A major health care trend in the last decade has been the increased use of complementary and alternative medicine and nutritional supplements. Indeed, we now have Physician's Desk References for both herbal therapies and dietary supplements. A large amount of out-of-pocket dollars are spent on complementary and alternative medicine each year in the United States, and complementary and alternative medicine users believe strongly in the efficacy of their treatments.
In the area of inflammatory bowel disease, probiotics appear to be a highly promising form of therapy. In acute pancreatitis, enteral nutrition has been shown to be safe and effective. Peppermint oil is one of the most widely used complementary and alternative medicine therapies for irritable bowel syndrome. Antioxidants are increasingly used in liver disease, especially agents involved in methionine metabolism. Both S-adenosylmethionine and betaine have shown efficacy in animal models of alcoholic liver disease, and “knockout” mice that develop S-adenosylmethionine deficiency also develop steatohepatitis. Thus, there is great interest in these complementary and alternative medicine agents in both alcoholic liver disease and nonalcoholic steatohepatitis. There are also important safety issues related to complementary and alternative medicine. Deaths of well-known athletes have highlighted the risks of ephedra, and some research suggests that complementary and alternative medicine agents are a major cause of fulminant liver failure necessitating liver transplantation.
Thus, physicians must be aware not only of the potential therapeutic benefits of complementary and alternative medicine agents and nutritional supplements, but also their potential risks, including toxicity and drug interactions.
aDepartment of Internal Medicine, bDivision of GI/Hepatology, University of Louisville Medical Center, Kentucky, USA
Supported in part by National Institutes of Health grants R37 AA01762-06 (McClain) and R01 AA010496 (McClain), and a Kentucky Science and Engineering Foundation grant (McClain), and the Veterans Administration).
Correspondence to Craig McClain, MD, Vice Chair for Research, Department of Internal Medicine, Professor of Internal Medicine, Pharmacology and Toxicology, University of Louisville Medical Center, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40292, USA
Tel: 502 562 3899; fax: 502 562 4271; e-mail: email@example.com