Black Cohosh in the news

A new study came out a few days ago that finds 160mg of powdered Black Cohosh (Cimicifuga / Actaea racemosa) root daily is ineffective for hot flash symptoms in peri- or post-menopausal women aged 45-55. And, or course, the media frenzy ensues: a quick Google News search reveals almost 400 reports with various defaming titles all claiming to show "proof" that this herb has no effect (my favorite: "Black Cohosh a Flash in the Pan for Menopause Symptoms". Who comes up with these amazing witticisms?)
A closer look at the study itself reveals a few interesting facts:

• The material used: powdered herb (root, I most certainly hope, although even this is unclear). This is in contrast to the multiple studies (see below) that demonstrated Black Cohosh's effectiveness for the vasomotor symptoms associated with perimenopause: most of the previous research focused on hydroalcoholic extracts of the root, not powdered root.
• The dose: 160mg (solo) to 200mg (in combination) daily, barely 1/5 of a gram. If an herbalist told me they were using this dose to help control hot flashes in one of their clients, I'd tell them to go back and study their phytopharmacology. Bottom line: this is a ridiculously small dose compared not only to previous modern research, but also to the tried-and-true experience of Eclectic physicians (see King's dispensatory) who recommend 1/2 to 2 drams (about 2 to 8 fluid ounces) of a 1:1 fluid extract, equivalent to about 2-8 grams (2,000mg to 8,000mg) of raw plant material! Who's doing the research for this new study? Where did they come up with the 160mg daily dose?
• Although the study author kindly comments that "the trials did not simulate the whole person approach used by naturopathic physicians", this study doesn't even make an attempt to classify the types of women in the treatment group (other than by age and whether they were peri- or post-menopausal). Many other studies are more comprehensive in their analyses, and find that women with "excess estrogen" patterns earlier in life (defined by menstrual history and/or estrogen-dependent breast cancer) benefit much more from this botanical. Its weak estrogen receptor antagonism and its ability to block LH have been hypothesized as possible mechanisms of action (see studies below).
  

So in sum, another poorly-designed clinical trial receievs undue media hype. I will most certainly continue to grow and use Black Cohosh in my practice (and not only for hot flashes, which isn't even its most beneficial application). A couple of studies (one from Europe, the other from the Mayo clinic) are included below for further reading.

Hungary
Mayo

Animal models have some serious flaws

Medical research, whether focused on pharmaceutical or herbal medicines, often makes use of animal models in the initial phases of study. For many herbal remedies, animal studies are the only data (other than, of course, thousands of years of traditional and experiential knowledge) available to the scientific community, and often these data are used to dismiss phytomedicines as ineffective. In an article in the British Journal of Medicine, researchers identify potential shortcomings of the animal model in drug trials. It comes down to two main conclusions: first, animal studies are often methodologically flawed (not sure why this is, perhaps people pay less attention if only little mice are involved). Second, the animal model has serious predictive deficits and very often has no relevance to actual human therapeutics.
We can speculate endlessly as to why this may be. An interesting thought comes from the European Journal of Cancer: perhaps mice that are genetically engineered to produce "research cancers" exhibit tumors that are substantially different in morphology and behavior from those that develop slowly and naturally in humans (or in pet dogs, as was the focus of this study). These differences may account for the discrepancy between the artificial models and actual human beings. But regardless of the "why", the bottom line remains a challenge to the established phase I, II, III drug trial model. It should also be food for thought for herbalists who are relying on animal models for therapeutic data. And perhaps, if this challenge remains relevant, the entire medical community can start to think about different research strategies that don't involve torturing and killing animals...

