Series of studies first to examine acupuncture's mechanisms of action

Understanding the molecular underpinnings of an ancient Chinese therapy's success could increase its acceptance by mainstream medicine


While acupuncture is used widely to treat chronic stress, the mechanism of action leading to reported health benefits are not understood. In a series of studies at Georgetown University Medical Center (GUMC), researchers are demonstrating how acupuncture can significantly reduce the stress hormone response in an animal model of chronic stress.

The latest study was published today in the April issue of Journal of Endocrinology.

"Many practitioners of acupuncture have observed that this ancient practice can reduce stress in their patients, but there is a lack of biological proof of how or why this happens," says the study's lead author, Ladan Eshkevari, PhD, an associate professor of nursing at Georgetown University School of Nursing & Health Studies, a part of GUMC. "We're starting to understand what's going on at the molecular level that helps explain acupuncture's benefit."

Eshkevari, a physiologist, nurse anesthetist and certified acupuncturist, designed a series of studies in rats to test the effect of electronic acupuncture on levels of proteins and hormones secreted by biologic pathways involved in stress response.

Eshkevari used rats because these animals are often used to research the biological determinants of stress. They mount a stress response when exposed to winter-like temperatures for an hour a day.

"I used electroacupuncture because I could make sure that each animal was getting the same treatment dose," she explains.

The spot used for the acupuncture needle is called "Zusanli," which is reported to help relieve a variety of conditions including stress. As with rats, that acupuncture point for humans is on the leg below the knee.

The study utilized four groups of rats for a 10-day experiment: a control group that was not stressed and received no acupuncture; a group that was stressed for an hour a day and did not receive acupuncture; a group that was stressed and received "sham" acupuncture near the tail; and the experimental group that were stressed and received acupuncture to the Zusanli spot on the leg.

The researchers then measured blood hormone levels secreted by the hypothalamus pituitary adrenal (HPA) axis, which includes the hypothalamus, the pituitary gland and the adrenal gland. The interactions among these organs control reactions to stress and regulate digestion, the immune system, mood and emotions, sexuality and energy storage and expenditure.

They also measured levels of NPY, a peptide secreted by the sympathetic nervous system in rodents and humans. This system is involved in the "flight or fight" response to acute stress, resulting in constriction of blood flow to all parts of the body except the heart, lungs and brain (the organs most needed to react to danger). Chronic stress, however, can cause elevated blood pressure and cardiac disease.

"We found that electronic acupuncture blocks the chronic, stress-induced elevations of the HPA axis hormones and the sympathetic NPY pathway," Eshkevari says. She adds that the rats receiving the sham electronic acupuncture had elevation of the hormones similar to that of the stress-only animals.

Eshkevari says this research complements her earlier reported work that focused only on NPY. In that study, Eshkevari and her team found that NPY levels were reduced in the experimental group almost to the level of the control group, while the rats that were stressed and not treated with Zusanli acupuncture had high levels of NPY (Experimental Biology and Medicine Dec. 2011).

"Our growing body of evidence points to acupuncture's protective effect against the stress response," she continues. Eshkevari says additional research is needed to examine if acupuncture would be effective in reducing hormone levels after the animals are exposed to the stress of cold temperatures, and whether a similar observation can be made in humans.

The effects of yoga on major psychiatric disorders

The 5,000-year-old Indian practice may have positive effects on major psychiatric disorders, including depression, schizophrenia, ADHD and sleep complaints

Yoga has positive effects on mild depression and sleep complaints, even in the absence of drug treatments, and improves symptoms associated with schizophrenia and ADHD in patients on medication, according to a systematic review of the exercise on major clinical psychiatric disorders.

Published in the open-access journal, Frontiers in Psychiatry, on January 25th, 2013, the review of more than one hundred studies focusing on 16 high-quality controlled studies looked at the effects of yoga on depression, schizophrenia, ADHD, sleep complaints, eating disorders and cognition problems.

Yoga in popular culture

Yoga is a popular exercise and is practiced by 15.8 million adults in the United States alone, according to a survey by the Harris Interactive Service Bureau, and its holistic goal of promoting psychical and mental health is widely held in popular belief.

"However, yoga has become such a cultural phenomenon that it has become difficult for physicians and patients to differentiate legitimate claims from hype," wrote the authors in their study. "Our goal was to examine whether the evidence matched the promise."

