Feel better without drugs

Arthritis, constipation, depression, heartburn, impotence, incontinence … you name the health problem and it's a good bet the pharmaceutical industry has a solution.

While there are nondrug treatments that often work just as well as drugs, they don't have the advantage of million-dollar ad campaigns. And it's usually easier for harried doctors to write a prescription than educate their patients about the lifestyle changes and other steps that could make a difference.

Nondrug remedies may not be as simple as popping a pill, but they typically pose little or no risk of side effects. And what you do to tackle one issue will often yield other benefits, too. Exercise, for example, addresses several health problems at once, as shown above. And even if a nondrug approach isn't completely effective, you might still feel better and need less medication.

Here's a look at several common conditions that can be cured or eased without opening a medicine bottle.

Aerobic and strength-training exercises as well as education in disease management can help older people with advanced osteoarthritis of the knee move easier with less pain.

Most recently, a two-year study published in January 2010 found similar results in people younger than 65 with mild arthritis. "We didn't expect the results to be so pronounced," says the lead author, Patrick McKnight, Ph.D., an assistant professor of psychology at George Mason University in Fairfax, Va. "But more than half of the people experienced a significant reduction in pain."

To find a similar program in your community, contact the Arthritis Foundation at 800-283-7800.

You could also consider glucosamine sulfate, a substance that occurs naturally in the fluid around joints. Some research suggests that taking about 1,500 milligrams a day may help. But there is less evidence for other forms of glucosamine.

Rheumatoid arthritis typically requires drugs to relieve symptoms and slow or stop joint damage, but nondrug measures can also help. A 2004 review found that occupational therapy that included instruction on joint protection helped improve function. Other research suggests that additional therapies—including fish-oil supplements, tai chi, and yoga—might also help.

Any over-the-counter or prescription pain reliever can have serious side effects if used in high doses or taken long-term, so it pays to explore other means of managing chronic or recurrent pain. In addition to losing excess weight and identifying pain triggers, many people find relief in gentle exercise. A 2007 review of 31 studies on nondrug treatments for fibromyalgia concluded that low-to-moderate intensity aerobic exercises, such as walking or water workouts, improved symptoms.

And exercise was the top-rated do-it-yourself measure for back pain in a recent survey of more than 14,000 people conducted by the Consumer Reports National Research Center. Overall, respondents rated massage, physical therapy, and other hands-on approaches among the most helpful. Spinal or chiropractic manipulation ranked higher than prescription drugs.

Other alternative therapies with some evidence are acupuncture, cognitive- behavioral therapy, biofeedback, and meditation. None is clearly superior overall, so start with one or more that appeals to you.

Before you try one of those widely advertised drugs for irritable bowel syndrome, consider peppermint oil. Research suggests that it improves symptoms in three of four people. Another effective alternative is soluble fiber from supplements such as psyllium (Metamucil and generic), preferably combined with plenty of water. But avoid insoluble wheat-bran fiber because it can worsen symptoms in some people.

Probiotics—yogurt and supplements containing "friendly" intestinal bacteria—have also been found to help with IBS as well as diarrhea and constipation. Look for yogurt with the Live & Active Cultures seal from the National Yogurt Association, which were made with viable bacteria.

If you have heartburn, lifestyle measures may eliminate the need for drugs such as esomeprazole (Nexium) and lansoprazole (Prevacid and generic), which have been linked to an increased risk of hip fracture in people older than 50. In addition to avoiding triggers such as alcohol, caffeine, and chocolate, steps that help include quitting smoking; losing excess weight; eating smaller, more frequent meals and avoiding all food for 3 hours before lying down; and not wearing constrictive clothing. Chewing sugarless gum after meals may also help, by neutralizing heartburn-inducing stomach acid.

Self-help measures can help counteract the two major forms of incontinence. Those are stress incontinence, characterized by the involuntary loss of urine when coughing, sneezing, or exercising; and urge incontinence, or overactive bladder, in which people have frequent, sudden urges to relieve themselves. If you have either problem check with your doctor first. The symptoms could be a side effect of a blood pressure drug or other medication or could be the result of a urinary-tract infection or another health problem.