The cholesterol conundrum

Pfizer has halted clinical trials of its new cholesterol medication, which was designed to increase HDL ("good") cholesterol levels in human blood. The hope: to get everyone on the planet to take a statin/torcetrapib combination and get everyone's cholesterol numbers into a "happy" testing range. Turns out the torcetrapib actually increases one's chances of dying. So Pfizer pulled the plug (at least they had the decency to do that, unlike Merck's Vioxx fiasco).
I have two main problems with the line of research pharmaceutical companies are pursuing regarding cholesterol. First off, why not consider a combination of herbal therapies, perhaps featuring Fenugreek (Trigonella faenum-graecum) along with other botanicals, which have not only been proven to lower LDL cholesterol, raise HDL, but also manage blood sugar, improve and soothe digestive function, and actually enhance life? Lack of patentability would be my first guess.
Secondly, the whole approach of attempting to alter serum levels of cholesterol and their lipoprotein packages seems like "teaching to the test" rather than trying to improve final outcomes. Sure, high cholesterol levels seem to be present when there is dangerous heart disease. But I haven't yet found conclusive evidence that there is a causal relationship between the two, and I am beginning to suspect that underlying cardiovascular inflammation is at the root of both conditions. It would seem that devising new drugs that are specific only for improving your cholesterol numbers on a blood test misses the point and can, apperently, be quite dangerous. My humble suggestion: if you and/or your doctor are concerned about high cholesterol levels, consider herbal therapy alongside nutritional intervention. There's a great track record out there, with no increased mortality risk.

Antibiotics overprescribed in bronchitis

The inflammation of the respiratory and lung passages known as bronchitis is most often (at least 70% of the time) caused by a lingering viral infection. Antibiotics are useless for this condition, and may in fact cause harm, even though they are administered in over 80% of the cases of bronchitis that present clinically. These are the conclusions of Drs. Wenzel and Fowler, as reported in a clinical vignette published in the New England Journal of Medicine.
While bacterial bronchitis is certainly a possibility, and bacterial pneumonia (which can sometimes be a complication of untreated respiratory infections) certainly warrants aggressive treatment, it is ridiculous to jump right in with antibiotic treatment in most cases. So what is left? Watch and wait, according to modern medicine. And while I applaud the recent cautions concerning antibiotic use (aviod for ear infections; aviod for respiratory infections), and recognize the healthy fear antibiotic resistance has engendered in the medical community (finally! it only took 50 years), I cannot condone a "watch and wait" attitude, and that is not the strategy in my practice.
This is a perfect example of how a complementary therapy like herbalism, when integrated intelligently into the holistic picture of patient care, can contribute significantly to improved outcomes. Our strategies: boost immunity, encourage the natural eliminative function of the lungs and respiratory system, and guard against opportunistic infection. All of these goals are extremely amenable to herbal intervention, and the results are there (both empirically and as part of clinical trials) to prove it. Why can't all primary care providers take the road many are following, and suggest the advice of a competent herbalist for chronic or lingering bronchitis, rather than simply sending their patients away (or even worse, giving them a harmful treatment out of ignorance)?

So I agree: antibiotics are harmful in most cases of bronchitis. Leave your doctor's office, and go straight to your local herbalist to learn how to take care of yourself using plants that, very possibly, are growing in your garden or back yard.

Ginkgo and Alzheimer's

The leaves of Ginkgo biloba have an extensive reasearch history behind them, although their therapeutic use is fairly recent. Though many claims have been made about this ancient tree (mostly relating to memory, energy, mental function), there are some clear indications and effects that almost everyone agrees on: first, ginkgo increases circulation; second, it has a marked antioxidant and cell-protective effect; third, it influences biochemical mechanisms in the blood resulting in an net reduction of clotting power.
Recently, based primarily on the first two facts listed above, researchers have been focusing on ginkgo's use in treating Alzheimer's-related dementia. A trial released in 2004 showed promising results and began to elucidate some of the mechanisms in the brain (relating to neurotransmitter activity and the reduction of protein tangles) that contributed to its positive effect. Now, a new trial in the European Journal of Neurology (those Europeans, always messing around with herbs...) confirms the previous results and lends more credence to ginkgo as a good treament for slowing the progress of Alzheimer's disease. It also reinforces the idea that ginkgo has the effect of increasing ACh (acetylcholine, an important neurotransmitter in the brain and body) sensitivity, and is much better tolerated than the prescription drugs that are currently used.

What is "Yang"?

