# LMCC/Complementary and Alternative Medicine
## Epidemiology

* Approximately 50-75% of Canadians use CAM at some point in their lives.
* CAM use is highest in Western provinces and lowest in Atlantic provinces.
* CAM is more likely to be used by younger patients, as well as those with higher education and higher income.
* Examples of CAM: chiropractice, acupuncture, massage, naturopathy, homeopathy, Traditional Chinese Medicine, Ayurveda
* Most commonly used for chronic diseases, such as back/neck problems, gynecological problems, anxiety, headaches, and digestive problems.
* More than half of Canadians do not disclose CAM use to their physicians.

## Herbal Products

* Over 50% of Canadians use natural health products.
* Most herbs have not yet been shown to be effective in clinical trials.
* Many patients believe herbal products are inherently safe and are unaware of potential side effects and interactions with conventional medicines.
* All natural health products must be regulated under the Natural Health Products Regulations; these products include herbal remedies, homeopathic medicines, vitamins, minerals, traditional medicines, probiotics, amino acids and essential fatty acids.
* Questions to ask patients who may be taking herbal products:
** Are you taking an herbal products, supplement or other natural remedy
** Are you taking any prescription or non-prescription medications for the same purpose as the herbal product?
** Are you allergic to any plant products?
** Are you pregnant or breast-feeding?

### Common Herbal Products

| Common Name | Reported Uses | Possible Adverse Effects | Possible Drug Interactions |
| Chamomile | mild sedative, anxiolytic, GI complaints, common cold | allergic/contact dermatitis, anaphylaxis | anxiolytics, sedatives |
| Echinacea | Common cold, flu, wound treatment, urinary tract infections, cancer | hypersensitivity, hepatotoxicity with prolonged use, avoid use if immunosuppresed | potentiates warfarin |
| Evening primrose | Dysmenorrhea, menopausal Sx, inflammation, allergies, eczema, arthritis, MS | Headache, restlessness, nausea, diarrhea, may decrease seizure threshold | anticoagulants, antiplatelets |
| Feverfew | Migraine prevention, rheumatoid arthritis, anti-inflammatory | Edginess, upset stomach, skin rash, miscarriage | Anticoagulants, antiplatelets |
| Garlic | Elevated lipids, hypertension, hyperglycemia, antimicrobial | GI irritation, contact dermatitis, may increase post op bleeding | anticoagulants, potentiates antihypertensives |
| Ginger | Nausea, motion sickness, dyspepsia, antiinflammatory | heartburn, not to be used for morning sickness | none known |
| Ginkgo biloba | Increases peripheral circulation (AD, dementia, intermittant claudication), premenstrual syndrome, vertigo | headache, cramping, bleeding, mild digestive problems, reports of intracranial hemmorage | anticoagulants, thiazide diuretics, MAO inhibitors |
| Ginseng | Energy enhancer, decreases stress, adjunct support for chemotherapy/radiation | Hypertension, nervousness, insominia, breakthrough bleeding, palpitations | Stimulant medications, antihypertensives, hormonal therapies |
| Glucosamine | osteoarthritis | GI distress, headache, drowsiness, palpitations | none known |
| Saw palmetto | BPH, adjunct to finasteride | Mild GI distress | a-adrenergics |
| St. John's Wort | Mild to moderate depression | Photosensitivity, increased liver enzymes, drowsiness, dizziness, nausea, headaches | CNS depressants |
| Valerian | Sedative, anxiolytic, muscle relaxant, PMS | Drowsiness, headache, digestive problems, paradoxical insomnia | CNS depressants |