Altmed Watch

October 1, 2003



 

ALTMED WATCH
The latest research on complementary and alternative medicine

Jump to:Choose article section... Should acupuncture play a role in pregnancy management? More myths about 'evil' carbohydrates Nerve stimulation relieves the nausea of pregnancy Oolong tea as an adjunct to antidiabetic drugs? Should diabetic patients take chromium? What's the best diet for type 2 diabetics?

Should acupuncture play a role in pregnancy management?

As with most complementary/alternative therapies, there are no large-scale randomized trials that conclusively prove acupuncture can alleviate labor pain, relieve morning sickness, induce labor, or help resolve a breech presentation. But there are a few tantalizing hints to suggest that it may have some therapeutic value.1

A small, randomized trial that divided 100 women between acupuncture and no acupuncture groups found that the treatment reduced the need for epidural analgesia by 22%, compared to 12% in the control group (RR = 0.52, 95% CI 0.3–0.92.) While the acupuncture group did not say the intensity of their pain was any less, they reported they were more relaxed. The therapy had no adverse effects, i.e., rates of instrumental vaginal deliveries and C-sections didn't differ, duration of labor was about the same, there were no 1- or 5-minute Apgar scores below 7, and there were no differences in the need for oxytocin.2

In a single-blind trial that compared acupuncture to a sham procedure, women reported significantly less pain and need for analgesics. They also spent less time in active labor, with no evidence that the procedure had adverse effects on labor or hospital stay.3

The research on labor induction is not as well controlled. One observational study has found that the median duration of first-stage labor was 196 minutes in an acupuncture group and 321 minutes in a control group.4 Similarly, 85% of the control group required oxytocin in the first stage, versus 15% (72% vs. 28% in second-stage labor). Two open clinical trials also concluded that acupuncture increased the intensity of labor contractions and reduced time to delivery.1

1. Tamayo C. Acupuncture and pregnancy. Altern Ther Women's Health. 2003;5:41-46.

2. Ramnero A, Hanson U, Kihlgren M. Acupuncture treatment during labour—a randomized controlled trial. BJOG. 2002;109:637-644.

3. Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002;81:943-948.

4. Zeisler H,Tempfer C, Mayerhofer K, et al. Influence of acupuncture on duration of labor. Gynecol Obstet Invest. 1998;46:22-25.

More myths about 'evil' carbohydrates

Carbohydrate bashing has become a popular sport in the lay press, but there's little scientific evidence to indicate that a diet high in unrefined, complex carbohydrates and low in fat is the demon behind the current obesity epidemic.

While several popular books claim a high-carbohydrate regimen elevates serum insulin to excessive levels and causes food to be stored in fat cells rather than burned as energy, a recent study indicates otherwise. Looking at data on nearly 12,000 adults, researchers from Michigan State, Harvard, and the University of Alabama have found no significant differences in serum insulin, glycosylated hemoglobin (HbA1c), or plasma glucose between those consuming less than 40% of their calories as carbohydrates and those taking in about 60% or more. There was also no significant weight difference between the groups.

Yang EJ, Kerver JM, Park YK, et al. Carbohydrate intake and biomarkers of glycemic control among US adults: the third National Health and Nutrition Examination Survey (NHANES III). Am J Clin Nutr. 2003;77:1426-1433.

Nerve stimulation relieves the nausea of pregnancy

Applying mild electric stimulation to the underside of the wrist can alleviate nausea and vomiting during the first trimester, according to this placebo-controlled clinical trial involving nearly 200 volunteers. Relief was provided by means of the ReliefBand Model WB-R (Woodside Biomedical Inc., Carlsbad, Calif.) over a period of 21 days. Control patients were given an identical-looking device that did not provide nerve stimulation.

Rosen T, de Veciana M, Miller HS, et al. A randomized controlled trial of nerve stimulation for relief of nausea and vomiting in pregnancy. Obstet Gynecol. 2003;102:129-135.

Oolong tea as an adjunct to antidiabetic drugs?

Drinking large quantities of oolong tea, a partially fermented tea popular in Taiwan and mainland China, can markedly lower plasma glucose levels in type 2 diabetics, suggests this small, randomized clinical trial. When researchers instructed 20 patients to drink 1.5 L a day of Chinese oolong tea, a particularly rich source of polyphenols like caffeine, or equivalent amounts of water over a 30-day period, tea drinkers saw their plasma glucose levels plummet from 229 mg/dL to 162 mg/dL (P< 0.001). Fructosamine levels, a measure of glucose levels over 1 to 2 weeks, dropped from 409 to 323 µm/L (P<0.01) The investigators point out that tea polyphenols have been shown to have insulin-like activity in animal studies and may even delay intestinal glucose absorption.

Hosoda K, Wang MF, Liao ML, et al. Antihyperglycemic effect of oolong tea in type 2 diabetes. Diabetes Care. 2003;26:1714-1718.

Should diabetic patients take chromium?

Maybe. While the evidence is by no means conclusive, there are controlled clinical trials that suggest chromium may be an effective adjunct to diet and drug therapy.

Trivalent chromium is considered an essential trace element, a deficiency of which has been shown to cause hyperglycemia and other symptoms of diabetes. The recommended adult intake of the nutrient is 25 to 35 µg/day and most Americans get less than 60% of this amount. That's largely because of heavy consumption of processed foods, simple sugars, and because they consume too few whole-grain foods and vegetables.

According to a recent review of the research, chromium supplements do not affect blood glucose in persons without diabetes. But there are a few trials that have found that 200 to 600 µg/day of chromium chloride can significantly reduce fasting blood glucose in diabetes. These and similar studies suggest that this dosage range is safe, causing only mild GI upset and changes in appetite in some cases. There are, however, isolated case reports of dermatitis, elevated serum creatinine levels, and abnormal liver function tests; most have followed ingestion of 600 to 2,400 µg/day.

Ryan GJ, Wanko NS, Redman AR, et al. Chromium as adjunctive treatment for type 2 diabetes. Ann Pharmacother. 2003;37:876-885.

What's the best diet for type 2 diabetics?

While the optimal diet for these patients remains controversial, a program that emphasizes foods with a low glycemic index (GI) seems to offer at least some benefits, according to the latest meta-analysis of the research literature.

Current dietary recommendations from groups like the American Diabetes Association continue to emphasize the need to control the quantity of carbohydrates a patient consumes, but mounting evidence indicates that patients should also be thinking about their quality. GI takes into account quality by directly measuring the blood-glucose elevating effects of individual foodstuffs. High GI foods like potatoes and white bread, for instance, have a greater glycemic effect than low-GI foods like lentils, beans, barley, and oats.

The research analysis, which looked at 14 controlled trials covering 356 patients, found that combined glycosylated hemoglobin and fructosamine readings were reduced by 7.4%, when compared to high GI regimens, prompting investigators to conclude that these foods have a "small but clinically useful effect."

Brand-Miller J, Hayne S, Petocz P, et al. Low-glycemic index diets in the management of diabetes: a meta-analysis of randomized controlled trials. Diabetes Care. 2003;26:2261-2267.

Department editor Paul L. Cerrato, MA, Managing Editor of Contemporary OB/GYN, is a guest lecturer at the Institute of Human Nutrition, Columbia University College of Physicians and Surgeons, New York, N.Y.

 

Altmed Watch. Contemporary Ob/Gyn Oct. 1, 2003;48:92-96.