When speaking in terms of herbal "energetics", there are many classifications that can be used. These are helpful in defining herbal actions because they addresss the plant remedy from a holistic point of view, giving a broader "feel" of the herb's medicinal virtues. Sometimes (though not always), these classifications bear a striking connection to physical / biochemical characteristics - for instance, "yin" herbs tend to be more cooling, soothing, demulcent and rich in mucilage; "blood (xue) tonic" herbs may have a good supply of iron, or serve to increase erythropoiesis. Recently, an interesting study out of Hong Kong highlighted a potential biochemical connection to the energetic idea of "yang", always associated with warmth, increased vitality, and energy.
A systematic review of some "yang" botanicals showed that they invariably increase mitochondrial ATP-generating capacity. Deep inside our cells, the mitochondria create a proton gradient between two membranes by moving electrons through the electron-transport-cycle. This gradient is used to drive a transmembrane protein, ATP-synthase, which attaches a phosphate group to spent ADP, renewing its energy-generating ability. The protons can also move back down the gradient through "leak" channels, akin to a short-circuit, instead of through the ATP synthase protein. This has the net effect of generating warmth, and serves as a basic temperature-regulating mechanism for the body. So, it seems, "yang" herbs do in fact increase energy, vitality and warmth. But, as chinese medicine rightly points out, they might be contraindicated in severely depleted conditions (can't stoke the furnace without enough fuel) or in highly overheated, overstimulated conditions (obviously).

File this under the "science finally catches up" category.

Saffron Crocus and Depression

Crocus sativus, best known for its stigma and pollen (source of saffron, perhaps the most expensive spice in the world), has traditionally been linked to various medicinal effects, depending on the part used: from mood enhancement of the saffron itself, to the treatment of gout with the alkaloid colchinine found in its underground bulb. A very recent (6/06) study from Iran evaluated the use of the petals of this wonderful fall-blooming flower to determine its use in a small sample (n=40) of individuals who me the diagnostic criteria for mild to moderate depression. The results: "At 6 weeks, petal of C. sativus produced a significantly better outcome on Hamilton Depression Rating Scale than placebo (d.f.=1, F=16.87, p<0.001). There were no significant differences in the two groups in terms of observed side effects. The results of this study indicate the efficacy of petal of C. sativus in the treatment of mild-to-moderate depression".
The authors recommend additional research, and larger-scale trials. I fully agree!
What is most interesting to me about this study is the fact that the petals of the crocus were used, rather than the more commonly studied (and way more expensive) stigmas. The researchers used capsules filled with the powdered petals, but pending some additional pharmacological research, I would tentatively say that the traditional hydroalcoholic tincture might be equally, and perhaps more, effective. Nevertheless, this presents a sustainable, affordable, effective, beautiful, and easy-to-grow option for mild to moderate depression.
Full abstract from Phytomedicine.

Cannabinoids mellow out a spastic colon

Our bodies are riddled with receptors for the class of molecules, known as cannabinoids, that are found in large concentrations in marijuana. While it may be that our own endogenous anandamide-like substances are the reason for the presence of these receptors, it seems that in the plant world marijuana is the only source of cannabinoids we have available. Co-evolution, anyone?
Regardless, a preliminary investigation by Michael Camilleri, M.D. (Mayo Clinic), who has spent the last decade researching drugs, neurotransmitters, receptors and pharmacological pathways involved in irritable bowel syndrome and other spasmodic conditions of the lower bowel, shows promise for using cannabinoid receptors in the gut to help modulate these distressing conditions. Doctor Camilleri's plan: feed folks with sensitive digestive systems over a pint of chocolate milkshake after giving them a pill of Marinol, a synthetic THC (tetra-hydro-cannabinol). Without getting into what a pint of chocolate milkshake would do to me (or anyone really) if taken on an empty stomach, and whether that represents cruel and unusual punishment for someone with colitis or irritable bowel, it seems that the synthetic cannabinoid is one of the most effective remedies the good doctor has ever seen for the cramping and pain people experience after pounding said milkshake. The next step: back to the lab, to find a synthetic cannabinoid that "does not have psychoactive properties".
If you ask me, that seems like a time-consuming, expensive proposition. Over and over, folks who have used cannabinoids as medicine (for glaucoma, wasting syndrome, chemo-induced nausea, and bowel trouble) complain that the pharmaceuticals are not as effective as a crude, inhalable folk-preparation of the marijuana plant (a.k.a. "the joint"). One puff may not be psychoactive, but it still seems to be quite medicinal if you trust the reports of those who have tried. But the feds might not appreciate that (nor the pharmaceutical companies, for that matter). And we all know the best way to fund research is to come up with a good, actionable, patentable pharmaceutical, not some devil-weed - regardless how cheap, accessible, or useful it may be.

