In a recent post, Trust Your Gut, we talked about the importance of gut health, and how a healthy gut is important to the immune system and balancing the gut-brain axis and nervous system. We have gotten so used to tummy troubles that a lot of people suffer daily, even without a diagnosed digestive disorder; at times, it can be hard to pinpoint the source of the discomfort. Americans are inundated with articles about food sensitivity, overconsumption, and other factors that lead to gastrointestinal problems. The good news is, acupuncture is a safe, effective approach to improving overall gut health, which has a positive impact throughout the body.
Acupuncture can help improve the performance of the different organs in the abdomen, as well as the nervous system, and balance hormonal imbalances – all of which impact gut health. An overactive nervous system alone decreases digestive function, which has a negative impact on how effectively our bodies absorb nutrients and process waste.
The Major Players
Generally, when we think about gut health, the stomach gets all of the attention. There’s more to how the digestive system works.
Chewing, beginning of food breakdown through saliva
Peristalsis – the movement of organ walls, allowing food and liquid to move through the GI tract
Where food and digestive juices meet
Produces digestive juices that help break down carbohydrates, fats, and proteins
Processes nutrients absorbed by the small intestine
Recent studies show that acupuncture can help promote or decrease peristalsis and reduce certain acid outputs.
Some of the areas acupuncture can impact:
Irritable Bowel Syndrome
Acupuncture has been effective in treating areas of digestive distress for thousands of years. Your acupuncturist will look at the body as a system, rather than a sum of individual parts, in developing a treatment plan specific to you and your needs.
It’s May, and everything in Nashville is covered in a layer of pollen. We go through it every year, but the scratchy throat, itchy eyes, and runny nose are still an unpleasant harbinger of spring. Some allergens are around us all the time in the form of dust mites, pet dander, or food sensitivities.
Allergies trigger histamines, which are incredibly helpful for the body – they help the body get rid of something bothering you, like an allergy. They’re part of the body’s defense system and want to get rid of the stimulant, which is why you might sneeze, tear up, or itch. When your body is triggered by an allergen, your immune system signals mast cells in the skin, lungs, nose, mouth, gut, and blood to release histamines. The histamines boost blood flow in the affected area, causing inflammation and inviting other parts of the body’s defense system to engage.
Sometimes, the histamine response is dramatic and prolonged, such as when a tick bite triggers an Alpha Gal response and an allergic response to animal products. Acupuncture is one of the only techniques that can effectively reduce the severity of an Alpha-Gal response – there are no drugs, vaccines, or allergy shots available.
Acupuncture Treatments with Affinity Acupuncture
Acupuncture treatments can help with other environmental, seasonal, and food allergies also – by up to 80-95%. A simple protocol involves an exam, one visit, and one needle. We help identify the allergen, place a small needle in the ear for several weeks, and then allergens can be carefully and systematically reintroduced. For allergies severe enough to anaphylactic shock – the goal is not to intentionally reintroduce, but to lessen the severity of response if the body is exposed to the allergen. If you’re interested in finding out if you’re a good candidate for acupuncture to help relieve your allergy symptoms, call 615-939-2787 today, or click on this link.
In recent years, “gut health” has become a popular buzz phrase with scientists, physicians, and on social media. The idea isn’t new – Hippocrates once said that “all disease begins in the gut.” Improving digestive health has been a foundational ethos of Ayurvedic and Traditional Chinese Medicine for thousands of years. As a society, we’ve strayed from prioritizing health and nutrition over convenience, and are seeing the ramifications in increased obesity, heart disease, and other ailments that weren’t as prevalent before processed foods became a mainstay in our diets.
So why does the gut matter? Does having a drive-thru meal once a week really make that much of a difference? Your immune system, mood, sleep, digestion, heart, and brain all say yes.
Over the next few months, we’ll be looking at why gut health is important, and the roles of some of the unsung heroes of the digestive system.
Why it Matters
More than 100 trillion bacteria live in the gut. That’s not a typo. There are more bacteria than human cells in the human body. Gut bacteria help our esophagus, stomach, and intestines work together to comfortably digest foods. When the biome is thrown off, it can lead to heartburn, bloating, constipation, nausea, and loose stools. The little bacteria can’t ward off infection or communicate well with the brain through nerves and hormones.
Roughly 70% of the immune system (by weight) lives in the digestive tract. Without getting too technical, the Gut Associated Lymphoid Tissue (GALT) is the largest mass of lymphoid tissue in the body, and helps protect the body from infection in the gut. The gut’s mucosal surface is thin – it to be in order to allow food absorption. That also means that it’s vulnerable to infection. GALT helps protect the body from a large population of plasma cells (which produce antibodies) – larger than the spleen, lymph nodes, and bone marrow combined.
