Chaga and cancer

Medicinal mushrooms have a long history of use for modulating immunity, protecting against cancer, and just generally strengthening the system (see, for instance, Rebecca's post on shiitakes). I spend long hours all year round looking for polypores (shelf-mushrooms, generally) in the woods around here, and there is one that can be found and harvested any time of year: the Chaga mushroom, also known as the Clinker polypore, or Inonotus obliquus in the old tongue. Folk medicine, especially in Siberia where these birch-loving fungi grow in abundance, has long regarded the Chaga as a premiere anti-cancer remedy. I generally find it growing on members of the Betula genus (birches, most often golden birches), often ones that are a bit sick. The Chaga almost looks like a cancerous outgrowth from the bark of these trees - an interesting signature. Some have speculated that the fungus acts somewhat as a processing lab for the betulin in birches, a compound that has received much attention as an anti-cancer agent.
I have used Chaga extensively, along with other mushrooms, to support comprehensive protocols for cancer management. Recently, scientific evidence has been building on this particular fungus. Hopefully soon we will get some human data, but for now here's a brief roundup:

Anti-tumor activity of two isolates from Chaga (animal model...)
Antimitotic activity of aqueous extracts of Inonotus (in vitro)
Antioxidant effect of Inonotus (in vitro)
Melanin complex in Chaga (biochemical analysis)
(Melanin has received attention as a potent botanical immunomodulator, perhaps linked to some of Echinacea's immune-enhancing effects).

I use a custom-made double extract of Chaga in my practice. The mushrooms are harvested, stored for a few weeks (not really to dry them, just to get them a bit 'cured') and then divided into two equal portions. You will need a good, sharp saw to cut it in half, and then a heavy hammer / hatchet to chop them up into manageable chunks (about the size of an almond). I steep the first half in a menstruum (solvent) made of 70% alcohol, 20% water, and 10% vegetable glycerin (in a 1:5 ratio, weight of Chaga to volume of menstruum). This tincture favors the phenolic compounds listed in the first study above. After 4-6 weeks of steeping, I strain the tincture and set it aside.
The second half (saved now for many weeks) I place in a crockpot with twice the volume of water as the volume of the strained tincture, and set it to a slow cook for about 48 hours. The goal is to cook it down and strain it so the amount of water extract equals the amount of strained tincture (add water during the cooking process if necessary). Finally, let everything cool down to room temperature, and whisk the two extracts together. Final alcohol percentage is 35%. The color: mahogany brown, beautiful and rich. The flavor: bittersweet, deep and woody, with overtones of humus. Strong healing medicine!

Cultivation of Endangered Medicinal Herbs

The American Herbal Products Association just released its most recent tracking report on the use of threatened medicinal species, summarizing ongoing survey data on the use of wild vs. cultivated herbs from the late 1990s onward. While it is difficult to draw clear and definite conclusions from this report, there are indications that the trend in the herbal products industry is towards a greater use of cultivated botanicals.
One of the main confounding factors is the overall trend in the whole industry - that is, across-the-board demand for all herbs. There seems to have been a peak in the 2001-2003 years for overall medicinal herbal demand, with a quick taper and a small resurgence recently. Accounting for this trend across the board, you can begin to see that herbs such as Goldenseal and Echinacea are more and more available through cultivated sources (although overall cultivated tonnage is less than in 2003 for some plants).
We can only hope that this trend is for real, and that it will continue. Additionally, the report doesn't go into detail on whether the cultivation is organic or not (as we know, commercially grown medicinal herbs, with their pesticide, fungicide, and fertilizer residues probably do more harm than good). In the meantime, you can help by getting involved with United Plant Savers.

Chocolate does it again

I've written before about the benefits of cocoa for cardiovascular disease, specifically for managing cholesterol. Past research has identified other heart-related benefits from chocolate: reducing high blood pressure, relaxing arteries, decreasing vascular inflammation. The commonalities in all the research include a focus on flavonols (chemical constituents of a similar class to resveratrol of red wine fame) present in cocoa powder alone (no cocoa butter).
The conference of the American Association for the Advancement of Science saw a special presentation on further study around cocoa's health benefits. Ian McDonald, of Nottingham, England, described how blood flow to the brain is improved for 2-3 hours after consumption of cocoa powder, as measured by activity on an fMRI (functional magnetic resonance imaging) brain scan of healthy volunteers performing complex tasks. Increased blood flow improves performace, and this new data generated some excitement around possible treatments for dementia and those with impaired blood flow to the brain.
Another interesting presentation, also published in the International Journal of Medical Sciences, provides a comparison between local populations in Panama that consume high amounts of cocoa and how this consumption seems to dramatically reduce risk of hypertension, diabetes, cancer and infectious disease. After leaving their traditional cultures, the Kuna began to display many of the imbalances listed above. Now, this may have a lot to do with other dietary alterations, living in a city, etc... Nevertheless, as the authors point out, their consumption of cocoa went from multiple cups daily to virtually none - suggesting that cocoa may have a serious protective effect.
These findings lend even more weight to using chocolate as a powerful and delicious herbal remedy. Again, I suggest Green and Black's organic cocoa powder, 2-3 TBS daily (or more) and brewed with hot water, a teaspoon of honey, and a pinch of cayenne. YUM!

Watercress

Nasturtium officinale, a member of the Brassica family that also includes broccoli and cabbage, has just made news as a powerful preventer of DNA damage in vulnerable blood cells. This research, published in the American Journal of Clinical Nutrition, gives further evidence that the plants of this family, rich in phytochemicals such as glucosinolates that are partially responsible for their flavor, have powerful anticancer and cell-protective activity when consumed at a daily dose of "about a cereal-bowl full".
Previous research had already underlined this point, but this most recent study is the first to show direct DNA and cell-protective effects. Some highlights:

· significant reduction in DNA damage to lymphocytes (white blood cells), by 22.9 per cent.

· reduction in DNA damage to lymphocytes (white blood cells) when a sample was challenged with the free radical generating chemical hydrogen peroxide, by 9.4%

· reduction in blood triglyceride levels, by an average of 10%

· significant increase in blood levels of lutein and beta-carotene, which have antioxidant activity, by 100% and 33% respectively(higher intakes of lutein have also been associated with a lower incidence of eye diseases such as cataract and age-related macular degeneration).

What is most interesting to me, from a relational point of view, is that members of the Brassicaceae produce many of these pungent compounds that are so protective to humans primarily to defend themselves against environmental stressors. This echoes the role of compounds such as resveratrol (red wine, japanese knotweed, of recent life-extension fame) in promoting an ecosystem inside human cells that favors DNA repair and protection, reduces apoptosis (in healthy cells), and increases the presence of antioxidant compounds.
The process whereby the human intracellular millieu is altered by ongoing ingestion of plants is known by the fancy term "xenohormesis". The implication: plants, like canaries in the coal mine, detect environmental changes very early: they are tightly integrated into soil, air, sun and water processes, and respond to changes in this living system with a high degree of sensitivity. These responses include alterations in the chemicals they produce, generally increasing the levels of substances like glucosinolates and sirtuin-activators like resveratrol during times of greater stress. When we consume these plants, we are then given higher doses of these compounds, which in turn protect us from the environmental changes that could potentially damage our cells and DNA.
Understanding this process of co-evolution is a long-term project for me, and this research on the humble watercress provides yet another piece of evidence in the puzzle.

One final note: please ensure that any watercress you consume is from organic sources, or at the very least grown with very pure spring water, as its ability to take up modern pollutants is very strong and would counteract any positive effect.