Kava-Kava doesn't seem to be liver-toxic at all.

Kava (Piper methysticum) has long been used in Polynesia as a relaxing beverage, made from the fresh roots in communal settings with the intention of promoting conviviality, community, and peace. While there are some anectdotal reports on long-term abuse leading to "kava skin" (patchy, scaly eruptions that disappear after kava is withdrawn), this plant was always considered safe until 2002, when Germany and other European countries banned its use after liver failure in a patient who had a history of liver disease grossly abused a strong Kava extract and died from liver failure (maybe we should ban whiskey too).
Anyway, in a study that just came out in Phytomedicine, we see interesting new information that, in animal models, doses of kava given daily don't seem to have any toxicity at all, even when administered for long periods of time. This seems to corroborate traditional info. Hopefully it will have an impact in Europe where the use of kava, a potent anxiolytic and relaxant, is still shunned after the 2002 decision.

Turmeric (Curcuma longa)

This spice has long been known for its amazing healing properties (just check Wikipedia for a quick review of some of the literature). Well, Turmeric has done it again: in a comprehensive trial that explored the histologic and genetic effects of curcuminoids in animal models, Janet Funk, M.D. (Univ. of Arizona) highlights some very interesting effects of Turmeric on tissue affected by rheumatoid arthritis (RA). Her findings focus on the role of NF-κB (nuclear transcription factor kappa-B), a pro-inflammatory molecule that the body uses to activate genes that cause the short- and long-term changes associated with RA. Turmeric seems to interfere with its expression and theraby reduce the subsequent cascade of inflammation that contributes to chronic pain and joint degradation:
"In vivo treatment prevented local activation of NF-κB and the subsequent expression of NF-κB-regulated genes mediating joint inflammation and destruction, including chemokines, cyclooxygenase 2, and RANKL [the receptor activator of NF-κB ligand]," the investigators wrote.
We herbalists know that Turmeric's anti-inflammatory effects are not limited to RA. We've been using this plant since it became available to the West - and Ayurvedic healers have been using it for over 4000 years. But now, thanks to modern science, we have this pearl of wisdom from Doctor Funk:
"Just as the willow bark provided relief for arthritis patients before the advent of aspirin, it would appear that the underground stem (rhizome) of a tropical plant may also hold promise for the treatment of joint inflammation and destruction."
Brilliant.

Autism and "alternative" medicine

W. Ben Gibbard, M.D., revealed some interesting information to us all at the recent American Academy of Child and Adolescent Psychiatry meeting. It seems that over 93% of those with some form of autism received "alternative" treatment (not surprising, considering the lack of effective "conventional" medicine for the condition). At the top of the list of treatments were nutritional and herbal interventions. Apparently, they are making a huge difference! Although I would argue that these treatments are good medicine for anyone, it seems the evidence is clear that for sensitive autistic constitutions, good food, essential fatty acids, avoiding chemical additives, and taking herbs remarkably improves subjective criteria.
Here is a more detailed breakdown:

The researchers reported:

• 17.1% tried some kind of omega fatty acid, with 64.3% rating it helpful,
• 10.2% tried an omega-6 fatty acid, with 61.1% rating it helpful,
• 10.2% used an omega-9 fatty acid, with 66.7% rating it helpful,
• 12.5% tried dimethylglycine, with 54.5% rating it helpful, and
• 6.3% tried Eflax oil, with 36.4% rating it helpful.

Dietary therapies were tried by 37.6% of the families. The findings were (percentage tried, percentage rated helpful):

• Gluten-free diet (23.3%, 61.0%),
• Casein-free diet (21.6%, 60.5%), and
• Lactose-free diet (17.6%, 45.2%).