90-95% of serotonin (the body’s mood boosting chemical) is produced in the gut. You read that right. You’re probably familiar with serotonin as a brain neurotransmitter, right? A recent Caltech study shows that certain bacteria in the guy play a pivotal role in serotonin production. The foods we eat impact our moods beyond what we refer to as “comfort food.”
Up to 90% of diseases can be traced back to the gut microbiome. An estimated 70 million Americans have digestive diseases, and almost 1 in 5 have IBS. Those little bacteria strengthen the digestive tract’s wall, protecting us from pathogens. When the pathogens get through, it leads to inflammation and digestive disorders.
Help a Gut out Already
There are some easy things you can do to help give your gut a break (while avoiding any allergens): 1) Eat a variety of whole grains and legumes 2) Minimize eating out 3) Stop eating when you’re full 4) Eat fresh fruit and vegetables every day 5) Have a handful of nuts each day 6) Drink lots of water 7) Avoid artificial sweeteners and minimize candies and confections 8) Keep a food diary. If you get heartburn, feel bloated, or experience other digestive distress after eating certain foods, try eliminating or minimizing them in your diet. 9) Get some exercise 10) Sleep 11) Be careful with antibiotics. If you need them, add yogurt to your diet for the duration of the prescription.
Why Doctors Approve Acupuncture For Medical Ailments Treatment
The American College of Physicians formally recommends acupuncture for the treatment of back pain. Published in the prestigious Annals of Internal Medicine, clinical guidelines were developed by the American College of Physicians (ACP) to present recommendations based on evidence. Citing quality evidence in modern research, the ACP notes that nonpharmacologic treatment with acupuncture for the treatment of chronic low back pain is recommended. The official grade by the ACP is a “strong recommendation.” 
The Medical Goal of Acupuncture
A major goal of the recommendation is for acupuncture and other nonpharmacological therapies to replace drug therapy as a primary source of pain relief. Treatment with opioids is only recommended, with an official “weak recommendation,” when other modalities do not provide adequate relief. A strong recommendation is also made by the American College of Physicians for the treatment of both acute and subacute lower back pain with heat, massage, acupuncture, and spinal manipulation.  The recommendations were approved by the ACP Board of Regents and involves evidence based recommendations from doctors at the Penn Health System (Philadelphia, Pennsylvania), Minneapolis Veterans Affairs Medical Center (Minnesota), and the Yale School of Medicine (New Haven, Connecticut).
The American College of Physicians notes that approximately 25% of USA adults have had, at the very minimum, a one day lower back pain episode within the past three months. The socioeconomic impact of lower back pain in the USA was approximately $100 billion in the year 2006 . The costs include medical care and indirect costs due to lost wages and declines in productivity.  Recommendations for treatment options, including those for the use of acupuncture, include considerations of positive medical patient outcomes, the total number of back pain episodes, duration between episodes, alleviation of lower back pain, improvement in function of the back, and work disability reductions. Recommendations are for both radicular and nonradicular lower back pain.
The target audience for the American College of Physicians recommendations includes all doctors, other clinicians, and the adult population with lower back pain. The ACP notes, “Moderate-quality evidence showed that acupuncture was associated with moderately lower pain intensity and improved function compared with no acupuncture at the end of treatment .”  In agreement, the National Institute of Neurological Disorders and Stroke (National Institutes of Health) notes that acupuncture is an effective treatment modality for the relief of chronic lower back pain. 
These findings are consistent with those published in Mayo Clinic proceedings finding that acupuncture is effective for the treatment of lower back pain. The same Mayo Clinic report notes that acupuncture does not cause any significant adverse effects.  The Mayo Clinic findings apply to both nociceptive and non-nociceptive pain. Nociceptive back pain includes musculoskeletal inflammation and pain involving nerve cells wherein nociceptors are activated. Nociceptors are afferent neurons in the skin, muscles, joints, and other areas. For example, nerve impingement (often referred to as a “pinched nerve”) produces one type of nociceptive pain.
Non-nociceptive pain does not involve inflammation and is more relevant to pain processing in the central nervous system. One type of non-nociceptive pain condition is fibromyalgia and acupuncture has been confirmed as an effective treatment modality for this condition. The Mayo Clinic proceedings note, “Martin et al. found a significant improvement between electroacupuncture vs sham electroacupuncture. Differences were seen on the Fibromyalgia Impact Questionnaire (FIQ) scores for fatigue and anxiety.” 
