The need and interest for alternate healthcare options that deviate from our allopathic model are growing as the prevalence of chronic disease is on the rise. Approximately 38% of adults and 12% of children in the United States have reported using some form of complementary and integrative medicine (CIM). Research also demonstrates the growing acceptance and use of CIM modalities across medical specialists. The CIM market is rapidly growing, reaching a global value of $100.04 billion in 2021, and is projected to grow to $315.5 billion by 2027.

But what exactly is complementary and integrative medicine? These terms are often thrown around but lack consistency in their use. This article aims to clarify the definition of CIM, discuss how it differs from other forms of medicinal philosophies, and explain popular CIM modalities sought out by patients and utilized by integrative providers.

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What Is Complementary and Integrative Medicine (CIM)?

Complementary and integrative medicine (CIM) refers to the group of healing approaches and interventions that have yet to be included or taught widely in conventional, mainstream Western medicine. Previously referred to as complementary and alternative medicine (CAM), the term "alternative" has recently been dropped from the name. Integrative medicine and health, or simply integrative medicine, are other terms that refer to the application of CIM modalities in the healthcare setting. (1, 2)

CIM modalities are divided into five categories, including alternative medical systems (e.g., ayurveda, naturopathy), mind-body interventions (e.g., biofeedback, meditation), biologically based treatment (e.g., botanical medicine, diet therapy), manipulative and body-based methods (e.g., massage, chiropractic), and energy therapies (e.g., acupuncture). (1, 2)

CIM bases its practices on evidence-informed practice (EIP). EIP integrates various levels of evidence, including expert opinion, external and internal evidence/scientific literature, and client perspective, to provide high-quality and evidence-based healthcare to individuals.

What Is the Difference Between Complementary and Integrative Medicine (CIM) and Alternative Medicine?

Complementary, alternative, and integrative medicine are terms often used interchangeably, but their meanings differ.

Complementary medicine refers to non-mainstream practices used with conventional medicine therapies (3).

Alternative medicine refers to non-mainstream practices used instead of conventional medicine (3).

Integrative medicine is a healthcare approach that combines conventional and non-mainstream modalities to meet the physical, emotional, mental, and spiritual needs to achieve whole-body health and wellness (3).

What Are the Most Common Complementary and Integrative Medicine (CIM) Treatment Therapies?

According to the 2012 National Health Interview Survey (NHIS), the top five most commonly used CIM therapies among American adults include dietary supplements other than vitamins and minerals (17.7%); deep breathing exercises (10.9%); yoga, tai chi, and qi gong (10.1%); chiropractic or osteopathic manipulation (8.4%); and massage therapy (8%). This article will discuss these in more detail, along with other popular CIM therapies, below.  

Acupuncture

Acupuncture has been used for thousands of years, originating from traditional Chinese medicine. It is a technique in which fine needles are inserted into specific points on the skin to treat health problems. A 50% increase in acupuncture users in the United States was reported between 2002 and 2012. In 2012, 6.4% of American adults said they had used acupuncture. (5)

Acupuncture is indicated for many health concerns, including infertility, polycystic ovarian syndrome, musculoskeletal and neurological pain, neurologic conditions, nausea and vomiting, and vertigo.

Chiropractic Manipulation

Chiropractic is a licensed healthcare profession that involves manual spinal and joint manipulations. The purpose of manipulations is to improve joint motion and function to address problems related to the musculoskeletal system, like arthritis, osteoarthritis, headaches, and back and neck pain.

In 2015, 20 million adults and 1.9 million children had chiropractic or osteopathic manipulation. In 2017, 10.3% of Americans reported using chiropractic adjustments as part of an integrative healthcare plan.

Dietary Supplements

According to the 2021 Consumer Survey on Dietary Supplements, 80% of Americans use dietary supplements. This number has skyrocketed compared to previous years; the 2012 NHIS reported that 18% of adults and 5% of children used natural products, defined as dietary supplements other than vitamins and minerals, in 2012 (4).

Dietary supplements are health products intended to supplement the diet to provide a health benefit. The most commonly used natural supplements by adults include fish oil, glucosamine, echinacea, flaxseed oil, and ginseng; and echinacea, fish oil, flaxseed oil, and probiotics by children.

Natural products provide many wellness-related benefits, including promoting general wellness; preventing disease; and improving immune function, energy, memory, and concentration (4).

Massage Therapy

Massage therapy includes various techniques, such as Swedish, sports, and clinical massage, to manipulate the body's soft tissues to accomplish specific health goals. Evidence supports the use of massage therapy in managing chronic low back pain, neck and shoulder pain, osteoarthritis, headaches, fibromyalgia, and anxiety.

Mind-Body Therapies

Mind-body therapies are treatments based on the interactions between the mind and body, used to reduce tension and stress and promote a sense of physical, mental, and emotional well-being. Mind-body therapies encompass meditation, mindfulness, tai chi, yoga, hypnosis, guided imagery, relaxation therapy, biofeedback, and deep breathing.

