Does caffeine help with migraine?

2nd Sep 2014

Dr Michael Tam   all articles by this author

Is it worth washing your analgesics down with a cup of coffee?

Clinical scenario

MATT, a 35-year-old lawyer, mentioned in passing that when he had a migraine, he took a couple of tablets of paracetamol with a double-shot espresso. Caffeine is also available in combination over-the-counter analgesics. What is the evidence?

Clinical question

Is paracetamol with caffeine more effective than paracetamol alone for the treatment of migraine headaches?

What does the research evidence say?

Step 1: The Cochrane Library

The Cochrane Library contains a 2012 systematic review and meta-analysis that examines the use of caffeine as an analgesic adjuvant for acute pain (including migraines) in adults^. 1

I conducted a search using TripDatabase and PubMed and could not find a better article to answer this question. The Australian-based eTG Complete guidelines does not mention caffeine at all. ²

Let’s look at the Cochrane systematic review by Ona et al (2012) in detail.

Critical appraisal

I will use the systematic reviews critical appraisal sheet from the Centre for Evidence Based Medicine. ³

What PICO question does the systematic review ask?

In adults with an acute painful condition (Participants); what is the effect of caffeine in addition to a number of oral analgesics (Intervention); compared to the same analgesic without caffeine (Comparator); on the proportion of participants achieving “at least 50% maximum pain relief” (p. 4)¹; (Outcome).

Is it clearly stated?

Yes.

Is it unlikely that important studies were missed?

No. The authors discovered the existence of at least 20 studies with more participants than those included in the review, for which the data for analysis were not obtainable (p. 6).¹ This is the most important limitation of this review.

Were the criteria used to select articles for inclusion appropriate?

Yes. The authors included studies that were double-blind trials that compared the single dose of oral analgesic plus caffeine, with the same dose of the analgesic alone. The caffeine had to be administered at the same time as the analgesic.

Were the included studies sufficiently valid for the question asked?

Probably/Unclear. The authors formally assessed the risk of bias of the included studies, and many were at risk of bias (Figure 1 p. 8).¹

Were the results similar between studies?

Yes. There is little heterogeneity in the results.

What were the results?

Four studies provided data specifically on headaches (migraine and tension-type). The addition of caffeine to the tested oral ­analgesic (paracetamol and others) was associated with a small benefit. More participants achieved at least 50% maximum pain relief after the dose:

• Relative risk (RR) = 1.1 (95% confidence interval [CI], 1.1 to 1.2)
• Number needed to treat (NNT) = 14 (95% CI, 9.5 to 25).

Eight studies provided data on paracetamol with caffeine, as compared to paracetamol alone (for all causes of acute pain). The result was a similar sized benefit (RR = 1.1, NNT = 15).

Conclusion

This paper provides evidence that caffeine used as adjuvant to oral analgesia (including paracetamol) has an impact on acute pain (including migraines). The effect size is an additional 5—10% of individuals getting good pain relief (i.e. NNT of 10—20), with a 100mg dose of caffeine. Interestingly, this is the approximate quantity of caffeine in a double-espresso, or a mug of instant coffee. ⁴ The effect appeared consistent and independent of the type of acute pain or analgesic in the systematic review. ¹

There are significant uncertainties with this review — the fact that so much of the data was unobtainable should make us cautious. Publication bias is a definite possibility. The review only provides evidence on single rather than repeated doses. Some thought should also be given to risks — it is possible to inadvertently take large doses of caffeine in the combination tablet formulations. ⁵

Nonetheless, the manner in which Matt used caffeine with paracetamol for his migraines (a one-off cup of coffee) is safe and possibly effective. I don’t think that I’ll recommend this often, but it may be an option for some patients.

References

1. Derry CJ, Derry S, Moore RA. Caffeine as an analgesic adjuvant for acute pain in adults. Cochrane Database of Systematic Reviews 2012, Issue 3. Art. No.: CD009281. DOI: 10.1002/14651858.CD009281.pub2

2. Acute migraine attack (etg42 March 2014) [website]. eTG Complete. Last updated: 2014 Mar (Retrieved: 2014 Jul 21). http://etg.tg.com.au/ip/desktop/tgc/nrg/2142.htm

3. Systematic Review: Are the results of the review valid [MS Word document]? Centre for Evidence Based Medicine, University of Oxford. Last updated: 2008 Oct 1 (Retrieved: 2014 Jul 21) http://www.cebm.net/critical-appraisal/

