Acupuncture, metabolomics and mitochondrial function

I got this in my inbox today and it piqued my cognitively foggy interest for a couple of reasons. NB these posts move onto considering a study on metabolomics and the credibility of acupuncture (the thread isn’t specific to this study).

First of all I want to comment that I’m very sceptical of a rat model of CFS. I don’t think we should read this assuming it has any particular relevance to us as a group.

But it is interesting that acupuncture seems to increase muscle force as a consequence of improved mitochondrial function (ATP synthase, AMPK etc). The rat aspect, despite being suspect in terms of CFS modelling, does probably get around placebo issues. If anything those exhausted rats would have nocebo effects from electro acupuncture they weren’t able to understand. They also used objective measures.

In my convoluted journey to improve symptoms I gave acupuncture a really decent go with weekly treatments for over a year. Obviously it didn’t cure me. Possibly it enabled me to work for that amount of time, possibly purely through placebo effect. Though I think mistranslation likely makes it sound more woohoo than it actually is. It could also be in the category of treatment which can be effective but not for the reasons given. I’m not sure what I think of it now.

Particular points I perceived to be of benefit did include Stomach 36 which is what was used in this study

I’ll see if I can find a diagram. It is possible to do acupressure on yourself.

 

Before thinking about other relevant studies, you probably need a sense of what they’re talking about. This video shows you how to do acupressure on Zusanli (Stomach 36)

https://www.youtube.com/watch?v=lgJG_v_bUFw

It’s considered a point for low metabolism, immune issues, fatigue and digestive issues. It seems like western science might evidence this too.

If you wanted to give acupressure a go it’s an acupoint worth trying. On me it’s sensitive on that spot so easy to find, I don’t know if that’s universal.

As an aside, Acupuncturists would tend to do this with Spleen 6 for me (ignore the English translations, it’s not really to do with the spleen)

https://www.youtube.com/watch?v=tuVOI90zP2E

Another one which seemed to work for me for whatever reason was
Anmian or Peaceful Sleep (EXHN22)

https://www.youtube.com/watch?v=IX8YwQqw_z0

 

A similar study is

And this one brings in immunoregulatory benefits from the same acupoint

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1810363/

 

This is probably more useful again that same acupoint below the knee but using a metabolomics approach in humans (haven’t read yet)

https://www.nature.com/articles/srep19942
(My bold)

The metabolomic approach is interesting anyway

 

I woke up thinking about the mysterious impact of prodding just below the knee. It is very puzzling.

This graph is from that Nature article which was a study on 20 healthy men (not a large sample but I don’t think you’d expect that with metabolomics).



On the lower graph
B) Construction of the metabolism pathways in acupuncture-treated human. The map was generated using the reference map by KEGG (http://www.genome.jp/kegg/). The green boxes: enzymatic activities with putative cases of analogy in acupuncture-treated human.

1, glycerophospholipid metabolism;
From another non TCM paper
“Marked alterations in neural membrane glycerophospholipid composition have been reported to occur in neurological disorders. These alterations result in changes in membrane fluidity and permeability. These processes along with the accumulation of lipid peroxides and compromised energy metabolism may be responsible for the neurodegeneration observed in neurological disorders.” https://www.ncbi.nlm.nih.gov/pubmed/10878232
So could an acupoint affecting this be useful for neurological conditions?

2, ether lipid metabolism;
From another paper “Emerging studies suggest that altered ether lipid production is also associated with several other disorders including neurodegenerative diseases, cancer, and metabolic disorders.“ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5818364/

3, fatty acid metabolism; 4, glycerolipid metabolism; 5, porphyrin metabolism; 6, sphingolipid metabolism; 7, primary bile acid biosynthesis; 8, fatty acid elongation in mitochondria; 9, fatty acid biosynthesis; 10, tryptophan metabolism.

In the discussion

 

Ha no one seems to want to comment on empirical studies into complementary treatments, too much of a hot potato?

My mind is currently stuck in the warren of whether acupoints have an anatomical basis though so I’ll add a couple more thoughts in case anyone else is interested.

Deciphering conflicting conclusions from Google is tricky. It is more tricky than normal because language and cultural issues come into play.

One paper concludes

https://pdfs.semanticscholar.org/04bc/91e4598cb1f65fc684925430faf0a368234f.pdf

I think it is worth separating the concept of meridians from specific acupoints. My hunch is it is very unlikely that meridians and every point on them is as described, especially as meridians haven’t stayed the same over time.

There are claims that a primo vascular system has been found which would correspond with the meridian concept

https://www.sciencedirect.com/science/article/pii/S2005290113002082
I don’t feel convinced

But there are also claims that meridians weren’t part of the Chinese concept of medicine and this is a lost in translation issue, which is also in the context of the mistranslation of qi (perhaps better translated as oxygen and blood vessels??)

https://chriskresser.com/chinese-medicine-demystified-part-iii-the-energy-meridian-model-debunked/

Although I’m happy to accept mistranslation is more likely than not, I’m equally unconvinced about this explanation. Wouldn’t more bilingual TCM practitioners speak up about this?

