Wrinkles Can Predict Bone Density

A menopausal woman's face can provide hints about her bones, new study says

by: Candy Sagon | from: AARP Bulletin | June 7, 2011

As if those brow furrows and laugh lines weren't distressing enough for a woman, now a new study says facial wrinkles may be sending a message about her bone density.

A menopausal woman's facial wrinkles, particularly between the brow, could indicate low bone density. — Photo by Image Source/Aurora

Yale scientists have found that the more wrinkles a woman has in her early menopause years, the lower her bone density.

This is important because women over 50 are at the greatest risk for bone fractures from osteoporosis, the thinning of bone tissue and loss of bone density over time.

"Women need to be aware that our skin is giving us a glimpse of what's happening inside to our skeleton," Lubna Pal, M.D., a reproductive endocrinologist at Yale's School of Medicine, told the Bulletin.

She says the study found that those furrows between the brows, which are often the first target of Botox treatments, were the strongest link between bone density and wrinkles.

"Different areas of the face wrinkle at different rates and after adjusting for all the parameters, the strongest impact was with the forehead wrinkles between the brows," she says.

Although the connection between skin and bone might not be obvious, Pal explained that they share common building blocks — a group of proteins called collagens.

As women age, the changes in collagen that visibly cause the skin to sag and wrinkle are also invisibly affecting bone quality and quantity.

The study demonstrates only an association — not an exact cause — between decreased bone density and early skin wrinkling, Pal emphasized, but it still could give doctors a low-cost way of identifying postmenopausal women who may be at risk for bone fracture.

The Yale researchers studied 114 women in their late 40s and 50s who were within three years of menopause and not on hormone or bone density drug therapy, she says.

The scientists also excluded women who had undergone any cosmetic skin procedures or who may have damaged their skin by tanning beds or extensive exposure to the sun.

The scientists measured the number and depth of the women's forehead, face and neck wrinkles, as well as the skin's firmness or rigidity. They then tested their bone density by x-ray and ultrasound.

The findings, which were presented Monday in Boston at the annual meeting of the Endocrine Society, showed that women with the worst wrinkles had the lowest bone density.

Conversely, those women with firm skin and the fewest wrinkles had greater bone density.

The relationship was evident at all skeletal sites tested, including hip, lumbar, spine and heel, and was independent of age, body composition or other factors known to affect bone density.

The study is part of a larger, multicenter investigation into menopausal hormone therapy.

Pal says a longer, four-year study is needed to look at the relationship between wrinkles and the risk of bone fracture.

"We want to know if intensity of skin wrinkles can allow identification of women who are more likely to fracture a bone," she says, especially fractures of the neck, femur or hip — injuries often fatal to older people.

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Heart Health: The Best Alternative Therapies

3 Ways to Make Yourself Heart-Attack Proof

Unleash the power of alternative medicine to help strengthen--and heal--your heart

By Catherine Winters

Could tiny needles, positive thinking, and slow-motion movement really be the ticket to a healthier heart?
Experts have long been equivocal, but an exciting--and growing--slew of new studies shows that alternative medicine can have a powerful impact on reducing heart disease risk.
Central to these strategies is stress reduction, but it doesn't stop there.

Research reveals that alternative medicine can augment the benefits of healthy behaviors--such as eating well, watching your weight, and exercising--to deliver results even faster.
They may even be what you need to keep you off medication or reduce your dose. "There is much more to the prevention and treatment of heart disease than pills and procedures," says preventive cardiologist Stephen Devries, MD, coeditor of Integrative Cardiology. Here, three therapies that can have big heart payoffs.

The Acupuncture Answer

Meet the newest weapon in the fight against high blood pressure.
Research suggests that weekly acupuncture sessions can slash systolic blood pressure by up to 20 points, producing results on par with prescription medications such as ACE inhibitors and calcium channel blockers.
By stimulating a few key acupoints near the elbows and knees, acupuncture releases neurotransmitters that travel to areas of the brain that regulate the cardiovascular system, explains John Longhurst, MD, PhD, a cardiologist and director of the Susan Samueli Center for Integrative Medicine at the University of California, Irvine.