4. Basic Report: 14210, Coffee, brewed, espresso, restaurant-prepared [website]. National Nutrient Database for Standard Reference, release 26, Agricultural Research Service, United States Department of Agriculture. Retrieved: 2014 Jul 21. http://ndb.nal.usda.gov/ndb/foods/show/4291?fg=&qlookup=espresso

5. Paracetamol with caffeine (Panadol Extra) available over the counter from pharmacies [website]. NPS RADAR. 2010 Aug 1. http://www.nps.org.au/publications/health-professional/nps-radar/2010/august-2010/brief-item-paracetamol-with-caffeine

6. Dubben H-H, Beck-Bornholdt H-P. Systematic review of publication bias in studies on publication bias. BMJ 2005;331. DOI: 10.1136/bmj.38478.497164.F7

Tags: , Guidelines, Research, Research Update

An extra nipple rarely causes concern

16th Sep 2014

Dr Ian McColl   all articles by this author

Accessory nipples rarely cause a problem.

THEY can range from a flat discolouration through to a fully developed nipple with underlying areola and breast tissue, and occur in both males and females in about 1–2% of the population.

They originate from bilateral milk lines which in embryogenesis stretch from the axillae through the breasts to the groin and can be seen anywhere along these lines. They become more prominent in pregnancy.

They have been mistaken for melanoma and been excised. A rare case of a ductal adenocarcinoma has been reported in an accessory nipple and spreading to axillary glands. However, routine excision of accessory nipples is not recommended.

There is a rare association of genital malignancies such as seminoma of the testis. Sometimes there is a family history inherited as an autosomal dominant disorder.

www.skinconsult.com.au

Tags: , Pregnancy, Dermatology

Father's vaccination boosts infant pertussis protection

16th Sep 2014

Sunalie Silva   all articles by this author

INFANTS younger than four months whose parents have both been immunised against pertussis have the greatest chance of avoiding infection with the disease, Australian researchers say.

Protection was greatest when both parents had been vaccinated at least four weeks before their child was born, according to the investigators. 

The vaccine is funded on the National Immunisation Program in a three-dose schedule for infants at two, four and six months of age, with a booster at four and at 10–15 years.

In 2009 the government funded the vaccine free of charge to mothers, fathers, grandparents and other close relatives of infants younger than 12 months following an outbreak of infant pertussis.

But the program was discontinued in 2012 after health authorities reported that the epidemic was waning and amid new evidence emerging that maternal vaccination pre-pregnancy offered greatest protection.

However, data published this week showed that vaccinating a mother before pregnancy and vaccinating a father at least four weeks before a baby was born reduced the risk of a baby being infected with pertussis by 51%. 

The study of 217 NSW cases of infants aged four months or younger who contracted pertussis found 14% of the mothers were vaccinated before delivery, compared with 26% of 585 case-matched controls.

When both parents were immunised at least four weeks before their child’s birth, the risk of infection before four months was reduced by 51% compared to vaccinating neither parent. 

The study didn’t find any additional impact of father and grandparent vaccination after accounting for maternal vaccination status however vaccination status of older siblings was a significant risk factor for infant pertussis, highlighting the importance of kids getting their booster vaccinations on time.

Dr Helen Quinn, a research fellow at the National Centre for Immunisation Research and Surveillance where the study was conducted, said the findings provide evidence that cocooning does work and supports a push for fathers to be vaccinated, even though pre-pregnant maternal vaccination is increasingly being accepted as safe and the most effective way of preventing infant pertussis.

“Clearly the current evidence suggests you get higher efficacy with pre-pregnancy maternal vaccination but even in states where this strategy is funded our study shows that fathers should also go along and get vaccinated.”

In July this year Qld Health began funding the vaccine for women in their third trimester of pregnancy. 

WA Health said it is continuing to assess the evidence for the effectiveness of pertussis vaccination in pregnant women and “is actively considering implementing such a strategy”, while NSW Health and SA Health said they would closely monitor the Queensland program.

Pediatrics 2014; online 15 Sept

Tags: pertussis, prescribing, pregnancy, postpartum, vaccination, immunisation,Medical News, Infectious Diseases, Research

Children's Eye Health Tips

Contrary to popular belief, eye disease is not just an affliction of the elderly, it can cause vision loss in babies, children, teenagers and adults alike. The first eight years of a child’s life are critical for eye development.

If problems are not picked up during this time, damage and vision loss can be permanent. The good news is that by being aware and informed, parents can detect the signs of their children's potential vision problems. As having a family history of eye disease puts you at greater risk, it's important for parents to discuss their family eye health history with their parents and grandparents on both sides of the family and if necessary, seek an eye test for the whole family.

