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Gingivitis (a reversible inflammation of the gums) and periodontitis (a gumsdestructive non reversible condition resulting in loss of the connective tissue attachment of the tooth to the bone) are oral inflammatory infections. Periodontitis is thought to be caused by an immune response stimulated by plaque around the margins of the gingiva. One way that the white blood cells contribute to the periodontitis is likely by releasing proteolytic enzymes and reactive oxygen species (ROS). There is also some suggestion that the periodontal inflammation might be associated with oxidative stress as well. Other research has shown that CoQ10 is an antioxidant and that there is a deficiency of CoQ10 in the gingiva of individuals with periodontitis.

The current study was a randomized, double-blind, controlled, parallel group clinical trial. A total of 30 non-smokers (14 women and 16 men), who had a plaque index score of > 2 and a gingival index score of > 2 with at least three non-adjacent interproximal sites with a pocket depth of > 5 were enrolled in the study. Individuals were randomized into the test group in which they took oral CoQ10 120 mg/day after scaling and root planing and the control group, in which patients received an oral placebo after scaling and root planing. The oral supplement or placebo was given for 3 months and did not use any mouthwash. The plaque index, gingival index and probing were done at baseline, one month and 3 months of the study period.

Results: Both groups showed marked reduction of the periodontal parameters at one month and three months. There was no significant difference in plaque index and pocket depth between the two groups. However, in the CoQ10 group, there was a significant difference in gingival inflammation at one month and 3 months compared to the placebo group.

Commentary: Bacterial plaque is the primary cause of periodontal disease and it is currently thought that the majority of periodontal tissue destruction is caused by an insufficient host response to the plaque bacteria and their products. Responsible mechanisms include an imbalance between proteolytic enzymes and their inhibitors, and an insufficient antioxidant defense to reactive oxygen species. Past research on CoQ10 has included improved oral hygiene plus CoQ10 and topical application of CoQ10 to periodontal pockets. Past research demonstrated that CoQ10 had anti-inflammatory and antioxidant effects as well as reduced bleeding of the gums. It may in fact be the anti-inflammatory properties of CoQ10 rather than the anti-oxidant properties. The current study supports that point of view and/or a possible deficiency of gingival CoQ10 in that while there was no difference in the plaque index and pocket depth between the oral CoQ10 group and placebo, there was a significant reduction in gingival inflammation in the oral CoQ10 group.

Reference: Manthena S, Venkata M, Rao R, et al. Effectiveness of CoQ10 oral supplements as an adjunct to scaling and root planning in improving periodontal health. J Clinical and Diagnostic Research 2015; 9(8): 26-28

This study included 45 women with ages 18-65 and a mean age of 41.5 yearselderly woman sad, anxious, who were in remission from their depression but who suffered from antidepressant-induced sexual dysfunction (AISD). Patients received either 1500 mg Maca root or placebo twice daily for 12 weeks. Sexual function was evaluated using common research questionnaires and scales.

These women met the criteria for depression/anxiety and were in remission. These were patients on current and stable doses of venlafaxine or a tri-heterocyclic antidepressant for depression for at least 4 weeks. They also had clinically significant arousal dysfunction or orgasmic dysfunction of 4 weeks or less and the onset of these symptoms had to coincide with the subsequent use of their anti-depressant. In addition, they participated in regular sexual activity at least twice monthly prior to anti-depressant use and needed to be open to continued sexual activity at least once weekly during the study.

The main goal of the study was to see if there were improvements in sexual function using the questionnaires and scales to evaluate.

The mean change in questionnaires and scales for Maca vs. placebo was not statistically significant overall, whether premenopausal or postmenopausal women. The remission rates however were higher for the Maca group than the placebo group for those who had started with less severe sexual dysfunction issues. The higher remission rates occurred in postmenopausal women and the premenopausal women had no significant difference in remission rates between treatment groups on both of the sexual function questionnaires.

It was only the postmenopausal women who were taking the Maca who had an improvement in orgasm compared with placebo and only premenopausal women taking the Maca who had an improvement in arousal disorder compared with placebo. On one questionnaire, there was also a significant correlation between the testosterone levels and reported sexual functioning with a trend toward a significant effect on the second evaluation scale. No other significant differences were seen in the other hormones that were tested, including estrogen.

