Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Adrenal Fatigue article more useful, or one of our other health articles.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
There is a growing disenchantment with conventional medicine, reflected by increasing sales of alternative remedies and therapies to the general public. The reasons for this are multifactorial but concerns about medical errors, reports of the side-effects of prescribed drugs and a desire for holistic therapies have all fanned the flames.Advocates of mainstream medicine have responded by debunking many of the pseudoscientific myths that support unconventional therapies and point out that the reason some patients considered them safer is simply because their adverse effects are unknown or unpublicised.
Whilst there is an increasing antagonism between mainstream medicine and alternative therapists, conventional clinicians need to be aware of the theories and therapies promulgated by alternative practitioners if for no other reason than to protect their patients. It must also be acknowledged that within the spectrum of non-mainstream medical tenets, a kernel of truth can sometimes be found, which eventually becomes subsumed into mainstream medicine. Acupuncture is a case in point.
The following is a list of common therapies and theories which patients seeking an alternative approach may encounter.
Adrenal fatigue is a term used by alternative practitioners to describe a condition in which long-term mental, emotional or physical stress over-stimulates the adrenal gland, resulting in an eventual reduction in activity. Symptoms include tiredness, trouble falling asleep at night or waking up in the morning, salt and sugar craving and needing stimulants like caffeine to get through the day.
The condition needs to be differentiated from chronic adrenal insufficiency which is a recognised medical disease associated with a number of demonstrable laboratory abnormalities. It is important to remember that investigations can be normal in the early stages of adrenal insufficiency, so patients need to be monitored regularly.
Various trials have been conducted to support the relationship between stress, the biochemical functioning of the adrenal glands (eg, the circadian rhythm of cortisol production) and a variety of systemic dysfunctions. Likewise, numerous therapies have been attempted to restore adrenal activity to normal levels, including botanical extracts, herbal remedies and vitamins. There are as yet no large randomised trials confirming the benefits of any of these treatments but research is ongoing.
The concept of adrenal fatigue has received support from some sections of the medical profession and may have some validity. However, patients need to be protected from unscrupulous individuals who seek to exploit their faith in the existence of this condition for their own financial gain.
Alterations in the human diet as a result of the agricultural and industrial revolutions have resulted in chemical changes to the food we eat. Over time there has been a decrease in the potassium content compared to sodium and an increase in chloride compared to bicarbonate. These changes, compounded by the loss of renal acid-base regulation with ageing, predispose to metabolic acidosis. Whilst this has little effect on blood chemistry, the effect on urinary composition significantly increases the risk of developing kidney stones. Adhering to an alkaline diet will reduce this possibility in patients who have other risk factors for renal stones (eg, the elderly with slow urine flow due to anatomical obstruction).
Trials have identified other possible health benefits of the alkaline diet although further research is needed. Increasing the amount of fruit and vegetables in the diet may help to preserve muscle mass in adults. Correction of acidosis with bicarbonate or potassium citrate increases growth hormone in children and may improve growth. Other links have been made with bone health, cardiovascular risk and even the response of tumours to chemotherapy.
It should be emphasised that the literature supporting the benefits of an alkaline diet are limited and that more tangible evidence is required before such an approach can be adopted into mainstream medicine.
Ayurveda is a Sanskrit word which can be roughly translated as 'the scripture for longevity'. It is impossible to do justice in a few lines to the cultural and academic background supporting this traditional Indian approach and this author will not try. Its origin is traceable to four Sanskrit books called the Vedas. Ayurveda presents an entire system of well-being and health promotion in which the diagnosis and treatment of disease feature prominently. In practical terms, the practice of Ayurveda in the west focuses on 'purification' procedures, rejuvenation therapies, herbal and mineral preparations, exercises and dietary advice based on 'body type'.
Ayurveda is over 5,000 years old but was lost to the mists of time until reconstituted in the early 1980s by the Maharishi Mahesh Yogi. Some proponents claim that Ayurveda was always meant to be an evolving system but was unintentionally frozen several centuries ago. There are moves to try to blend it with conventional medicine.