Mind-body therapies have a variety of health benefits and are often utilized to help people manage anxiety, stress, depression, pain, insomnia, and substance withdrawal. A 2017 nationwide survey concluded that the use of mind-body practices, especially yoga and meditation, is increasing among the adult and pediatric populations; in fact, the use of meditation practices increased more than threefold between 2012 and 2017.

Therapeutic Diets

Diet therapy uses a food-as-medicine approach to treat and prevent specific health disorders, promote wellness, and detoxify the body. Some diets, such as the Mediterranean and DASH, are firmly accepted as evidence-based and effective interventions in the conventional and integrative fields, especially for treating cardiovascular-related concerns. Other popular therapeutic diets include the Paleolithic, Autoimmune Protocol, and low FODMAP diets. Diet therapy can be incorporated into nearly every integrative treatment plan, indicated to address various conditions, including, but certainly not limited to, arthritis, autoimmune diseases, weight management, metabolic syndrome, and gastrointestinal concerns.

Collaboration and Communication Between Conventional and Integrative Practitioners

CIM does not reject conventional medicine but works alongside it. It acknowledges the importance of evidence-based practices, medical diagnoses, and interventions such as pharmaceutical drugs, surgeries, and medical procedures. Complementary and Integrative Medicine promotes collaboration and open communication between conventional medical practitioners and complementary therapists. This interdisciplinary approach allows for a comprehensive understanding of the patient's needs and facilitates the coordination of care.

Common Labs Used in Complementary and Integrative Medicine (CIM)

Lab tests, alongside a thorough patient history and physical exam, help clarify a patient's condition and establish a roadmap required to achieve optimal health. Most routine blood work cannot detect functional imbalances present in the stages leading to overt pathology and dysfunction. Complementary and integrative providers, therefore, use specialty labs, which measure less traditional biomarkers, and interpret them using optimal reference ranges to help differentiate between normal, optimal, and pathologic health states. Some of the most common labs used by CIM practitioners are described below.

Comprehensive Stool Analysis

With increasing recognition of the importance of gut health for general well-being, comprehensive stool testing is an exceedingly popular specialty testing option. Comprehensive stool tests measure various biomarkers to assess digestive function and screen for intestinal inflammation, infection, and large intestinal dysbiosis. Not only is stool testing indicated during the diagnostic evaluation of digestive concerns, but it can also be used in treating autoimmune diseases, skin conditions, hormonal imbalances, mood disorders, and nutritional deficiencies. Popular stool testing options include Diagnostic Solutions' GI MAP, and Genova Diagnostics' GI Effects.

Comprehensive Hormone Analysis

Endocrine imbalances, having too much or too little of certain hormones or irregular secretion patterns, can cause many symptoms, including irregular menstrual periods, acne, hair loss, unexplained weight changes, and fatigue. Standard labs help identify frank pathology within the various hormonal systems but cannot accurately identify functional differences in hormonal signaling, nor do they reflect how the body metabolizes and utilizes hormones once they are secreted into circulation.

Functional lab panels can use blood, urinary, and salivary samples to assess thyroid, adrenal, and reproductive hormone status. Popular hormonal panel testing options include Ayumetrix's Adrenal Stress Panel, and Precision Analytical's DUTCH Plus.

Food Sensitivity Testing

Food sensitivities, delayed adverse reactions to foods caused by an IgG-immune response, are not routinely acknowledged or tested by conventional doctors. However, their presence can contribute to increased intestinal permeability and systemic inflammation, leading to symptoms like abnormal bowel movements, bloating, abdominal pain, rashes, headaches, fatigue, joint pain, and mood changes. Therefore, detecting food sensitivities can be an important step in an integrative healthcare approach and personalization of diet therapy. Popular food sensitivity panels include Mosaic Diagnostics' IgG Food MAP, Alletess Medical Laboratory's 96 IgG Food Sensitivity Panel, and US BioTek's 96 General Food Panel.

Comprehensive Nutritional Assessment

Specialty labs that measure intracellular and extracellular micronutrients and organic acids help identify biochemical and physiologic nutritional deficiencies and imbalances contributing to suboptimal wellness. These results help providers to make specific recommendations regarding necessary dietary supplements and diet therapies when creating treatment plans. Popular testing options include Mosaic Diagnostics' OAT, and Genova Diagnostics' NutrEval Plasma.

Environmental Exposure Panel

Environmental toxins are substances found ubiquitously in the environment that can harm and negatively affect human health. Toxic exposure, especially combined with sluggish detoxification pathways, can create a multitude of systemic symptoms and cause significant impairment to quality of life. Panels that screen for chemical, heavy metal, and mold exposure can identify specific exposures to customize plans that support the body in detoxifying and eliminating harmful substances after overexposure.

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Summary

CIM refers to medical products and practices not considered part of standard medical practices and treatment. It combines dietary and herbal supplements, dietary interventions, mindfulness practices, and chiropractic care (among others) with conventional modalities to approach healthcare holistically. CIM is rapidly gaining popularity worldwide, with people seeking practitioners to provide CIM services to treat chronic health conditions and symptoms. To learn more about the complementary and integrative medical approach, check out the many resources available through Rupa Health, including the magazine, podcast, and free live classes.