Commentary: This is good news….. Maca root, in this dose of 1,500 mg twice daily may alleviate antidepressant-induced sexual dysfunction specifically in postmenopausal women. It appears that the explanation for this, at least in part, is due to the Maca root altering testosterone levels.

Reference: Dording C, Schettler P, Dalton E, et al. A double-blind placebo-controlled trial of maca root as treatment for antidepressant-induced sexual dysfunction in women. Evid Based Complment Altern Med 2015;Article ID 949036 9 pages

Prevention of falling is one of the main ways of preventing fractures related to osteoporosis. And, it makes sense that exercise programs that support muscle strength and balance, would lower the risk for a fall in elderly individuals. Improving eyesight helps too. There have been randomized trials that have shown that an exercise program that emphasizes balance does indeed lower the risk for falls in elderly housing, but these studies have not had some of the statistical strength that is often desired as a gold standard. In this current study, done at multiple centers in France, 706 women ages 75-85 who had decreased balance or compromised gait and were still living in their own homes, were randomly assigned to a 2 year balance training program or no such program. The balance training program consisted of a weekly supervised group session which was then augmented with an individual home exercise program.

Senior woman sitting on ball and exercising with dumbbellsIn the balance training program group, there were significantly fewer injurious falls than in the control group. In those women who had a serious fall (fracture or head injury and hospitalization, joint dislocation or laceration and surgical repair), 68 occurred in the treatment group and 87 in the non-treatment group. After 2 years, women in the balance training program had significantly better balance and gait testing than women in the no treatment group.

Commentary: Having a fall that causes a fracture and especially a hip fracture, is one of those life-changing events for a high percentage of elderly women. Not only is there a risk of dying due to the fall and associated complications, there is often a health decline and premature need to be in a nursing home situation. This study confirms and encourages us as to the importance of balance training programs to reduce the incidence of falls in elderly women who are at risk for falls.

Reference: El-Khoury F, et al. Effectiveness of two year balance training program on prevention of fall induced injuries in at risk women aged 75-85 living in community: Ossebo randomized controlled trial. BMJ 2015;July 22; h3830.

There is a robust amount of published research, including major clinical trials, on the ability of the Mediterranean diet (MeDiet) to protect against cardiovascular disease —now, according to results from the PREDIMED trial, it might also prevent breast cancer. One can easily read the specifics of the MeDiet on the internet and some excellent books, but this diet is basically an abundance of plant foods, fish, and olive oil. The PREDIMED study —was stopped early in 2009, due to the cardiovascular benefits of the MeDiet compared with a low-fat diet. A secondary outcome on breast cancer incidence how now been released. The results suggest that a benefit of the MeDiet supplemented with extra-virgin olive oil provides primary prevention of breast cancer. This is the first randomized trial to see the effect of a long-term dietary regimen on breast cancer incidence. In 4282 postmenopausal women, and with a follow-up of 4.8Olive oil years, the observed rates for breast cancer were 1.1 for those on the MeDiet supplemented with extra virgin olive oil (1 liter per week for the woman and her family), 1.8 for MeDiet with supplemented nuts (mixed nuts=walnuts 15 g, hazelnuts 7.5 g, and almonds 7.5 g), and 2.9 for those women on a low-fat diet. The risk for a malignant breast cancer was significantly 62% lower in women randomized to the MeDiet supplemented with extra-virgin olive oil compared to those randomized to the low-fat diet. The MeDiet supplemented with nuts was also associated with a lower risk, but it was not statistically significant, as was the diet with the extra virgin olive oil. While the number of breast cancer cases was small (35 confirmed cases out of those 4282 women, the results are statistically significant.

While the study has multiple limitations such as the women were not all screened for breast cancer with mammography, they were all Caucasian and postmenopausal, and they had to be at high risk for cardiovascular disease in order to be enrolled in the trial.

All types of olive oil contain a high supply of monounsaturated fatty acids, mainly oleic acid, as well as squalene, but extra virgin is a thinner, more viscous oil, and contains active compounds such as several polyphenols. It is thought that the olive oil is antiproliferative against cancer cells by affecting the expression of human oncogenes, and the MeDiet with its high amount of plant foods and fish oils, is anti-inflammatory and reduces DNA oxidative damage.

