Blog RSS

Migraine headaches are one of the most common causes of pain and can vary from a minimal impact on activities of daily living to even incapacitating. Numerous over the counter and prescription drugs exist for acute migraine headaches but problems abound with poor satisfaction in many cases and varied side effects in others. In addition, some migraine sufferers have very frequent chronic and recurrent attacks, necessitating the frequent use of some of these acute intervention drugs and thus again, side effects can become an issue. An effective herbal intervention for acute pain relief would be a welcome addition to the list of options.

This double-blind randomized controlled clinical trial compared the efficacy of Ginger root and powderginger to sumatriptan, a standard conventional prescription treatment, in the treatment of common migraine. Study subjects were randomly delivered either one ginger capsule of 250 mg upon onset of headache or 50 mg of sumatriptan. Questionnaires were completed for each headache attack, recording time of headache onset, severity, timing of drug taking and response self-assessments at 30, 60, 90 and 120 minutes and 24 hours. Any adverse effects were also recorded. The overall study duration was one month.

One hundred sufferers of common migraine headaches, from a Hospital in Iran were the study subjects. The average age of participants was 35.1 in the sumatriptan group and 33.9 in the ginger group. Women comprised 68% of the sumatriptan group vs. 74% of the ginger group. The average duration of a migraine diagnosis was similar in both groups at approximately 7 years. The average number of headache attacks in the sumatriptan groups were 5.8 and 4.9 in the ginger treated group. Inclusion criteria for the study included a confirmed diagnosis of migraine without aura by a neurologist, 18 years and older, high school diploma or higher and a frequency of 2 to 10 headaches/month.

Both sumatriptan and ginger powder decreased the mean severity of common migraine attacks within 2 hours of use. No significant difference existed between the two treatments. Before taking the medication, 22% of the sumatriptan group and 20% of the ginger group had severe headaches. The mean headache severity at 2 hours after sumatriptan or ginger use demonstrated similar effectiveness for both groups. There was 4.7 unit reduction in the headache severity in the sumatriptan group and a 4.6 reduction in the ginger group. Favorable relief was achieved in 70% of the sumatriptan treated headache individuals and 64% of the ginger treated patients at 2 hours following intake. Both the sumatriptan and ginger significantly provided pain relief and no significant differences were achieved.

There were more side effects from sumatriptan using including dizziness, sedation, vertigo and heartburn. The only clinical adverse effect of ginger was dyspepsia.

Commentary: Ginger products have a long tradition of use for joint pain, nausea and vomiting, motion sickness, lipid lowering and a broad range of anti-inflammatory implications. For migraines, a previous study in 2005 demonstrated that ginger completely alleviated migraine headache in 48% of individuals and partially in 34% of individuals within 2 hours. Another study demonstrated that the ginger treated group had a higher pain relief rate at 65% for ginger versus 36% for the placebo.

I am quite impressed that the current study reveals both sumatriptan at 50 mg and ginger powder at 250 mg decreased the mean severity of a common migraine attack and within 2 hours of use. Pain relief and patient satisfaction did not show any significant difference, although side effects due to ginger were far less than those with sumatriptan.

In my experience, the natural medicine strategies for reducing the frequency and severity and duration of migraines are quite effective and include basic lifestyle and nutritional plans, but more robustly involve a multi-factorial approach using riboflavin, ginger, feverfew, 5-HTP, butterbur, magnesium, CoQ10, and sometimes cyclic estrogen patches in women with menstrual migraines. I have never felt very optimistic about acute intervention with these supplements or others in reducing the severity of an acute migraine. I am encouraged by this study, that acute use of ginger capsules for acute migraines may provide pain reduction, with an overall 44% palliation in all headache attacks within 2 hours.

Reference

Maghbooli M, Golipour F, Esfandabadi A, Yousefi M. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytotherapy Res 2014;28:412-415.

Current study: Xi S, Liske E, Wang S, et al. Effect of isopropanolic Cimicifuga racemosa extract on uterine fibroids in comparison with tibolone among patients of a recent randomized, double blind, parallel-controlled study in Chinese women with menopausal symptoms.