Vitamins and minerals were tried by 63.1% of respondents, making it the most popular category. Nearly 40% had tried a vitamin or mineral supplement besides a multivitamin. The mean number tried was 3.2 (range 1 to 20). The researchers reported:

• 49.4% had tried a multivitamin with 35.6% reporting it helpful,
• 16.5% used an oral calcium supplement with 51.7% reporting it helpful,
• 14.8% tried oral vitamin C with 53.8% reporting it helpful,
• 16.5% had tried any magnesium supplement, and
• 14.2% used any vitamin B6 supplement.

Natural therapies had been used for 40.3% of the children (mean 2.0 different therapies). The most common were:

• Herbal remedies (11.9%, 71.4% rated as helpful),
• Evening primrose (9.1%, 31.3% rated as helpful), and
• Naturopathy (7.4%, 69.2% rated as helpful).

Rethinking flu vaccines

An article in the British Medical Journal highlights questions around the push towards influenza vaccination that happens around this time every year. Some salient points:
- in general, the vaccine is at best 40% effective - and that's only for influenza infection, not for preventing hospitalizations or reducing mortality (there is no difference between vaccinated and unvaccinated folks in the latter cases).
- in children under 2 years old, and in portions of the elderly population, there is no evidence of any kind pertaining to the vaccine's effectiveness (i.e. we just don't know, no one has done the research).

In conclusion, the article suggests that the price of production, distribution, etc... may be a waste of resources and time. My opinion: it would be fantastic if some of that funding went into well-thought-out research on good herbal antiviral standbys - Echinacea, Hyssop, Catnip, Lemon Balm, Licorice for example - and their effects on influenza. All the more important if we consider how freaked out everyone got last year around a vaccine that doesn't seem to help much at all...

Lycopodium serrata

Chinese club moss, Lycopodium serrata (a.k.a. Huperzia serrata) has received a lot of attention in the last few years as a source of the compound Huperzine A. This phytonutrient, traditionally used for memory enhancement and as a tonic for "old age" in Chinese medicine, seems to work as a potent inhibitor of acetylcholinesterase, an enzyme that breaks down the neurotransmitter acetylcholine. This transmitter is essential in a variety of processes, participating in nerve signaling throughout the brain and also between the nerves and muscles. Huperzine seems to be more effective than many other, more toxic, pharmaceuticals used as Ach inhibitors (like tacrine, e.g. Cheng 1998).
Some of the most interesting research focuses on the club moss's benefits in treating myasthenia gravis ("severe muscle tiredness", literally), a disease in which the levels of acetylcholine in the neuromuscular junction drop. Another area of focus recently involves the treatment of Alzheimer's disease, a more common and well-known condition that also may involve decreased levels of acetylcholine in the brain (amongst other things). An impressively large clinical trial, started in April 2006 in hospitals all across the country, focuses on this plant's ability to treat Alzheimer's disease. The results are due in December. Stay tuned.

Achillea millefolium

Yarrow (Achillea millefoium) rules the blood. Look at the slight pinkish tinge on these flowers from our garden - sometimes you'll find one that is blood-red amongst its more typical white cousins.
The name Achillea comes from the legend that Achilles, hero of the Trojan war, used it to heal the wounds of his soldiers in battle. Indeed, it is probably the best vulnerary we know, serving to instantly stop bleeding and to disinfect even a horribly deep wound. It is always a good idea to carry Yarrow if you are out hiking or far from home.
It has a particular power to curb inflammation and pain in the urinary system, and is used for infections of the prostate or the urinary tract to this end (and also because of its antiseptic and diuretic actions).
As a remedy for fever, it combines especially well with Elder flowers in the form of a hot infusion, take often, until the fever subsides.
Traditionally, Yarrow has a famous history as a plant with the power to unlock the psychic mind. It was eaten or placed under the pillow, at first bloom, for prophetic dreams. The flower stalks are dried and used to cast the I-Ching, the Chinese oracle called The Book of Changes. Perhaps this power is related to its ability to loosen, or unblock, internal stagnations (it is especially good for stagnant blood from old wounds, often colored purple under the skin) in the whole body/mind: as we know, our psychic powers are merely forgotten or repressed.