Electroacupuncture, which uses battery-driven needles, is especially effective, says Dr. Longhurst, because it lets the acupuncturist standardize the amount of stimulation and adjust the frequency. Acupuncture can't permanently lower blood pressure, though. "Once you have hypertension, you have it for life," says Dr. Longhurst.
So just as you would with medication, you need to continue getting weekly acupuncture treatments to see results--but with very few side effects or risks.

The Positivity Payoff

Stopping stress in its tracks sounds good, but can people really learn to change the way they react to upsetting situations?
If so, can this response lower blood pressure? Yes and yes, according to a study by the Institute of HeartMath, a nonprofit research and education organization.
The researchers showed that practicing "positive-emotion refocusing"--a technique that teaches you to interrupt your typical stress response by redirecting your attention--can significantly lower blood pressure in hypertensive patients after just 3 months of daily practice.
The results were promising: All participants saw their blood pressure drop, 12% were able to reduce their dose of blood-pressure-lowering medication, and one went off the pills altogether.
Stress triggers a cascade of hard-on-your-heart hormones such as cortisol and adrenaline--and positive refocusing sparks a counterflood of energizing feel-good hormones, short-circuiting the stress response.

Positive refocusing is easy to learn. When you feel anxiety coming on, identify what you're stressed-out about, then hold the thought in your mind like a freeze-frame of a movie.
As you do this, breathe deeply for several minutes and focus your attention on your heartbeat.
 Now identify a positive feeling, such as appreciation for a pet or a loved one. "This calms your emotions and shifts your attention away from negative thoughts," says Deborah Rozman, PhD, a behavioral psychologist.
Though it can be tough to let go of negative thoughts when you're fuming, regularly practicing this positive refocusing technique can result in fewer stressed-out moments overall. Even if you can't find the recommended 10 minutes a day for positive thinking, a couple of minutes here or there helps.

Silent Signals You're Stressed

TLC Through Tai Chi

Tai chi (a Chinese martial art) combined with qigong (called the Chinese yoga) is more than just a gentle way to work out.
Practicing these ancient disciplines can reduce stress and have a powerful effect on metabolic syndrome--a cluster of five conditions that ups your risk of heart disease--reducing systolic and diastolic blood pressure and trimming waist size by at least an inch, according to a study published in the British Journal of Sports Medicine.
One reason? These slow-mo sports can burn as many calories as moderate-intensity activities, such as walking--but the mind-calming benefits of tai chi and qigong increase its heart-healthy cred.

Tai chi is sometimes described as "meditation in motion," and research shows that because people find the meditative component relaxing and enjoyable, they tend to stick with it--which is important for any heart disease-prevention strategy. "Sustainability is very important if you want to see ongoing effects of the practice," says Xin Liu, PhD, a senior research fellow at the University of Queensland's School of Medicine in Australia.

Published January 2012, Prevention | Updated January 2012

http://www.prevention.com/health/health-concerns/heart-health-best-alternative-therapies

March 18, 2011, 1:18 pm

Tai Chi Eases Depression in Elderly

By TARA PARKER-POPE

Robert Spencer for The New York Times A tai chi group practicing in Pawtucket, R.I.

The ancient Chinese practice of tai chi appears to relieve symptoms of depression in older people, a new study shows.

The findings, published this month in The American Journal of Geriatric Psychiatry, are the latest to suggest that the slow movement, breathing and meditation of tai chi results in meaningful benefits to patients with chronic health problems.

Other recent studies have shown that practicing tai chi may provide benefits for patients with arthritis and fibromyalgia. But the newest research is important because depression is notoriously difficult to treat in older people, many of whom are already coping with other health problems and are less likely to respond to drug treatment.

Researchers from the University of California, Los Angeles, studied 112 older adults in whom major depression had been diagnosed, including many who had been struggling with the illness for years. Their average age was about 70. Everyone was first treated with Lexapro, and 73 exhibited a partial improvement but still scored high on depression scales. The rest of the patients dropped out of the study, including just one patient who had a full remission after drug treatment.

The remaining depressed patients were randomly assigned to either a 10-week course of tai chi or a health education class, which included 10 minutes of simple stretching exercises. Both courses were given for two hours once a week.