Here are 5 tips from The Eye Foundation for your child’s eye health:

- Be Eye Aware: Early detection and treatment is the best defence against eye disease. Symptoms to watch out for include rubbing of eyes, poor hand-eye co-ordination, lack of concentration and complaining of headaches, blurred or double vision;

- Green is Good: Provide your child with a balanced, nutritious diet rich in fruit and vegetables. Dark green leafy vegetables such as spinach and yellow vegetables such as pumpkin and carrot will help to keep your child’s eyes healthy;

- Hats Help: Make sure that your child always wears a broad-­‐brimmed hat when playing outside as this will reduce the amount of UV reaching your child’s eyes by up to half;

- Specs Appeal: When in the sun, make sure your child wears sunglasses with UV to protect their eyes from damaging UV rays;

- Balls Galore: Ensure appropriate safety procedures are covered with your child prior to playing sports that include high velocity ball action. Example sports include: tennis, soccer, basketball, squash and hockey. 

Gaps in good birth control

29th Jul 2014

Dr Deborah Bateson   all articles by this author

Contraceptive use varies by age and culture. Here is an update on women’s choices in Australia.

TWO-thirds of Australian women of reproductive age report currently using contraception.

The recently published Reproductive and Sexual Health in Australia report ¹highlights that oral contraception remains the most common method (up to 34%), followed by condoms (23%), vasectomy (11%) and tubal ligation (8.6%).

By contrast, the least used are intrauterine methods (3%) and the contraceptive implant (3%). Withdrawal is reported by 2.4% of women and the proportion reporting they had ever used emergency contraception is 27%. 

While limitations to the data are acknowledged, it is notable that Australia lags behind similar high-income countries in the uptake of long-acting reversible contraception (LARC).

This is an effective and safe choice for women across the reproductive life course, including young nulliparous women.

LARC, including contraceptive implants, intrauterine devices (IUDs) and the contraceptive injection, provides highly effective contraception and does not require user input.

Despite these proven benefits, LARC uptake remains low with barriers existing at the level of the healthcare system, providers and the community. Lack of awareness, misinformation, concerns about side effects, lack of access to trained providers and relatively high upfront costs may contribute to the low uptake.

Increasing uptake of LARC has been identified as a public health priority to decrease unintended pregnancy and abortion in many countries, including the UK and the US.

Contraceptive use by age group

Contraceptive use increases from teenage years into the 20s and declines at ages 30—35 years prior to another increase. The dip most likely reflects a desire to conceive given that the average maternal age in Australia is 30 years.

Young women, who have the highest fertility, tend to use the least effective contraceptive methods, including condoms and oral contraception, while women approaching menopause have a higher uptake of intrauterine and permanent methods.

While evidence points to insufficient awareness of age-related infertility, an underestimation of fertility may also contribute to unintended pregnancy in women in their 40s. LARC will likely replace permanent methods for this group in the future.

Dual protection

Condoms are highly effective at preventing STIs but have a high failure rate in preventing unintended pregnancy. Promoting dual use of condoms and other effective methods of contraception is important for women of all ages who are at risk of contracting an STI. 

Emergency contraception

Despite increased accessibility to the emergency contraception pill (ECP), there has not been a reduction in unintended pregnancy or abortion rates.

This failure may be attributable to lack of knowledge that ECP is available without a prescription and that its effectiveness extends beyond 24 hours to up to 96  hours after unprotected intercourse.

Improved access to the copper IUD, which provides highly effective post-coital contraception and can be continued in the long term, is likely to have an impact on reproductive health outcomes.

Contraceptive use in Aboriginal communities

Contraceptive use among Aboriginal women is lower than among non-Aboriginal women (64% vs 71% ), with higher rates of tubal ligation (14% vs 4.1%) and lower uptake of oral contraception (23% vs 35%).

Both the implant and injection are used more commonly by Aboriginal women (7% and 8% respectively) than the national average (less than 2% for both methods). 

Lack of access to culturally sensitive services, transport and affordability as well as a positive attitude to pregnancy at a young age have been identified as factors limiting contraceptive uptake. 

Contraceptive use among women from non-English speaking backgrounds

Contraceptive use among this group of women is much lower than among women from Australia or other English-speaking countries (50% vs 71%), which is likely to be related to sociocultural factors in relation to family size as well as issues of access to culturally and linguistically appropriate information and services, and affordability.

