How Does One Test Acupuncture Against Placebo Anyway?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Pinpointing The Usefulness Of Acupuncture
We asked you for your opinions on acupuncture, and got the above-depicted, below-described, set of answers:
- A little under half of all respondents voted for “It’s well-backed by modern science, per neurology, cardiology, immunology, etc”
- Slightly fewer respondents voted for “We don’t understand how it works, but it works!”
- A little under a fifth of respondents voted for “It may have some limited clinical applications beyond placebo”
- One (1) respondent voted for for “It’s placebo at best”
When we did a main feature about homeopathy, a couple of subscribers wrote to say that they were confused as to what homeopathy was, so this time, we’ll start with a quick definition first.
First, what is acupuncture? For the convenience of a quick definition so that we can move on to the science, let’s borrow from Wikipedia:
❝Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine in which thin needles are inserted into the body.
Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientific knowledge, and it has been characterized as quackery.❞
Now, that’s not a promising start, but we will not be deterred! We will instead examine the science itself, rather than relying on tertiary sources like Wikipedia.
It’s worth noting before we move on, however, that there is vigorous debate behind the scenes of that article. The gist of the argument is:
- On one side: “Acupuncture is not pseudoscience/quackery! This has long been disproved and there are peer-reviewed research papers on the subject.”
- On the other: “Yes, but only in disreputable quack journals created specifically for that purpose”
The latter counterclaim is a) potentially a “no true Scotsman” rhetorical ploy b) potentially true regardless
Some counterclaims exhibit specific sinophobia, per “if the source is Chinese, don’t believe it”. That’s not helpful either.
Well, the waters sure are muddy. Where to begin? Let’s start with a relatively easy one:
It may have some clinical applications beyond placebo: True or False?
True! Admittedly, “may” is doing some of the heavy lifting here, but we’ll take what we can get to get us going.
One of the least controversial uses of acupuncture is to alleviate chronic pain. Dr. Vickers et al, in a study published under the auspices of JAMA (a very respectable journal, and based in the US, not China), found:
❝Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.
However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture❞
Source: Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis
If you’re feeling sharp today, you may be wondering how the differences are described as “significant” and “relatively modest” in the same text. That’s because these words have different meanings in academic literature:
- Significant = p<0.05, where p is the probability of the achieved results occurring randomly
- Modest = the differences between the test group and the control group were small
In other words, “significant modest differences” means “the sample sizes were large, and the test group reliably got slightly better results than placebo”
We don’t understand how it works, but it works: True or False
Broadly False. When it works, we generally have an idea how.
Placebo is, of course, the main explanation. And even in examples such as the above, how is placebo acupuncture given?
By inserting acupuncture needles off-target rather than in accord with established meridians and points (the lines and dots that, per Traditional Chinese Medicine, indicate the flow of qi, our body’s vital energy, and welling-points of such).
So, if a patient feels that needles are being inserted randomly, they may no longer have the same confidence that they aren’t in the control group receiving placebo, which could explain the “modest” difference, without there being anything “to” acupuncture beyond placebo. After all, placebo works less well if you believe you are only receiving placebo!
Indeed, a (Korean, for the record) group of researchers wrote about this—and how this confounding factor cuts both ways:
❝Given the current research evidence that sham acupuncture can exert not only the originally expected non-specific effects but also sham acupuncture-specific effects, it would be misleading to simply regard sham acupuncture as the same as placebo.
Therefore, researchers should be cautious when using the term sham acupuncture in clinical investigations.❞
Source: Sham Acupuncture Is Not Just a Placebo
It’s well-backed by modern science, per neurology, cardiology, immunology, etc: True or False?
False, for the most part.
While yes, the meridians and points of acupuncture charts broadly correspond to nerves and vasculature, there is no evidence that inserting needles into those points does anything for one’s qi, itself a concept that has not made it into Western science—as a unified concept, anyway…
Note that our bodies are indeed full of energy. Electrical energy in our nerves, chemical energy in every living cell, kinetic energy in all our moving parts. Even, to stretch the point a bit, gravitational potential energy based on our mass.
All of these things could broadly be described as qi, if we so wish. Indeed, the ki in the Japanese martial art of aikido is the latter kinds; kinetic energy and gravitational potential energy based on our mass. Same goes, therefore for the ki in kiatsu, a kind of Japanese massage, while the ki in reiki, a Japanese spiritual healing practice, is rather more mystical.