Reference: Toledo E, Salas-Salvado J, Donat-Vargas C, et al. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial, :  A Randomized Clinical Trial

JAMA Intern Med. Published online September 14, 2015. doi:10.1001/jamainternmed.2015.4838

IMG_24243245lavanderLavender flower essential oil has a long traditional history of use for anxiety and stress, but also some modern meaningful scientific research confirming its excellent effectiveness in treating general anxiety disorders. Here is yet another recent randomized, double-blind, placebo-controlled study comparing the effects of a lavender cream and foot bathing on anxiety, stress and even depression, in pregnant women.

A group of 141 healthy pregnant women who were 25-28 weeks pregnant were randomly assigned to 3 groups: 1) placebo 2) lavender cream 3) lavender cream plus a foot bath. The lavender cream contained 1.25% lavender essential oil and the women applied 2 gm of lavender or placebo cream on their legs for 10-20 minutes in the evening, 1.5 hours before bedtime. In those women who were in the lavender plus the foot bath, they soaked their feet in 40-42 degree centigrade water at a depth of just above the ankle, for 30 minutes, after they applied the cream.

The women completed a questionnaire for anxiety, stress and depression at baseline, week 4 and week 8. After 4 weeks, there was a significant improvement in stress and anxiety in the lavender cream compared to placebo. In the lavender cream plus foot bath group, they had a significant improvement in stress scores compared to placebo. After 8 weeks, there were significant improvements in all parameters of anxiety, stress and depress the lavender cream group and in the lavender plus foot bath group, when compared to the placebo. The improvement in just the lavender cream and the cream plus foot bath were similar.

Commentary: While this study excluded women with severe depression, severe anxiety or severe stress, this simple safe treatment approach during pregnancy is worth noting, as mild to moderate symptoms are common during pregnancy. It is appealing to have a pregnancy safe topical treatment. Given the similar results between the cream and the cream plus foot bath, and the more cumbersome nature of instituting a nightly foot bath, I will likely just recommend the lavender cream. I will also think of this treatment for mild to moderate anxiety, depression and stress in non-pregnant women and add this to my lavender delivery options, that include an oral essential oil of lavender product ( called “Lavela”for the professional market from Integrative Therapeutics, and “ Calm-Aid” in the retail setting from Nature’s Way)- an impressively proven product for general anxiety disorder comparable to prescription anti-anxiety medications and a prescription SSRI, a topical essential oil for aroma therapy and (I usually use doTERRA products), and a lavender flower pillow.


Effati-Daryani F, Mohammed-Alizaeh-Charandabi S, Mirghafouvand M, et al. Topical lavender cream alleviates anxiety, stress and depression in pregnant women. J Caring Sci 2015;4(1):63-73.

hop conesThe use of herbal medicines, including those with phytoestrogen (weak estrogen-like, but not estrogen) compounds have gained an important place in the management of menopause symptoms.

Phytoestrogens are classified in 3 main categories of flavonoids, coumestans and lignans. The hop plant contains phytoestrogens including prenylnaringenin and is thought to be the most potent of all the phytoestrogen compounds.

The current study was a double-blind controlled randomized clinical trial performed in Iran in 2013. Women enrolled were postmenopausal women aged 40-60 years, with at least 12 months since their last menstrual period, and premenopausal women who were still having menses, but less than one per month in the last 12 months, had hot flashes and had a significant Greene scale score. A total of 120 participants were divided into two groups, with one group receiving a hops tablet that contains 500 mg of the flowering part of the hop plant and 100mcg of the prenylnaringenin active ingredient and the other group placebo. Each group received one pill daily for 90 days.

Menopause symptoms were assessed using the Greene scale and hot flash diary before study medicine was given and at 4, 8 and 12 weeks of intervention. The mean Greene score was significantly lower in the hops group than the placebo group at the end of weeks 4, 8 and 12. The number of hot flashes was significantly lower in the hops group than the control group during weeks 4, 8 and 12. The hops tablet reduced the total score of the Greene Scale in premenopausal and postmenopausal women at weeks 4, 8 and 12 as 38%, 69.5% and 90% respectively compared with placebo of 1.2%, 2.6% and 3.6% respectively. The number of hot flashes in premenopausal and postmenopausal women was reduced in the hops group by 35.5%, 70.5% and 94.5% respectively and in the placebo group by 1.1%, 0.4% and 0.8% respectively.