There is very litte evidence in the scientific literature to support Ayurvedic techniques. There have been concerns about the safety of remedies (the use of toxic substances such as heavy metals) and ineffective treatments (eg, for HIV and cancer).[6, 7]
In summary, Ayurveda is an ancient system of mind/body medicine which may have relevance to people who subscribe to this particular set of cultural beliefs. However, as with other forms of alternative medicine, its use can be exploited by the unprincipled to extract money from the vulnerable.
This is based on the concept of intestinal overgrowth of commensural Candida spp. in the gut, which is purported to give rise to 'yeast syndrome' or 'yeast overgrowth'. The symptoms of this include fatigue, headache and poor memory. The features are very similar to chronic fatigue syndrome and anti-candidal therapy has also been suggested for this condition. The diet excludes sugar, white flour, yeast and cheese on the basis that these foods promote candidal overgrowth.
A randomised controlled trial has failed to support the benefits of a low-sugar low-yeast candidal diet in chronic fatigue syndrome compared to a normal healthy diet.
There is growing evidence that intestinal candidiasis may be associated with inflammatory bowel disease, gastric ulcers and irritable bowel syndrome. The use of anti-fungal drugs has been shown to promote benefit in patients with a high candidal load. However, similar benefit has not been seen with anti-candidal dietary manipulation.
Diatomaceous earth is a soft siliceous sedimentary rock consisting of fossilised remains of diatoms, a type of hard-shelled algae. It crumbles easily into a gritty powder. It consists mainly of silica with small amounts of aluminium oxide and iron oxide.
There has been one study of 19 patients in the literature reporting that diatomaceous earth was capable of reducing blood cholesterol and positively influencing lipid metabolism. The authors concluded that placebo controlled trials were required to confirm their findings but to date these have not been published.
Despite lack of scientific evidence, the use of diatomaceous earth as a cholesterol-lowering agent has gained some public support, particularly as an alternative to statins.
Functional medicine is an alternative approach based on the interaction between the environment, genetics and lifestyle factors. It stresses the importance of an holistic approach and of establishing a therapeutic partnership between the patient and the doctor. Proponents of functional medicine are heavily critical of conventional medicine and what they describe as the 'acute-care model', particularly with respect to the management of chronic disease. The core concepts of disease pathogenesis are antecedents, triggers and mediators. Antecedents are factors, genetic or acquired, that predispose to illness; triggers are factors that provoke the symptoms and signs of illness; and mediators are factors, biochemical or psychosocial, that contribute to pathological changes and dysfunctional responses. By understanding the antecedents, triggers and mediators that underlie illness or dysfunction in each patient, the functional medicine practitioner devises a matrix from which a treatment plan is devised.
Critics of functional medicine maintain that the principles on which functional medicine are based are vague and that many of the treatments and concepts involved have not been validated by scientific research - eg:
- Clinical detoxification therapies - further research is needed to determine the safety and efficacy of these approaches.
- Diagnosis of chronic occult infections - eg, chronic Lyme disease (studies have shown that most patients diagnosed with chronic Lyme disease either have no objective evidence of previous or current infection with Borrelia burgdorferi or should be classified as having post-Lyme disease syndrome.
- Biopuncture - unsubstantiated claims have been made that subcutaneous injection of various substances can heal acute and chronic musculoskeletal injuries and that it is effective in asthma, hay fever, bronchitis, colitis and a variety of other conditions.
Leaky gut syndrome
It has recently been discovered that the intestine plays a role in regulating the trafficking of environmental antigens across the host mucosal barrier. Loss of the protective function of this barrier ('leaky gut') is considered to be involved in the development of autoimmune conditions. Permeability regulation is thought to be associated with the production of a protein called zonulin, which has recently been identified. The therapeutic implications of these findings are yet to be elucidated but may well involve the development of agents which affect the activity of zonulin and other permeability regulators as yet to be discovered.