The qi in Chinese qigong is mostly about oxygen, thus indirectly chemical energy, and the electrical energy of the nerves that are receiving oxygenated blood at higher or lower levels.
On the other hand, the efficacy of the use of acupuncture for various kinds of pain is well-enough evidenced. Indeed, even the UK’s famously thrifty NHS (that certainly would not spend money on something it did not find to work) offers it as a complementary therapy for some kinds of pain:
❝Western medical acupuncture (dry needling) is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles.
This results in the body producing natural substances, such as pain-relieving endorphins. It’s likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.❞
Source: NHS | Acupuncture
Meanwhile, the NIH’s National Cancer Institute recommends it… But not as a cancer treatment.
Rather, they recommend it as a complementary therapy for pain management, and also against nausea, for which there is also evidence that it can help.
Frustratingly, while they mention that there is lots of evidence for this, they don’t actually link the studies they’re citing, or give enough information to find them. Instead, they say things like “seven randomized clinical trials found that…” and provide links that look reassuring until one finds, upon clicking on them, that it’s just a link to the definition of “randomized clinical trial”:
Source: NIH | Nactional Cancer Institute | Acupuncture (PDQ®)–Patient Version
However, doing our own searches finds many studies (mostly in specialized, potentially biased, journals such as the Journal of Acupuncture and Meridian Studies) finding significant modest outperformance of [what passes for] placebo.
Sometimes, the existence of papers with promising titles, and statements of how acupuncture might work for things other than relief of pain and nausea, hides the fact that the papers themselves do not, in fact, contain any evidence to support the hypothesis. Here’s an example:
❝The underlying mechanisms behind the benefits of acupuncture may be linked with the regulation of the hypothalamic-pituitary-gonadal (adrenal) axis and activation of the Wnt/β-catenin and OPG/RANKL/RANK signaling pathways.
In summary, strong evidence may still come from prospective and well-designed clinical trials to shed light on the potential role of acupuncture in preserving bone loss❞
Source: Acupuncture for Osteoporosis: a Review of Its Clinical and Preclinical Studies
So, here they offered a very sciencey hypothesis, and to support that hypothesis, “strong evidence may still come”.
“We must keep faith” is not usually considered evidence worthy of inclusion in a paper!
PS: the above link is just to the abstract, because the “Full Text” link offered in that abstract leads to a completely unrelated article about HIV/AIDS-related cryptococcosis, in a completely different journal, nothing to do with acupuncture or osteoporosis).
Again, this is not the kind of professionalism we expect from peer-reviewed academic journals.
Bottom line:
Acupuncture reliably performs slightly better than sham acupuncture for the management of pain, and may also help against nausea.
Beyond placebo and the stimulation of endorphin release, there is no consistently reliable evidence that is has any other discernible medical effect by any mechanism known to Western science—though there are plenty of hypotheses.
That said, absence of evidence is not evidence of absence, and the logistical difficulty of testing acupuncture against placebo makes for slow research. Maybe one day we’ll know more.
For now:
- If you find it helps you: great! Enjoy
- If you think it might help you: try it! By a licensed professional with a good reputation, please.
- If you are not inclined to having needles put in you unnecessarily: skip it! Extant science suggests that at worst, you’ll be missing out on slight relief of pain/nausea.
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Recommended
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Why You Can’t Skimp On Amino Acids
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our body requires 20 amino acids (the building blocks of protein), 9 of which it can’t synthesize (thus called: “essential”) and absolutely must get from food. Normally, we get these amino acids from protein in our diet, and we can also supplement them by taking amino acid supplements if we wish.
Specifically, we require (per kg of bodyweight) a daily average of:
- Histidine: 10 mg
- Isoleucine: 20 mg
- Leucine: 39 mg
- Lysine: 30 mg
- Methionine: 10.4 mg
- Phenylalanine*: 25 mg
- Threonine: 15 mg
- Tryptophan: 4 mg
- Valine: 26 mg
*combined with the non-essential amino acid tyrosine
Source: Protein and Amino Acid Requirements In Human Nutrition: WHO Technical Report
Why this matters
A lot of attention is given to protein, and making sure we get enough of it, especially as we get older, because the risk of sarcopenia (muscle mass loss) increases with age:
However, not every protein comes with a complete set of essential amino acids, and/or have only trace amounts of of some amino acids, meaning that a dietary deficiency can arrive if one’s diet is too restrictive.