Cannabinoids and Alzheimer's

A preliminary study seems to imply that the use of cannabinoids (one of the many biochemically active agents in marijuana) can protect the brain from inflammatory degeneration and its complications, such as Alzheimer's disease. The current study relies on an animal model and requires the consumption of cannabinoids during youth - but in that particular situation, the results are a dramatic reduction in the changes in brain tissue that lead to the formation of amyloid plaque, thought to be a chief culprit in Alzheimer's.
Gary Wenk, Ph.D, conducted the research at the University of Ohio:

... as the animals age, Dr. Wenk said, they develop inflammation in parts of the brain analogous to the parts damaged by inflammation in people with Alzheimer's.

Recent research in other fields suggested that cannabinoids -- the active ingredients in marijuana -- can cross the blood-brain barrier, even at low doses, and can reduce inflammation, Dr. Wenk said.

So, in young rats, Dr. Wenk and colleagues created brain inflammation by infusing nanogram quantities of lipopolysaccharide and then treated them with a synthetic cannabinoid called WIN-55212-2.

"We saw an 80% to 90% drop in the inflammation in the brain," he said, "and also the impairment in memory that inflammation produces could be reversed."

http://www.medpagetoday.com/Neurology/AlzheimersDisease/tb2/4321

Disease outbreaks around the world

Coupling with Google Maps, the website healthmap.org tracks global alerts and disease outbreaks.

Black Cohosh in the Blue Ridge

It may not look like much, but this is a stand of Black Cohosh we discovered a few weeks ago on the Blue Ridge. It was an honor to step into this plant's genomic homeland - old, tall oaks kept the forest floor cool and moist. It was still and quiet. And all down the hillside spread the Cohosh, at all stages of growth, its seedheads full and ripe.
We grow this plant up here in Vermont, but I could tell how much more at home it felt down in the rich soil of North Carolina. Black Cohosh is traditionally used as an anti-inflammatory for autoimmune conditions (antirheumatic) and has recently gotten a lot of attention as a helpful aid in menopause: I find it seems to help most with the "hot flash" symptoms (again, perhaps, echoing its ability to control "heat" in the body).
It was so well established in this wild patch! I could feel the large, tangled roots just under the leaf litter. The sheer biomass of it was overwhelming. All I could do was hold some seeds in my hand for a few minutes, sit with the plants, scatter the seeds and get on my way. I promised to return for a longer stay in the wilds of the Blue Ridge.

History of Medicine 1800-2000 in the USA

A short history of herbal medicine in the United States
1800s and 1900s

Technological medicine is hardly "traditional". Here is a quick chart (zoom in as needed) that details the criminal vagaries of the AMA and the exclusionist, politicized ascendance of reductionist healing. Many of the problems we see today (lack of staff; over-specialization; impossible costs) are directly linked to the choices made over the last 100 years.

A radicle Convergence

From the Herbal Convergence (a historic occasion!):

"The genomic structure of woodland plants
holds the integrity of the forest
since the last ice age." K. Gilday

"We must spread free herbal clinics using a model of community education, work-exchange, and participatory medicine making." guido

http://traditionalmedicines.info/

http://www.ithacahealth.org/

Plant sterols, cholesterol and heart health

Phytosterols (found in a wide variety of different herbs, and particularly the Leguminosae such as licorice, red clover, and soy) have a marked effect on decreasing the risk of cardiovascular disease and balancing cholesterol:

One gram of plant sterols added into reduced-calorie orange juice reduced C-reactive protein by 12% and significantly improved cholesterol levels compared with plain low-calorie OJ, reported Sridevi Devaraj, Ph.D., of the University of California at Davis here, and colleagues, in the October issue of the American Journal of Clinical Nutrition.

Downing the supplemented juice twice daily significantly decreased total cholesterol by 5% and reduced LDL cholesterol by 9.4% compared with study participants' baseline levels and compared to placebo.

Likewise, HDL levels improved significantly compared with baseline (6% increase), though not with placebo, over the eight-week period.

From http://www.medpagetoday.com/Cardiology/Prevention/tb2/4282

My only question: why are we adding isolated phytosterols to orange juice? Ever heard of tea? What about black bean soup?