Herbal alternatives for cholesterol roundup

Herbalgram provides us with a decent HerbClip summary of some of the different herbal and dietary options for managing dislipidemias. Some interesting points:
  • dietary fiber is crucial (reducing the absorption of exogenous cholesterol)
  • phytosterols seems to have two mechanisms of action: competing with exogenous cholesterol for micelle formation; and working in the liver on lipid metabolism itself (esp. guggulsterone)
  • omega-3 essential fatty acids (of course)
  • garlic - powerful stuff, but its mechanism of action is still unclear
  • red yeast rice. I haven't used this popular supplement in my practice yet, mostly because I'm unfamiliar with its effects overall, and its dosage ranges. Doing a little research, it seems at least part of this supplement's effect comes from the formation of statin-like substances during the fermentation of the rice. Some reports outline potential muscular and liver complications from taking red yeast rice. Hmmm... stay tuned.


Comfrey and arthritis

Comfrey (Symphytum officinalis) usually ranks high on my list of topical applications to stimulate regeneration of skin and tissue after an injury. Its preparations (root or leaf) are soothing, and their allantoin content helps new skin cells proliferate. Historically, Comfrey preaparations have been used for a whole variety of other purposes, many of which relate to its usefulness as a regenerator of mucous membranes when taken internally. Of course, blessed pyrrolizidine alkaloids, we just can't use Comfrey internally anymore (in fact, we should probably ban it) - that is, if we enjoy letting the government tell us what to do. But I digress.
Though still a historical use, recent investigations have uncovered a pronounced therapeutic effect for Comfrey in folks with arthritis pain (osteoarthritis - degradation and subsequent inflammation in the joints). Some details:
  • a strong oil-based root salve, Kytta-salbe, made in Germany and produced by Merck
  • over 200 people with long-standing (over 6 years) osteoarthritis of the knee
  • 3 week double-blind, placebo-controlled trial
  • over 50% reduction in severity of symptoms
  • increased mobility
Pretty good! Perhaps more curative than just analgesic?


Cold medicine kills infants

"Clinicians should use caution when prescribing cough and cold medications to children under 2" Why is the CDC (and not the FDA?!?) issuing this warning? The results of a long-term investigation show that over-the-counter medications used to treat common coughs and colds were responsible in the deaths of multiple infants in 2005 - and these are just the documented cases. Medicines involved: acetaminophen (Tylenol), detromethorphan (Robotussin), pseudoephedrine (Sudafed and just about every other OTC decongestant) and carbinoxamine (Pediatex, Palcid).
I'd venture to say that, in one fell swoop, this class of cold-related suppressive cocktails generated more adverse event reports than any herb has over the course of its documented use. It's good that we get a warning. And a good dozen references on Google News. It's hard to hide from the media frenzy! But I can understand all they hype: you couple these deaths with the use of pseudoephedrine in methamphetamine production, and it's almost as newsworthy as a poorly designed study on how Echinacea doesn't help children's colds. I think we should ban Echinacea from pharmacy shelves! Pass the Tylenol Cold & Flu, please!


Black Cohosh and breast cancer

The root of this woodland plant is back in the forefront in a new study from the University of Pennsylvania that tracks its use, among other herbals, in perimenopausal women who also had breast cancer (over 900) along with controls (over 1500). Not only do we continue to see improvement in menopausal symptoms, but Black Cohosh specifically seems to protect against breast cancer.
There has long been a debate as to whether "phytoestrogens" (mostly steroidal-like molecules present in plants) are harmful or helpful in cases of breast cancer. The argument that plants like Black Cohosh are harmful runs something like this: if estrogen-dependent breast cancers are exposed to estrogen-like substances from the plant world, proliferation will ensue as these substances are mild agonists at the estrogen receptor - after all, they help alleviate estrogen-deficiency symptoms, right? In contrast, many herbalists argue that phytoestrogens are amphoteric, and their weak action at the estrogen receptor actually leads to less proliferation by blocking the receptor from the much more powerful human estrogen. Since cancer cells are overproducing this receptor, Black Cohosh actually has a net benefit by "plugging up" those cancer-stimulating sites.
Hopefully this study will help in the ongoing discussion on the role of phytoestrogens.