And, if we become deficient in even just one amino acid, then bad things start to happen quite soon. We only have so much space, so we’re going to oversimplify here, but:
- Histidine: is needed to produce histamine (vital for immune responses, amongst other things), and is also important for maintaining the myelin sheaths on nerve cells.
- Isoleucine: is very involved in muscle metabolism and makes up the bulk of muscle tissue.
- Leucine: is critical for muscle synthesis and repair, as well as wound healing in general, and blood sugar regulation.
- Lysine: is also critical in muscle synthesis, as well as calcium absorption and hormone production, as well as making collagen.
- Methionine: is very important for energy metabolism, zinc absorption, and detoxification.
- Phenylalanine: is a necessary building block of a lot of neurotransmitters, as well as being a building block of some amino acids not listed here (i.e., the ones your body synthesizes, but can’t without phenylalanine).
- Threonine: is mostly about collagen and elastin production, and is also very important for your joints, as well as fat metabolism.
- Tryptophan: is the body’s primary precursor to serotonin, so good luck making the latter without the former.
- Valine: is mostly about muscle growth and regeneration.
So there you see, the ill effects of deficiency can range from “muscle atrophy” to “brain stops working” and “bones fall apart” and more. In short, any essential amino acid deficiency not remedied will ultimately result in death; we literally become non-viable as organisms without these 9 things.
What to do about it (the “life hack” part)
Firstly, if you eat a lot of animal products, those are “complete” proteins, meaning that they contain all 9 essential amino acids in sensible quantities. The reason that all animal products have these, is because they are just as essential for the other animals as they are for us, so they, just like us, must consume (and thus contain) them.
However, a lot of animal products come with other health risks:
Do We Need Animal Products To Be Healthy? ← this covers which animal products are definitely very health-risky, and which are probably fine according to current best science
…so many people may prefer to get more (or possibly all) dietary protein from plants.
However, plants, unlike us, do not need to consume all 9 essential amino acids, and this may or may not contain them all.
Soy is famously a “complete” protein insofar as it has all the amino acids we need.
But what if you’re allergic to soy?
Good news! Peas are also a “complete” protein and will do the job just fine. They’re also usually cheaper.
Final note
An oft-forgotten thing is that some other amino acids are “conditionally essential”, meaning that while we can technically synthesize them, sometimes we can’t synthesize enough and must get them from our diet.
The conditions that trigger this “conditionally essential” status are usually such things as fighting a serious illness, recovering from a serious injury, or pregnancy—basically, things where your body has to work at 110% efficiency if it wants to get through it in one piece, and that extra 10% has to come from somewhere outside the body.
Examples of commonly conditionally essential amino acids are arginine and glycine.
Arginine is critical for a lot of cell-signalling processes as well as mitochondrial function, as well as being a precursor to other amino acids, including creatine.
As for glycine?
Check out: The Sweet Truth About Glycine
Enjoy!
Share This Post
-
Understanding and Responding to Self-Harm – by Dr. Allan House
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Whether it’s yourself, or (statistically much more likely) a loved one, it’s common to be faced with the deeply unpleasant reality of self-harm. This is a case where most definitely, “forewarned is forearmed”.
Dr. House covers not just the “what” and “why” of self-harm, but also the differences between suicidal and non-suicidal self-harm, as well as the impulsive and the planned.
Stylistically, the book is well-written, well-edited, and well-formatted. All this makes for easy reading and efficient learning.
Much of the book is, of course, given over to how to help in cases of self-harm. More specifically: how to approach things with both seriousness and compassion, and how to help in a way that doesn’t create undue pressure.
Because, as Dr. House explains and illustrates, a lot of well-meaning people end up causing more harm, by their botched attempts to help.
This book looks to avoid such tragedies.
Bottom line: if you’d rather know these things now, instead of wishing you’d known later, then this book is the one-stop guide it claims to be.
Click here to check out Understanding and Responding to Self-Harm, and be prepared!
Share This Post
-
This Is Your Brain on Music – by Dr. Daniel Levitin
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Music has sometimes been touted as having cognitive benefits, by its practice and even by the passive experience of it. But what’s the actual science of it?