Practice Points

• Australia has relatively low LARC uptake despite proven advantages of it.
• Dual protection against unintended pregnancy and STIs can be achieved through the use of condoms and an effective contraceptive method.
• Knowledge that emergency contraception can be obtained without a doctor’s visit and is effective up to 96 hours after unprotected intercourse remains low.
• Older women need evidence-based information, both in relation to declining fertility and the chance of a successful pregnancy through ART, and the need for contraception to prevent unintended pregnancy. 
• The lower uptake of contraception by Aboriginal women and by women from non-English speaking countries is likely to be related to sociocultural factors, access barriers and affordability.

References

1. Family Planning NSW. Reproductive and sexual health in Australia. Ashfield, Sydney: 2013; http://www.fpnsw.org.au/688423_21_13559012.html

Tags: , Pregnancy, Sexual Health, Womens Health, Research

Poor diet in kids linked to depression

15th Sep 2014

Clare Pain   all articles by this author

The Deakin University review found four out of five studies showed a significant relationship between an unhealthy eating pattern (such as a Western diet, or a snack-dominated diet) and worse scores on questionnaires examining depression and anxiety. CHILDREN and adolescents with unhealthy eating patterns are more likely to suffer from depression and anxiety, a systematic review of 12 epidemiological studies has found.

However, it was less clear that healthy food patterns were linked with better mental health, the authors said.
For those studies that calculated a dietary quality score, rather than looking at a dietary pattern, a “consistent trend” was found, with children eating nutrient-rich “high quality” diets exhibiting less anxiety and depressive illness.

The review included results from nearly 83,000 children and adolescents, with studies from seven countries, including Australia, China and the US.

This is the first such review in children and adolescents, said the authors. Studies on adults had indicated that better-quality diet was associated with better health outcomes, they noted.

However, the review in children and adolescents had revealed the paucity of data available, they remarked. Because of this, the evidence for the associations was limited, and more research using longitudinal designs was needed.

The majority of the studies were cross-sectional, with only three prospective studies included, the authors said. The findings of the prospective studies were conflicting, they added.

It was not possible to rule out reverse causation, with depressed and anxious children possibly adopting unhealthy diets as “a form of self-medication”, they said.

On the other hand, there was biological plausibility in diets deficient in nutrients being linked to poor mental health.

Other research had shown dietary intake of folate, zinc and magnesium to be inversely associated with depressive disorders, they said, while dietary long-chain omega-3 fatty acids were linked with a reduction in anxiety disorders.

Am J Pub Health 2014; in press

Tags: diet, mental health, children, adolescents, systematic review, Research, MedicalNews

Migraine link to Parkinson’s

12th Sep 2014

Rada Rouse   all articles by this author

PEOPLE who experience migraine with aura have more than twice the risk of developing Parkinson’s disease in later life, according to findings from a large population-based study.

Given that previous studies have associated movement disorders with individuals who suffer from migraine, researchers involved with a large cohort study in Iceland examined the association in participants over 25 years.

Among 5620 people aged 33–65 at baseline, about 1000 had headaches, 430 had migraine with aura and 238 had migraine with no aura.

Parkinsonian symptoms were more common in participants with mid-life headache compared to those with no headache, with participants experiencing migraine with aura having more than three times the likelihood of symptoms. 

A total 1.2% of participants self-reported a diagnosis of Parkinson’s disease. 

The rate was highest among people with migraine with aura (2.4% compared to 1.1% among those with no headaches), the study showed.

The researchers, from the US and Iceland and funded in part by the US National Institutes of Health, found people with a history of headache were also more likely to develop restless legs syndrome.

The researchers said it was possible that there was a shared cerebral vulnerability between patients with migraine and those with movement disorder.

“Dopaminergic dysfunction, common to both parkinsonism and [restless legs syndrome], has been hypothesised as a causal factor in migraine pathogenesis for many years,” the authors wrote.

Symptoms of migraine such as excessive yawning, nausea and vomiting are thought to be related to dopamine receptor stimulation, they said.

Neurology 2014; in press

Tags: migraine, aura, neurology, parkinsonism, Research, Medical News

Sex position research may reduce back pain

12th Sep 2014

Sunalie Silva   all articles by this author

A STUDY using motion capture technology provides new information on sexual positions that may exacerbate back pain in some men.

The findings could help men with lower back pain (LBP) to avoid the triggers that cause pain during sex which can eventually lead to less intimacy with partners.