But it does shift focus from a mysterious, spiritual sounding system to specific acupoints. I find it easier to accept that specific points could have a biomedical impact. It would make some sense if acupuncturists noticed by trial and error that some points had a stronger impact and points such as ST36 were gradually used frequently, and other points became more obscure. You can hit on a successful treatment without knowing why (western medicine also does this).

Next I’m going to google if there’s a specific anatomical reason why ST36 has health benefits and then hopefully I can switch my mind off from it.

 

"rats with chronic fatigue syndrome"?

There seem to be a lot of weak papers that try to claim traditional Chinese medicine is valuable and I'm not enthusiastic about reading more of them tbh.

edit: This sounds a bit rude by mistake.

 

@Esther12 Yes as I commented we should take it with a pinch of salt that the rats have CFS, it’s just that I saw it because I get CFS abstracts sent to my email. The CFS bit isn’t what I’m commenting on here. It’s more that that paper set me thinking about TCM again.

What’s curious is objective measurement of improvement in things like mitochondrial function using this specific acupoint. I don’t think we should dismiss all studies of acupuncture out of hand because they’re on acupuncture (but it’s also wise to take into account the issues with this body of research mentioned in my last post).

It could well be explained by methodological issues, or there could be something specific of interest.

 

So focusing on the anatomy of ST36/Zusanli

Both from https://www.acupunctureclinic.ie/acupuncture-point-anatomy-found/

I’m out of spoons to evaluate this info.

 

As far as I know, acupuncture studies that control for biased reporting tend to find no effects.

Electroacupuncture is probably just electrostimulation with a dubious explanatory model attached to it. I have no problem believing that electrostimulation has an effect on muscles. Similarly, if you stick needles into tissue, it's going to provoke some reaction. It doesn't necessarily mean there is something to acupuncture.

 

Chinese electro-acupuncture on rats? I certainly don't think we should be afraid the grasp the potato. Firstly I'd like to know which criteria was used to diagnose the rats with "CFS" - Fukuda, CCC, SEID, or Ramsey? Secondly I note that there were only a small number of rats (n=10) in each group, so obviously any findings will need replicating on a larger scale. Thirdly, on the positive side

The authors are to be commended for exceeding the number of objective measurements used by the PACE trial authors, making their paper more reliable and less open to criticism.

Will there be a follow-up study on these rats just to make sure the effects weren't temporary, and due to e.g. having a grabbing force detector to play with?

 

Yes I thought it was better than PACE too

Though I’m not commenting on it because I think they were actually studying CFS in rats. I can’t read the methodology but when I’ve read about rat models of CFS before it’s simply involved exhausting them which isn’t the same at all.

I’m interested in whether the mitochondrial benefits are real - sort of assuming this isn’t specific to CFS because I’m assuming they don’t know enough to model this.

The rats probably died before they’d written up the first paper so not in anticipation of a follow Up!

 

That's hardly a glowing endorsement of their treatment.

 

These seem to be objective measures, which removes some scope for bias. I’m fairly sure the rats don’t experience placebo effects. The main area for bias seems to be publication- are the null studies simply not published?

The human metabolics study could be due to fishing expedition issues (if so something to bear in mind with the ME research too).

Also I’m not suggesting we need to buy into the theory of TCM/acupuncture to consider whether something is really happening. If sticking needles into skin improves my mitochondrial function I’m booking back into acupuncture, whether or not it has anything to do with what the therapist believes is happening.

 

I don’t know this, just because rats don’t live long and publication takes ages

 

This could well be bad and prejudiced of me, but when the first author is at the University of Traditional Chinese Medicine my instinct is to not read the paper. There has been a bit of a history of dodgy findings from these sorts of places on TCM that doesn't hold up when more sceptical researchers look to replicate it. Maybe I'm missing out on some interesting work but until there's a bit more of a history of significant findings that hold up with independent investigators I think I'm going to remain instinctively sceptical.

PS: Looking back, my last post seems a bit rude. I think I was just trying to explain why people might not be going for the 'hot potato', so sorry if it seemed like I was criticising you for posting about it, or anything like that.

 

@Esther12 there’s nothing wrong in being sceptical- I’m sceptical about it too and usually I do ignore rat models and just don’t have the energy to read much TCM stuff. There’s something about this that caught my interest though.

I also think we might need to guard against a cultural prejudice with TCM. We’re not sceptical simply because a doctor in a UK hospital publishes on western medicine (though perhaps we should be automatically sceptical of that too, rather than not sceptical of TCM doctors). It seems likely to me that bits of both systems are beneficial, bits do more harm than good and some of it is nuts. Often in medicine things are discovered by accident and the given theory isn’t important or correct.

If an acupoint is evidenced to be objectively beneficial I don’t want to ignore it because it’s part of something I don’t buy into 100%, that’s treating Western Medicine as a religion I can’t be unfaithful to. The difficult thing is weighing up whether there’s anything in it. If we take an open minded approach are we convinced? It is justifiable to decide this is too difficult.

I also realise people here have emotional history with complementary medicine, we’re not discussing this in a sterile intellectual environment. Either there’s people nagging us to try things we don’t agree with, or we’re spending hope and energy on things which haven’t worked. I suppose my experience with acupuncture is a bit different in that I found it somewhat beneficial but I don’t know how to interpret that. So I’m vaguely positive in my confusion.