Dr. Levitin, an accomplished musician and neuroscientist, explores and explains.
We learn about how music in all likelihood allowed our ancestors to develop speech, something that set us apart (and ahead!) as a species. How music was naturally-selected-for in accordance with its relationship with health. How processing music involves almost every part of the brain. How music pertains specifically to memory. And more.
As a bonus, as well as explaining a lot about our brain, this book offers those of us with limited knowledge of music theory a valuable overview of the seven main dimensions of music, too.
Bottom line: if you’d like to know more about the many-faceted relationship between music and cognitive function, this is a top-tier book about such.
Click here to check out “This Is Your Brain On Music”, and learn more about yours!
Share This Post
Related Posts
-
The Forgotten Exercise That Could Save Your Health After 50
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A lot depends on this:
Your heart is also a “use it or lose it” muscle
It’s well-known that muscles in general require maintenance (by regular exertion thereof), or they will atrophy and weaken. However, this is not only true of our skeletal muscles (the ones people think about when they say “muscles”), but also muscles like the heart.
Now, of course, we are all using our heart all the time, every day. One might be tempted to think it’ll be fine. It won’t; the body will not maintain anything beyond necessity. Thus, the prescription here is to regularly get our heart out of “zone 1”, its regular resting rate, which is usually about 50% or so of its maximum rate, and into “zone 2”, in which it beats at 60–70% of its maximum rate.
To find your maximum rate: as a general rule of thumb, 220 minus your age will usually give a fairly accurate estimate, unless you are unusually fit or unusually unfit.
Alternatively, if you have a fitness tracker, it can probably give you a number based on actual observation of your heartrate.
The benefits of doing so, as mentioned in this video:
- Improves heart health, circulation, and lowers blood pressure.
- Burns belly fat by using stored fat as energy*
- Boosts aerobic capacity, making daily activities easier.
- Enhances insulin sensitivity, mental health, and sleep.
- Helps manage arthritis, osteoporosis, and high cholesterol.
*note that this won’t happen in zone 1, and if you spend more than a little time in zone 3, it will happen but your body will do a metabolic slump afterwards to compensate, while doing its best to replenish the fat reserves. So, zone 2 is really the goal for this one, unless you want to do HIIT, which is beyond the scope of today’s article.
He recommends activities like brisk walking, cycling, or swimming. You don’t have to become a triathlon competitor if you don’t want to, but just pick what you like and do it at a fair pace. If it’s the brisk walking or cycling*, then (unless it’s very hot/humid where you are), if you break a sweat, you probably broke out of zone 2 and into zone 3. Which is fine, but wasn’t what you were aiming for, so it’s a sign you can go a little easier than that if you want.
*of course the same statement is also true of swimming, but you’ll not notice sweating in a pool 😉
As for how much and how often, averaging 20 minutes per day is good; if you want to condense that into 40 minutes 2–3 times per week, that’s fine too.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
The Doctor Who Wants Us To Exercise Less & Move More
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Magic mushrooms may one day treat anorexia, but not just yet
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Anorexia nervosa is a severe mental health disorder where people fear weight gain. Those with the disorder have distorted body image and hold rigid beliefs their body is too big. They typically manage this through restricted eating, leading to the serious medical consequences of malnutrition.
Anorexia has one of the highest death rates of any mental illness. Yet there are currently no effective drug treatments and the outcomes of psychotherapy (talk therapy) are poor. So we’re desperately in need of new and improved treatments.
Psilocybin, commonly known as magic mushrooms, is one such novel treatment. But while it shows early promise, you won’t see it used in clinical practice just yet – more research is needed to test if it’s safe and effective.
Ground Picture/Shutterstock What does treatment involve?
The treatment involves the patient taking a dose of psilocybin in a safe environment, which is usually a specifically set up clinic. The patient undergoes preparation therapy before the dosing session and integration therapy after.
Psilocybin, extracted from mushrooms, is a psychedelic, which means it can produce altered thinking, sense of time and emotions, and can often result in hallucinations. It also has the potential to shift patients out of their rigid thinking patterns.
Psilocybin is not administered alone but instead with combined structured psychotherapy sessions to help the patient make sense of their experiences and the changes to their thinking. This is an important part of the treatment.
What does the research show?