The Mayo Clinic and American College of Physicians findings are consistent with additional quality research. Memorial Sloan Kettering Cancer Center (New York) and University of York (United Kingdom) researchers note “We have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed.” 
Doctors understand the true need for effective pain management. Nonpharmacological solutions are important for a variety of reasons including prevention of addiction, effective relief of pain, and prevention of adverse effects. This is often of heightened concern during pregnancy and for children. As a result, university hospitals integrate acupuncture into usual care settings to improve patient outcomes. For example, pediatric doctors at the UCSF Benioff Children’s Hospital San Francisco provide acupuncture to children, including non-needle laser acupuncture. At the University of California hospital, acupuncture is made available for both inpatients and outpatients. Dr. Kim notes that acupuncture reduces nausea up to 70%. She adds that acupuncture is also effective for significant reductions in post-surgical pain and chronic headaches. 
Recently, researchers have discovered how acupuncture stops pain and provides other forms of relief for patients. Breakthrough research conducted by University of South Florida (Tampa) and Fujian University of Traditional Chinese Medicine (Fuzhou) researchers documents how acupuncture stops pain. The researchers note, “acupuncture exerts a remarkable analgesic effect on SCI [spinal cord injury] by also inhibiting production of microglial cells through attenuation of p38MAPK and ERK activation.” 
Microglia are central nervous system immunity cells that secrete proinflammatory and neurotoxic mediators. Acupuncture reduces pain by attenuating this response. The researchers also document that acupuncture provides neuroprotection. The researchers note that acupuncture prevents brain damage in the hippocampus by “preventing microglial activation.” The University of South Florida members of the research team were from the Department of Neurosurgery and Brain Repair and the Department of Pharmaceutical Sciences. Funding was provided by the United States Department of Defense, University of South Florida Neurosurgery and Brain Repair, and the James and Esther King Biomedical Research Foundation.
The aforementioned research reveals an important biochemical mechanism involved in acupuncture’s ability to alleviate pain and reduce harmful inflammation. Researchers focus on other mechanisms activated by administration of acupuncture treatments. For example, laboratory investigations reveal how acupuncture regulates blood pressure.
University of California (Irvine) researchers find acupuncture effective for the treatment of high blood pressure. In a controlled laboratory study, University of California researchers have proven that electroacupuncture at acupoint ST36 (Zusanli) promotes enkephalin production, which dampens proinflammatory excitatory responses from the sympathetic nervous system that cause hypertension. Specifically, electroacupuncture regulates preproenkephalin gene expression, a precursor substance that encodes proenkephalin, which then stimulates the production of enkephalin. 
The formal recommendation for the use of acupuncture in cases of lower back pain by the American College of Physicians is based on modern research. Mayo Clinic findings and research from the Memorial Sloan Kettering Cancer Center (New York) and the University of York support this recommendation. In response to the needs of patients, doctors have already implemented acupuncture into several hospitals throughout the USA and both inpatient and outpatient acupuncture treatments are available.
Now, modern scientific investigations reveal how acupuncture works. University of South Florida and Fujian University of Traditional Chinese Medicine researchers confirm acupuncture’s ability to attenuate microglial activation. University of California researchers have quantified acupuncture’s ability to control inflammation by regulating enkephalins. In addition, the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) provides professional certification for acupuncturists, which ensures standards of excellence for licensed acupuncturists. Given the large body of supportive research and the administrative support for providing safe and effective acupuncture to the general public, expect to see greater implementation of acupuncture into usual care settings.
References 1. Qaseem, Amir, Timothy J. Wilt, Robert M. McLean, and Mary Ann Forciea. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of PhysiciansNoninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain.” Annals of Internal Medicine (2017). 2. Qaseem, et al. Annals of Internal Medicine (2017).
3. Katz J.N. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences.J Bone Joint Surg Am200688 Suppl 2214. 4. Lam M. Galvin R. Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.Spine (Philadelphia, Pennsylvania 1976) 201338212438. 5. ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet. Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. 6. Nahin, Richard L., Robin Boineau, Partap S. Khalsa, Barbara J. Stussman, and Wendy J. Weber. “Evidence-based evaluation of complementary health approaches for pain management in the United States.” In Mayo Clinic Proceedings, vol. 91, no. 9, pp. 1292-1306. Elsevier, 2016. 7. Martin DP, Sletten CD, Williams BA, Berger IH. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc. 2006;81(6):749-757. 8. MacPherson, H., A. Vickers, M. Bland, D. Torgerson, M. Corbett, E. Spackman, P. Saramago et al. “Acupuncture for chronic pain and depression in primary care: a programme of research.” (2017).