Researchers from the University of Waterloo, Ontario, said a lack of evidence-based guidelines on how to avoid triggering back pain during sex prompted the research.

Ten healthy male and female couples who had been in their relationship for four years or more were recruited for the study and filmed using an electromagnetic motion capture system while they had sex. 

The researchers were in a separate booth where they could hear, but not see, the participants.

Couples were randomised to one of five different coitus positions – missionary, sidelying and two variants of quadruped (rear-entry, in which the female is in the quadruped position and the male is kneeling behind her). 

Interestingly, the researchers found that the sidelying or ‘spooning’ position – the position most commonly recommended for all people with LBP – actually produced the greatest strain on the male partner's spine if he was flexion-intolerant.

For men with that particular back pain trigger, the study suggested that the quadruped position was far less likely to aggravate the back problem.

In general, the researchers found that the person on top – whether male or female – was most responsible for motion.

For men who are motion intolerant, all positions included in the study were found to aggravate back pain. Researchers said these patients should be advised to try coital movements that were more hip-dominant rather than spine-dominant.

This technique may also be beneficial for the flexion – and extension-intolerant patient, but the effectiveness of this movement pattern intervention will require further investigation, they said.

The study also found that even a seemingly subtle change in posture – for example, the male supporting his upper body with his elbows during different variations of the missionary position – altered the spine movement profile significantly and was among the more spine-conserving coital positions.

However, supporting the upper body with the hands while in the missionary position was among the least spine conserving for flexion-intolerant patients.

Even a slight adjustment in the female partner's posture – for example, the female supporting her upper body with her elbows or her hands during different variations of the quadruped position affected the male spine movement profile, the authors said, which might suggest that the partner may be an integral factor in the intervention.

The researchers said they hoped that their data would help doctors to provide specific recommendations to the male LBP patient, including specific coital positions and movement strategies, to avoid LBP triggers during sex.

Spine 2014; online 15 Sept

Tags: pain, lower back pain, sexual health medical news., Guidelines, Research

针刺手法的精妙－－－“飞经走气”

近来临证，常常能体会针下气穴传导的精妙。经气的感觉可以从一穴，导引经气到另一处。因此，针刺手法帮助得气催气和守气，是能够帮助并达到“明乎若见苍天”的美妙感觉。

小记一下，与各位针灸同道共勉。

Healthy eyes tips

http://www.nei.nih.gov/healthyeyes/eyehealthtips.asp

Your eyes are an important part of your health. There are many things you can do to keep them healthy and make sure you are seeing your best. Follow these simple steps for maintaining healthy eyes well into your golden years.

Have a comprehensive dilated eye exam. You might think your vision is fine or that your eyes are healthy, but visiting your eye care professional for a comprehensive dilated eye exam is the only way to really be sure. When it comes to common vision problems, some people don抰 realize they could see better with glasses or contact lenses. In addition, many common eye diseases such as glaucoma, diabetic eye disease and age-related macular degeneration often have no warning signs. A dilated eye exam is the only way to detect these diseases in their early stages.

During a comprehensive dilated eye exam, your eye care professional places drops in your eyes to dilate, or widen, the pupil to allow more light to enter the eye the same way an open door lets more light into a dark room. This enables your eye care professional to get a good look at the back of the eyes and examine them for any signs of damage or disease. Your eye care professional is the only one who can determine if your eyes are healthy and if you抮e seeing your best.

Know your family抯 eye health history. Talk to your family members about their eye health history. It抯 important to know if anyone has been diagnosed with a disease or condition since many are hereditary. This will help to determine if you are at higher risk for developing an eye disease or condition.

Eat right to protect your sight. You抳e heard carrots are good for your eyes. But eating a diet rich in fruits and vegetables, particularly dark leafy greens such as spinach, kale, or collard greens is important for keeping your eyes healthy, too.ⁱ Research has also shown there are eye health benefits from eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut.

Maintain a healthy weight. Being overweight or obese increases your risk of developing diabetes and other systemic conditions, which can lead to vision loss, such as diabetic eye disease or glaucoma. If you are having trouble maintaining a healthy weight, talk to your doctor.

Wear protective eyewear. Wear protective eyewear when playing sports or doing activities around the home. Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Most protective eyewear lenses are made of polycarbonate, which is 10 times stronger than other plastics. Many eye care providers sell protective eyewear, as do some sporting goods stores.

Quit smoking or never start. Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.^ii, iii

Be cool and wear your shades. Sunglasses are a great fashion accessory, but their most important job is to protect your eyes from the sun抯 ultraviolet rays. When purchasing sunglasses, look for ones that block out 99 to 100 percent of both UV-A and UV-B radiation.

