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Online Chat with Dr. Henri Roca, Medical Director, Center for Integrative Medicine

Monday, Februrary 9, 2009
12 Noon – 1pm

Disclaimer: All information provided during this chat is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Moderator: Good afternoon. Thank you for joining our chat today. We have received numerous advance questions from the public and Dr. Roca will try to answer as many as possible. Here is the first question.

Question: Has acupuncture been used to treat anxiety problems?

Dr. Roca: Acupuncture is very useful in treating both anxiety and depression. In conventional medicine we are approaching anxiety from a very conventional place. In traditional Chinese medicine, we have a very specific approach that looks at the flow of Chi or life force through various meridians. One of those meridians is called the heart meridian which is specific for emotional and spiritual imbalances.

In traditional Chinese medicine (TCM) we can use either acupuncture, traditional Chinese herbs, acupuncture in the ear alone to adjust the flow of Chi and to improve anxiety symptoms. The improvement tends to occur very quickly after treatment. At times the effect can last days to weeks. Often, we need to repeat the intervention several times over the course of weeks.

The degree to which the treatment takes hold is dependent upon the overall underlying physiologic balance of the person. This means that occasionally even as we use acupuncture to treat anxiety, we may still need to do various other blood work, nutritional interventions, supplements or vitamins to balance the underlying physiology.

Question: What is your opinion about hypnosis as a treatment for chronic obesity/overeating?

Dr. Roca: Obesity is one of the greatest threats to health faced by Americans in this age. So many other diagnoses are related to imbalances caused by overweight and obesity.

The answer to the question isn't really as simple as using hypnosis, though hypnosis can be a very effective intervention for certain people in their quest for weight balance. For that reason, I myself practice hypnotherapy and have used it successfully to treat patients who have these challenges.

But we need to expand the conversation. Indeed hypnotherapy can be used to help people make good food choices, limit their portion size, change the times of day they eat, and increase their activity level.

Even this is but the beginning of the equation with regard to weight issues. We need to look deeper into the physiology of the individual and into the connection between mental states, emotional states, and even spiritual states with the overall person.

With regard to the physiology, we need to understand the role of hormones in the problem. These include thyroid hormones, adrenal hormones, reproductive hormones, and hormones secreted by fat cells. In addition, we need to understand the metabolic processes occurring within the individual. Is the person insulin resistant? Do they fall asleep after eating a meal high in carbohydrates? Does weight seem impossible to lose? Do they really not eat much, but still gain weight? All of these things need to be considered.

We have a holisitic weight loss program that incorporates acupuncture, biofeedback, cognitive behavioral therapy, hormone balance, metabolic typing, and hypnotherapy as necessary to help the individual meet their goals.

Question: I read that acupuncture helps reduce the terrible hot flashes breast cancer survivors suffer. Have you found any truth to that?

Dr. Roca: Yes. Acupuncture and traditional Chinese medicine are very useful in the management of hot flashes - both those associated with breast cancer and with menopause. The meridian that is usually used is the spleen meridian.

Acupuncture can also be useful in reducing lymphedema often associated with breast cancer. It can also be very useful treating nausea, fatigue, insomnia, anxiety, post-surgical pain, scar reduction, and changes in bowel habits.

Question: What do you recommend for multilevel disc disease?

Dr. Roca: Very often people who have multilevel disc disease also have multilevel degenerative joint disease. And so we work with this from the combined perspective. The disc disease issue deals with impaired connective tissue and the joint disease deals with processes resulting from arthritis. One question is usually, when did this first begin and what were the life-style habits during that period of the person's life?

When we work with disc disease, we try to nourish the disc. We do this using supplements, often including glucosamine sulfate. In addition, we work to decrease the pressure and mechanical tension on the disc. For these purposes, chiropractic care and acupuncture can be useful.

In chiropractic care, we need to understand whether or not there are any chronic imbalances in the skeletal system. These could include flat feet, pronation of the feet, leg length differences, pelvic tilt issues, scoliosis, or differences in muscle strength from one side of the body to the other.

When any of these circumstances occur, they propagate through the entire system and create differential stresses and strains that can lead to tension on the vertebrae and changes in the shape of damaged discs.

When we deal with arthritis in the spine, and this is important to discs, because if the vertebrae have spiny outgrowths associated with arthritis, it makes the disc disease more likely to be symptomatic. So for arthritis, we look to autoimmune issues, to nutritional issues, to structural issues, and to hormonal issues. For example, if a person has a diet rich in meat and simple starches, they could have slightly acidic blood. If the body's buffers are taken up then the body will resort to the calcium in bone to balance the blood. The excess calcium can then be deposited on those areas of bone that are under the most stress. If the person happens to be obese, then the calcium is more likely to be deposited in the knees, hips and spine. Of course osteoporosis makes all of these situations worse.

Question: How much of hypnosis, acupuncture, healing touch, etc. is psychological rather than physical and how much does it depend on the recipient "believing" it will work? Does it really matter as long as it "seems" to work for the patient?

Dr. Roca: Excellent question. It brings up several issues. One: is there objective data supporting the mind-body and energetic therapies? Two: what is the nature of the placebo response?

For the first question, we do have objective randomized controlled studies documenting the effectiveness of acupuncture and healing touch. We actually have a device called the Super-conducting Quantum Interference Device (SQUID) that measures the energy flow associated with healing touch practitioners and Chi-Gong practitioners. This is a fascinating area of frontier medicine that is currently being researched. Interestingly, with regard to acupuncture, if a person believes in it, it tends to work better.

