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What is wealth? What is it you can accumulate that actually means something and is difficult to take away from you? Find out how to attain one source of true riches. Click here:
Riches

Do you think that a mere self-help book couldn't really do any good? Find out what one skeptical researcher discovered about the power of a book:
Self-Help

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next:How to Order

A short essay about investing yourself in a relationship, then the person leaves and you have to let go.

Life Letters

To a friend who is hurting,

You are saddened, hurt and angry that you have put so much energy into yet another relationship, given unselfishly of yourself to one more wounded soul. And now that she is nourished, comforted, and healed, she's walked out of your life, abandoned you. I watch this strong woman whom I have come to care deeply about weep bitter tears. As is so often the case when I am with you, I am once again at a loss. Words of comfort seem inadequate just now. I have only my compassion and understanding to offer. I sit quietly for a time, holding you in my heart.

Then I remember the squirrel. And you, the weaver of words and worlds, quietly listen while I tell you a story...

I had been working on a case summary when I heard just out my window, a soft and pathetic wailing. When I looked outside, I discovered, to my distress, a tiny animal struggling in what looked very much to me like death throws. Its tiny body was writhing and quivering in apparent and absolute agony. I turned away from the window in horror, but I couldn't block out the creature's cries. My first impulse was to turn the music on loudly and return to my work, allowing nature to take its course. Within minutes though, I was reluctantly stepping outside.

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It was a squirrel. Its little body was gyrating so rapidly that I couldn't even begin to assess the damage. Satisfied that I was helpless, I ran off down the road to my neighbor's house where I began pounding on the door. Basil appeared in the doorway looking anxious, understanding instantly that I was distressed. I blurted out my story and then took off towards my cottage, trusting Basil to follow. Bless him, he did. As we stood beside the squirrel, I asked him what we should do. "Jeez, Tammie, I don't know." He sounded irritated. "I could chop off its head," he offered unenthusiastically. "Oh, No!" I exclaimed, horrified. "Can you help me get it into a container so I can take it to the vet?" I whined. He clearly didn't want to, but he said he would. I ran into our storage shed and brought out a lobster pot with a lid. Basil, grim faced, proceeded to prod the squirrel into the pot with a stick. I placed the pot on the passenger seat and sped out of the driveway. I had just gone a short distance when the squirrel began his dramatic attempts to escape. The lid began clattering, the pot began bouncing, and I was struck by two thoughts. One, I didn't know where the nearest vet was, as we used one in another town; and two, what if the squirrel had rabies, managed to escape and bit me! I could see the headlines now, "Local woman attacked by rabid squirrel while driving!"

I was a nervous wreck, attempting to drive with one hand and keep the lid on (literally and figuratively) with the other. I pulled into a gas station, saw a young man, blew my horn and motioned him over. "Where's the nearest vet?" I practically yelled to the poor kid. He looked leery as he peered into the blazer window at a wild-haired, wild-eyed woman, desperately struggling to hold a cover on a pot which contained a screaming, unidentified object. He told me how to get to the vet, glancing uneasily over at my captive pot as he recited the directions. I thanked him and was off again. The squirrel seemed to be unbelievably strong, and I was terrified that I was going to lose the battle. I fought with the lid, drove, and devised a plan of retreat should the squirrel win.

Finally, I made it to the animal hospital. I was not well received. The receptionist informed me coldly that they did not treat wild animals. I begged her. I promised I would pay whatever the fee was. The vet, a young and kind looking woman, agreed to take a look at the squirrel as soon as she could, and suggested I come back just before closing time.

When I returned, I was handed a cat carrying box which contained a pretty eyed, anesthetized squirrel, resting peacefully. I was informed that he had sustained what looked to be a pretty serious head injury, and had been infested with fleas. He had been treated for both conditions. I was told to keep him safely in the box for 24 hours, and that if he survived the night, he would probably recover, and it would then be safe to release him. I was presented with a ninety-dollar bill, which I gratefully paid, and off we went home.

I watched the squirrel until late into the night. He cried pitifully and I vacillated between fearing he would die one moment, and wishing for us both to be put out of our misery the next. I barely slept all night and was thrilled to find him wide-eyed and alive the next morning. After seeing Kristen off to school, I reluctantly went to work, hating to leave him alone. On the way to my office, I began to consider keeping the squirrel for a pet. I thought about him off and on all day - about my investment in his rescue, and my growing attachment to and sense of ownership of him. I vacillated back and forth and by the end of the day, I reluctantly accepted what I had to do.

That night, I watched with sadness and with pride, as Kevin set my squirrel free. As my little friend scampered away, I watched him disappear with both a sense of longing as well as satisfaction.