Give your eyes a rest. If you spend a lot of time at the computer or focusing on any one thing, you sometimes forget to blink and your eyes can get fatigued. Try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds. This can help reduce eyestrain.

Clean your hands and your contact lenses梡roperly. To avoid the risk of infection, always wash your hands thoroughly before putting in or taking out your contact lenses. Make sure to disinfect contact lenses as instructed and replace them as appropriate.

Practice workplace eye safety. Employers are required to provide a safe work environment. When protective eyewear is required as a part of your job, make a habit of wearing the appropriate type at all times and encourage your coworkers to do the same.

Treating Female Infertility with Acupuncture

by Aina Zhang, L. Ac. MD 

Fall 2006

In recent years acupuncture has been increasingly used as an alternative and complementary treatment to Assisted Reproductive Technology (ART). Although there are only a few clinical studies published outside China to support this ancient therapy in the treatment of female infertility, reports from patients who have tried it are very favourable.

Reported benefits from published clinical studies

According to recently published clinical studies, acupuncture can:

• increase the success rate of in vitro fertilization (IVF) by 42%, with pre & post transfer acupuncture

• relieve stress related to infertility and its treatment

• improve the production and quality of ova

• normalize the hypothalamic-pituitary-ovarian axis and menstrual cycle ³

• reduce the risk of miscarriage and ectopic pregnancy

• provide an alternative treatment for patients who are intolerant, ineligible, contraindicated or simply cannot afford conventional infertility treatment ³

Observed benefits from my clinical practice

There are many additional benefits that I have observed during my twenty years of practice:

• It is an effective treatment for unexplained infertility.

• It has many desirable effects, such as a regulated menstrual cycle, reduced premenstrual syndromes (PMS), relieved physical and emotional stresses associated with infertility and subsequent treatment, and improved overall health.

• It has no short-term or long-term side effects.

• It offers new hope for patients who are unable to conceive with the help of ART alone.

• It is relatively inexpensive and is often covered by private insurance.

Pathology of female infertility in traditional Chinese medicine

As you can imagine, the pathology of female infertility in Traditional Chinese Medicine (TCM) can be very complex. The terms used in TCM, such as Kidney, Liver and Blood, have different meanings from those of Western medicine, and are capitalized here to show that the meaning isn’t the same. They are widely used for lack of better translations. If you’d like to learn more about TCM and infertility, refer to the three books recommended at the end of this article.

According to a study published in the Journal of Traditional Chinese Medicine, liver Qi (vital energy) Stagnation and Kidney Deficiencies account for 51.7% and 22.4% of female infertility patients. This conclusion is hardly surprising when you consider current lifestyles and the demography of manyfemale infertility patients. Liver Qi Stagnation is often associated with stress, a sedentary lifestyle, and a greasy diet. Kidney (whether Yin, Yang or Essence) Deficiency on the other hand is often the result of a very demanding lifestyle and the natural process of aging.

These percentages confirm my own clinical observation which is that younger infertility patients tend to have Liver Qi Stagnation and older (over 40) patients tend to have Kidney Deficiency. However, it’s important to understand that this finding is just one piece of the puzzle as almost all fertility patients show more than one pattern.

According to TCM theory, the liver plays a vital role in the reproductive system. Liver Qi moves the Blood and stagnation of Liver Qi is likely to cause Blood Stasis. In time, Blood Stasis may cause endometriosis, uterine fibroids and ovarian cysts, dysmenorrhoea, irregular menstruation and scanty menstruation, which are all known contributors to female infertility.

The kidney is the most important organ in the reproductive system, and any aspect of kidney deficiency, whether Yin, Yang or Essence Deficiency often leads to amenorrhea, anovulation, a small uterus, thin endometrium, low ova quality and premature ovarian failure.

Treatment of female infertility by traditional Chinese medicine

Like western medicine, the first step to successful treatment with TCM is proper diagnosis. Once the syndromes (the nature of illness) are diagnosed, the TCM practitioner has already formed an opinion on the pathogenic factors, pathogenesis, location, and prognosis.

In my practice, I pay more attention to the syndromes than the disease itself. This means that if I find the same disease in a number of patients and determine that they have different syndromes, I treat each case differently. For example, two female patients each have polycystic ovarian syndromes (PCOS), but one patient’s PCOS is caused by Spleen and Kidney Deficiency, and the other by Liver Qi Stagnation. In treating each of these patients, I would use very different acupuncture points and herbs.