So we have a situation in which we can demonstrate an effect that is independent of the mind, and also, dependent on the mind. In addition, we have studies with acupuncture (Traditional Chinese Medicine) and healing touch that are done on worms, plants, and bacteria, who theoretically have no mind, that demonstrates effectiveness.

Now hypnotherapy is generally based on outcome studies so that we see groups of people who have the intervention do better than groups who do not have the intervention. Hypnotherapy is completely dependent upon a person's suggestibility. Everyone who gives permission to be hypnotized can be hypnotized, but it may take differing amounts of time.

For question two, the placebo is actually a demonstrable, reversible physiologic process. It links the mental state with the emotional state with the body. It is among several techniques that shows that there is no separation at all between what we think, what we feel, and what we experience in our bodies.

The placebo response can be blocked or reversed by the same medications that block some pain-killing medications.

Question: I am 53, thin, healthy, have walked for years and just got off birth control pills after 27 years. I'm told that I have osteoporosis and must take Fosamax. I am concerned about its side effects and want to know what can be done to reverse or stop this bone loss now.

Dr. Roca: As y'all have figured out by now, there are no simple answers.

And you might know from the "y'all" that I'm from N'Orleans.

So osteoporosis results from a complicated interaction between hormone levels, nutrient levels, activity levels and genetics.

Birth control pills with excessive progestin derivatives can contribute to osteoporosis. Diet, as we alluded to before, can contribute to osteoporosis. Changes in hormones as both men and women enter middle age, can contribute to osteoporosis.

We measure osteoporosis with regard to what we consider to be healthy bone in a young person. With a diagnosis of osteoporosis, it is important to consider estrogen levels, testosterone levels, calcium levels, vitamin D, magnesium, and trace elements. All of these will need to be optimized to return the person to a healthy bone status or to prevent the worsening of osteoporosis.

In my practice, I check all of these things, look at the objective measures provided by the Dexa Scan, investigate the person's genetic heritage before I suggest treatment options. Treatment options usually contain specific suggestions on dietary changes, supplementation with vitamins and minerals, and a specific exercise regimen. Depending upon the circumstance, this may be all that's necessary. We check the Dexa scan once a year and adjust as necessary. At times the person may need hormone optimization. And at times, they may even need pharmaceuticals. We have more tools in our tool kit so our interventions can be more varied.

Question: Have any of the techniques discussed today been shown to help men who have had severe incontinence and impotence problems after treatment for prostate cancer, or can this physical damage not be helped in these ways?

Dr. Roca: It depends upon the cause of the damage. If the damage has been caused by surgical separation of the nerves supplying the bladder, the penis, and the prostate, then, although we can try acupuncture, it will be just that: a try.

If, however, some of the problem lies with changes in the musculature of the bladder, the hormone balance or the arterial supply to these organs, then there can be some return of function. Often, men, as they age, have lower testosterone levels. These can be adjusted back to optimal functioning, but must be done so with the utmost care and concern in the case of prostate cancer patients. Just the other day, I had a patient who had a prostatectomy with radiation and who had had problems with erections, have an erection with nothing but nutrient supplementation.

Question: I'm a 49 year old female who had always had perfect health. Since the death of my father 2 years ago I have suffered from depression and put on 40 pounds! I've also learned that I have large uterine fibroids. Could it be possible that "depression" is caused by a hormone imbalance and that I should look into that instead of the depression I'm being treated for? I'd love to get on with a healthy life, without medications.

Dr. Roca: Bereavement is a time of huge stress that taxes the coping mechanisms of the best of us. During this time, the body churns through nutrients and neurotransmitters. The result can be a type of depression.

It can also cause people's adrenal glands to function poorly, especially if the stress continues for a long period of time. This can also contribute to depression. Once a person feels depressed, the brain changes. People can crave exactly the types of foods that are poorest for them, sweets, and simple carbs. Depression is often associated with weight gain. Fibroids can occur for a number of reasons, and even though it is possible that they can result from environmental xenoestrogens, it's impossible to currently identify that as a cause in an individual. As one goes through menopause, fibroids often resolve themselves. I have also had good response of fibroids to a diet rich in organic juiced fruits and vegetables.

Question: 1) Assuming one has a diet with plenty of fruits and vegetables, what vitamins and supplements do you recommend? 2) More specifically, what levels of vitamins D and E do you recommend?

Dr. Roca: The best source of vitamins is from food. If you have a question about vitamin levels in yourself, then I suggest testing your blood to find out if you are deficient. If you are deficient, and cannot change your nutritional intake, then using a vitamin supplement that comes from fresh fruits and vegetables is best. I encourage everyone to have their vitamin D level checked.

Question: How do you get skeptical doctors to buy into complementary treatment modalities?

Dr. Roca: Doctors rarely believe other doctors, or even research. Doctors do believe their patients. Share your good results with your physicians, demand that your physicians look beyond the symptom, insist that stress be addressed, and if you want options other than medications, ask for them.

Moderator: Thank you for joining our chat today. If you wish to schedule an appointment with Dr. Roca or receive holistic services from Greenwich Hospital's Center for Integrative Medicine, please call 203-863-3615. They are located at 35 River Road, Cos Cob, CT.