After 10 weeks of tai chi, 94 percent of depressed older adults showed marked improvement on depression scales, compared with 77 percent in the health education group. And 65 percent of the people in the tai chi group experienced remission, compared with 51 percent in the education group.

The tai chi group also showed marked improvement in measures of physical function, cognitive tests and blood tests measuring levels of inflammation.

“Altogether the effects were pretty dramatic,’’ said Dr. Helen Lavretsky, lead author and professor of psychiatry at U.C.L.A. “If a psychiatrist were to add exercise like tai chi, which is very nondemanding and easy to access, that would be a very beneficial thing instead of adding another drug.”

Dr. Lavretsky said one reason both study groups showed improvement was that all the patients probably benefited from spending time with other people, whether it was in the practice of tai chi or the group education class. “I’m sure the social aspect contributed to the improvement in both groups,’’ she said. “In the control group we see improvement, and that was purely because of the social interaction and bonding that occurred.”

But the marked improvement in the tai chi group suggests an additional benefit from tai chi. Research has shown tai chi can improve physical function and quality of life, relieve stress and anxiety and lead to improved sleep quality, the study authors noted.

The study used a form of tai chi called T’ai Chi Chih that uses 20 simple exercises that are nonstrenuous and easy enough to be performed by older adults.

Dr. Lavretsky said the findings are exciting because depression is so difficult to treat in older people, two-thirds of whom don’t respond to initial drug therapy. Often when a patient doesn’t respond to the first drug, an additional drug is given, but that’s not always practical for patients who are already taking 10 or 15 drugs for other health problems. A study this month found that more than 60 percent of patients over 65 experience moderate or major side effects the first time they are prescribed an antidepressant.

“This is very easily translatable into community care,’’ she said. “As their health improves, they may be able to reduce the other drugs they are taking for pain or other problems.”

February 9, 2012, 10:02 am

Tai Chi Benefits Patients With Parkinson’s

By TARA PARKER-POPE

Stuart Isett for The New York Times

Can Tai Chi, the ancient martial art, help alleviate Parkinson’s symptoms?

Tai chi, an ancient martial art characterized by slow, flowing movement and meditation, helps improve balance and movement control for people with Parkinson’s disease.

The finding, published in The New England Journal of Medicine, is the latest study to show the benefits of tai chi for people with chronic health problems. Past studies have shown that tai chi reduces falls and depression among the elderly, and lessens pain for patients with arthritis and fibromyalgia.

In Parkinson’s disease, nerve cells in the brain that produce the chemical dopamine begin to die. Lower dopamine production can lead to tremors, balance problems, stiff facial expressions and muffled speech, among other problems.

An estimated one million people in the United States have the disease, and another 60,000 receive the diagnosis each year. Although the condition usually develops after the age of 60, 15 percent of those who learn of the diagnosis are under 50.

In the latest research, 195 people with movement and balance problems caused by Parkinson’s disease were recruited from four Oregon cities. The patients were divided into three exercise classes that met for an hour a day, twice a week. One group took part in an extensive stretching class, another was taught resistance training, and the third group performed tai chi.

After six months, patients in the tai chi group performed better on a number of measures related to strength, movement control, balance, stride length and reach. Resistance training also offered some benefits, and both the tai chi and resistance training groups had fewer falls than the stretching group.

The findings are good news for people with Parkinson’s, who often lose the ability to maintain standing balance and have difficulty walking and are at risk for frequent falls. Although some symptoms of Parkinson’s, like tremors, can be relieved by drug therapy, balance and walking problems are typically not helped by drug treatment.

“Current medications do not work well in terms of providing relief for impaired balance or postural instability,” said Fuzhong Li, a research scientist at Oregon Research Institute in Eugene and the study’s lead author. “In fact, patients suffer a great deal of medication side effects which may lead to further deterioration in balance control.”

Why tai chi helps people with Parkinson’s isn’t entirely clear. Even for a healthy person it can be hard to maintain balance and stability while performing the continuous, rhythmical, weight-shifting movements of tai chi. It may be that practicing tai chi trains the parts of the brain that control balance and movement to adapt more quickly in response to the motor control challenges of Parkinson’s.