Black-Cohosh-C-racemosa

An original menopause study, published in 2007[1] enrolled 244 Chinese women aged 40-60 years with menopause symptoms who were treated with either black cohosh extract, 40 mg/day (n=122) or tibolone 2.5 mg/day (n=122) for 3 months. The current study investigated the subset of women from that study (n=62) who had at least one uterine fibroid at the onset of the study, and compared the effect of black cohosh extract (n=34) on fibroid size compared with tibolone (n=28), using transvaginal ultrasound.

The patients were treated for 12 weeks with iCR (isopropanolic Cimicifuga Racemosa) or tibolone. Study visits were at entry, 4 weeks and 12 weeks. Clinical variables including the Kupperman Index (KI), vital signs, body weight, co-existing diseases, adverse events and co-existing medications were recorded. In addition to blood samples for follicle stimulating hormone (FSH), estrogen, standard hematology and biochemistry and urine samples, transvaginal ultrasound was also performed before onset of study and at the end of treatment.

In the black cohosh group, the median volume of the largest individual fibroid decreased from 1787 mm3 at visit one to 1086 mm3 after 12 weeks. The mean diameter of the largest fibroid per patient significantly decreased during the treatment with a decrease of the total myoma volume of – 30.3% on average observed in 24 of the women in the black cohosh group (70.1%) during the 12 weeks. In the tibolone group, the median volume of the largest individual fibroid changed from 1063 mm to 1096 mm after 12 weeks, actually slightly larger. No statistically significant difference was found for the mean diameter of the individual largest fibroid as well, from baseline to 12 weeks. There was a decrease in the myoma volume in 10 of the women in the tibolone group (35.7%), but on average, it increased by +4.7% in the tibolone group.

In summary, the key results were that the percentage of volume change in the black cohosh extract group (-30.3% decrease) was significantly superior to the tibolone group, a 4.7% increase and the percentage of mean diameter change in the herbal group was significantly superior to tibolone as well. Lastly, the superior response rate of black cohosh 70.1% vs. tibolone 35.7% was important.

Other questions about the effect of black cohosh on hormone sensitive tissues might be considered here as well. A 12 month study showed that after 12 months of treatment with black cohosh extract, no increase in the risk of malignant change of the breast or endometrium was observed.[2] In another study, black cohosh extract did not increase the risk of tumor recurrent in patients with early endometrial cancer after 24 months of treatment for menopausal symptoms and after surgery.[3] In another study, 6 months of treatment with black cohosh daily did not cause change in the mammographic density and breast cell proliferation.[4] And yet another found that isopropanolic black cohosh extract did not increase the risk of breast cancer recurrence. [5]

To my knowledge, the current clinical study analysis is the first of its kind evaluating the effect of iCR on uterine fibroids. I will add this to my eager approach to helping perimenopausal women in particular, decrease their fibroid growth. We now have two recent botanical studies of import for uterine fibroids, this one, and the green tea extract study I wrote in an earlier blog posting. [6]

References


[1] W. Bai, H.-H. Henneicke-von Zepelin, S. Wang, et al. Efficacy and tolerability of a medicinal product containing an isopropanolic Cimicifuga racemosa, aka black cohosh (iCR) extract was in Chinese women from five hospitals in China, with menopausal symptoms: a randomized, double blind, parallel-controlled study versus tibolone. Maturitas 2007;58(1):31-41)

[2] Geller S, Shulman L, van Breemen R, et al. Safety and efficacy of black cohosh and red clover for the management of vasomotor symptoms: a randomized controlled trial. Menopause 2009;16(6):1156-1166.

[3] Li W, Sun N, Chen X, et al. Cimicifuga racemosa for the treatment of menopausal symptoms in patients with eaerly endometrial cancer after operation. Academic Journal of Second Military Medical University 2012;33(5):562-564.

[4] Hirschberg A, Edlund M, Svane G, et al. An isopropanolic extract of black cohosh does not increase mammographic breast density or breast cell proliferation in postmenopausal women. Menopause 2007;14(1):89-96.

[5] Henneicke-von Zepelin H, Meden H, Kostev K, et al. Isopropanolic black cohosh extract and recurrence-free survival after breast cancer. International J of Clinical Pharmacology and Therapeutics 2007;45(3):143-154.

