3 therapies from yesteryear that are making a comeback

By Jonathan Ford Hughes, for MDLinx
Published November 21, 2018

Key Takeaways

What is old is new again. The world of medicine is no exception to this universal truth. Though science continues to expand the number of clinical options available to physicians, it also has validated some common treatments of yesteryear.

While some interventions have rightfully been cast into the dustbin of history—see phrenology, mercury pills for sexually transmitted infections, and heroin cough syrup for children—others are finding a home in modern medical practice. Here are a few examples of treatments that are gaining traction in medicine once again.

The ketogenic diet

It’s impossible to go on the internet today without encountering an article touting the merits or demerits of the ketogenic diet. One thing isn’t up for debate: It limits the number of seizures in pediatric patients with epilepsy.

At a time when there were fewer pharmaceutical options, the ketogenic diet became prominent in the 1920s as a means of treating epilepsy. As more drugs became available, the diet fell out of favor. Recent interest in the diet for its utility in weight management may have rekindled interest in exploring it for epilepsy treatment.

In a study published in 2008 in The Lancet Neurology, researchers assessed the efficacy of the ketogenic diet for seizure management in children. Among the 145 enrolled study participants, 73 were randomized to the ketogenic diet and 72 to the control group. A total of 42 participants did not complete the study. Of those who did, the ketogenic diet group averaged a 75% reduction in seizures compared with the control group.

Intermittent fasting

It seems that not eating has become just as popular as eating a fat-rich diet. Just like the ketogenic diet, intermittent fasting was also used in the 1920s to manage pediatric epilepsy. And like the diet, it’s rising in popularity once again for its myriad health benefits.

A 2015 article published in the Journal of the Academy of Nutrition and Dietetics delved into the many benefits of time-restricted eating, which include weight loss and lower glucose and insulin levels. But intermittent fasting is no panacea, the researchers cautioned. Further research is required to determine the effect of intermittent fasting on other important health behaviors, such as sleep and physical activity. Intermittent fasting also has an adherence problem, due to hunger pangs.

Therapeutic hypothermia (targeted temperature management)

Before NSAIDs and acetaminophen, doctors had to make do with what they had to manage fever and pain in their patients. In the world’s colder climes, this was easy.

In 2011, the European journal Resuscitation published a historic overview of the use of therapeutic hypothermia in medical practice. The benefits of induced hypothermia were anecdotal and observational in the beginning, according to author Henry Guly, FRCP, FCEM, Derriford Hospital, Plymouth, United Kingdom. Only later with the ability to measure body temperature did physicians begin to intentionally induce hypothermia.

Dr. Guly goes on to explain that cold “had been used for the treatment of fever and other conditions but hypothermia was used in the late 1930s for the treatment of malignancy, intractable pain, morphine addiction, leukaemia, and schizophrenia.”

In more modern times, therapeutic hypothermia has been shown to improve outcomes after cardiac events. It may even be beneficial in patients looking to lose weight. According to study results of a 2009 publication in Diabetes, cold exposure can lead to increased production of brown adipose fat tissue in healthy humans, which could help with weight loss.

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