Integrative Herbalism Roundup

How have consumers and patients been using herbal medicine? How does it mix with modern therapies? How well informed is everyone about the different choices patients are making?
Here's a brief summary of the research perspectives on some of these important questions.

Herbal medicine: women's views, knowledge and interaction with doctors: a qualitative study.: BMC Complement Altern Med. 2006;6:40 Authors: Vickers KA, Jolly KB, Greenfield SM
CONCLUSION: The women had little knowledge about herb-drug interactions and rarely disclosed use of herbal medicines to their doctor. Doctors' communication and openness regarding herbal medicines needs to improve and there should be increased access to accurate information on herbal medicines in the public and health care domain.

Alternative medicine and herbal use among university students.: Alternative medicine and herbal use among university students. J Am Coll Health. 2006 Nov-Dec;55(3):163-8 Authors: Johnson SK, Blanchard A
Overall, 58 % of the participants had used at least one type of CAM, and 79 % of the students had used at least one herbal substance in the past 12 months. A hierarchical regression determined that increased age, female gender, flu-like symptoms, musculoskeletal symptoms, pseudoneurological symptoms, and modern health worries were significantly related to students' CAM use.

Ethnicity and use of alternative products in psychiatric patients.: Psychosomatics. 2006 Sep-Oct;47(5):408-13 Authors: Ng B, Camacho A, Simmons A, Matthews SC
The use of herbal and natural products for medical purposes is common in all human civilizations, and use in Western societies has grown considerably in recent years. However, differences in usage patterns between different ethnic groups are yet to be delineated. The current study examined the frequency and type of complementary/alternative medications used by a sample of 453 rural psychiatric outpatients of two different ethnic groups. The products were classified as "natural" (herbal products requiring some preparation before consumption) and "processed" (products in "ready-to-use" form). There were significant ethnic differences in usage patterns of the various preparations: Hispanics, relative to Caucasians, were twice as likely to use natural products, whereas Caucasians were more likely than Hispanics to use processed products. The symptoms addressed were predominantly psychiatric, with natural products, and nonpsychiatric, with processed products. These results may increase awareness among healthcare providers regarding the usage frequency of such complementary/alternative medications products and the different usage patterns across ethnic groups.

Herbal medicine and anesthesia.: Curr Opin Anaesthesiol. 2001 Dec;14(6):667-9 Authors: Dorman T
Unfortunately little is understood about many of the interactions that can occur and as many as 50% of the patients do not inform their health care providers about these complementary and alternative therapies. The interactions that are most important in the perioperative period include sympathomimetic, sedative, and coagulopathic effects.

Evidence for the use of nutritional supplements and herbal medicines in common eye diseases.: Am J Ophthalmol. 2006 Jan; 141(1): 157-66 West AL, Oren GA, Moroi SE
CONCLUSION: Because of the widespread use of nutritional supplements and herbal medicines, ophthalmologists should be aware of their use so that they can inform patients properly when the supplements and herbal medicine are being used for eye disease.

Epidemiology of insomnia: Prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors.: Sleep Med. 2006 Feb 1; Authors: Morin CM, Leblanc M, Daley M, Gregoire JP, Mérette C
CONCLUSIONS: These findings confirm the high prevalence of insomnia in the general population. While few insomnia sufferers seek professional consultations, many individuals initiate self-help treatments, particularly when daytime impairments such as fatigue become more noticeable. Improved knowledge of the determinants of help-seeking behaviors could guide the development of effective public health prevention and intervention programs to promote healthy sleep.

The Sh-h-h-h Project: nonpharmacological interventions.: Holist Nurs Pract. 2005 Nov-Dec;19(6):263-6 Authors: Robinson SB, Weitzel T, Henderson L
Promoting rest and sleep is integral to the profession of nursing. The Sh-h-h-h Project, a nonpharmacological program designed to enhance rest and sleep, was implemented on a hospital medical unit. Nursing assistants provided patients with various modalities to improve sleep, including back rubs, warm drinks, blankets warmed in a blanket warmer, aromatherapy, relaxation music, and earplugs. Additional interventions were taken to reduce noise. The outcomes of the Sh-h-h-h Project are reported here, with patients indicating improved sleep quality and quantity.

