Dear Doctor: What do you think about acupuncture for lower back pain? What is it, and how does it work?

Dear Reader: Acupuncture is a key component of traditional medicine in China, but until recently, it was viewed as alternative therapy here in the United States. Then, in 1997, the National Institutes of Health issued a pro-acupuncture consensus statement, acknowledging acupuncture as an effective tool for managing pain and nausea. The agency also recommended that acupuncture be taught in medical schools. As doctors, we both see a role for acupuncture in our practices. Dr. Ko recently finished her training in acupuncture and uses this treatment.

Acupuncture is a centuries-old practice that builds on the premise that the human body contains energy pathways, known as meridians, which are comprised of more than 2,000 specific points. During an acupuncture treatment, a practitioner stimulates certain groups of points by inserting hair-thin sterile needles. The feeling is more of a distinct sensation than actual pain. Acupuncture needles may also be heated during a treatment, or they can be stimulated to conduct a mild electric current. A usual course of treatment typically includes multiple sessions that can continue for weeks or months.

Despite centuries of use, modern medicine doesn’t really understand how this ancient technique works. One theory ties the stimulation of acupuncture points to the release of specific biochemicals, which play a role in healing, as well as physical and emotional well-being.

A study published in 2014 used advanced 3D imaging techniques to examine acupuncture points at the cellular level. The researchers found that, unlike neighboring tissues, acupuncture points contained a high density of micro-vessels and other vascular structures. Not a definitive answer to the mysteries of acupuncture, but certainly an intriguing start.

Clinical studies have shown the value of acupuncture for pain relief, nausea, headache and osteoarthritis. A growing number of medical insurance plans cover acupuncture treatments. The U.S. armed services now use acupuncture as a form of pain management. And the Centers for Medicare & Medicaid Services is considering a proposal to cover acupuncture treatments for patients with chronic lower back pain participating in certain clinical trials.

If you do decide to try acupuncture, please be sure to find an experienced practitioner. As with many integrative therapies, licensing requirements vary from state to state. If you live in an area that doesn’t have licensing requirements or oversight for acupuncturists, consider looking for a practitioner certified by the National Certification Commission for Acupuncture and Oriental Medicine, a national oversight and advocacy organization. You can find more information at nccaom.org.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Is it true that dog treats made from pigs’ ears are giving humans a dangerous infection? I don’t buy them because, honestly, they look kind of gross, but our dogsitter brings them over sometimes. Should we be worried?

Dear Reader: You’re referring to a series of alerts issued by the Centers for Disease Control and Prevention about an outbreak of salmonella infections, which have been identified as being resistant to several different antibiotics. These infections have been tied to dog chews made out of pig ears.

As of the CDC’s latest update on July 17, a total of 93 people living in 27 states have become ill, including 20 individuals who had to be hospitalized. No deaths have been reported at this time. If you have these dog treats in your home, the CDC recommends wrapping them securely and disposing of them. Use hot, soapy water to wash anything that came into contact with the treats, including surfaces, containers and, of course, your hands.

Salmonella is a group of bacteria that cause about 1.2 million people to become sick each year. They can cause an illness known as salmonellosis, which develops as soon as 12 hours and up to three days after ingesting the bacterium. The infection often occurs when feces infected with the bacteria comes into contact with food or water and is unknowingly consumed. Symptoms, which include fever, abdominal pain and diarrhea, last from four to seven days. Although the majority of people recover without medical treatment, in some cases the diarrhea can be severe enough to require hospitalization.

The danger is that a salmonella infection can move from the intestines into the bloodstream, and then spread to other areas of the body. The infection is particularly risky for children under age 5, for the elderly, for individuals who are medically frail and for those with weakened or suppressed immune systems. Treatment typically focuses on managing diarrhea and pain, preventing dehydration and, if the infection has spread via the bloodstream, the use of antibiotics.

Pig ear treats are just the most recent source of a salmonella outbreak. In recent years, sources as diverse as pet guinea pigs, pet hedgehogs, dog food, papayas, sprouts, nut butters, backyard chickens, small turtles and chicken salad have been linked to outbreaks. In response to the current outbreak, Pet Supplies Plus, a distributor of bulk pig ears, which are stored in large, open bins, has agreed to a voluntary recall of the treats. At this time, pre-packaged pig ear treats from individual brands are not part of the recall.

Pets can also become ill from a salmonella infection. Their symptoms can include lethargy, diarrhea that may be bloody, vomiting and fever. Pets with salmonella infections may be sluggish, run a fever, begin vomiting and have diarrhea that may contain blood or mucus.

For the latest information on the current outbreak, visit cdc.gov/salmonella.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Does insulin resistance increase as we age? I just read it has something to do with the gut. Why would that be true?

Dear Reader: To talk about insulin resistance, we should start with insulin. It’s a hormone produced by the pancreas that helps to make glucose available to the body, which uses it for energy. After you eat, as your body digests the food, glucose is released into the blood. The pancreas then releases insulin. This hormone makes it possible for muscle, fat and liver cells to absorb glucose. When your insulin metabolism is working properly, cells get the building blocks they need to produce energy, and the level of glucose in the blood remains within a healthy range.

One way things can go awry is insulin resistance. This means that even though the pancreas releases insulin into the blood, the fat, muscle and liver cells don’t respond properly to the hormone. This leaves too much glucose in the blood, which prompts the pancreas to release even more insulin. As long as the beta cells of the pancreas remain capable of producing the extra insulin that the muscle, fat and liver cells now need, blood sugar levels will remain in a healthy range. But once the pancreas can no longer keep up with the increased demand for insulin, the resulting extra blood glucose can lead to an individual developing Type 2 diabetes.

It’s estimated that up to 1 in 3 Americans, including half of people age 60 and up, experience insulin resistance. Last year, the results of a study published by scientists at the National Institute on Aging shed light on possible reasons for the link between age and insulin resistance. For answers, the researchers turned to the gut. Specifically, they became interested in the fact that despite differences in ethnicity, geographic location and the contents of their diets, people had similar changes to their gut microbiomes as they aged. One of these changes is a decrease in the healthy layer of mucus in the gut, which is needed for optimal production and absorption of nutrients. The health of this mucus layer relies, in part, on a specific beneficial bacterium known as Akkermansia muciniphila, or Akk.

While studying mice, and then rhesus monkeys, researchers found that aging was associated with a drop in levels of mucus-friendly Akk. This triggered a series of events that gave rise to certain immune cells, which were linked to insulin resistance. When levels of Akk bacteria were restored to normal, the insulin metabolism in the animals returned to normal as well.

The research is exciting because it opens up new avenues of inquiry into the problem of insulin resistance. It’s good news because Type 2 diabetes has already reached epidemic proportions around the world. Now, with a rapidly aging population, novel therapies to maintain a healthy insulin metabolism are more important than ever.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)