9. Leslie Lingaas. ucsf.edu/news/2014/04/113966/acupuncture-helps-young-patients-manage-pain. Acupuncture Helps Pediatric Patients Manage Pain and Nausea, 2014. 10. Lin, Lili, Nikola Skakavac, Xiaoyang Lin, Dong Lin, Mia C. Borlongan, Cesar V. Borlongan, and Chuanhai Cao. “Acupuncture-induced analgesia: the role of microglial inhibition.” Cell transplantation 25, no. 4 (2016): 621-628. 11. Cevic, C and Iseri, SO. The effect of acupuncture on high blood pressure of patients using antihypertensive drugs. Acupuncture & electro-therapeutics research 2013; 38(1-2): 1-15. ncbi.nlm.nih.gov/pubmed/23724695.
Researchers find acupuncture combined with clomiphene more effective than clomiphene plus supplementary hormonal pharmaceuticals for the treatment of infertility. The combination of acupuncture plus clomiphene produces significantly higher pregnancy rates for women with anovulatory infertility than clomiphene plus estradiol cypionate and dydrogesterone. The data was published in the report entitled Effects of Acupuncture on the Endometrium in Anovulatory Cases Treated by Clomiphene: A Clinical Observation.
The addition of acupuncture to clomiphene therapy increased pregnancy rates, lowered the resistance and pulsatility indices of the uterine arteries, and reduced the adverse effects caused by clomiphene. The increase in positive patient outcomes combined with reductions of adverse effects supports the research team’s (Taian Maternal and Child Health Care Hospital) conclusion, “TCM [Traditional Chinese Medicine] can be either applied alone or combined with Western medicine to up pregnancy rates and treat infertility. With the help of TCM [i.e., acupuncture], treatment for infertility can be more effective while producing much less adverse effects.” 
Clomiphene triggers the pituitary gland to produce hormones that stimulate ovulation. The upside of this medication is that it stimulates the release of eggs from the ovaries. The downside is that it may produce adverse effects and it is contraindicated for patients with endometriosis and uterine fibroids. Notably, it may increase the incidence of having twins or triplets. The researchers conclude that the addition of acupuncture to the clomiphene treatment regimen mitigates the drug’s adverse effects and ups the pregnancy rate. Moreover, the acupuncture protocol outperforms the clomiphene plus estradiol cypionate and dydrogesterone protocol. Estradiol cypionate is an estrogen hormone and is often used for the treatment of low estrogen levels. Estradiol cypionate may increase the rate of developing blood clots, melasma (dark skin patches on the face), and may cause other adverse effects. Dydrogesterone is a steroidal progestin used in many countries for the treatment of infertility and threatened miscarriages.
The clinical study was conducted with a semi-protocolized approach to acupuncture point selection. Identical primary acupuncture points were assigned to all patients and secondary acupuncture points were prescribed based upon differential diagnostics. As a variable control, secondary acupuncture point prescriptions were limited to one of three acupuncture point groupings: liver qi stagnation, phlegm-dampness, blood stasis. Patients were not divided into treatment and control groups based upon the diagnostic groups. Instead, they were randomly divided into three groups and then diagnostic decisions were made for the addition of secondary acupuncture points for the TCM treatment group.
A total of 43 patients were randomly distributed into three groups. Group 1 received only clomiphene. Group 2 received clomiphene plus estradiol cypionate and dydrogesterone. Group 3 received clomiphene plus acupuncture and moxibustion. The number of patients in each group was 15, 14, and 14 respectively. Patients ranged from ages 21–39. The preexisting duration of anovulatory infertility ranged from 1–8 years.