To learn more about the challenges of living with Parkinson’s, go to “The Voices of Parkinson’s Disease.” And to learn more about tai chi, read Jane E. Brody’s column, “A Downside to Tai Chi? None That I Can See,”.

Exercise as Housecleaning for the Body

By GRETCHEN REYNOLDS

Kris Hanke

When ticking off the benefits of physical activity, few of us would include intracellular housecleaning. But a new study suggests that the ability of exercise to speed the removal of garbage from inside our body’s cells may be one of its most valuable, if least visible, effects.

In the new research, which was published last month in Nature, scientists at the University of Texas Southwestern Medical Center in Dallas gathered two groups of mice. One set was normal, with a finely tuned cellular scrubbing system. The other had been bred to have a blunted cleaning system.

It’s long been known that cells accumulate flotsam from the wear and tear of everyday living. Broken or misshapen proteins, shreds of cellular membranes, invasive viruses or bacteria, and worn-out, broken-down cellular components, like aged mitochondria, the tiny organelles within cells that produce energy, form a kind of trash heap inside the cell.

In most instances, cells diligently sweep away this debris. They even recycle it for fuel. Through a process with the expressive name of autophagy, or “self-eating,” cells create specialized membranes that engulf junk in the cell’s cytoplasm and carry it to a part of the cell known as the lysosome, where the trash is broken apart and then burned by the cell for energy.

Without this efficient system, cells could become choked with trash and malfunction or die. In recent years, some scientists have begun to suspect that faulty autophagy mechanisms contribute to the development of a range of diseases, including diabetes, muscular dystrophy, Alzheimer’s and cancer. The slowing of autophagy as we reach middle age is also believed to play a role in aging.

Most metabolism researchers think that the process evolved in response to the stress of starvation; cells would round up and consume superfluous bits of themselves to keep the rest of the cell alive. In petri dishes, the rate of autophagy increases when cells are starved or otherwise placed under physiological stress.

Exercise, of course, is physiological stress. But until recently, few researchers had thought to ask whether exercise might somehow affect the amount of autophagy within cells and, if so, whether that mattered to the body as a whole.

“Autophagy affects metabolism and has wide-ranging health-related benefits in the body, and so does exercise,” says Dr. Beth Levine, a Howard Hughes Medical Institute investigator at U.T. Southwestern. “There seemed to be considerable overlap, in fact, between the health-related benefits of exercise and those of autophagy,” but it wasn’t clear how the two interacted, she says.

So she and her colleagues had lab mice run. The animals first had been medically treated so that the membranes that engulf debris inside their cells would glow, revealing themselves to the researchers. After just 30 minutes of running, the mice had significantly more membranes in cells throughout their bodies, the researchers found, meaning they were undergoing accelerated autophagy.

That finding, however, didn’t explain what the augmented cellular cleaning meant for the well-being of the mice, so the researchers developed a new strain of mouse that showed normal autophagy levels in most instances, but could not increase its cellular self-eating in response to stress. Autophagy levels would stubbornly remain the same, even if the animals were starved or vigorously exercised.

Then the researchers had these mice run, alongside a control group of normal animals. The autophagy-resistant mice quickly grew fatigued. Their muscles seemed incapable of drawing sugar from the blood as the muscles of the normal mice did.

More striking, when Dr. Levine stuffed both groups of animals with high-fat kibble for several weeks until they developed a rodent version of diabetes, the normal mice subsequently reversed the condition by running, even as they continued on the fatty diet. The autophagy-resistant animals did not. After weeks of running, they remained diabetic. Their cells could not absorb blood sugar normally. They also had higher levels of cholesterol in their blood than the other mice. Exercise had not made them healthier.

In other words, Dr. Levine and her colleagues concluded, an increase in autophagy, prompted by exercise, seems to be a critical step in achieving the health benefits of exercise.

The finding is “extremely exciting,” says Zhen Yan, the director of the Center for Skeletal Muscle Research at the University of Virginia, who is also studying autophagy and exercise. The study, Dr. Yan says, “improves our understanding of how exercise has salutary impacts on health.”

