Most other treatments for angina have no scientifically proven benefit. That said, many people with angina do better with attention and encouragement.

Complementary therapies which encourage relaxation may be useful if you are stressed. In the 1930s it was shown that even placebo (inactive) tablets could be helpful, relieving pain in a third of people with angina. Any effects with unproven treatment may therefore be the results of the placebo effect. As long as complementary treatment - be it herbs, acupuncture or reflexology - does no harm, feel free to try it. Bear in mind that, if the treatments were really proven to be useful, all doctors would be recommending them!

People who recommend these treatments tend to deride the scepticism sometimes shown by doctors but, even so, often do not provide the proof of success or submit the therapy to scientific validation. If someone could prove to me that massaging your right big toe was safe and relieved angina, I'd be the first to recommend it. I would have to advise you on the evidence (called evidence-based medicine) and there is none so far. Lots of people started using beta carotene for heart disease and cancer. Proper clinical trials have shown no benefit for this but did raise anxieties about adverse effects (see the section Risks of high cholesterol levels in Chapter 2). If you want to try an alternative approach, first be sure it is safe, then ask what proof there is. Always remember that isolated dramatic cases could be the result of the placebo factor.

I am not too sure what the 'placebo factor' means. Can you explain this to me?

Placebo translated from Latin means 'I will please'. A placebo effect is a benefit that cannot be explained by chemical actions from drugs or any scientific form of treatment. The benefit may be due to your belief (hope) that a treatment will work or just your total confidence in the doctor or alternative medicine practitioner ('This doctor is good; he will make me better'). Doctors use placebos to act as controls for their scientific preparations. Typically, they will test a new drug for angina and compare it with a placebo in such a way that neither you nor your doctor know which preparation is being taken. This is known as a 'double blind trial' and is a means of making sure that a new drug really does convey a benefit.

Could alternative medicine with acupuncture, homeopathy or herbal therapy just be a placebo effect?

You have put your finger on the problem! Alternative therapies have not undergone the rigorous testing that doctors would like to see. However, it is difficult to study alternative therapies as there is little motivation from large drug companies to fund such studies, since herbs cannot be patented. Alternative medicine practitioners believe there is no need for this sort of study, as they feel the ideas have been practised for many years.

What types of alternative therapy are available for people with heart problems?

Acupuncture uses needles at various points of the body to release energy (chi) and this is believed to be essential to good health. Homeopathy uses minute quantities of substances which produce similar symptoms to those experienced by people with heart problems, in the belief that resistance will develop. Herbalism uses plant-based preparations (often in an alcohol base) believed to restore good health. Herbal medicine is known as phytotherapy (plant therapy) and is quite separate from homeopathy.

I have heard that herbs can be helpful in heart disease and angina. Can you give me some advice?

Any alternative therapy (such as herbs) should not replace an accurate conventional diagnosis but only be tried once the diagnosis has been made and the safety of that treatment established. Some of the effects that have been claimed for herbs and other plants include:

• breakdown of plaques in arteries (alfalfa, garlic, hawthorn, mistletoe);

- relaxation (lemon balm, lily-of-the-valley, St John's wort, valerian);

• relief of anginal symptoms (pineapple);

• lowering of hypertension (bugle, hawthorn, mistletoe, skullcap, yarrow);

• relief of stress and anxiety (camomile, skullcap, St John's wort);

• circulation stimulation (cayenne, ginger, hawthorn);

• diuretic (dandelion, lily-of-the-valley, yarrow);

• antioxidant (garlic);

• lowering of cholesterol (ginger, motherwort, onion);

• reduction of clotting (gingko, onion);

• relief of palpitations (motherwort).

None of the claims for these herbs has reliably passed scientific scrutiny, yet a whole industry exists based on the assertions made. Only garlic has been studied in any depth and, whilst there seems to be some benefit, it should be considered a supplement not an alternative (see the question on garlic in Chapter 9). In other words, don't stop your medication, which has been scientifically proved to help, but do try complementary treatments that can be bought in reputable chemists' shops if you want to, following the advice on the information leaflets.

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