My story was over. We sat again in silence for a time. Then I added, "When you invest a huge part of yourself into something or someone, it almost begins to seem as though some part of them belongs to you, even though you know realistically that we belong only to ourselves. Sometimes, all we get to do is care for something or someone and then have to let go." I paused for a moment, searching for what I would say next and then continued. "We usually feel a significant loss in the letting go, we can even feel abandoned. We might even begin to wonder why we bothered in the first place. What we don't always recognize is that we're never left empty handed. We can hold on to the satisfaction and pride that comes from knowing that we've participated in someone's growth or healing, that our lives have made a difference. "

You smiled at me, and I knew immediately that you understood. It seems my friend that you always do.

Yours Always, A Fellow Traveler

next: Life Letters: Pass It On

Proper breathing can reduce stress and anxiety levels. Learn about breathing and stress and breathing techniques to help you relax.

The primary role of breathing is gas exchange: our cells need oxygen and their waste product, carbon dioxide, needs to be expelled. Breathing is an automatic body function, controlled by the respiratory center of the brain. However, we can also deliberately change our rate of breathing.

Different healing systems, from different cultures, have long realized the healing benefits of the breath, including Yoga, Tai Chi, and some forms of meditation. Many holistic practitioners believe that the breath is the link between the physical body and the ethereal mind, and that spiritual insight is possible through conscious breathing.

Regardless of the philosophy, scientific studies have shown that correct breathing can help manage stress and stress-related conditions by soothing the autonomic nervous system.

A range of disorders
The use of controlled breathing as a means of promoting relaxation can help manage a range of disorders, including:

• Anxiety
• Asthma
• Chronic fatigue syndrome
• Chronic pain
• High blood pressure
• Insomnia
• Panic attacks
• Some skin conditions, such as eczema
• Stress.

How we breathe
To stay inflated, the lungs rely on a vacuum inside the chest. The diaphragm is a sheet of muscle slung underneath the lungs. When we breathe, the diaphragm contracts and relaxes. This change in pressure means that air is 'sucked' into the lungs on inhalation and 'pushed' out of the lungs on exhalation.

The intercostal muscles between the ribs help to change the internal pressure by lifting and relaxing the ribcage in rhythm with the diaphragm. Flexing the diaphragm requires the use of the lower abdominals. If your abdomen gently moves in and out while you breathe, then you are breathing correctly.

Breathing and stress
The brain sets the breathing rate according to carbon dioxide levels, rather than oxygen levels. When a person is under stress, their breathing pattern changes. Typically, an anxious person takes small, shallow breaths, using their shoulders rather than their diaphragm to move air in and out of their lungs. This style of breathing empties too much carbon dioxide out of the blood and upsets the body's balance of gases. Shallow over-breathing - or hyperventilation - can prolong feelings of anxiety by exacerbating physical symptoms of stress, including:

• Chest tightness
• Constant fatigue
• Faintness and lightheadedness
• Feelings of panic
• Headaches
• Heart palpitations
• Insomnia
• Muscular aches, twitches or stiffness
• Tingling, numb and cold hands and face.

The relaxation response
When a person is relaxed, their breathing is nasal, slow, even, and gentle. Deliberately mimicking a relaxed breathing pattern seems to calm the autonomic nervous system, which governs involuntary bodily functions. Physiological changes can include:

• Lowered blood pressure and heart rate
• Reduced amounts of stress hormones
• Reduced lactic acid build-up in muscle tissue
• Balanced levels of oxygen and carbon dioxide in the blood
• Improved immune system functioning
• Increased physical energy
• Feelings of calm and wellbeing.

Abdominal breathing

There are different breathing techniques to bring about relaxation. In essence, the general aim is to shift from upper chest breathing to abdominal breathing. You will need a quiet, relaxed environment where you won't be disturbed for 10 to 20 minutes. Set an alarm if you don't want to lose track of time.

Sit comfortably and raise your ribcage to expand your chest. Place one hand on your chest and the other on your abdomen. Take notice of how your upper chest and abdomen are moving while you breathe. Concentrate on your breath and try to breathe in and out gently through the nose. Your upper chest and stomach should be still, allowing the diaphragm to work more efficiently with your abdomen and less with your chest.

With each breath, allow any tension in your body to slip away. Once you are breathing slowly and with your abdominals, sit quietly and enjoy the sensation of physical relaxation.

Special considerations
Some people find that concentrating on their breath actually provokes panic and hyperventilation. If this is the case, look for another way to relax.

Where to get help

• Your doctor
• Stress management specialist, such as a psychologist

Things to remember

• Shallow, upper chest breathing is part of the typical stress response.
• The stress response can be switched off by consciously breathing with the diaphragm.
• Abdominal breathing plugs into the autonomic nervous system and encourages it to relax, bringing about a range of health benefits.

Self-Therapy For People Who ENJOY Learning About Themselves

Since you are competent enough to read and understand this, the question isn't whether you need therapy but whether you want it. And whether you want it enough.

You can decide if you want therapy enough by weighing the expected costs against the expected rewards.

You can evaluate the costs by thinking about money, time, and energy.

FINANCIAL COSTS

Your out of pocket costs can range from nothing (for those with great insurance) to much more than $150 per hour (for those who need a psychiatrist and must pay on their own).

