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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6
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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