Commentary: This is the third study using a hops tablet or hops capsule for relief of hot flashes, and other menopause symptoms. In one randomized, double-blind, placebo-controlled study, 67 menopausal women were given either a placebo, 100 mg, or 250 mg standardized hops extract for 12 weeks (Heyerick A, Vervarcke S, Depypere H, et al. A first prospective, randomized, double blind, placebo-controlled study on the use of a standardized hops extract to alleviate menopausal discomforts. Maturitas 2006;54:164-175). At 6 weeks, the 100 and 250 mg doses were significantly superior to placebo, but not after 12 weeks. Even so, there was a more rapid decrease in menopause symptoms, especially hot flashes, for both doses of hops extract.

A 2010 randomized, double-blind, placebo-controlled, cross-over pilot study was done to examine the efficacy of a hop extract for relief of menopausal symptoms. (Erkkola R, Vervarcke S, Vansteelandt S, et al. A randomized, double-blind, placebo-controlled, cross-over pilot study on the use of a standardized hops extract to alleviate menopausal discomforts. Phytomedicine 2010;17:389-396.)

Thirty six menopausal women were randomized to take either a placebo or the hops extract for a period of eight weeks and then they were switched to the opposite group for another 8 weeks. Common menopause research reporting forms were used including the Kummperman Index (KI), the Menopause Rating Scale (MRS) and a multifactorial Visual Analogue Scale (VAS). These reporting forms were used prior to starting the study, after 8 weeks and 16 weeks. After 8 weeks, both the hops group and the placebo group had significant improvement in outcome measures compared to the baseline and actually higher average reductions in the placebo group. After 16 weeks however, only the group that was on the hops extract in the second 8 weeks had a reduction in all outcome measures whereas the placebo group in the second 8 weeks had an increase for all outcome measures. Although the overall treatment efficacy of the hops treatment compared with the placebo did not show a significant effect, the time specific uses did indicate significant reductions in the KI and the VAS for the hops group, and a marginal reduction in symptoms for the MRS after 16 weeks.

Of these 3 studies, I would conclude that this current, 2015 study is the most positive report to date, on the use of an oral hop tablet or capsule for reducing menopause symptoms, and in particular, hot flashes.

Reference: Aghamiri V, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Nazemiyeh H. The effect of Hop (Humulus lupulus L.) on early menopause symptoms and hot flashes: A randomized placebo-controlled trial. Complementary Therapies in Clinical Practice (2015),

What if I told you there was a natural therapy that boosts the immune system, lowers blood pressure, improves mood, improves sleep, reduces stress, increases energy, increases focus, and speeds the recovery from surgery…..and, is free!!! I’m guessing you would say… “I definitely want some of that!”

Forest bench - Mt. TaborTurns out the healing power of nature is not just the innate inner healing force that is the primary principle of Naturopathic Medicine, but is literally true in that being in a forest does have physiological health effects, and it’s called Shinrin-yoku (taking in the forest atmosphere or forest bathing). This term was coined in 1982 by the Japanese Ministry of Agriculture, Forestry and Fisheries. There are many studies that have been published on the effects of forest bathing, but one published paper reviewing previous research highlights the essentials. (Park B, et al. The physiological effects of Shinrin-yoku: evidence from field experiments in 24 forests across Japan. Environ Health Prev Med. 2010 Jan;15(1):18-26 ) They conducted field experiments in 24 forests across Japan. In each experiment, 12 subjects, with a total of 280 individuals, walked in a forest or city area for approximately 16 minutes and viewed a forest or city area for approximately 14 minutes. The results of this study demonstrated that forest environments promote lower concentrations of cortisol, lower pulse rate, lower blood pressure, greater parasympathetic nerve activity, and lower sympathetic nerve activity than the city walking and viewing.

One of the mechanisms of forest bathing is that you breathe in phytoncides, (wood essential oils), which are antimicrobial volatile organic compounds derived from trees, and include a-pinene and limonene. But the healing power of nature does not stop at just the one sense of odor, but also the effects on all the five senses including listening to the sound of a running stream and taking in the beauty of the forest scene.