The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation.: Eur J Cardiovasc Prev Rehabil. 2006 Feb;13(1):3-9 Authors: Arthur HM, Patterson C, Stone JA
CONCLUSIONS: Some complementary and alternative medicine therapies hold promise for patients in cardiac rehabilitation. Further research is essential, however, in all areas of complementary and alternative medicine to confirm its usefulness as an adjunct to cardiac rehabilitation.

Differences Between Herbal and Nonherbal Users in Dental Practice.: J Dent Hyg. 2006;80(1):10 Authors: Tam KK, Gadbury-Amyot CC, Cobb CM, Williams KB
RESULTS: Eighty participants (54%) reported using some form of herbs. They were characterized as mostly female (71%), who were less likely to disclose herbal usage to practitioners (p< .05), believed in herbal effectiveness (p< .05), and reported a more positive perceived level of health status compared to nonusers (p= .02). Although herb users reported a willingness to disclose use of herbs to health practitioners, only three patients had any written documentation of their herb use in their medical/dental health chart (p= .0001). Fifty-five herb users were also taking prescription drugs (69%) that could potentially lead to herb-drug interactions. CONCLUSION: The findings provide supportive evidence that dental hygiene practitioners need to be aware of their patients' use of herbs. Knowing potential risks, side effects, and possible drug interactions is necessary for patient management and each patient's oral health.

My conclusions: Some key patterns seem to be emerging from the analyses done around herbal and "alternative" medicine use and how it interfaces with the modern medical establishment. As the studies above indicate, many different specialties have "uncovered" evidence of herbal use by their patients: dentists, opthalmologists, cardiologists, anesthesiologists as well as general practitioners and nurses. Well over 50% of patients seem to be using some form of "alternative" medicine (which begs the question - is it really "alternative"?). More women than men are reporting its use. Certain ethnicities seem to also be more likely to report its use. Overall, doctors are strongly encouraged to learn more about these therapies (call your local herbalist would be my first suggestion!). And finally, these therapies seem to be offering some real help, often with many fewer side effects.

One final paper, presented by a group of nurses from Brazil, shows some amazing insights that I believe apply equally to health care here in the United States. It delves into some thorny issues relating to the use of herbs in nursing practice, and its conclusions show a great deal of empathy, intelligence, and heart. I recommend it as inspiring reading - even though the spectre of legal repercussions looms large.

The use of medicinal plants as a therapeutical resource: from the influences of the professional formation to the ethical and legal implications of its applicability as an extension of nursing care practice.: Rev Lat Am Enfermagem. 2006 May-Jun; 14(3): 316-23 Alvim NA, Ferreira Mde A, Cabral IE, de Almeida Filho AJ


Chocolate flavonoids and cholesterol

Chocolate (Theobroma cacao) has had a long history of scientific inquiry highlighting its extensive cariovascular benefits, from reducing blood lipids and bad cholesterol while raising good cholesterol (1, 2) to improving endothelial integritiy in blood vessels (1), even reducing inflammation and improving cardiovascular tone and platelet function in smokers (1). To say nothing about the effect of theophylline (a major alkaloid present in dark chocolate) and its effects on asthma and airway inflammation, where it can be a lifesaving remedy; or its effects on mood and well-being.
A new study has reinforced the idea that chocolate's flavonoid content has a beneficial effect on serum lipids and bad cholesterol, helping reduce LDL by over 7% (that's 17 points for someone at 250 total cholesterol - read the review at the American Botanical Council). This continues to be great news for a chocolate-lover like myself. However, some important points bear mention:
  • Dark chocolate is the only way to go. All studies find that flavonoid concentration in dark chocolate is much higher.
  • Cocoa butter is not great in huge quantities, so I generally use cocoa powder (Green and Black's organic criollo is my favorite by far). The daily dose is between 2 and 4 tablespoons.
  • Large amounts of sugar are also not too helpful. Again, a reason to use cocoa powder instead of sweetened bars.
So, a quick recipe for a great chocolate drink:
1 to 1 and 1/2 TBS dark cocoa powder
1 TBS milk, or almond, rice, or soy milk
1 tsp honey
a pinch of cayenne

mix cocoa and milk until a nice paste is formed. Add hot water (to about 12 oz), stir in some honey, and a pinch of cayenne to taste. Excellent!