When the diseases presented in different patients are different, but the syndromes are the same, I treat the patients similarly. For example, if I have three infertility patients, one with PCOS, another with endometriosis and a third with premature ovarian failure (POF), and I find that they are all caused by Kidney Deficiency, then I would use very similar acupuncture points and herbs to treat these three patients.

Depending on the diagnosed syndromes, the patient’s personal constitution and diagnosis from the fertility clinic, I then outline a treatment objective. To achieve the treatment objective, I often use a combination of acupuncture and Chinese herbal medicine. Sometimes, nutritional supplements and dietary regulation are also used.

Acupuncture treatment protocols to complement ART

The protocols for using acupuncture and herbal medicine to support fertility treatment are clearly explained in a book titled Acupuncture & IVF by Lifang Liang. Treatments complementary to IVF involve three phases: Pre-IVF, During IVF and Post-IVF.

In the Pre-IVF phase, weekly acupuncture is recommended for at least three months to alleviate the side effects of medical treatments, increase the response to hormonal stimulation and improve the reproductive organs and overall health.

In the 2nd phase, for the duration of the IVF treatment, weekly acupuncture plus pre & post transfer acupuncture is recommended. This will increase blood flow to the uterus and ovaries, reduce the stress response caused by IVF and calm the uterus to facilitate implantation.

In the Post-IVF phase, weekly acupuncture for up to three months is recommended for pregnant patients to reduce their risk of miscarriage and ectopic pregnancy. It is essential for patients with a history of miscarriage and ectopic pregnancy to receive treatment during this phase.

In my clinical practice, the above protocol can easily be modified to accommodate just about any ART procedure.

Success rates of acupuncture treatment

I have been asked numerous times about the success rate of acupuncture to treat female infertility. Unfortunately, I can’t offer a straight and definitive answer to this question. Presently, there aren’t many sizable, randomized and controlled clinical studies available to prove the efficacy of acupuncture in the treatment of female infertility. The absence of such studies is probably due to a lack of funding.

Currently, the majority of infertility patients come for acupuncture treatment after they have exhausted all other options, and these are often the most difficult cases to treat. Until there are randomized, controlled studies to make a fair comparison between the efficacy of acupuncture and various ART techniques, simply comparing success rates is not viable.

In addition, successful treatments also largely depend on the knowledge and experience of the individual practitioner. In Quebec, the minimum requirement is a three-year CEGEP degree, which isonly offered at Rosemont College, but Chinese herbal medicine is not part of the curriculum.  

However, as the feedback from patients who have tried acupuncture is overwhelmingly positive, there is a growing number of patients seeking acupuncture treatment early in the fertility treatment process rather than making it a solution of last resort.

From May to June 2006, I am pleased to report that there were eighteen pregnancies in my clinic. Eleven of these patients used acupuncture and herbal medicine exclusively and were treated from a few weeks to over a year. The other seven patients received ART treatment, mostly IVF, in addition to acupuncture and herbal medicine. Although these numbers are not statistically significant, they do show that acupuncture treatment certainly does not lack for success in the treatment of female infertility.

                       

Safety issues, myths and controversies

The safe practice of acupuncture and herbal medicine has been meticulously recorded over two millennia in China. Today, well-developed acupuncture treatment protocols used to complement modern ART have been tested in clinical studies to ensure their efficacy and safety.

Despite its impeccable safety record and growing popularity, many people still have difficulty understanding the power of these tiny needles in the hands of an acupuncturist, because it is:

• based on a completely unfamiliar paradigm and philosophy.

• currently unexplainable by modern science.

• built on the existence of meridians, which don’t actually correspond to any recognized body system, such as the blood, lymphatic or nerve systems.

• not intuitively believable. How can a few thin needles, placed randomly on the skin, produce significant physiological changes?

• a practice that’s only a few decades old in North America, although it has been practiced for over two thousand years in China.

• insufficiently supported by randomized, controlled studies.    

Chinese herbal medicine is also safe and even more versatile and potent than acupuncture. It is much less known and therefore much less used, even by many acupuncturists in North America.  

Some patients and fertility doctors have unfounded fears of these herbs interfering with fertility procedures and drugs. If used expertly in conjunction with acupuncture, they are truly a powerful tool in the treatment of female infertility. Personally, I have been using herbal powders in my clinic since 1995 and have never found any adverse reactions.