The implications of Dr. Levine’s results are, in fact, broad. It’s possible that people who don’t respond as robustly to aerobic exercise as their training partners may have sputtering or inadequate autophagy systems, although that idea is speculative. “It’s very difficult to study autophagy in humans,” Dr. Levine says. Still, it’s possible that at some point, autophagy-prompting drugs or specialized exercise programs might help everyone to fully benefit from exercise.

In the meantime, the study underscores, again, the importance of staying active. Both the control mice and the genetically modified group had “normal background levels of autophagy” during everyday circumstances, Dr. Levine points out. But this baseline level of cellular housecleaning wasn’t enough to protect them from developing diabetes in the face of a poor diet. Only when the control animals ran and pumped up their intracellular trash collection did they regain their health.

“I never worked out consistently before,” Dr. Levine says. But now, having witnessed how exercise helped scour the cells of the running mice, she owns a treadmill.

How Acupuncture can help you lose Weight

Lose the Last 5 Pounds For Good

Why are the last five pounds so hard to lose? "When you've got only a handful of pounds to go, you've really got to rev up your metabolism and, at the same time, lower your body's production of cortisol, the stress hormone, which promotes fat storage," says Los Angeles nutritionist Haylie Pomroy, who helps Jennifer Lopez stay movie and photo shoot ready. It's not as tricky as it sounds, but it does require diligence. So give yourself three to four weeks, follow these tips from our experts, and make "Go for the burn" your new motto.

By Wendy Schmid

Eat Fat-Burning Foods

What you eat really counts when you've got just an inch or so to pinch. "Your metabolism is already working relatively well, so focus on fiber-rich foods that have a thermogenic effect, making your body expend more energy as it breaks them down," says Pomroy. According to Manhattan weight-control specialist Stephen Gullo, high-fiber foods also form a coating on the intestinal walls that prevents some of the absorption of calories from other foods. A final bonus: When you lose weight, fat exits through the bowel, and fiber aids that exit strategy. Make this your grocery list: dark leafy greens, asparagus, radishes, cucumbers, broccoli, cauliflower, artichokes, zucchini, green beans, hearts of palm, mushrooms, quinoa, raw almonds, and low-sugar fruits like Asian pears, kiwi, and grapefruit. Supplement these fat burners with lean, organic proteins such as egg whites, chicken, turkey, bison, and wild-caught fish.

Photo Credit: Donna Trope/Trunkarchive.com

Forget "Fat Free" and "Sugar Free"

You don't have to give up dairy, just the fat-free variety. "When you take the fat out of a dairy product, the natural milk sugar it contains gets into the bloodstream faster, sending your body into fat-storing mode," explains Pomroy. "Suddenly that fat-free Greek yogurt is fattening." Instead, choose organic, hormone-free two-percent dairy. Ditch the sugar-free stuff too. "The body can't process chemical sweeteners, so not only do they get stored in your fat, they impair your body's ability to release that fat for fuel," says Pomroy.

Be Calorie Clever

"I tell my clients to treat calories like dollars and avoid paying retail," says Gullo. That means a get-more-for-your-money strategy of substitutions. Examples: Trade brown rice (around 200 calories per cup) for high-fiber GG Bran Crispbread (12 calories per piece), and rather than a tablespoon of olive oil (120 calories), mix just a teaspoon with balsamic vinegar and lemon juice for salad dressing. "You save calories without sacrificing taste, plus vinegar slows the emptying of the stomach, so you feel more satiated," he says. For the month, eliminate calorie-dense bananas, grapes, cherries, starchy squash, edamame, potatoes, and avocados.

Cut Caffeine and Alcohol

Need motivation? Consider how they affect your body's inner workings. "Caffeine stimulates the adrenals to produce cortisol, and alcohol both slows metabolism and is readily stored as fat," explains Pomroy. "So you're making your body less efficient at doing what you want it to do. If you're drinking more than two alcoholic beverages a week, you can drop two to three pounds in the first two weeks simply by cutting them out."

