CAM, placebo and real science

[JFH]

Here's a radio broadcast from the BBC that some might find interesting: http://www.bbc.co.uk/radio4/science/oth ... cine.shtml

Every year, one in five of us tries some sort of complementary or alternative medicine (CAM) - what's the attraction? And what do we get out of it

Jump to the third programme on the page for a brief discussion of CAM, placebo effect and immune systems.

Anyone got any experience of any CAM and MS?

John

PS I'm not evangelising any CAM nor even suggesting it might be a "hope" - accupuncture probably helped me stop smoking though

PPS PDF of transcript http://www.bbc.co.uk/radio4/science/pdf ... _prog3.pdf

[Shayk]

Hi John!

Well, I was really hoping someone else would respond because CAM for MS can undoubtedly be a lightning rod topic. In many places in the US, I would guess that anything that is not a CRAB drug may be categorized as CAM. I’m definitely with you in not promoting any particular CAM. If exercise and meditation (as a way to help manage stress) are considered “CAM”, I have “experience” with those. I’m hoping they’ll help in the management of my MS.

The cover story of the September 27th issue of Newsweek here in the US recently featured The New Science of Mind and Body and they covered the placebo effect as well as limited references to the immune system that you noted. It starts

From anger to optimism, our emotions are physiological states. The brain, as the source of those states, offers a potential gateway to other tissues and organs—the heart and blood vessels, the gut and even the immune system.

Now, you’ve given me a great opportunity to post my personal biases about stress and the immune system. In April, Medical News Today http://www.medicalnewstoday.com/index.php?newsid=7398 reported:

Stress affects hormones which affect immune system which alters mental and physical disease

A panel of experts speaking at Experimental Biology 2004 reports on new understandings of the mechanisms and pathways through which the body’s hormonal response to stress alters immune system function and influences susceptibility, onset and exacerbation of mental and physical diseases, including autoimmune diseases such as multiple sclerosis….

How does stress create damage? Dr. William B. Malarkey, Ohio State University, describes how the perception of stress activates the interface between the endocrine (or hormonal) system and the immune system, initiating a cascade of physiological events. If the perception of stress is short-term, these hormonal changes fade away.

But if the stressful sensory input persists, the resulting dysregulation of the immune system initiates an inflammatory state that, if not stabilized, leads to symptoms and then established disease processes….

As the immune system modifies in response to hormones produced by stress as perceived by the brain, it produces soluble factors that affect the brain itself….

Unfortunately, it’s my impression most of the research about stress and MS has been investigated from a psychological perspective, instead of from a perspective that recognizes this “cascade of physiological events”.

The news article did lead me to the Ohio State University Institute for Behavioral Medicine Research http://medicine.osu.edu/ibmr/about.html Even without a scientific background, there seems to be quite an impressive list there of articles on stress and the immune response and stress-induced immunomodulation, including: Social stress and the reactivation of latent herpes virus type 1; Acute stress enhances while chronic stress suppresses immune function in vivo: A role for leukocyte trafficking; Chronic stress down-regulates growth hormone gene expression in peripheral blood mononuclear cells of older adults; Bidirectional effects of stress and glucocorticoid hormones on immune function: Possible explanations for paradoxical observations; Stress induced immunomodulation: Implications for infectious diseases; Autonomic and glucocorticoid associations with the steady-state expression of latent Epstein-Barr virus; stress associated immune modulation: Relevance to viral infections and chronic fatigue syndrome and on and on.

Now, I haven’t read any of these and the full references are available at the link, I’m just trying to make a point, (can you tell? ) with stress and MS, I personally think it’s the physiology and not the psychology that should be front and center in the research on MS and stress.

And, back to the beginning, I personally think there are a variety of “CAM” approaches to reducing stress that PWMS might want to consider, especially if they think there’s a link between their MS and stress.

FYI also, the US has a National Center for Complementary and Alternative Medicine (NCCAM). Information about their clinical trials for MS (very limited) can be found at http://nccam.nih.gov/clinicaltrials/mul ... erosis.htm Preliminary information about the yoga trials is available. (It was a news article here a while back.)