You need a psychiatrist if you have medical complications related to therapy. Most therapists are "clinical social workers" and some are "clinical psychologists."

If you need medication you might see a psychiatrist just once or occasionally and sometimes for less than an hour but you'd see the social worker or psychologist for your regular meetings.

Fees vary greatly. Competence is not directly related to fees! Fees are mostly related to the therapist's circumstances:
overhead, agency policies, lifestyle, etc. [My monthly rate is low because of low expenses. Ask for info if you want telephone counseling or could see me in person in Milwaukee.]

Finances should not keep you out of therapy. If you can't afford the fees and have no insurance, call a Family Service agency or call the local Mental Health Association. They can find help based on your ability to pay. (If you have enough income but prefer to spend it on other things, you don't want therapy enough...)

One of the best ways to evaluate whether you want therapy enough is simply to ask yourself:
"Would it be worth an hour of my time and energy each week to talk to a therapist about the things I want to improve about my life?"

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If the answer to this question is "Yes," then you probably want therapy enough.

If the answer is "No," you probably don't want it enough. (Unless deciding to value yourself is one of the problems you should work on.)

It is reasonable to assume that you will at least learn to understand yourself and your situation very well through therapy.

Since nothing is perfect, it is not reasonable to assume that you will solve all of the problems in your life.

When I end therapy with someone, I ask them to rate everything they wanted to change during therapy.
They then put a percentage on each item to indicate the degree to which we were successful or unsuccessful.

Most people report improvement in all areas, and enough improvement to be quite happy about it on 90% of the things they wanted to change.

The Best Ways To Find A Good Therapist:

• Go back to any therapist you had in the past if you were happy with their work.

• Ask your friends what they like about their therapists, and notice if these same factors are important to you.

Don't rely on your insurance company. Their primary interest is in keeping costs down. They usually refer to therapists who agree to follow the insurance company's very restrictive guidelines for short-term therapy.

Remember: You Are Hiring The Therapist. You decide if they are right for you, and you have every right to shop around if you want. A therapist should feel like a good match for you, regardless of their credentials.

One of the most important factors in finding a good therapist is whether the therapist truly believes he or she can help you. Notice their level of personal confidence.

Something is very wrong if your therapist believes they know you better than you know yourself or if the therapist acts "superior" in any way.

Therapists are the experts on the therapy process. You are the expert on yourself!

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Depression In The Culture

Self-Therapy For People Who ENJOY Learning About Themselves

On September 11, 2001 the World Trade Center in New York was completely destroyed, and the Pentagon, the center of American military power, was greatly damaged as well.

About three thousand people died. All U.S. citizens, and citizens of all other countries, were in shock.

I was scheduled to attend a professional workshop six days after this attack.

Since a friend of mine traveled quite a distance to attend the workshop with me, I decided to go even though my mind wasn't at all on the subject.

The workshop itself was not good, but, because of the attack, the instructor handed us the following quote which she said was written by "Mother Theresa" (a famous religious figure from Belgium).

As soon as I read it I knew I wanted to share it with you, even though I've only wanted to put my own writing at this site, and even though my own definition of "God" might differ from hers.

Here it is. I hope it holds as much meaning for you as it does for me.

People are often unreasonable, illogical, and self-centered.
Forgive them anyway.
If you are kind, people may accuse you of selfish, ulterior motives.
Be kind anyway.
If you are successful, you will win some false friends and some true enemies.
Succeed anyway.
If you are honest and frank, people may cheat you.
Be honest and frank anyway.
What you spend years building someone could destroy overnight.
Build anyway.
If you find serenity and happiness, they may be jealous.
Be happy anyway.
The good you do today, people will forget tomorrow.
Do good anyway.
Give the world the best you have, and it may never be enough.
Give the world the best you have anyway.
You see, in the final analysis, it is between you and God.
It was never between you and them anyway.

 

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next: Are You Expecting Too Much?

Articles to help you improve in your relationships, family, at work, with any addictions you may have. Learn how to feel better and improve yourself.

Click on a link to see the menu of articles on that specific topic

• I'm curious about myself.
• I'm curious about my mental health knowledge.
• I'm a therapist or other helping professional.
• I want to improve and I am willing to work on myself for a while.
• I may be depressed.
• I am often scared or anxious.
• I often feel ashamed.
• I often feel futile or hopeless.
• I want to learn about child abuse.
• I want to learn about addictions.
• I want help with my love relationship.
• I want help socially, with all kinds of relationships.
• I want help with children or with family problems.
• I want help about employment problems.
• Topics everyone should eventually read

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back to: Inter Dependence Homepage

Chapter 78 of the book Self-Help Stuff That Works

by Adam Khan

YEARS AGO I READ the book Shogun, by James Clavell, about the Japanese samurai (professional warriors). A samurai gave total allegiance to his liege lord and would die for him without question. The whole system was filled with honor and loyalty and was very beautiful in that respect.