[6] Roshdy E, Rajaratnam V, Maitra S, et al. Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. Int J Womens Health. 2013;5:477-486.

 

Photo credit: http://chestofbooks.com/flora-plants/flowers/Wild/Black-Cohosh-Bugbane-Black-Snakeroot-Cimicifuga-Racemosa-Crowfoot-Family.html#.U6tOFLFhsTA

Nearly 50% of women who undergo screening mammography are classified as having either heterogeneously dense or extremely dense breast tissue. Dense breast tissue is defined as a greater amount of fibrous or glandular tissue than fatty tissue in the breasts. Women with dense breast tissue have a modestly elevated risk for breast cancer and the sensitivity of screening mammography is reduced. One 2007 report states a four to five fold increased likelihood of developing breast cancer in women with dense breast versus women with low breast density. [i] Due to this data, and some assertive women’s health scientists and activists, certain states now require that women found to have dense breast tissue on screening mammography be provided a letter informing them of these findings and are then encouraged to follow up with their primary care provider to discuss risk and screening guidelines. While this is dictated by at least 11 state jurisdictions, and more to come, most physicians have yet to urge patients to get further testing. Even the American College of Obstetrics and Gynecologists (ACOG) is currently not offering guidelines to physicians, for further testing when the mammogram detects heterogeneously dense or extremely dense (grade 3 and 4 density respectively).

In a recent evidence based review, ACOG noted that “the assessment of breast breast scandensity is subjective and affected by the perspective of individual radiologists.”[ii] Their statement also indicates that “use of supplemental imaging such as ultrasound, magnetic resonance imaging (MRI), tomosynthesis, or thermography has not been associated with meaningful benefits for women found at screening to dense breasts.” They support further research on the topics but as of this writing, ACOG does not recommend use of alternative tests for dense breast detected on screening mammography

Commentary

As a practicing clinician providing healthcare for women these last 30 years, I am currently recommending a more proactive approach and not waiting for guidelines from ACOG. I advise my patients to have additional imaging if they have heterogeneously dense or extremely dense breasts. If they have no other risk factors for breast cancer, I am likely to just recommend a screening breast ultrasound. If they also have other risk factors for breast cancer (ex/ first degree relative with breast cancer, obesity, an intake of greater than 7 alcohol drinks per week, history of estrogen/progestin for greater than 4 years), then I may consider an MRI, in consultation with the radiologist and a breast surgeon.

References


[i] Boyd, N.F., et al. (2007). Mammographic breast density and the risk and detection of breast cancer. N Engl J Med. 356(3):227-36.

[ii] Committee on Gynecologic Practice. Committee Opinion No. 593: Management of women with dense breasts diagnosed by mammography.  Obstet Gynecol 2014 Apr; 123:910

This randomized, double-blind, 2-group parallel, clinical trial conducted in Brazil compared the effects of melatonin compared with a placebo on endometriosis-associated pelvic pain, brain derived neurotrophic factor level and sleep quality. Forty women were randomized into melatonin 10 mg/day (n=20) or placebo (n=20) groups for 8 weeks.

clip_image002Forty women with chronic pelvic pain, who were between 18 and 45 y.o. were recruited from gynecology outpatient clinics. Chronic pelvic pain was defined as a moderate-to-severe pain lasting for more than 6 months and eliciting pain scores of at least 4 or greater on a 10 point pain scale that required regular analgesic use. All patients had a diagnosis of endometriosis as confirmed on laparoscopy and included patients with any stage from stage 1 to stage 4. Three patients in the melatonin group and one in the placebo group withdrew due to treatment inefficacy.

The primary outcome of the trial was pain, as assessed by pain score diaries within the last 24 hours, painful menstrual periods or dyspareunia, as well as the amount of analgesics used each week throughout the treatment period and the level of brain derived neurotrophic factor (BDNF). Secondary outcomes were pain during urination or defecation and sleep quality.

The melatonin group had significantly lower pain visual analogue scale (VAS) scores than the placebo-treated group with a mean pain reduction of 39.3% in the melatonin group vs the placebo group. The melatonin group also had significantly lower pain score during menstruation with mean reduction in analgesic use of 42.2% in the placebo group and 22.9% of patients in the melatonin group. The placebo group was 80% more likely to require additional analgesics than the melatonin group. In the placebo group, acetaminophen was used by 66.7%, NSAIDS by 60% and codeine or tramadol by 60%. In the melatonin group, 33.3% used acetaminophen, 40% used tramadol or codeine and 35% used NSAIDS.