Unfortunately, these legitimate scientific advances have been transmogrified by practitioners outside mainstream medicine into the concept of 'leaky gut syndrome' which is purported to be linked to a variety of conditions including multiple sclerosis, diabetes and lupus.Inevitably, all manner of unsubstantiated treatments have been inflicted on the unsuspecting public, including:
Other conditions and therapies
For other therapies not mentioned here, see further reading and reference links below.
Further reading and references
Roberti di Sarsina P, Alivia M, Guadagni P; Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine-person-centred medicine. EPMA J. 2012 Nov 63(1):15. doi: 10.1186/1878-5085-3-15.
Sumantran VN, Tillu G; Insights on personalized medicine from Ayurveda. J Altern Complement Med. 2013 Apr19(4):370-5. doi: 10.1089/acm.2011.0698. Epub 2012 Oct 25.
Alternative medicine sales soar as consumers shake off cynicism; Daily Mail, 2010
Head KA, Kelly GS; Nutrients and botanicals for treatment of stress: adrenal fatigue, neurotransmitter imbalance, anxiety, and restless sleep. Altern Med Rev. 2009 Jun14(2):114-40.
Schwalfenberg GK; The alkaline diet: is there evidence that an alkaline pH diet benefits health? J Environ Public Health. 20122012:727630. doi: 10.1155/2012/727630. Epub 2011 Oct 12.
Patwardhan B; Bridging Ayurveda with evidence-based scientific approaches in medicine. EPMA J. 2014 Nov 15(1):19. doi: 10.1186/1878-5085-5-19. eCollection 2014.
Ven Murthy MR, Ranjekar PK, Ramassamy C, et al; Scientific basis for the use of Indian ayurvedic medicinal plants in the treatment of neurodegenerative disorders: ashwagandha. Cent Nerv Syst Agents Med Chem. 2010 Sep 110(3):238-46.
Saper RB, Phillips RS, Sehgal A, et al; Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. JAMA. 2008 Aug 27300(8):915-23. doi: 10.1001/jama.300.8.915.
Ayurvedic medicine; Cancer Research UK, 2013
Hobday RA, Thomas S, O'Donovan A, et al; Dietary intervention in chronic fatigue syndrome. J Hum Nutr Diet. 2008 Apr21(2):141-9. doi: 10.1111/j.1365-277X.2008.00857.x.
Kumamoto CA; Inflammation and gastrointestinal Candida colonization. Curr Opin Microbiol. 2011 Aug14(4):386-91. doi: 10.1016/j.mib.2011.07.015. Epub 2011 Jul 28.
Sepp S,; Diatomaceous earth, Sandatlas
Wachter H, Lechleitner M, Artner-Dworzak E, et al; Diatomaceous earth lowers blood cholesterol concentrations. Eur J Med Res. 1998 Apr 83(4):211-5.
Diatomaceous earth, food grade, is this really so good, or dangerous?; The Science Forum
Galland L; Patient-centered care: antecedents, triggers, and mediators. Altern Ther Health Med. 2006 Jul-Aug12(4):62-70.
Allen J, Montalto M, Lovejoy J, et al; Detoxification in naturopathic medicine: a survey. J Altern Complement Med. 2011 Dec17(12):1175-80. doi: 10.1089/acm.2010.0572. Epub 2011 Nov 21.
Marques A; Chronic Lyme disease: a review. Infect Dis Clin North Am. 2008 Jun22(2):341-60, vii-viii. doi: 10.1016/j.idc.2007.12.011.
Bellamy J; The DC as PCP? The battle continues, Science-based Medicine, 2013
Fasano A; Physiological, pathological, and therapeutic implications of zonulin-mediated intestinal barrier modulation: living life on the edge of the wall. Am J Pathol. 2008 Nov173(5):1243-52. doi: 10.2353/ajpath.2008.080192. Epub 2008 Oct 2.
Balmier M; Colostrum & Autoimmune Disorders, 2014
Treatments For Leaky Gut; leakygut.co.uk
Resnick C; Nutritional Protocol for the Treatment of Intestinal Permeability Defects and Related Conditions, Natural Medicine Journal, 2010