While reading the book, I started treating my boss like my liege lord. What a difference it made! My attitude toward my boss changed and my boss's attitude toward me changed dramatically. The working relationship became smoother, more friendly and more efficient. I did everything my boss asked me to do, to the best of my ability and without question. Of course, if my boss asked me to jump off a bridge, I wouldn't have, but usually bosses don't ask employees to do anything but their jobs.

I've often seen a different kind of attitude in the workplace, however, and I'm sure you've seen it too. It can be stated as "I'm not going to kiss anyone's ass!" This attitude is characterized by arguing with the boss when asked to do something or trying to get away with not doing it very well. These people, even more than the rest of us, don't like being told what to do, and actively resist it, which forces the boss to bear down to maintain control, turning the working relationship into an unnecessarily antagonistic contest of wills.

I've worked with people who got along great with everyone except the boss. And I've worked in places where I had a great boss, but my coworkers had a supreme jerk for a boss - and it was the same person. My "samurai" attitude had changed my boss for me.

In a way, your attitude toward a person creates that person. Interact with someone with a chip on your shoulder and the person will usually respond defensively. Approach someone with friendliness and cooperation and the person is likely to respond in kind. We play a part in creating the way someone treats us.

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Do you want to stand out? Treat your boss like a liege lord and do what she or he asks you to do cheerfully, without question, and to the best of your ability and you will stand out. In your boss's mind, you will contrast sharply with the people who don't want to be told what to do. And it'll be more enjoyable for you to be at work.

Create a boss you enjoy working with. In actual behavior, the difference isn't much. You won't be any more tired or worn out by it. But you and your organization will be better off when you adopt a samurai attitude.

Treat your boss like a liege lord.

Here's a way to make your work more enjoyable.
Play the Game

One way to be promoted at work and succeed on the job may seem entirely unrelated to your actual tasks or purpose at work.
Vocabulary Raises

This is a simple technique to allow you to get more done without relying on time-management or willpower.
Forbidden Fruits

Here is a way to turn your daily life into a fulfilling, peace-inducing meditation.
Life is a Meditation

A good principle of human relations is don't brag, but if you internalize this too thoroughly, it can make you feel that your efforts are futile.
Taking Credit

next: Unnatural Acts

Magnetic Therapy, Electroconvulsive Therapy and Acupuncture are reviewed here as experimental procedures for bipolar disorder.

Magnetic Therapy. Repeated transcranial magnetic stimulation (rTMS) is also being studied for depression and bipolar disorder. Unlike ECT, this procedure appears not to cause seizures, memory lapses, or impaired thinking. The only side effect reported is a mild headache. One study in patients with unipolar depression found that after one year relapse rates were significantly lower after rTMS than after ECT, although only a few small studies have been conducted using this procedure and it still needs refinement.

Acupuncture. The first study on acupuncture as an add-on therapy for bipolar disorder is currently underway in the US. Some studies have suggested that acupuncture may affect part of the nervous system that regulates the stress response, which might aid patients with bipolar disorder.

next: The Impact of Antidepressant Discontinuation on Relapse, Remission, and Mood Episode Cycling in Bipolar Disorder
~ bipolar disorder library
~ all bipolar disorder articles

Polarity therapy is said to help treat ADHD, depression, anxiety, eating disorders and other psychiatric disorders. Learn about polarity treatment.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
• Theory
• Evidence
• Unproven Uses
• Potential Dangers
• Summary
• Resources

Background

Polarity was developed in the 1940s by Randolph Stone, a naturopath, chiropractor and osteopath. Naturopath Pierre Pannetier continued Dr. Stone's teachings after the mid-1970s. Polarity applies three principles and five chakras of Ayurvedic (traditional Indian) medicine. According to Tantric texts, there are a number of points in the body from which psychic forces flow. These are called "chakra points." Different hypothesis exist on the actual number (seven is the most common) and location of points. The term chakra comes from the Sanskrit cakram, meaning "wheel" or "circle." Polarity also draws from ancient Hermetic philosophy.

Touch (using the hands) is believed to influence the body's energy flow. Bodywork is said to remove energy blockages and strengthen energy fields. Dietary changes (believed to purify or build health), counseling, yoga, craniosacral therapy and other bodywork techniques may be integrated.

Scientific study of the effects of polarity in humans is lacking.

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Theory

Polarity therapy is based on a theory that energy flows through the body along five pathways and that this flow can be affected by the therapeutic placement of the practitioner's hands at specific points to correct disorders or imbalances. Polarity practitioners have proposed that cells in the body have negative and positive poles and are involved in this flow of energy. Practitioners aim to access a patient's energy using palpation (touch), observation and patient interviews. Polarity shares some principles with the yin-yang concept in traditional Chinese medicine and the chakra system in Ayurvedic medicine.

Polarity treatment often begins with a consultation and a history of the patient's health problem. Therapy may be conducted on a treatment couch. The practitioner may use physical manipulation techniques and apply pressure to certain points on the body.

Treatment may last for 60 to 90 minutes. Weekly sessions for up to eight weeks, with occasional maintenance treatments, may be suggested.