Stress incontinence often stems from weakened muscles surrounding the bladder and responds well to Kegel exercises, which strengthen the pelvic floor. To do them, squeeze the muscles as if you were stopping a stream of urine or trying to prevent the passage of gas. Do two types of squeezes: short ones lasting 2 seconds, and longer ones lasting 5 to 10 seconds. Do each type 40 to 50 times a day, either all at once or at scattered intervals, five to seven days a week. Contracting pelvic-floor muscles right before a cough or sneeze can also reduce leaking.

Urge incontinence seldom responds to pelvic-floor exercises alone, and because it's harder to treat, many people turn to medications. But more than half stop taking the drugs within six months, often because of side effects such as blurred vision, confusion, constipation, and dry mouth. So talk with your doctor about "bladder training," which teaches you to time urination at regular intervals, for example, and gradually hold your urine for longer periods.

According to Tomas Griebling, M.D., vice chairman of the department of urology at the University of Kansas, that "gotta go" moment is a good time to short-circuit an overactive bladder. "Instead of rushing to the toilet, stop, focus on the sensations from your bladder, do three pelvic-floor contractions, and then walk to the bathroom at a normal pace," Griebling says.

Dietary changes can also help. Drink less between dinner and bedtime. And reduce your intake of acidic foods such as citrus fruits and tomatoes, as well as alcohol and caffeine.

Overall, research suggests that nondrug measures can ease incontinence in about 80 percent of the people with an overactive bladder and eliminate symptoms in about 25 percent of them.

A recent review that analyzed data from 25 previous trials concluded that exercise can ease depression, perhaps by diverting attention from negative thoughts, reducing stress hormones, and boosting feel-good brain chemicals. And two clinical trials that compared exercise with antidepressant drugs for major depression found that after about four months, both approaches worked equally well.

While antidepressants are often indicated for major depression—feelings that interfere with sleeping, eating, or working for more than three weeks—it's worth considering talk therapy as well. According to a 2004 Consumer Reports National Research Center survey of people with depression, those treated mostly with medication noticed improvement faster than those treated with talk therapy. But people who used talk therapy had better long-term outcomes. The most successful patients used both talk therapy and medication.

After six weeks, cognitive-behavioral therapy that included training in improved sleep habits worked as well as training plus the sleeping pill zolpidem (Ambien and generic), according to a 2009 Canadian study of 160 adults with insomnia. And after six months, those on the combined therapy who switched to just good sleep habits slept better than those who also took the pill as needed.

To practice good sleep hygiene, stick to a regular sleep schedule. Keep the bedroom cool, dark, and reserved for just sex and sleep. Avoid caffeine after midafternoon and don't drink alcohol, smoke, or exercise for several hours before heading to bed.

The same pelvic-floor exercises that counteract incontinence may help men restore potency without the cost and risks of erectile-dysfunction drugs. A six-month British trial found that 40 percent of men who did the exercises regained normal sexual function, and another 35 percent improved significantly. Other lifestyle changes that may help include losing excess weight, quitting smoking, exercising, drinking less alcohol, and avoiding undue pressure from bicycle seats.

Milk for heartburn. Though it may feel good going down, milk can stimulate the secretion of stomach acid, worsening the problem.

Sharply limiting fluid intake for overactive bladder disorder. Dehydration concentrates the urine, which can irritate the bladder, making it harder to control your urine.

A nightcap before bed. That may help you fall asleep but you're more likely to have shallow, fitful sleep as your body metabolizes the alcohol. And it may cause you to wake up to go to the bathroom.

Supplements for erectile dysfunction. The herb yohimbe can cause blood pressure to drop and, in high doses, trigger heart-beat abnormalities and even heart failure. Some other supplements sold online have turned out to be no safer than prescription drugs because they in fact contained the real deal—sildenafil (Viagra) or tadalafil (Cialis).

Magnets and copper bracelets for arthritis pain. There's little evidence if any to support either of these products.