Burn Calories While Drinking

To keep your system humming, down 12 to 16 glasses of water a day (dehydration hinders metabolic function) and drink decaf oolong tea, advises Gullo. "It's been shown to increase metabolism by 10 percent—even more than green tea," he says. Before bed, skip the tea and instead have a thermogenic brew made with the juice of one lemon, hot water, a tablespoon of chopped, potassium-rich parsley, and a pinch of cayenne. (Steep for 15 minutes.) "It increases calorie burning while you sleep and prevents water retention," Pomroy says. "My clients find the depuffing effect encouraging."

Photo Credit: Alexi Lumbomirski

Take These 5 Supplements

1. PROBIOTICS These can help maintain a healthy balance of bacteria in your digestive tract; imbalances have been linked to weight gain. Try Klaire Labs Ther-Biotic Complete ($41; one cap daily).

2. B-COMPLEX "B vitamins lower cortisol production and stimulate metabolism," says Pomroy. Try Living Beyond Organic B-Complex ($50; one half teaspoon with meals).

3. CALCIUM "High-calcium diets lead to greater weight loss, particularly in the abdominal area," says Gullo. (Good news, since that's where pesky cortisol packs on the pounds.) Try Schiff Super Calcium 1200 ($7.65; two soft gels daily with a meal).

4. VITAMIN D A deficiency can make it harder to lose weight. Try Jarrow Formulas Vitamin D3 1000 IU ($7.95; one soft gel twice daily with meals).

5. OMEGAS Essential fatty acids help stabilize blood sugar and encourage fat metabolism, Pomroy says. Fans of her popular organic flax-oil blend swear it helps fight cellulite too. Try East West Essentials Optimal Fatty Acid Blend ($48; one capsule three times daily with meals). Want to swallow fewer pills? Consider SafSlim, a new liquid supplement said to target belly fat with omega-rich linoleic acid from safflower oil ($29.99; one tablespoon twice daily). "Studies suggest that linoleic acid may aid weight loss by helping with appetite control and metabolic efficiency," says Gullo.

Sleep 7 to 8 Hours A Night

Otherwise, you may not budge that extra pudge. Research shows that sleeping less than six hours a night not only prevents weight loss, it can lead to an elevated BMI (body mass index) and a higher risk of obesity. "When you get too little sleep, leptin, the satiety hormone, decreases and ghrelin, the hunger hormone, increases. People become hungrier and tend to overeat," says Eve Van Cauter, director of the University of Chicago Medical Center's sleep-research laboratory and a leading authority on the subject. Lack of shut-eye also raises cortisol, and, warns Van Cauter, these hormones can get out of whack if you sleep less for just two days. So wind down early for your best results.

Double Up Your Workouts

It sounds difficult, but even the Victoria's Secret models cop to working out twice a day before the big holiday show. "You've got to split up your workouts to torch that last bit of fat," says celebrity trainer Bob Harper. Follow this program every other day; it doesn't even require a gym.

A.M.: "These compound body movements utilize multiple muscle groups and get your metabolism going," he says. Do the circuit three times.

1. Two minutes jumping rope.

2. Twenty sumo squats: With legs just wider than shoulder width and toes pointing slightly outward, slowly lower your body into a squat, keeping weight in your heels, and drop your butt just lower than 90 degrees (so fingers touch the floor) before slowly raising up.

3. Fifteen burpees: Stand upright, feet hip width apart. Drop down into pushup position, kicking your legs back and out. Do a pushup, then pull legs back under you as you push off the floor, and hop to a standing position.

4. Ten traditional pushups.

P.M.: "Pump up your calorie burn by doing cardio at the end of the day, when your body naturally wants to rest," says Harper. Get outside and run for 30 to 45 minutes. Or do run-walk intervals for the duration, running for four minutes and then walking for one.

Photo Credit: Net-a-Porter.com

Try An Alternative Therapy

If you've hit your late 30s or 40s, when your metabolism can get sluggish, your body may need an extra nudge. "Acupuncture has been shown in studies to stimulate metabolism, lower cortisol, and improve thyroid function," says Los Angeles acupuncturist and antiaging specialist Mao Shing Ni. "One treatment a week can easily help you lose five pounds in a month, even if you're not strenuously dieting and exercising." How it works: During a 30-minute session, you lie down comfortably and close your eyes. Painless acupuncture needles are inserted into designated points (on the head, arms, hands, belly, and legs) that regulate metabolism, hormone production, digestion, elimination, and satiety. How's that for effortless weight loss?