Polarity may integrate yoga. Polarity yoga consists of a group of simple relaxing exercises intended for easing pain, "cleansing," improving muscle tone or energizing. Postures often use gentle rocking and stretching movements combined with vocal expression.

Evidence

There is no evidence for this technique.

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Unproven Uses

Polarity has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using polarity for any use.

Anxiety Arthritis Attention-deficit hyperactivity disorder Autism Cancer Cerebral palsy Chemotherapy side effects Chronic fatigue syndrome Depression Digestive disorders Eating disorders Exercise-induced asthma Exhaustion Fatigue Hair loss

Hardening or scarring of breast tissue in mastectomy patients Improved thinking Infertility Insomnia Fatigue Fibromyalgia Lumbar back pain Menopausal symptoms Nausea Neuropathy (nerve pain) Pain Plantar fasciitis Postoperative side effects Psychological conditions Radiation therapy side effects Sciatica Stress

Potential Dangers

The safety of polarity has not been thoroughly studied scientifically. Polarity should not be used in place of more proven therapies for potentially severe conditions.

Summary

Polarity has been suggested for many health problems, but it has not been proven effective for any specific one. Do not rely on polarity alone to treat a potentially severe medical condition. You should speak with your health care provider if you are considering polarity therapy.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

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Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Selected Scientific Studies: Polarity

Natural Standard reviewed the available scientific literature to prepare the professional monograph from which this version was created.

Some of the more recent English-language articles are listed below:

1. Clifford D. Hospital study shows benefits of polarity therapy. Energy News Amer Polarity Ther Assoc 1997;12(2):1.
2. Dudley H. Polarity therapy case study: working with Evan. Energy News Amer Polarity Ther Assoc 1998;13(4):1.
3. Gilchrist R. Polarity therapy and counseling. Energy News Amer Polarity Ther Assoc 1995;10(4):17.
4. Harwood M. Study: using polarity therapy with ADHD. Energy News Amer Polarity Ther Assoc 1997;12(3):26-27.
5. Roscoe JA, Matteson SE, Mustian KM, et al. Treatment of radiotherapy-induced fatigue through a nonpharmacological approach. Integr Cancer Ther 2005;4(1):8-13.
6. Siegel A. Polarity Therapy: The Power That Heals. Dorset, UK: Prism Press, 1987.
7. Sills F. The Polarity Process: Energy as a Healing Art. Berkeley, CA: North Atlantic Books, 1989.
8. Stone R. Polarity Therapy: The Collected Works of Dr. Randolph Stone. Sebastopol, CA: CRS Pubs, 1986.
9. Young P. The Art of Polarity Therapy: A Practitioners Perspective. Dorset, UK: Prism Press, 1990.

back to: Alternative Medicine Home ~ Alternative Medicine Treatments

Detailed information on dietary supplements - what they are, how they're used, and safe use of dietary supplements.

On this page

• Introduction
• Questions and Answers
• Definitions
• For More Information
• References

Introduction

Dietary supplements are a topic of great public interest. Whether you are in a store, using the Internet, or talking to people you know, you may hear about supplements and claims of benefits for health. How do you find out whether "what's in the bottle" is safe to take and whether science has proven that the product does what it claims? This fact sheet provides some answers.

Questions and Answers

1. What are dietary supplements?
2. Why do people take supplements?
3. Is using supplements considered conventional medicine or complementary and alternative medicine (CAM)?
4. How can I get science-based information on a supplement?
5. If I am interested in using a supplement as CAM, how can I do so most safely?
6. I see the word "natural" on a lot of supplement labels. Does "natural" always mean "safe"?
7. Does the Federal Government regulate supplements?
8. Is NCCAM supporting research on supplements?

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1. What are dietary supplements?

Dietary supplements (also called nutritional supplements, or supplements for short) were defined in a law passed by Congress in 1994 (see the box below).^{1, 2}

Dietary Supplements...

• Are taken by mouth.
• Contain a "dietary ingredient" intended to supplement the diet. Examples of dietary ingredients include vitamins, minerals, herbs* (as single herbs or mixtures), other botanicals, amino acids, and dietary substances such as enzymes and glandulars.
• Come in different forms, such as tablets, capsules, softgels, gelcaps, liquids, and powders.
• Are not represented for use as a conventional food or as a sole item of a meal or the diet.
• Are labeled as being a dietary supplement.

* Linked terms are defined at the end of this fact sheet.

Dietary supplements are sold in grocery, health food, drug, and discount stores, as well as through mail-order catalogs, TV programs, the Internet, and direct sales.

References

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2. Why do people take dietary supplements?

People take supplements for many reasons. A scientific study on this topic was published in 2002.³ In it, over 2,500 Americans reported on supplements they used (given the categories of vitamins/minerals and herbal products/natural supplements) and for what reasons. Their responses are summarized in the table below.

Supplements: Why Taken? *
Vitamins/ Minerals	% of Responses	Herbals/ Supplements	% of Responses
Health/good for you	35	Health/good for you	16
Dietary supplement	11	Arthritis	7
Vitamin/mineral supplement	8	Memory improvement	6
Prevent osteoporosis	6	Energy	5
Physician recommended	6	Immune booster	5
Prevent colds/influenza	3	Joint	4
Don't know/no reason specified	3	Supplement diet	4
Immune booster	2	Sleep aid	3
Recommended by friend/family/media	2	Prostate	3
Energy	2	Don't know/no reason specified	2
All others	22	All others	45

* Adapted from Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Journal of the American Medical Association. 2002;287(3):337-344. Copyright © 2002, American Medical Association. All rights reserved.

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3. Is using supplements considered conventional medicine or complementary and alternative medicine (CAM)?

Some uses of dietary supplements have become part of conventional medicine (see box below). For example, scientists have found that the vitamin folic acid prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the eye disease age-related macular degeneration.

On the other hand, some supplements are considered to be complementary and alternative medicine (CAM)--either the supplement itself or one or more of its uses. An example of a CAM supplement would be an herbal formula that claims to relieve arthritis pain, but has not been proven to do so through scientific studies. An example of a CAM use of a supplement would be taking 1,000 milligrams of vitamin C per day to prevent or treat a cold, as the use of large amounts of vitamin C for these purposes has not been proven.

References

Conventional Medicine

Conventional medicine is medicine as practiced by holders of M.D.(medical doctor) or D.O. (doctor of osteopathy) degrees and by their allied health professionals, such as nurses, physical therapists, and dietitians. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine.

Complementary and Alternative Medicine (CAM)

Health care practices and products that are not presently considered to be part of conventional medicine are called CAM. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. There is scientific evidence for the effectiveness of some CAM treatments. But for most, there are key questions yet to be answered through well-designed scientific studies, such as whether they are safe and work for the diseases or conditions for which they are used. The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), is the Federal Government's lead agency for scientific research on CAM.

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4. How can I get science-based information on a supplement?

There are several ways to get information on supplements that is based on the results of rigorous scientific testing, rather than on testimonials and other unscientific information.

• Ask your health care provider. Even if your provider does not happen to know about a particular supplement, he can access the latest medical guidance about its uses and risks.
• Dietitians and pharmacists also have helpful information.
• You can find out yourself whether there are any scientific research findings on the CAM supplement you are interested in. NCCAM and other Federal agencies have free publications, clearinghouses, and databases with this information (see "For More Information").

5. If I am interested in using a supplement as CAM, how can I do so most safely?

Here are some points to keep in mind:

• It is important to talk to your health care provider (or providers, if you have more than one) about the supplement. This is for your safety and a complete treatment plan. It is especially important to talk to your provider if you:

  • Are thinking about replacing your regular medical care with one or more supplements.
  • Are taking any medications (whether prescription or over-the-counter). Some supplements have been found to interact with medications (see box below).

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  • Have a chronic medical condition.
  • Are planning to have surgery. Certain supplements may increase the risk of bleeding or affect anesthetics and painkillers.
  • Are pregnant or nursing a baby.
  • Are thinking about giving a child a supplement. Many products being marketed for children have not been tested for their safety and effectiveness in children.⁴
• Do not take a higher dose of a supplement than what is listed on the label, unless your health care provider advises you to do so.
• If you experience any side effects that concern you, stop taking the supplement, and contact your provider. You can also report your experience to the U.S. Food and Drug Administration's (FDA) MedWatch program, which tracks consumer safety reports on supplements (see "For More Information").
• If you are considering or using herbal supplements, there are some special safety issues to consider. See the NCCAM fact sheet "Herbal Supplements: Consider Safety, Too."
• For current information from the Federal Government on the safety of particular supplements, check the "Alerts and Advisories" section of the NCCAM Web site or the FDA Web site (see "For More Information").

References

Supplements and Drugs Can Interact

For example⁵:

• St. John's wort can increase the effects of prescription drugs used to treat depression. It can also interfere with drugs used to treat HIV infection, to treat cancer, for birth control, or to prevent the body from rejecting transplanted organs.

• Ginseng can increase the stimulant effects of caffeine (as in coffee, tea, and cola). It can also lower blood sugar levels, creating the possibility of problems when used with diabetes drugs.

• Ginkgo, taken with anticoagulant or antiplatelet drugs, can increase the risk of bleeding. It is also possible that ginkgo might interact with certain psychiatric drugs and with certain drugs that affect blood sugar levels.

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6. I see the word "natural" on a lot of supplement labels. Does "natural" always mean "safe"?

There are many supplements, as well as many prescription drugs, that come from natural sources and are both useful and safe. However, "natural" does not always mean "safe" or "without harmful effects." For example, consider mushrooms that grow in the wild--some are safe to eat, while others are poisonous.

The FDA issues warnings about supplements that pose risks to consumers, including those used for CAM therapies. A sample list is in the box below. The FDA found these products of concern because they:

• Could damage health--in some cases severely.
• Were contaminated--with other unlabeled herbs, pesticides, heavy metals, or prescription drugs.
• Interacted dangerously with prescription drugs.

Examples of Supplements That Have Carried FDA Cautions About Safety^6,7

• Ephedra
• Kava
• Some "dieter's teas"
• GHB (gamma hydroxybutyric acid), GBL (gamma butyrolactone), and BD (1,4-butanediol)
• L-tryptophan
• PC SPES and SPES
• Aristolochic acid
• Comfrey
• St. John's wort
• Certain products, marketed for sexual enhancement and claimed to be "natural" versions of the drug ,® which were found to contain an unlabeled drug (sildenafil or tadalafil).

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7. Does the Federal Government regulate supplements?

Yes, the Federal Government regulates supplements through the FDA. Currently, the FDA regulates supplements as foods rather than drugs. In general, the laws about putting foods (including supplements) on the market and keeping them on the market are less strict than the laws for drugs. Specifically:

• Research studies in people to prove a supplement's safety are not required before the supplement is marketed, unlike for drugs.
• The manufacturer does not have to prove that the supplement is effective, unlike for drugs. The manufacturer can say that the product addresses a nutrient deficiency, supports health, or reduces the risk of developing a health problem, if that is true. If the manufacturer does make a claim, it must be followed by the statement "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."
• The manufacturer does not have to prove supplement quality. Specifically:
  • The FDA does not analyze the content of dietary supplements.
  • At this time, supplement manufacturers must meet the requirements of the FDA's Good Manufacturing Practices (GMPs) for foods. GMPs describe conditions under which products must be prepared, packed, and stored. Food GMPs do not always cover all issues of supplement quality. Some manufacturers voluntarily follow the FDA's GMPs for drugs, which are stricter.
  • Some manufacturers use the term "standardized" to describe efforts to make their products consistent. However, U.S. law does not define standardization. Therefore, the use of this term (or similar terms such as "verified" or "certified") does not guarantee product quality or consistency.
• If the FDA finds a supplement to be unsafe once it is on the market, only then can it take action against the manufacturer and/or distributor, such as by issuing a warning or requiring the product to be removed from the marketplace.

References

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In March 2003, the FDA published new proposed guidelines for supplements that would require manufacturers to avoid contaminating their products with other herbs, pesticides, heavy metals, or prescription drugs. The guidelines would also require supplement labels to be accurate. These new guidelines could take effect as early as 2004.

The Federal Government also regulates supplement advertising, through the Federal Trade Commission. It requires that all information about supplements be truthful and not mislead consumers.

What's in the Bottle Does Not Always Match What's on the Label

A supplement might:

• Not contain the correct ingredient (plant species). For example, one study that analyzed 59 preparations of echinacea found that about half did not contain the species listed on the label.⁸
• Contain higher or lower amounts of the active ingredient. For example, an NCCAM-funded study of ginseng products found that most contained less than half the amount of ginseng listed on their labels.⁹
• Be contaminated (as discussed in Question 6).

8. Is NCCAM supporting research on supplements?

Yes, NCCAM is funding most of the nation's current research aimed at increasing scientific knowledge about supplements--including whether they work; if so, how they work; and how purer and more standardized products could be developed. Among the substances that researchers are studying are:

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• Yeast-fermented rice, to see if it can lower cholesterol levels in the blood
• Soy, to see if it slows the growth of tumors
• Ginger and turmeric, to see if they can reduce inflammation associated with arthritis and asthma
• Chromium, to better understand its biological effects and impact upon insulin in the body, possibly offering new pathways to treating type 2 diabetes
• Green tea, to find out if it can prevent heart disease

NCCAM is also sponsoring or cosponsoring clinical trials on supplements, including:

• Glucosamine hydrochloride and chondroitin sulfate, to find out if they relieve knee pain from osteoarthritis
• Black cohosh, to see if it reduces hot flashes and other symptoms of menopause
• Echinacea, to see if it shortens the length or lessens the severity of colds in children
• Garlic, to find out if it can lower moderately high cholesterol levels
• Ginkgo biloba, to determine whether it prevents or delays decline in cognitive (thinking) function in people aged 85 or older
• Ginger, to confirm whether it eases nausea and vomiting after cancer chemotherapy

Definitions

Amino acid: Building block of proteins.

Botanical: See "herb." "Botanical" is a synonym for "herb."

Clinical trials: Research studies in which a treatment or therapy is tested in people to see whether it is safe and effective.

Depression: An illness that involves the body, mood, and thoughts. The symptoms of depression often include feelings of sadness, hopelessness, or pessimism; and changes in sleep, appetite, and thinking.

Enzymes: Proteins that speed up chemical reactions in the body.

Glandulars: Dietary ingredients or supplements that are made from the glands of animals.

References

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Heavy metals: A class of metals that, in chemical terms, have a density at least five times that of water. They are widely used in industry. A few examples of heavy metals that are toxic and have contaminated some dietary supplements are lead, arsenic, and mercury.