The reduction in BDNF, greater with melatonin than placebo, suggests that melatonin has a direct effect on pain pathways or on the levels of chemicals that are signals for pain. Patients in the melatonin group also had better sleep quality than the placebo group and melatonin produced a mean improvement of 42% in how patients felt upon waking in the morning.

Commentary: This study demonstrated that melatonin at 10 mg/day reduces endometriosis associated chronic pelvic pain, including a reduction in pelvic pain, pelvic pain during menses, pain during vaginal penetration, pain during urination and pain during defecation that is statistically and clinically significant. This reduction in pelvic pain due to melatonin was of a magnitude > 35% overall, as well as an 80% reduction in analgesic use.

This study is consistent with evidence from animal studies in which melatonin caused regression and atrophy of endometriotic lesions. The current study also corroborates other randomized clinical trials on melatonin and pain in particular, in treating fibromyalgia and acute postoperative pain.

Melatonin is well tolerated by most patients and appears to represent an effective option for pain symptoms related to endometriosis. A 2013 observational study on N acetyl cysteine also resulted in significant pain reduction and ovarian cyst size reduction associated with endometriosis. I consider these two nutrients as mainstays in our treatment strategies for endometriosis.

Reference

Schwertner A, Conceicao dos Santos C, Costa G, et al. Efficacy of melatonin in the treatment of placebo endometriosis: A phase II, randomized, double-blind, placebo controlled trial. PAIN 2013;154(6):874-881.

Safari II Le ContadourAnother quality study has emerged using the oral encapsulated lavender essential oil. This randomized, double-blind, placebo-controlled trial investigated two doses of oral lavender essential oil in comparison to a selective serotonin reuptake inhibitor, paroxetine, in patients who have been diagnosed with generalized anxiety disorder (GAD). Individuals were given a lavender essential oil made from the steam-distilled fresh flowering top of lavender that has then been standardized to contain approximately 70% of two constituents, linalool and linalyl acetate. The product was given as either an 80 or 160 mg dose and then 1 placebo or 2 placebo pills daily. The paroxetine was given in capsules of 20 mg. Treatment was given for 10 weeks, and measurements of safety and efficacy were done at 2, 4, 6, 8, and 10 weeks. During a week of "down-titration" following the study, patients who were on the paroxetine, took the treatments every other day to account for any withdrawal problems caused by paroxetine. Patients in the lavender essential oil group took placebo.

A total of 616 patients were recruited and then 536 patients randomized to treatment. These were men and women, between ages 18 and 65 year old, from 57 general practice and psychiatric practices in Germany, who had a diagnosis of moderate to marked severity of GAD for an average of 2.5 years. Psychiatric medications other than the paroxetine were not allowed during the study and for 30 days prior to entering the study. A total of 128 were in the 160 mg Lavender group, 135 in the 80 mg/day group, 137 in the paroxetine group and 136 in the placebo group.

After 4 weeks of the study and at other study time points, the intake of 160 mg/day of lavender essential oil resulted in a significantly greater change in the HAMA (Hamilton Anxiety Scale) score compared to placebo (P< 0.01). After 6 weeks and beyond, those taking the 80 mg/day of lavender essential oil had a significantly greater change in the HAMA scores compared to placebo. At week 6 the HAMA score in those taking paroxetine approached significance but they were not significantly better than placebo after that point.

Significantly more patients in the 160 mg/d lavender group showed an improvement in the HAMA score of 50% or more compared to the placebo group (60.3% vs. 37.8%). This was also observed in the 80 mg/d group (51.9% vs. 37.8%). The HAMA score was < 10 in significantly more of those patients taking the lavender product compared to the placebo (46.3% vs. 29.6%). All three treatment groups, the 80 mg/day, 160 mg/day and the paroxetine contained a greater percentage of patients who were "much/very much improved" or had a "moderate/marked" therapeutic effect as compared to the placebo group. The adverse events that were reported were 25% of those in the 160 mg/day lavender group, oddly higher of 34.8% in the 80 mg/day group, 40.9% in the paroxetine group and 30.9% in the placebo group. These adverse events were reported as gastrointestinal disorders, infections, and nervous system problems.

Commentary: Both doses of oral essential oil of lavender were effective in treating GAD and were more effective than the conventional medicine, paroxetine. In terms of adverse events, those taking lavender were similar to placebo and lower than paroxetine. This study is another welcomed positive study in using an oral lavender essential oil standardized to linalool and linalyl acetate in the treatment of GAD. Conventional medications, whether anti-depressants or anxiolytics or barbiturates are fraught with side effects, which makes the lavender essential oil product that much more appealing. That said, there are nonresponders to natural medicine, including this lavender oil and we all must recognize that some individuals will need the conventional medications for anxiety, at least until other efforts are made in assessing the complexities of causation and then addressing those.

Reference

Kasper S, Gastpar M, Müller WE, et al. Silexan is effective in generalized anxiety disorder – a randomized, double-blind comparison to placebo and paroxetine. Int J Neuropsychopharmacol. January 23, 2014:1-11. [epub ahead of print]. doi: 10.1017/S1461145714000017.

soybeans fresh

The authors of this study were testing the hypothesis that Asian women may have fewer health complaints and that this may be due to higher consumption of soy products. This double-blind, placebo-controlled randomized study assessed the effect of soy isoflavones on menopausal symptoms, bone mineral density (BMD), serum cytokines, and bone metabolism indices.

Chinese menopausal women were recruited from 3 medical centers in China. Women were between the ages of 45 and 55, had moderate menopause symptoms based on a questionnaire and were excluded if they had menopausal symptoms for more than 5 years, high blood pressure, endocrine disorders, cardiovascular disease, or were currently on hormone replacement therapy (HRT), pregnant, obese, or allergic to soy products.

Women were given capsules of soy isoflavone (22.5 mg, 52.2% genistein, 47.8% daidzein) or placebo, 2 capsules twice a day for 6 months. They were asked to limit their soy dietary consumption. A menopause symptom questionnaire and BMD of the radius and tibia (using ultrasound measurement) were done at baseline and at 6 months. Blood tests included genistein, daidzein, calcium, phosphorus, alkaline phosphatase (ALP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α).

A total of 70 women completed the study (37 in treatment group and 33 in placebo group). There were overall significant decreases in menopausal symptoms such as hot flashes, insomnia, restlessness and tantrums, dizziness, lassitude, headache, heart palpitations, feeling of crawling skin, urinary tract infection, and state of sexual life of 11.5 points in the treatment group vs. 7.3 points in the placebo group. And, for almost all of the same symptoms in the placebo group (all P<0.05). Hot flashes specifically, significantly decreased in the isoflavone group vs. no significant decrease in the placebo group.

The BMD of the tibia increased significantly with soy isoflavone ingestion, although the radial BMD did not change. Alkaline phosphatase, IL-6, and TNF-α decreased significantly in the treatment group as well.

Commentary: Common perimenopause and postmenopausal symptoms include hot flashes, insomnia, and night sweats. There is also a normal bone loss, especially in the first 4 years, associated with the decline of estrogen, which can increase the risk of osteoporosis and fractures. Soy isoflavones have been shown to decrease bone loss in animal and human studies, likely due to the phytoestrogens that have weak estrogenic activity. Not all published reports confirm that Asian women have less menopause symptoms than Western Caucasian women, but if they do in fact, it is hypothesized that one reason may be the higher consumption of soy products in Asia.

To summarize, in this study, soy isoflavones had a significant, positive effect on a number of subjective and objective markers of menopause including the decrease in overall symptoms of menopause and an increase in the tibia BMD. Alkaline phosphatase levels and TNF-alpha normally rise after menopause and IL-6 is partially regulated by estrogen. Because soy isoflavones possess weak estrogen-like properties, they may alter bone formation and resorption in a manner similar to estrogen. Soy isoflavones appear to decrease blood levels of ALP, IL-6, and TNF-α, suggesting again their weak estrogenic effect and favorable influence on bone metabolism. This study should not be construed as concluding that soy isoflavones have equivalent effects of estrogen therapy, on either menopause symptoms or on slowing bone loss, but this simple intervention does have endocrine effects that have clinical meaning in menopause management.

Reference

Chi X-X, Zhang T. The effects of soy isoflavone on bone density in north region of climacteric Chinese women. J Clin Biochem Nutr. September 2013;53(2):102-107

clip_image002There has been interest for some time now about the role of vitamin D levels in the blood and the potential protective benefits of adequate levels in the prevention of breast, colon and other adenocarcinomas.

This meta-analysis was conducted using a PUBMED search for observational studies of serum 25(OH)D and risk of breast cancer between 1966 and 2010. Articles were included if they were published in medical journals, were prospective or historical follow-up studies and if they articles reported survival or mortality rates in relationship to quintiles of serum 25(OH)D. A total of 77 studies were identified but after review by these two researchers, only five studies were eligible for inclusion.

A higher serum concentration of 25(OH)D was associated with lower case- fatality rates in breast cancer patients. Three of the five studies found that serum vitamin D in the highest quantile was associated with significantly lower mortality rates than serum vitamin D levels in the lowest quantile. Two other studies found a trend in that same direction. Breast cancer patients with the highest concentration of 25(OH)D had approximately half the mortality rate compared to those with the lowest concentration.

Commentary: Laboratory studies have found anticancer benefits of metabolites of vitamin D on cell differentiation, apoptosis (cell death) and angiogenesis (blood supply to tumor sites) of breast tumors. The hypothesis is that breast cancer survival may be influenced by serum levels of vitamin D and its effect on maintaining cell differentiation, promoting apoptosis and inhibiting angiogenesis. In terms of clinical trials of vitamin D for prevention, I am aware of one such trial where 1,000 IU of vitamin D daily with calcium, showed a 77% reduction in incidence of all combined invasive cancer, including breast cancer.

Vitamin D testing is a simple test, called a serum 25(OH)D. I routinely test breast cancer patients for this and assure that they have adequate vitamin D levels of 30-80 ng/ml. That said, there has been some concern about levels > 40 ng/ml and increased risk of pancreatic cancer. My goal therefore, is 30-40 ng/ml. Vitamin D supplementation is by and large safe and definitely one of the most inexpensive vitamins to take. And don’t forget the sunshine— just harder to determine exposure necessary for adequate serum levels– plus potential negative effects of too much exposure and increased skin aging, and precancerous and cancerous skin lesions.

Reference

Mohr S, Gorham E, Kim J, et al. Meta-analysis of Vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Research 2014;34:1163-1166.

The purposes of this study were to evaluate the effects of a walking routine on bone mineral density (BMD) at the lumbar spine, at the femoral neck (a part of the hip), at the radius (wrist) and for the whole body in perimenopausal and postmenopausal women and to identify the optimal duration of a walking program. The study reported on randomized and non randomized clinical trials through systematic review and meta-analysis of those clinical trials.

Ten data bases were searched from their origin through December 2012. All randomized and nonrandomized controlled studies on walking interventions in perimenopausal and postmenopausal women were considered. Efforts were made in the analysis to avoid double counting of participants in the meta-analysis papers. Only studies that evaluated walking alone as the sole exercise program were included. The outcomes were defined as BMD at the lumbar spine, femoral neck, radius and whole body, as measured by single-photon absorptiometry (SPA), dual-photon absorptiometry (DPA), or dual x-ray absorptiometry (DXA).

clip_image002

From these searches, 229 articles for potential inclusion in the review were found and identified but in the end, only 10 trials were eligible for inclusion. Among those 10, seven were randomized controlled trials. Participants were predominantly from the U.S., UK and Japan. Walking for 40 to 60 minutes per session was reported in 8 of the trials, with one being two levels of 45 and 30 minutes per session and another only 30 minutes per session. The frequency of the walking was approximately 3-4 times per week in 9 of the 10 trials. A meta-analysis of trials evaluating lumbar spine BMD showed no significant effects regardless of the length of the exercise program. When all the ten trials were taken into account, walking interventions with durations of 3 months to 2 years were NOT found to have beneficial effects. However, two of the meta-analysis did observe a significant positive effect of walking on the BMD at the femoral neck. These two that showed this increase were the programs that were at least 6 months (vs 3 months) up to 2 years. It is thought the difference between the negative results and the positive results is in fact duration of the walking program. The effects of walking on the radius and whole body were not significant.

Commentary: Menopause is a major risk factor for bone loss in women due to the lowering of the body’s natural estrogen level. Low BMD increases the risk for osteoporosis and fractures. Several recent reviews have investigated the effects of walking but the conclusions were inconsistent. Two randomized controlled trials have demonstrated significant effects of walking on BMD preservation. A Cochrane Review based on 3 randomized controlled trials showed not significant effect except in the spine. The Nurse’s Health Study suggested that the risk of fracture was reduced by regular walking and others have shown no benefits or just modest benefits on BMD after 1 year of walking.

In this systematic review, walking for 40 to 60 minutes per day, 3-4 days per week showed almost no benefit to BMD except after 6 months and at the femoral neck only. If that were just the whole story, it would not be that compelling as a treatment strategy to preserve postmenopausal BMD. However, walking has been shown to decrease the risk of many diseases such as congestive heart failure, stroke, type II diabetes, high blood pressure, high cholesterol and even some cancers, and even as a fundamental treatment for weight management, PMS, depression, high blood pressure, type II diabetes, high cholesterol. Women don’t have just bones of course, and have many compelling reasons to walk a minimum of 40 minutes, 4 days per week.

Reference

BS D, Wu L, He Zhong. Effects of walking on the preservation of bone mineral density in perimenopausal and postmenopausal women: a systematic review and meta-analysis. Menopause 2013;20(11): 1216-1226.

Hot flashes and/or night sweats are the most common symptoms that perimenopause/menopause women seek relief for. They can be mild, moderate or severe and can be infrequent or daily and many times a day if not several times per hour and can last an unpredictable amount of months/years. Some women are affected greatly and this can impact mood, sleep, social encounters, work and general quality of life. About 70-80% of women who go through normal natural menopause have hot flashes/night sweats and 90-100% of women with surgical menopause (both ovaries removed) experience them.

In this double blind clinical trial, 76 menopausal women with the chief symptom of hot flashes were enrolled with the treatment group receiving a 225 mg valerian capsule three times per day and the other group placebo, for 8 weeks. Five women from the placebo and 3 from the valerian groups were excluded due to irregular use, inaccurate recording, mild side effects or taking other medications that affect hot flashes. A total of 68 women completed the study. Symptom diaries (although the questionnaire and specifics of this were not reported in the study) were kept. Results were recorded by the participants and collected by the researchers. After 4 and 8 weeks of treatment, the evaluation of results showed a meaningful difference between the valerian group and the placebo group.

At week 4 and week 8 post-treatment, the valerian group had significantly less severe hot flashes (9.82 + 1.87 pre-treatment and 5.23 + 1.52 after 8 weeks) compared with the placebo group (9.96 + 1.84 pre-treatment and 9.86 + 1.95 after 8 weeks). There was no significant change in severity of hot flashes in the placebo group compared with baseline. In addition, at week 4 and week 8 post-treatment the valerian group had significantly fewer hot flashes compared with the placebo group. Valerian pre-treatment was a mean frequency of 7.91 + 30.0 and 4.83 + 0.52 after 8 weeks vs. placebo pre-treatment 7.73 + 42.0 and after 8 weeks 7.75 + 0.32. There was no significant change in frequency of hot flashes in the placebo group compared with baseline.

Commentary:valerian

The purpose of this randomized, double-blind, placebo-controlled study was to evaluate the effect of valerian treatment for 8-weeks on hot flashes. Valerian is an interesting choice, but it does contain some flavonoids, which are phytoestrogenic components and therefore it is a reasonable hypothesis that it may reduce menopause symptoms.

Currently available conventional treatments include various regimens of hormone therapy, conventional non hormonal options such as an SNRI or SSRI, gabapentin, clonidine and possibly an anti-histamine. Efficacy of the non hormonal treatments are less than with adequate doses of estrogen. However, all of these have a benefit and risk profile that needs to be considered by patient and menopause practitioner. Natural treatments that have scientific support span all kinds of plants and nutraceuticals. Some of the plants are phytoestrogen containing plants such as soy, red clover, kudzu, hops and others. Some of the plants that do not contain phytoestrogens include black cohosh, maca, Siberian rhubarb, St. John’s wort, pine bark and kava. Even fish oils have shown some efficacy in treating hot flashes. These herbal/nutraceutical treatments can be quite effective in reducing severity and frequency of hot flashes, but are also sometimes not effective, or some times not effective enough. Having more options to help women with hot flashes and/or night sweats is extremely helpful in order to address the diverse array of clinical situations and individual needs/choices based on benefits and risks.

There seems to be quite a bit of herbal research in women’s health coming out of Iran which I am pleased about. I will add this study and this tool to my list of options.

Reference

Mirabi P, Mojab F. The effects of valerian root on hot flashes in menopausal women. Iran J Pharm Res. 2013;12(1):217-222.

Peanuts to the Rescue!

clip_image002In this study, children of women who participated in the Nurses Health Study II (NHSII) and the Growing Up Today Study 2 (GUTS2) and were born between January 1990 and Dec 31, 1994 were identified. A questionnaire was sent out in 2009 to the mother of every child in these two studies in order to identify children with food allergies. The children themselves had already been surveyed in 2006, on whether or not they had a food allergy. The researchers evaluated the results of these two questionnaires and identified cases of allergies to either peanuts or tree nuts. These cases were then divided into seven levels ranging from likely food allergy to possible food allergy based on the review of the medical information. The mothers had also previously reported on their diet in 1991 and 1995 on the NHSII questionnaires. The questionnaire closest to the birthday of each child was selected to determine the maternal peanut intake.

A total of 8205 children with 140 cases of peanut/tree nut allergy were identified. Over 95% of the NHSII and GUTS2 participants were Caucasian and 2% of the mothers reported a nut allergy. Women with the highest consumption of peanuts/tree nuts in their peripregnancy (typically 5 months before, during pregnancy and 1 month after pregnancy) diet were more likely to introduce these items into their child’s diet at < 2 years old. The odds of having a child with peanut/tree nut allergy among the mothers without these allergies and who consumed these food 5 or more times/week had the lowest incidence.

Commentary:

The U.S. has seen an increase in the incidence of peanut allergy from 0.4% in 1997 to 1.4% in 2010. It’s become significant enough that some preschools and school settings ban peanuts in snacks and lunches. Frequently occurring together, 80-90% of peanut and tree nut allergies that have an onset in childhood then persist into the adult years. Media and schools and magazines and practitioners have been telling women for many years to avoid giving their children peanuts in the first 3 years of life. Some have even recommended to women that they avoid peanuts during pregnancy and lactation. However, these guidelines changed due to lack of evidence in that several studies demonstrated that peanut consumption during pregnancy and lactation had no effect on subsequent peanut/tree nut allergies in offspring. The current study is attempting to clarify further, any association with peripregnancy consumption of peanuts/tree nuts by mothers and the development or not, of these allergies in their children. This is the first study to my knowledge, actually showing that ingestion during pregnancy may actually be protective for their children, at least that is the case in women who do have any known peanut/tree nut allergy themselves. While this study is not a pure prospective study where diet records are controlled more diligently during pregnancy, and this study did not included information on exclusive breastfeeding rates or duration, I still find it useful, and logical actually. Pediatric guidelines currently states that there is not enough evidence that maternal dietary restrictions during pregnancy will play any role in the prevention of atopic allergic disease in infants. And, although there is not enough evidence to say that consumption of dietary food allergens in pregnancy can reduce the chance of infants developing allergies to those allergens, the current study supports that possibility, and at least gives license for pregnant women who do not themselves have these allergens, to feel free to enjoy the health benefits and yummy goodness of peanuts, peanut butter, and other nuts/nut butters. I would add though, steer clear of sugar containing, hydrogenated fat containing, and even the “creamy” versions, due to palm oil and the usual practice of destructive deforestation, illegal forest fires and the devastating impact on animal species and the destruction of their habitat and endangerment to their survival. You might be interested in reading about some of the multinational corporation practices in this regard, and the Greenpeace investigations and efforts to halt these practices. Oh, and while we are at it, try to choose organic.

Reference: Frazier A, et al. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatrics Dec 23, 2013 (Epub ahead of print).

Next »