Groups 1 and 2 received 50–100 mg of clomiphene, once per day. Group 2 also received 1 mg of estradiol cypionate and 10 mg of dydrogesterone. Group 3 received clomiphene plus acupuncture and moxibustion. The administration of care for all groups started on the 5th day of menstruation and lasted for 5 consecutive days. One treatment course consisted of three menstrual cycles. In total, 1–2 courses of treatment were applied. The TCM acupuncture treatment protocol was as follows. Patients rested in a supine position. Upon disinfection, a 0.30 mm x 40 mm filiform needle was inserted into the following acupoints:
CV4 (Guanyuan) CV3 (Zhongji) Zigong ST29 (Guilai) SP6 (Sanyinjiao) ST36 (Zusanli) CV4, CV3, Zigong, and ST29 were inserted transverse-obliquely (15° angle) to a depth of 1–1.2 cm. SP6 and ST36 were needled perpendicularly and manipulated with the Ping Bu Ping Xie (tonify and sedate) technique. Additional acupoints were administered based on differential diagnostic patterns. For liver qi stagnation, the following acupoint was added:
BL18 (Ganshu) For phlegm and dampness, the following acupoint was added:
ST40 (Fenglong) For blood stasis, the following acupoints were added:
SP10 (Xuehai) LV2 (Xingjian) Moxibustion sessions lasted 30 minutes and were applied at a heat intensity level until the skin became flushed. Sessions were conducted once per day. Moxibustion was not applied until 10 days passed after ovulation. Moxibustion was applied at the following acupoints:
Zigong CV3 (Zhongji) CV4 (Guanyuan) ST29 (Guilai) Additional research confirms that acupuncture combined with moxibustion is effective for the treatment of infertility. Researchers conclude that acupuncture acts on the hypothalamus, pituitary gland, and ovaries and regulates hormone levels in the body. [2, 3] Yu et al. conclude that electroacupuncture can increase gonadotropin releasing hormone (GnRH) levels and increases sensitivity of the ovaries to gonadotropin. The study documents that electroacupuncture is effective for the treatment of infertility in anovulatory cases with low levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
In a related study, Xu et.al conclude that acupuncture combined with moxibustion increases ovulation rates.  The treatment protocol was as follows. First, acupuncture was applied to the following acupoints:
Zigong CV3 (Zhongji) CV4 (Guanyuan) ST36 (Zusanli) SP6 (Sanyinjiao) LV3 (Taichong) Additional acupoints were added based upon diagnostic patterns. For liver qi stagnation, BL18 was added; for phlegm and dampness, ST40 was added; for blood stasis, SP10 and LV2 were added. Next, moxibustion was applied to Zigong, CV3, CV4, and ST36. Subsequently, an electroacupuncture device was connected to the acupoints. The treatment was applied daily for 3–7 consecutive days. The results of B-scan ultrasonography conducted during the study documents that ovulation rates increase when acupuncture combined with moxibustion is applied.
In another study, acupuncture has been found effective for increasing infertility rates for women receiving IVF (in vitro fertilization) treatments. This highlights the role of acupuncture in an integrative medicine environment. University of Maryland School of Medicine researchers conclude that acupuncture increases pregnancy rates for women receiving IVF. In a study of 16 high quality clinical trials consisting of 4,021 subjects, acupuncture significantly raised pregnancy rates for women receiving IVF where otherwise pregnancy rates would have been low.
Strong evidence indicates that acupuncture increases pregnancy rates for women with anovulatory infertility and other forms of infertility. Acupuncture has been proven an effective complementary therapy to drug therapy and IVF protocols. Research indicates that acupuncture provides an additional benefit; it reduces the adverse effect rates of infertility medications. Based on the findings of modern research, the use of acupuncture is an appropriate, safe, and effective complementary therapy for the treatment of infertility.
References 1. Effects of Acupuncture on the Endometrium in Anovulatory Cases Treated by Clomiphene: A Clinical Observation. Journal of Taishan Medical College. 2016, 37(9):1029-1031. 2. Yu J, Zheng HM, Bing SM. Changes in sSrum FSH, LH and Ovarian Follicular Growth During Electroacupuncture for Induction of Ovulation [J]. Chinese Journal of Integrated Traditional and Western Medicine. 1989, 9(4):199-202. 3. Sha GE, Huang WC, Ma RH. Acupuncture for Infertility: A Clinical Observation Based on 84 cases [J]. Journal of Clinical Acupuncture and Moxibustion. 1998, 14(1):16-18. 5. Xu XF, Gu Y, Gu Ling, Zhu YP. Investigating Advantages of TCM Intervention for Inducting Ovulation in Infertile Women [J]. Chinese Archives of Traditional Chinese Medicine. 2012, 30(3):467-468. 6. Cao ZY. Obstetrics and Gynecology [M]. Beijing: People’s Military Medical Publisher. 1999: 2474. 7. Manheimer, Eric, Daniëlle van der Windt, Ke Cheng, Kristen Stafford, Jianping Liu, Jayne Tierney, Lixing Lao, Brian M. Berman, Patricia Langenberg, and Lex M. Bouter. “The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis.” Human reproduction update (2013). University of Maryland.