And, a university in California has initiated a clinical trial focused on stress and MS but I don't know what approach they're taking for the stress reduction.

That's all for now. Here's wishing you and everyone else a stress free day. It may help.

Sharon

[dignan]

have you seen this news report from a few weeks ago? It relates to your post in saying that the short-term type of stress might actually be helpful.


Jolting system may be what autoimmune patients need to counter chronic effects

BY LAURA BEIL - The Dallas Morning News - DALLAS - (KRT) - The brain and the immune system are at times like members of a dysfunctional family. Sure, they're close. They depend on each other. But under stress, one can drive the other to self-destruction.

Perhaps few people feel this more than the millions who already have a love-hate relationship with their immune systems. People who suffer from any of a host of autoimmune diseases – rheumatoid arthritis, multiple sclerosis or psoriasis, to name a few – can feel the pressures of stress literally in their every move.

Scientists who study the interplay between the brain and immune system are trying to help people with autoimmune conditions buffer themselves from the mental backlash of daily life by studying the effects of proper rest, stress management and other coping strategies. And one idea may be surprising: Fighting stress with stress.

"The key to chronic stress is acute stress," says Dr. Andrew Miller of Emory University School of Medicine. He believes that short bursts of benign stress - a scary movie, say - may actually be good for you.

But where the immune system is concerned, he and others point out, no answer is simple. The immune system is one of the body's most intricate operations, run by the chemical cross-talk between nerve cells, hormones from the brain and glands throughout the body. Troops of cells in the blood can quickly storm and retreat.

In autoimmune disease, something goes awry, and the system designed to attack outside threats starts to attack itself. The target varies by disease. In arthritis, it's the joints. In multiple sclerosis, it's the central nervous system.

Then on top of this comes stress, which can wreak havoc on even a healthy immune system. Human beings evolved in a world of mostly short-term threats, like an attacking bear. In modern life, the most menacing bear usually comes out of the stock market. Stress resonates at a sustained, yet unpredictable pitch. Fight or flight has become cope or mope.

Stress excites a trigger in the brain called the HPA axis. "HPA" stands for hypothalamus, pituitary gland and adrenal gland. It is the key relay that translates mental stress into physiological action. When you feel stressed, the hypothalamus in the brain fires a chemical signal to the pituitary gland, which then sends another signal to the adrenal glands. The adrenal glands (where the name "adrenaline" comes from) start pumping out a variety of substances that talk to the immune system and the rest of the body. One of the key substances is cortisol.

Cortisol is a potent compound that affects systems throughout the body. It raises blood sugar and works with adrenaline to increase heart rate, for example, readying the body for the stressful situation. It also sends a "message received" signal back to the brain, so the hypothalamus and pituitary don't stay all atwitter. And when things operate as they're supposed to, cortisol calms the immune system.

Thus, a paradox: Stress leads to cortisol, and cortisol can control a raging immune system - which is just what someone with arthritis wants.

"You would think that stress would tend to suppress the disease," says Dr. Esther Sternberg. A rheumatologist by training, Dr. Sternberg now directs the Integrative Neural Immune Program at the National Institute of Mental Health.

Yet that's not how people who have autoimmune conditions say they feel. Under stress, their conditions often get worse. And it's not just perception. For example, one study published earlier this year from researchers at Arizona State University found that people with rheumatoid arthritis have higher amounts of a naturally occurring inflammatory substance during stressful periods.

"What happens in chronic stress," says Emory's Dr. Miller, "is that cortisol doesn't work anymore." Prolonged stress affects either the production of cortisol, or the body's ability to respond to it. Some scientists believe the system may simply burn out. For whatever reason, the immune system loses a key chaperone.

What might help, he believes, are short-term stressors that would give the body a blast of cortisol. As evidence to support this idea, he points to a study of multiple sclerosis patients in Tel Aviv. The study happened to take place in 1991 during the first Gulf War, when Israel came under fire from Scud missile attacks. Researchers were surprised to find that the patients reported an improvement in their symptoms. According to a review published last year, this is the only study that has found multiple sclerosis symptoms actually improving under stress.