Photo Credit: iStockphoto

A Healthy Poke: Demystifying the Science Behind Acupuncture

By Alice G. Walton

Sep 29 2011, 10:07 AM ET 440

Many of us have started to embrace the use of alternative medicine, but acupuncture, with its qi, yin, and meridians, still raises eyebrows

While many practices in alternative medicine are slowly but surely making their way into the mainstream, acupuncture is one that still produces skeptical eyebrow raises. This phenomenon is partly due to linguistics. Scientists have worked to elucidate the mechanisms by which yoga, meditation, and various dietary interventions may work on the cells of the body, but there is something fundamentally more ancient-feeling about the language of acupuncture. Go to the NIH's website on complementary and alternative medicine (NCCAM), and even here you'll find a discussion that involves qi, yin, yang, and meridians.

Acupuncture is a "retrospective science, going on for 3,000 years. We know it works, we just don't know why."

Is it possible to discuss acupuncture in a way that makes sense to even the most Westernized brains? The short answer is yes -- but with the caveat there there is no single unifying explanation for how it works. While acupuncture has been demonstrated to be useful in pain management and in treating the nausea and vomiting associated with chemotherapy, other uses have had more mixed results when studied scientifically.

Dr. Leena Mathew is an attending physician in Anesthesiology and Pain Medicine at New York Presbyterian Hospital/Columbia University Medical Center. She uses acupuncture as an "adjunct analgesic modality," meaning that she uses it as a complementary treatment for pain in her patients should they require or prefer it. She and Dr. Josephine Briggs, director of NCCAM, discussed with us the most likely theories of the mechanisms behind acupuncture.

For pain management, one idea is that acupuncture may be working via the gate control theory, first outlined by Melzack and Wall in the 1960s. This theory suggests that pain is transmitted through small nerve fibers from the skin through the spinal cord and on up to the brain. Also present are larger fibers which normally send inhibitory signals to the small pain fibers, which essentially "gates" or prevents a pain signal from being set off. When a painful stimulus comes in, however, the activity in the small nerve fibers overwhelms the large ones, so inhibition is released and the gates of pain opened. Where does acupuncture come in? Theoretically, the needles are placed in positions to stimulate the large nerve fibers, so that the small -- painful -- ones are inhibited. Mathew says that the same logic theoretically underlies why rubbing your elbow after you bang it helps alleviate the pain: you're stimulating the inhibition that quiets the pain.

Another possibility is that endorphins, the body's famed "feel good" chemicals, are behind the effect of acupuncture on quelling pain. Mathew says that the happy little chemicals are released in response to a range of phenomena -- distress, injury, running long distances, chocolate -- and have the knack for acting like morphine on the body and brain. Studies have tracked levels of these molecules in the blood, and shown that acupuncture is linked to higher levels of beta-endorphin at the same time that patients are reporting decreases in their pain levels. Even more, when you inject people with the anti-morphine drug naloxone, the effects of acupuncture are reduced.

But other theories better explain why acupuncture has been shown to work well on the nausea and vomiting (PDF) associated with chemotherapy. In the 1950s, the nerve reflex theory was proposed, suggesting that the body's periphery (the skin) is connected to the internal organs through a reflex called the viscero-cutaneous reflex. "If you stimulate the periphery with acupuncture needles," explains Mathew, "you can change the blood flow pattern to the stomach and abdomen, which could explain the effect on nausea and vomiting."

Acupuncture may also have an effect on the body's stress response system, otherwise known as the hypothalamus-pituitary-adrenal (HPA) axis, which could be why acupuncture patients report lower stress levels and anxiety after treatment, at least in the short term.

If you were wondering when the word "placebo" was going to enter the discussion, here it is -- but it's not what you think. What researchers now know about the placebo effect is that it isn't some hokey "mind over matter" thing. The response is a robust, demonstrable physiological phenomenon, according to Mathew. When people are being "treated" with placebo, you can actually see the change in blood flow patterns in the cortices of their brains in fMRI. Some people are more responsive to the placebo effect than others, and there is no doubt that some of this effect is going on with acupuncture, and particularly heightened in placebo-sensitive individuals.