Benefits of the exercise were found for all mental health illnesses included in the review, except for eating disorders and cognition problems as the evidence for these was conflicting or lacking.

Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke University Medical Center, US, and author of the study, explained that the emerging scientific evidence in support of the 5,000 year old Indian practice on psychiatric disorders is "highly promising" and showed that yoga may not only help to improve symptoms, but also may have an ancillary role in the prevention of stress-related mental illnesses.

The review found evidence from biomarker studies showing that yoga influences key elements of the human body thought to play a role in mental health in similar ways to that of antidepressants and psychotherapy. One study found that the exercise affects neurotransmitters, inflammation, oxidative stress, lipids, growth factors and second messengers.

Unmet need among mental health patients

Depression alone affects more than 350 million people globally and is the leading cause of disability worldwide, according to the World Health Organization (WHO). On World Mental Health Day last year, the WHO called for improved access to treatments.

While there has been an increase in the number of medications available for mental health disorders, many of which can be life saving for patients, there remains "a considerable unmet need," according to Dr. Meera Balasubramaniam, lead author of the study, who is also based at Duke University, US.

Poor compliance and relapse as well as treatment resistance are growing problems, and medications are expensive and can leave patients with significant side effects.

The Primary Care study, carried out by WHO, found that 60% of patients were still depressed after a year of being treated with an anti-depressant and a National Institute of Mental Health funded research showed remission in only one-third of patients.

"The search for improved treatments, including non-drug based, to meet the holistic needs of patients is of paramount importance and we call for more research into yoga as a global priority," said Doraiswamy. "If the promise of yoga on mental health was found in a drug, it would be the best selling medication world-wide," he added.

There are many benefits associated with practicing yoga for improving mental health, including, fewer side effects, relatively low cost, generally good access and the improvement of physical fitness, added the authors.

The authors also note that while the results are promising, the findings should be viewed as preliminary because all studies of yoga to date have consisted of small samples, and more rigorous research will be needed before the exercise can be applied to help patients with mental health disorders.

Mindfulness Meditation May Relieve Chronic Inflammation

People suffering from chronic inflammatory conditions, such as rheumatoid arthritis, inflammatory bowel disease and asthma -- in which psychological stress plays a major role -- may benefit from mindfulness meditation techniques, according to a study by University of Wisconsin-Madison neuroscientists with the Center for Investigating Healthy Minds at the Waisman Center.

Mindfulness-based stress reduction, originally designed for patients with chronic pain, consists of continuously focusing attention on the breath, bodily sensations and mental content while seated, walking or practicing yoga.

While interest in meditation as a means of reducing stress has grown over the years, there has been little evidence to support benefits specific to mindfulness meditation practice. This was the first study designed to control for other therapeutic mechanisms, such as supportive social interaction, expert instruction, or learning new skills.

A class in stress reduction can be beneficial in many ways, some of which have little to do with mindfulness, according to Melissa Rosenkranz, assistant scientist at the center and lead author on the paper, which was published recently in the journal Brain, Behavior and Immunity. For example, learning to manage stress by engaging in regular physical activity may be therapeutic.

"We wanted to develop an intervention that was meant to produce positive change and compare the mindfulness approach to an intervention that was structurally equivalent," Rosenkranz says.

The study compared two methods of reducing stress: a mindfulness meditation-based approach, and a program designed to enhance health in ways unrelated to mindfulness.

The comparison group participated in the Health Enhancement Program, which consisted of nutritional education; physical activity, such as walking; balance, agility and core strengthening; and music therapy. The content of the program was meant to match aspects of the mindfulness instruction in some way. For example, physical exercise was meant to match walking meditation, without the mindfulness component. Both groups had the same amount of training, the same level of expertise in the instructors, and the same amount of home practice required by participants.

"In this setting, we could see if there were changes that we could detect that were specific to mindfulness," Rosenkranz explains.

Using a tool called the Trier Social Stress Test to induce psychological stress, and a capsaicin cream to produce inflammation on the skin, immune and endocrine measures were collected before and after training in the two methods. While both techniques were proven effective in reducing stress, the mindfulness-based stress reduction approach was more effective at reducing stress-induced inflammation.

The results show that behavioral interventions designed to reduce emotional reactivity are beneficial to people suffering from chronic inflammatory conditions.

The study also suggests that mindfulness techniques may be more effective in relieving inflammatory symptoms than other activities that promote well-being.

Rosenkranz emphasizes that the mindfulness-based approach is not a magic bullet.