Research has shown improved effects of psilocybin-assisted psychotherapy after one or two dosing sessions, a couple of weeks apart. Most research to date has targeted depression.
Psilocybin has been found to increase cognitive flexibility – our ability to adjust our thinking patterns according to changing environments or demands. This is one of the ways researchers believe psilocybin might improve symptoms for conditions such as depression and alcohol use disorder, which are marked by rigid thinking styles.
People with anorexia similarly struggle with rigid thinking patterns. So researchers and clinicians have recently turned their attention to anorexia.
In 2023, a small pilot study of ten women with anorexia was published in the journal Nature Medicine. It showed psilocybin-assisted psychotherapy (with 25mg of psilocybin) was safe and acceptable. There were no significant side effects and participants reported having valuable experiences.
Although the trial was not a formal efficacy trial, 40% of the patients did have significant drops in their eating disorder behaviour.
However, the trial only had one dosing session and no long-term follow up, so further research is needed.
Researchers are still working out dosages and frequency. 24K-Production/Shutterstock A recent animal study using rats examined whether rigid thinking could be improved in rats when given psilocybin. After the psilocybin, rats gained weight and had more flexible thinking (using a reversal learning task).
These positive changes were related to the serotonin neurotransmitter system, which regulates mood, behaviour and satiety (feeling full).
Brain imaging studies in humans show serotonin disturbances in people with anorexia. Psilocybin-assisted psychotherapy is showing promise at modifying the serotonin disturbances and cognitive inflexibility that have been shown to be problematic in anorexia.
Research with animals can provide unique insights into the brain which can sometimes not be investigated in living humans. But animal models can never truly mimic human behaviour and the complex nature of chronic mental health conditions.
What’s next for research?
Further clinical trials in humans are very much needed – and are underway from a research team at the University of Sydney and ours at Swinburne.
Our trial will involve an initial 5mg dose followed by two subsequent doses of 25mg, several weeks apart. An initial low dose aims to help participants prepare for what is likely to be a new and somewhat unpredictable experience.
Our trial will examine the usefulness of providing psychotherapy that directly addresses body image disturbance. We are also investigating if including a family member or close friend in the treatment increases support for their loved one.
We’re investigating whether including a family member or close friend in treatment could help. Shutterstock Data from other mental health conditions has suggested that not everyone sees benefits, with some people having bad trips and a deterioration in their mental health. So this treatment won’t be for everyone. It’s important to work out who is most likely to respond and under what conditions.
New trials and those underway will be critical in understanding whether psilocybin-assisted psychotherapy is a safe and effective treatment for anorexia, and the optimal conditions to improve the patient’s response. But we are some way off from seeing this treatment in the clinic. One of the big issues being the cost of this intervention and how this will be funded.
Susan Rossell, Director Clinical Trials and Professor Cognitive Neuropsychiatry Centre for Mental Health and Brain Sciences, Swinburne University of Technology and Claire Finkelstein, Clinical Psychologist and PhD candidate, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Self-Compassion – by Dr. Kristin Neff
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A lot of people struggle with self-esteem, and depending on one’s surrounding culture, it can even seem socially obligatory to be constantly valuing oneself highly (or else, who else will if we do not?). But, as Dr. Neff points out, there’s an inherent problem with reinforcing for oneself even a positive message like “I am smart, strong, and capable!” because sometimes all of us have moments of being stupid, weak, and incapable (occasionally all three at once!), which places us in a position of having to choose between self-deceit and self-deprecation, neither of which are good.
Instead, Dr. Neff advocates for self-compassion, for treating oneself as one (hopefully) would a loved one—seeing their/our mistakes, weaknesses, failures, and loving them/ourself anyway.
She does not, however, argue that we should accept just anything from ourselves uncritically, but rather, we identify our mistakes, learn, grow, and progress. So not “I should have known better!”, nor even “How was I supposed to know?!”, but rather, “Now I have learned a thing”.
The style of the book is quite personal, as though having a heart-to-heart over a hot drink perhaps, but the format is organized and progresses naturally from one idea to the next, taking the reader to where we need to be.
Bottom line: if you have trouble with self-esteem (as most people do), then that’s a trap that there is a way out of, and it doesn’t require being perfect or lowering one’s standards, just being kinder to oneself along the way—and this book can help inculcate that.
Click here to check out Self-Compassion, and indeed be kind to yourself!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: