Sunday, August 11, 2013

Homeopathic IBD Treatments

Homeopathy and Watered Down Treatment Options For IBD

Homeopathy was invented by Samuel Christian Hahnemann in the late 1700’s and became popular toward the end of the 18th and the beginning of the 19th centuries.  Homeopathy was based on Hahnemann’s Principle of Similars.  Hahnemann believed that treatments that caused symptoms similar to those of a disease would also cure that disease.  Second, homeopathic treatments are diluted with water or alcohol to extract their “vital essence”, with dilutions occurring on the “C” scale from 1C to 100C.  Each “C” represents a dilution stage where the essence is diluted with the alcohol or water in a 1:100 ratio.  Finally, homeopathy proposes to treat based on the presentation of symptoms instead of the root cause – Ulcerative Colitis with bleeding and abdominal pain would be treated completely differently than UC with excessive diarrhea and rectal irritation.(1)

Compared with other treatments of its time like purging (through bleeding, vomiting, sweating, or other means) to balance one’s humors (or fluids and fibers, depending on your medical “beliefs”)(1) or the use of the jugum for nocturnal incontinence (not for the feint of heart) (2), homeopathy was relatively safe and did meet the “first do no harm” test for the most part at the time, but did it do any good?

A concise treatment of the effectiveness of homeopathy in general can be found in an article by Dr. Stephen Barrett over on Quackwatch.  Basically, true homeopathic treatments run afoul of a basic law of chemistry.  Avogadro’s Constant (6.02x10e23, which represents the number of particles in one mole of a substance).  Any dilution beyond that number will result in no molecules of the original compound being present.  Thus, dilutions greater than 12C, which represents most homeopathic remedies, contain none of the substance that they claim will cure the underlying condition, essentially making them pure water or alcohol.  Hahnemann was aware of the dilution limits (Avogadro was a contemporary), but proposed that the “essence” of the substance was left behind.  There is no known scientific basis, chemical or physical, for substances to have an “essence”.

Homeopathy has been put forth as a treatment for both Crohn’s Disease and Ulcerative Colitis and its use appears to be on the rise.  Though current numbers are difficult to come by, a prior article in Gut in 1986 found that 1% of Crohn’s patients were treating their illness with homeopathy.(5)  That number rose to approximately 9% in 2011 in the United States, and may be up to three times that percentage in Germany (where homeopathy is most popular).(6)

The claims for homeopathic treatment of IBD are fairly significant.  One of the major online providers of homeopathic remedies notes the following:

Homoeopathic medicines have proven their efficacy in all sought of Inflammatory Bowel conditions and help by reducing the inflammation & ulcerations and helping in restoring intestinal functions back to normal. It also helps by enhancing ones immune response. If homoeopathic treatment is sought early it helps in preventing the progress of disease and preventing any complications (Skin, Liver, and Arthritis) from occurring, which are usually associated with the disease. It helps by reducing the ulcerations at first and over a period of time by healing them.[sic for the whole paragraph](7)

Others are more moderated in their approach, and don’t claim a cure but just symptom relief as an adjunct to real medical care by a physician:

Homeopathy will not be a cure for Crohn's, but rather is another way to try to deal with your symptoms.(8)

Unfortunately, none of the claims of homeopathy in IBD are backed up by clinical trials – there are no well-designed, double blind studies with homeopathic treatments that show efficacy beyond placebo for IBD in either reducing symptoms or curing the underlying conditions.  In fact, there is no evidence of the efficacy of homeopathy in treating any condition.  The most comprehensive meta-analysis of homeopathy, from the British Journal of Clinical Pharmacology, analyzed 17 prior reviews and concluded:

… there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice. (9)

Bottom Line

-          There no evidence that treatment of any medical condition by homeopathy is effective, including IBD
-          Because homeopathic dilutions beyond 12C contain no active ingredient, those wanting to add homeopathic treatment to their existing regime can do so at a lower cost by drinking a glass of water a day

1.       Jonas, Wayne B., and Jennifer Jacobs. Healing with homeopathy: The complete guide. Hachette Digital, Inc., 2009.
5.       Smart, H. L., J. F. Mayberry, and M. Atkinson. "Alternative medicine consultations and remedies in patients with the irritable bowel syndrome." Gut27, no. 7 (1986): 826-828.
6.       Hilsden, Robert J., Marja J. Verhoef, Heidi Rasmussen, Antony Porcino, and Jennifer CC DeBruyn. "Use of complementary and alternative medicine by patients with inflammatory bowel disease." Inflammatory bowel diseases 17, no. 2 (2011): 655-662.

9.       Ernst, Edzard. "A systematic review of systematic reviews of homeopathy."British journal of clinical pharmacology 54, no. 6 (2002): 577-582.