Herb: A plant or plant part that is used for its flavor, scent, and/or therapeutic properties.

Peer reviewed: Reviewed before publication by a group of experts in the same field.

Testimonials: Information provided by individuals who claim to have been helped or cured by a particular product. The information provided lacks the necessary elements to be evaluated in a rigorous and scientific manner and is not used in the scientific literature.

For More Information

NCCAM Clearinghouse
Toll-free in the U.S.: 1-888-644-6226; 1-888-644-6226
International: 301-519-3153
TTY (for deaf or hard-of-hearing callers): 1-866-464-3615

E-mail: info@nccam.nih.gov
NCCAM Web site: http://nccam.nih.gov
Address: NCCAM Clearinghouse,
P.O. Box 7923, Gaithersburg, MD 20898-7923
Fax: 1-866-464-3616
Fax-on-Demand service: 1-888-644-6226

U.S. Food and Drug Administration (FDA)
The FDA monitors--and regulates for safety--foods, medicines, medical devices, cosmetics, and radiation-emitting consumer products.

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  Center for Food Safety and Applied Nutrition (CFSAN)
  Web site: www.cfsan.fda.gov
  Toll-free in the U.S.: 1-888-723-3366

  CFSAN oversees the safety and labeling of supplements, foods, and cosmetics. Publications include "Tips for the Savvy Supplement User: Making Informed Decisions and Evaluating Information."

• MedWatch
  Web site: www.fda.gov/medwatch/report/consumer/consumer.htm
  Toll-free in the U.S.: 1-888-463-6332

  MedWatch is the FDA's safety information and adverse event reporting program. Consumers or health care providers may file a report on a serious problem that they suspect is associated with a dietary supplement by following instructions available through the Web site or phone number above.

Federal Trade Commission (FTC)
Web site: www.ftc.gov
Toll-free in the U.S.: 1-877-382-4357

The FTC is a Federal agency that works to maintain a competitive marketplace for both consumers and businesses. Its has publications for consumers about supplements, including " 'Miracle' Health Claims: Add a Dose of Skepticism."

Office of Dietary Supplements (ODS), NIH
Web site: http://ods.od.nih.gov

The ODS supports research and disseminates research results in the area of dietary supplements. It produces the International Bibliographic Information on Dietary Supplements (IBIDS) database on the Web, which contains citations to and abstracts (brief summaries) of peer-reviewed scientific literature on dietary supplements; go to dietary-supplements.info.nih.gov and select "Health Information." ODS's information is offered through its Web site only.

CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html

CAM on PubMed, a database on the Web developed jointly by NCCAM and the National Library of Medicine, offers citations to (and in most cases, abstracts of) articles in scientifically based, peer-reviewed journals on complementary and alternative medicine. Most citations include abstracts, and some link to the full text of articles.

The Cochrane Library
Web site: www.cochrane.org/reviews/clibintro.htm

The Cochrane Library is a collection of science-based reviews from the Cochrane Collaboration, an international nonprofit organization that seeks to provide "up-to-date, accurate information about the effects of health care." Its authors analyze the results of rigorous clinical trials on a given topic and prepare summaries called systematic reviews. Abstracts of these reviews can be read on the Web without charge. You can search by treatment name (such as the name of an herb) or medical condition. Subscriptions to the full text are offered at a fee and are carried by some libraries.

References

1. Dietary Supplement Health and Education Act of 1994. Food and Drug Administration Web site. Accessed at www.fda.gov/opacom/laws/dshea.html on April 14, 2003.

2. Dietary supplements: overview. U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition Web site. Accessed at www.cfsan.fda.gov/~dms/supplmnt.html on August 20, 2003.

3. Kaufman DW, Kelly JP, Rosenberg L, et al. Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. Journal of the American Medical Association. 2002;287(3):337-344.

4. Federal Trade Commission. Promotions for kids' dietary supplements leave sour taste. Federal Trade Commission Web site. Accessed at http://www.ftc.gov/opa/2004/06/kidsupp.shtm on May 2, 2003.

5. Natural Medicines Comprehensive Database. Natural Medicines Comprehensive Database Web site. Accessed at http://naturaldatabase.com on August 20, 2003.

6. MedWatch: the FDA safety information and adverse event reporting program. U.S. Food and Drug Administration Web site. Accessed at www.fda.gov/medwatch on August 20, 2003.

7. Dietary supplements: warnings and safety information. U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition Web site. Accessed at www.cfsan.fda.gov/~dms/ds-warn.html on April 14, 2003.

8. Gilroy CM, Steiner JF, Byers T, et al. Echinacea and truth in labeling. Archives of Internal Medicine. 2003;163(6):699-704.

9. Harkey MR, Henderson GL, Gershwin ME, et al. Variability in commercial ginseng products: an analysis of 25 preparations. American Journal of Clinical Nutrition. 2001;73(6):1101-1106.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy in this information is not an endorsement by NCCAM.

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