Hot peppers

Capsicum species, members of the Nightshade family and used throughout the world these days, are native to the Western hemisphere, and most probably originated from a common Mesoamerican ancestor.
An interesting bit of news: it seems that, over 6000 years ago, peoples living in what is now Ecuador made extensive use of these peppers in their cooking, mixing them with the staple maize. This 'paleobotanical' find was made by microscopically analyzing starch grains found at these ancient sites and discovering unique shapes characteristic to the Capsicum genus mixed in with the corn residues.
Given hot peppers' myriad uses for adjusting digestive function, reducing inflammation, impacting neurological symptoms, and more, it is not surprising that this medicine was domesticated so early. It has since spread across the globe. One of my favorite uses: externally, in a cream or salve, for reducing the pain and swelling associated with joint inflammation. This can be most easily made by steeping dried, chopped hot peppers in olive oil over a double boiler, for at least half an hour, straining, returning the infused oil to the double boiler and then thickening by adding beeswax (1oz beeswax by weight to 10oz of oil by volume). Wait until the beeswax melts completely, then pour the salve off into small jars for use. Be careful! Wash your hands with plenty of warm, soapy water after working with or using this salve, and don't forget to clean under your fingernails (alas, much personal experience has taught me this).

Pelargonium sidoides

This geranium native to southern Africa, and is often known as Umckaloabo. A common preparation is Umcka, which was first used and marketed in Europe and is now sold in the U.S. under the Nature's Way brand.
Its most common application is the treatment of upper respiratory infection, from the common cold to bronchitis and pneumonia. Because it is generally well-tolerated and has a good amount of specific research behind it, many often recommend it for children.
Phytomedicine has just released a supplement to its regular issues that reviews some of the most recent research on this remarkable plant. Here is a quick roundup:

EPs® 7630, an extract from Pelargonium sidoides roots inhibits adherence of Helicobacter pylori to gastric epithelial cells


Fascinating metabolic pools of Pelargonium sidoides and Pelargonium reniforme, traditional and phytomedicinal sources of the herbal medicine Umckaloabo®

In vitro evaluation of antibacterial and immunomodulatory activities of Pelargonium reniforme, Pelargonium sidoides and the related herbal drug preparation EPs® 7630

Inhibition of lipopolysaccharid-induced sickness behavior by a dry extract from the roots of Pelargonium sidoides (EPs® 7630) in mice

Mass spectroscopic characterisation of oligomeric proanthocyanidins derived from an extract of Pelargonium sidoides roots (EPs® 7630) and pharmacological screening in CNS models

Treatment of rats with the Pelargonium sidoides extract EPs® 7630 has no effect on blood coagulation parameters or on the pharmacokinetics of warfarin

Extract of Pelargonium sidoides (EPs® 7630) improves phagocytosis, oxidative burst, and intracellular killing of human peripheral blood phagocytes in vitro

Extract of Pelargonium sidoides (EPs® 7630) inhibits the interactions of group A-streptococci and host epithelia in vitro

Treatment effect and safety of EPs® 7630-solution in acute bronchitis in childhood: Report of a multicentre observational study

EPs® 7630-solution - an effective therapeutic option in acute and exacerbating bronchitis

Pelargonium sidoides preparation (EPs® 7630) in the treatment of acute bronchitis in adults and children

Liquid herbal drug preparation from the root of Pelargonium sidoides is effective against acute bronchitis: Results of a double-blind study with 124 patients

Some issues: the patented liquid preparation, for one. This is a "1X homeopathic dilution of an alcohol extract of Pelargonium". I tend to prefer whole-plant administrations that are traditionally prepared. Also, the large amount of in-vitro and animal studies. Nevertheless, there is some good data on this plant and more is becoming available. As modern medicine continues its shift away from the overuse of antibiotics in respiratory infection, this herb seems to be a helpful adjunct to the tried-and-true diaphoretics and immunomodulators herbalists have been using. I will try to grow it this summer, and see if I can overwinter it in my heated greenhouse...

Cannabis decreases neuropathy

Dr. Abrams (and others), who has a history of working on treatments to improve the quality of live for HIV patients, has co-authored a small but statistically significant trial on the effects of smoked cannabis on the neuropathy associated with HIV. The nerve pain in question is characterized by hypersensitivity to even the smallest stimuli, like the brushing of clothing on the skin, and has some similarities to the intense burning and pain associated with shingles, the herpes zoster infection.
Here is a quick summary of some of this placebo-controlled study's findings:

• Over the course of the study, smoked cannabis reduced daily pain by 34%, versus 17% with placebo.
• 52% of the cannabis group reported at least a 30% reduction in pain, compared with 24% in the placebo group.
• The first cannabis cigarette reduced chronic pain by 72%.
• No serious adverse events were reported.