"This is not a cure-all, but our study does show that there are specific ways that mindfulness can be beneficial, and that there are specific people who may be more likely to benefit from this approach than other interventions."

Significant portions of the population do not benefit from available pharmaceutical treatment options, for example. Some of these patients suffer from negative side effects of the drugs, or simply do not respond to the standard-of-care for treatment of the disorder.

"The mindfulness-based approach to stress reduction may offer a lower-cost alternative or complement to standard treatment, and it can be practiced easily by patients in their own homes, whenever they need," Rosenkranz says.

Scientists at the Center for Investigating Healthy Minds conduct rigorous research on the physiological effects of meditation on the brain, and the power of the brain to influence human health. This study adds to the growing body of knowledge concerning the mechanisms of mindfulness and how it affects the body.

Co-authors on the paper were Richard J. Davidson, Donal G. MacCoon, John F. Sheridan, Ned H. Kalin and Antoine Lutz.

This work was supported by grants from the National Center for Complementary and Alternative Medicine (U01AT002114-01A1 to Antoine Lutz; and P01-AT004952 to Richard J. Davidson), the National Institute of Mental Health (P50-MH069315 to Richard J. Davidson), and a core grant from the National Institutes of Health to the Waisman Center (P30-HD003352, to Marsha Selzer), the Fetzer Institute, the John Templeton Foundation, and the Mental Insight Foundation.

Alternative medicine use high among children with chronic conditions: UAlberta medical research

Children who regularly see specialists for chronic medical conditions are also using complementary medicine at a high rate, demonstrates recently published research from the University of Alberta and the University of Ottawa.

About 71 per cent of pediatric patients attending various specialty clinics at the Stollery Children's Hospital in Edmonton used alternative medicine, while the rate of use at the Children's Hospital of Eastern Ontario in Ottawa was 42 per cent. Nearly 20 per cent of the families who took part in the study said they never told their physician or pharmacist about concurrently using prescription and alternative medicine.

Sunita Vohra, a researcher with the Faculty of Medicine & Dentistry at the U of A, was the lead investigator on the study, which was recently published in the peer-reviewed journal Pediatrics. Her co-investigator was W James King from the University of Ottawa.

"The children in this study are often given prescription medicines," says Vohra, a pediatrician who works in the Department of Pediatrics and the School of Public Health at the U of A.

"And many of these children used complementary therapies at the same time or instead of taking prescription medicine. We asked families if they would like to talk about the use of alternative medicine, more than 80 per cent of them said, 'yes, please.'

"Right now, these families are getting information about alternative medicine from friends, family and the Internet, but a key place they should be getting this information from is their doctor or another member of their health-care team, who would know about possible drug interactions with prescription medicines." Vohra said the study "identified a gap in communications" in dealing with pediatric patients and their families.

"It's important to get these conversations going with every patient, especially when you consider it's not widely recognized how common it is for children with chronic illnesses to use alternative medicine," says the Alberta Innovates-Health Solutions scholar.

"We need to make sure these families are comfortable telling their specialists they are taking other therapies," she said. Right now, Vohra and her colleagues at the U of A have developed curricula for undergraduate medical students about the use of alternative medicine by pediatric patients, which is considered innovative and novel. Ensuring medical students receive information about alternative medicine is key because it arms them with more knowledge about potential interactions with prescription medicine, says Vohra.

"Considering parents are saying they want this information, we have an obligation to ensure future physicians have the education and resources they need for these conversations," Vohra says.

Can Acupuncture Improve Exercise Performance and Post-Exercise Recovery?

The effects of acute acupuncture applied during exercise on performance factors such as power and blood pressure and on the body's ability to recover post-exercise were evaluated in a review article published in The Journal of Alternative and Complementary Medicine, a peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available free on the Journal website.

A review of the literature uncovered four studies designed to test whether a person receiving acupuncture while exercising would have enhanced exercise performance and/or recover more quickly from an exercise session. In their systematic review article, Paola Urroz, Ben Colagiuri, Caroline Smith, and Birinder Singh Cheema, University of Western Sydney (Campbelltown), and University of Sydney, Australia, suggest that based on these four published studies, acupuncture may have a positive effect.

They caution, however, that additional trials, with larger numbers of participants and randomized, controlled study designs, as well as standardized reporting of research methods and results, are needed to confirm and more thoroughly explore the effects of acupuncture on exercise performance and recovery.