"The question for us is, why is chronic stress different?" says Dr. David Mohr of the University of California, San Francisco. Mohr, who studies the effects of stress among people with multiple sclerosis, concludes, "the short answer is, we don't know."

Researchers, including Miller, emphasize that cortisol isn't the sole cause of all things good and evil in the immune system. And its ultimate role in the exacerbation of autoimmune disease is still under study. The immune system has several kinds of soldiers, depending on the threat, and cortisol isn't the only colonel. There is even evidence suggesting that gender makes a difference, that men's and women's bodies don't respond to stress in the same way.

"You don't have just one thing going on in the body at the same time," Sternberg says. Which means there's no one thing to advise people with autoimmune conditions, but a host of possibilities that might help. "Listen to your body," she says. "Listen to your body because everyone is different. Different people will have different reactions to different kinds of stresses."

Pacing yourself is also important for people with autoimmune conditions, she says, because of its contribution to stress relief. So is moderate exercise. "You need more sleep than most people," she says. "There's nothing wrong with that."

By mastering stress, people with autoimmune conditions may feel like they have more control over their health. However, UCSF's Mohr cautioned that patients shouldn't feel like they have failed if their disease flares up. "This type of information should never be used by patients to place blame," he says. "These aren't diseases that people cause by themselves."

[Shayk]

Hi Dignan

I did see that, but only glanced at it. I'm really glad you posted it.

Lots of food for thought. Low fat food of course.

Sharon

[OddDuck]

Hi, guys!

Yea, I've seen both of those articles, and I can't tell you how happy I was to see that FINALLY something was being proven that some of us already knew! Stress(es) DO result in physiological changes. Some of them permanent, even after the stress has been "relieved", thereafter making people hyper-sensitive to stimuli and therefore much more susceptible to disease.

Deb

[JFH]

Thanks for your responses. We've gone a little off topic but it I've found it interesting and that's one of the benefits of these forums isnt it?

Here's a paper from the BMJ "Self reported stressful life events and exacerbations in multiple sclerosis" that shows that

Patients with multiple sclerosis who experience a stressful event are subsequently at increased risk of an exacerbation of their disease

and that

Stress and infection are independently associated with the risk of an exacerbation

My reading of this paper (it is written in Medic not English so I have to read it in translation ) is that we are more than twice as likely to experience an exacerbation in the 4 four weeks following a "stressful life event" than if no such event occured.

Now, in the context of my original post, I wonder, is there any CAM that has been shown in general to reduce the effect stress has? (The more I go down any route the further away the end point seems to be!)

http://bmj.bmjjournals.com/cgi/content/ ... 6/646#TBL1

[OddDuck]

Oh, I guess that was my fault. You're right. I was reading the article with the focus on the "stress" part.

By CAM, are you referring to alternative drug treatments? Otherwise, my response would be the same as Sharon's. Exercise being a big one. Mindset (I always refer to "mind over matter", which isn't always a popular subject of discussion amongst friends.... ) can also be a contributing factor.

I DO believe that a vitamin and anti-oxidant regimen is important in MS. Of course, that also is highly controversial on what helps MS and what doesn't, but I would hazzard a guess that quite of few of us will support the fact that certain supplements help.

Low-fat diet. That's another one. But you know, I personally wouldn't consider any of the above "CAM". I advocate a "whole body approach" to treating MS.

Of course, there is also massage and acupuncture. I love a good massage (but who doesn't, I'd guess). I've never had acupuncture, unless you can refer to the EMG test as something similar. (JUST kidding.)

Of course, there is also chiropractic techniques and reflexology.

A co-worker of mine with MS is practicing STRICTLY CAM (and exercise) for her MS. Part of what she is doing is hypnosis, also. Trying to reach the unconscious mind and re-program it. (Well, I can't throw too many stones regarding re-programming the brain. They found that works in some autistic children.....not hypnosis, but reprogramming the brain through repetition, etc.) I have also done something similar in the past myself, and I would swear that it works (particularly regarding "function").

Deb