckler, senior resident for her excellent presentation titled Integrative Medicine for the Skeptic. She covered the evidence behind some important herbs and supplements for common primary care conditions.
Dr. Meckler wanted us to feel comfortable knowing the data for some specific integrative remedies for common medical problems:
- Ginger for nausea and vomiting of pregnancy
- 500-1500 mg BID to TID
- A metanalysis of 10 RCTs found that ginger at these doses is as effective as pyridoxine and metoclopramide, and dimenhydrinate
- Most common side effect: heartburn
- There is also some evidence for ginger in migraine, dysmenorrhea, metabolic syndrome, respiratory diseases, and milk volume in the early post partum period
- Take home: consider recommending ginger either alone or as an adjunct to the traditional rx'd in pregnancy. Stop ginger when nausea starts (to prevent heartburn)
- Daily Magnesium for migraine headache prophylaxis
- 400-600mg/daily
- Safe in pregnancy
- Most common side effect: diarrhea
- PO magnesium alleviates frequency and intensity of migraine (statistically significant)
- IV magnesium has the best evidence for treatment of acute migraine, but oral has good evidence as ppx
- IV magnesium helped migraine within 15-45 minutes after initial infusion, and lasted up to 24 hours
- Additional supplements that may be useful in migraine:
- Riboflavin 400mg/day reduces headache from 4 days/month to 2 days/month (must be taken for 3-6 months),
- Butterbur (but careful, must come from trusted source to remove pyrrolizidine alkaloids)
- Ginger 400mg + ibuprofen, can also be used for dysmenorrhea (2 days prior to onset of menses)
- Side note on Licorice safety in pregnancy (licorice is often found in combination in ginger tea products)
- Licorice contains glycyrrhizin, which can act as a mineralocorticoid
- Side effects: hypertension, hypernatremia, hypokalemia, renin suppression
- Glycyrrhizin is often present in low doses in these teas, about 31mg/cup of tea.
A longitudinal cohort study in Finland found licorice consumption in pregnancy to be associated with lower intelligence and memory scores, higher HPA-axis activity, and higher incidence of ADHD in offspring. This high dose of glycyrrhizin was >= 500mg/week, So a pregnant person would have to drink upwards of two cups of tea containing licorice every day to get an adverse event
- Turmeric for osteoarthritis pain
- 100-2000mg daily for knee OA
- In a study of turmeric vs. paracetamol 500 BID vs. 650 TID x 6 weeks for OA, both arms showed decrease in pain and stiffness, increase in function =equivalent to tylenol!
- 1000mg should be paired with 6 mg piperine -- black pepper extract -- (just a tiny amount) for improved absorption
- Warming up turmeric increases absorption and likely efficacy
- Most common side effect: GI upset, diarrhea
Recommended Resources for practitioners and patients
- Institute for Functional Medicine (ifm.org)
- Nurtritionfacts.org (Dr. Michael Greger)
- IHerb.com
- Consumerlabs.org (requires subscription)
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