And, bottom line: "Smoked cannabis was well tolerated and effectively relieved chronic neuropathic pain from HIV-associated sensory neuropathy. The findings are comparable to oral drugs used for chronic neuropathic pain". This is a significant result: not only is chronic neuropathy very difficult to deal with, both as a patient and as a clinician, but conventional drugs like neurontin (not to mention the narcotics) leave a lot to be desired.
This trial provides yet another safe and effective clinical use for this much-maligned botanical medicine.

Antibiotic resistance update

Some of the responses from medical doctors involved in a brand-new prospective study published in the Lancet today are downright alarming:

• "...get on and do something about it before the antibiotic era finally grinds to its apocalyptic halt..."
• "...antibiotic prescribing affects the patient, their environment, and all the people that come into contact with that patient or with their environment..."
• "Physicians should take into account the striking ecological side-effects of antibiotics when prescribing such drugs to their patients..."

Two macrolide antibiotics, Zithromax and Biaxin, were administered to patients and the naturally-occurring strep bacteria in their throats were examined at the end of treatment. Within a week at most, the treatment group showed over 50% more resistant bacteria than did the placebo group. These effects, the study concludes, were evident for up to 180 days after the treatment (at which point the study stopped following the patients).
And as the comments above rightly point out, antibiotic resistance isn't limited to the patient receiving treatment - bacteria are experts at spreading their successful adaptations.
Herbalists have been pointing out the dangers of antibiotic overuse for years now, and the medical community has been coming around (note the recommendation against antibiotics in childhood ear infections, and against overprescription in bronchitis). Antibiotics are fantastic lifesavers when used in dire situations. But with the dangers of their indiscriminate use now clearly proven, what can we turn to?

Talk to your local herbalist.

Wormwood in Crohn's

Wormwood, that famous Artemisia known as a primary ingredient in absinthe, has long been used as a tonic for the digestive tract. New research points to its use in managing Crohn's disease, an inflammatory condition that generally manifests in the lower bowel. Steroids, which are sometimes used to treat this inflammation, can only be used for short periods of time (due to their myriad powerful side-effects), and patients usually suffer relapses after the steroids are tapered off. By adding wormwood to the treatment regimen:
"...there was a steady improvement in CD [Crohn's disease] symptoms in 18 patients (90%) who received wormwood in spite of tapering of steroids as shown by CDA-Index, IBDQ, HAMD, and VAS. After 8 weeks of treatment with wormwood there was almost complete remission of symptoms in 13 (65%) patients in this group as compared to none in the placebo group. This remission persisted till the end of the observation period that was week 20, and the addition of steroids was not necessary".

Wormwood is a powerful herb, and remarkably bitter. The dose is usually lower than average - about 30 drops of a 1:5 tincture, taken 2-3 times daily before food is what I usually recommend. If it were me, I would also combine it with a warming, carminative herb (like fennel seed) and a bit of a soothing demulcent/astringent (like meadowsweet, or even licorice) in a custom herbal formula.

Apigenin and breast cancer

The flavone apigenin, common in many members of the Umbelliferae (Apiaceae), has been shown in a recent study to have marked and positive impact on human breast cancer. These findings, coupled with previous research on apigenin's good oral bioavailability from crude plant preparations, builds on previous evidence for the beneficial role of such humble foods as common Parsley in supporting sometimes difficult conditions like cancer.
One note: the dose of Parsley should be relatively high - up to 2g of "blanched" Parsley per kg of body weight on a daily basis. This comes out to about 140g for an averabe 150lb human, which is quite a bit. But combined with soups, veggie stir-fries, and steamed greens, such a dose can be easily achieved. And it reduces the need for added salt, while providing lots of dietary potassium.

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!

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.