Which leads to the final theory about why acupuncture may work on certain conditions. The very presence of human touch may have a lot to do with acupuncture's healing power, Mathew suggests. "This is therapeutic touch," she says. "As Westerners, we're disconnected from this. We don't want to touch patients." But just as a mother calms a child simply through her physical/emotional presence, having another human being exert a well-intentioned touch may, in its simplicity, also do a lot to alleviate pain. This effect may have to do with the alleviation of fear and anxiety, things we know account for a huge portion of our perception of pain.

Briggs adds to this idea by mentioning that some of the effects of acupuncture can also be seen when "sham" treatments like toothpicks are used, which can sometimes have an effect similar to acupuncture. This, she says, "tells us that a very important part of acupuncture's effect is the ritual involved, which includes pressure, reassuring practitioners, and the patient's expectation." In other words, the act of acupuncture itself is at least partially what accounts for its effect.

She adds that we need to start asking different questions about acupuncture, and using different language to discuss is. For example, she says that "meridians were developed by a tradition of people who didn't dissect human body -- meridians are not good a scientific question. But, 'How does the practice change our perception of pain?' is a good question. It's quite plausible that pain pathways are modulated by emotion, pill placebo, etc., so it's not surprising that reassurance of ritual or expectation is at play here. "

As Mathews points out, acupuncture is a "retrospective science, going on for 3,000 years. We know it works, we just don't know why. It's very hard to translate into Western language." Still, it should be possible to do so, and we seem to have made some progress. Hopefully more researchers asking the right questions, and coming up with clever new techniques to address them, will help elucidate the mechanisms and unify the theories.

Alice G. Walton - Alice G. Walton is a health-and-science journalist who writes on medical issues, particularly those related to the brain and behavior. She holds a Ph.D. in biopsychology and is an editor at TheDoctorWillSeeYouNow.com.

Image: REUTERS/Mike Cassese.

Ancient Chinese Herbal Recipe Eases Side Effects of Chemotherapy

A combination of Chinese herbs in use for more than 1,800 years reduced the gastrointestinal side effects of chemotherapy in mice, while actually enhancing the effects of the cancer treatment, Yale University researchers report.

The formula used in the experiment consists of four herbs, called PHY906, and is based on a herbal recipe called Huang Qin Tang, used historically to treat nausea, vomiting and diarrhea. The study, published August 18 in the journal Science Translational Medicine, asked whether the use of the formula could reduce gastrointestinal effects of a common chemotherapy drug without affecting its ability to kill cancerous cells.

Video: Yung-Chi “Tommy” Cheng, Henry Bronson professor of pharmacology, co-director of the Yale Cancer Center’s Developmental Therapeutics program and senior author of the paper. Watch »

Chemotherapy causes a number of toxic side effects, which are usually treated with several different drugs with mixed success.

“Chemotherapy causes great distress for millions of patients, but PHY906 has multiple biologically active compounds which can act on multiple sources of discomfort,” said Yung-Chi “Tommy” Cheng, Henry Bronson professor of pharmacology, co-director of the Yale Cancer Center’s Developmental Therapeutics program and senior author of the paper.

Mice undergoing chemotherapy that were given PHY906 lost less weight and experienced more anti-tumor activity than mice not given the formula, the team reported.

The herbal formula reduced toxicity of the chemotherapy by multiple mechanisms, including the inhibiting inflammation and promoting the creation of new intestinal cells, the team reported. This cannot be accomplished by current drugs, which usually target only one mechanism.

“This combination of chemotherapy and herbs represents a marriage of Western and Eastern approaches to the treatment of cancer,” Cheng said.

Cheng is the co-discover of PHY906 and, with Yale, has a financial interest in PhytoCeutica Inc., a New Haven company developing the formula.

The study was funded by the National Cancer Institute of the National Institutes of Health.

Wing Lam of Yale was lead author of the paper. Other Yale authors include Scott Bussom, Fulan Guan, Zaoli Jiang, Wei Zhang, Elizabeth A. Gullen, Shwu-Huey Li