Three case studies

To illustrate the healing potential of acupuncture and Chinese herbal medicine, here are the histories of three recent patients of mine.

Conclusion

In recent years, acupuncture has been gaining support from patients and some fertility specialists. Many fertility clinics have started recommending acupuncture to their patients, and some US clinics now have acupuncturists on staff.

Finding an experienced acupuncturist and faithfully following the requirements - whether it’s drinking bitter herbal teas, changing your lifestyle or receiving regular acupuncture treatments - are the keys to successful fertility treatment.

About the author

Aina Zhang, L. Ac. (Quebec), MD & Master’s Degree in Gynaecology (China), owns and operates Clinique SinoCare located in Montreal. In recent years, she has devoted most of her practice to the treatment of infertility. Her professionalism and expertise have earned her respect of numerous patients and fertility specialists in Montreal. She can be reached at 514-483-6669,ainazhang@sinocare.ca or at www.sinocare.ca .

Recommended reading

• The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies by Randine Lewis. Little, Brown and Company, 2004.

• Fulfilling The Essence: the Handbook of Traditional & Contemporary Chinese Treatments for Female Infertility by Bob Flaws. Blue Poppy Press, 1999.

• Acupuncture & IVF by Lifang Liang. Blue Poppy Press, 2003.

Footnotes

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please go to www.sinocare.ca for a comprehensive list of relevant studies and articles

W. E. Paulus and M. Zhang, et al., “Influence of acupuncture on the pregnancy rate in patients who undergo ART,” Fertility and Sterility, vol. 77, no. 4 (Apr. 2002).

R. Chang, et al., “Role of acupuncture in the treatment of female infertility,” Fertility and Sterility, vol. 78, no. 6 (Dec. 2002).

X. Min, et al., “Kidney-reinforcing herbal therapy increases pregnancy rate in older infertility women,” Journal of Guangzhou University of Traditional Chinese Medicine(July 2004).

P. Magarelli, “Acupuncture in IVF linked to lower miscarriage and ectopic rates,” Ob/Gyn News (Jan. 2005).

Journal of Traditional Chinese Medicine, vol. 46, no. 3, March 2005, p. 216

Acupuncture & IVF by Lifang Liang. Blue Poppy Press, 2003

Prediabetes increases cancer risk: study

Sunalie Silva   all articles by this author

PREDIABETES, whether defined as impaired glucose tolerance or impaired fasting glucose, increases the risk of developing cancer by 15% compared to people who are normoglycaemic, researchers have claimed.

Researchers reviewed 16 studies that included nearly 900,000 people from around the world and found that people with prediabetes had a 15% overall increased risk of cancer.

The condition was significantly associated with increased risks of cancer of the stomach/colorectum (relative risk, RR 1.55), liver (RR 2.01), pancreas (RR 1.19), breast (RR 1.19) and endometrium (RR 1.60).

There was no link between prediabetes and lung, prostate, ovarian, kidney or bladder cancer. 

According to the researchers, subgroup analyses showed no differences in cancer risk by sex, age or follow-up duration, but did reveal a significantly higher relative risk for Asian (1.50) than non-Asian patients (1.12).

In a sub-analysis that controlled for BMI, the presence of prediabetes and obesity was associated with a 22% increased risk of cancer. 

Prediabetes was defined as impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or both. 

IFG was defined as a fasting plasma glucose (FPG) range of 5.6–6.9mmol/L if the study used American Diabetes Association guidelines, or 6.1–6.9mmol/L if the study used World Health Organization guidelines. 

IGT was defined as a two-hour plasma glucose of 7.8–11.1mmol/L during an oral glucose tolerance test.

But the authors warned that risk increased even in people with an FPG as low as 5.6mmol/L.

The authors suggest one mechanism that could explain the increased risk of cancer seen in people with prediabetes might be that hyperglycaemia and its related conditions, such as chronic oxidative stress, act as carcinogenic factors.

They also point out that the type 2 diabetes drug metformin is now increasingly being recognised as having some protective anticancer properties.

According to the researchers, metformin affords an approximately 30% reduction in the lifetime risk of cancer in diabetic patients — but whether this is true in prediabetic individuals is not yet known, they said. 

“Long-term, large-scale studies of high-risk individuals, especially those with IGT or a combination of IGT and IFG, are urgently needed to explore the effects of metformin interventions on the risk of cancer in people with prediabetes.” 

Diabetologia 2014; online 10 Sept

Tags: , Cancer, Chronic, Diabetes, Guidelines, Obesity, Research, Medical News