As precious forests in the West are burning this summer due to extensive droughts and extended hot weather, it only continues to remind me of the profound nourishment and fundamental human importance of our natural surroundings. I could go on and on, but then you’d have to keep reading and this would keep you from being out in nature, amidst the beauty and healing power of the forest.

Melatonin is a hormone secreted mostly by the pineal gland in response to the normal variations in the circadian cycle. As a dietary supplement, melatonin is one of the most common nutraceutical supplements that individuals try for self-treatment of their sleep problems and many trials have been done to assess its effectiveness in treating primary sleep disorders.

Primary sleep disorders are sleep problems that are not associated with a medical condition, substance use or a psychological disorder. Nine percent of Americans report insomnia and thirty-five to forty percent have problems falling asleep or are excessively sleepy during the day.

sleepwellThe current paper is a meta-analysis of melatonin for the treatment of primary sleep disorders. Nineteen studies involving 1683 individuals were included. Melatonin was significantly effective in reducing the time it takes to fall asleep (sleep latency) as well as increasing total sleep time. Trials that used higher doses of melatonin and conducted over a longer duration demonstrated even greater effects on these two sleep issues, and overall sleep quality was also significantly improved in melatonin users. Doses in adults included in the study were as low as 0.1 mg/day and as high as 5 mg/of. Three studies were in children and doses used were as low as 0.05 mg/kg and up to 5 mg/day.


While the results of this meta-analysis demonstrated what might be considered only modest results with supplementing melatonin in individuals with primary sleep disorders and improvement in sleep latency, total sleep time and sleep quality, these results support the use of melatonin as a nutrient intervention for many folks with chronic sleep problems. Multi-ingredient formulas that contain herbs that have demonstrated efficacy (ex/ valerian, passion flower, lemon balm, hops), along with melatonin may provide the opportunity to help more individuals.


Ferracioli-Oda E, Qawasmi A, Bloch M. Meta-Analysis: Melatonin for the treatment of primary sleep disorders. PLOS ONE 2013; 8(5)

Green tea plantationGreen tea has been studied for its beneficial effects on cardiovascular and metabolic diseases. Epigallocatechin gallate (EGCG) is the most abundant green tea catechin and is considered the most bioactive constituent that can reduce body weight by decreasing fat cell differentiation and proliferation. One study has demonstrated that green tea extracts and drinks could reduce body weight and body mass index in obese individuals in 2 months. (Basu A, et al. Green tea supplementation affects body weight, lipids, and lipid peroxidation in obese subjects with metabolic syndrome. J Am Coll Nutr 2010;29:31-40.) On the other hand, a study by some of the same authors of the current study found that 302 mg of EGCG daily did not reduce weight in obese women. (Hsu C, Sai T, Kao Y, et al. Effect of green tea extract on obese women: a randomized, double-blind, placebo-controlled clinical trial. Clin Nutr 2008;27:363-370.) The current study set out to increase the concentration of EGCG to a daily dose of 856.8 mg/day to examine the effects on weight in obese individuals.

This randomized, double-blind trial was conducted in 115 women with central obesity with 102 of them having a body mass index (BMI) >27 kg/m2 and a waist circumference > 80 cm. Women were randomized to either a high dose green tea group or placebo group for 12 weeks. One capsule of green tea or placebo was given three times per day, 30 minutes after meals for a total daily dose of 856.8 mg EGCG.

Body weight decreased from 76.8 kg to 75.7 kg after 12 weeks in the EGCG group. BMI and waist circumference were reduced from 31.0 cm to 30.6 cm and 95.1cm to 92.8 cm respectively. In the placebo group, only waist circumference and hip circumference reached significant reduction from 95.7 cm to 91.5 cm and 107.2 cm to 103.7 cm respectively. No differences were seen in weight or BMI.

The study also demonstrated a trend of decreased total cholesterol and decreased LDL cholesterol. Significantly lower ghrelin levels and elevated adiponectin levels were also seen in the green tea group than in the placebo group.

Commentary: Obesity is one of the most challenging issues in women’s health care. No one strategy produces consistent results in all women. Nutritional modifications, exercise programs, behavioral therapy, and agents that can affect insulin resistance, fat burning, fat oxidation and metabolic rates occupy central roles in efforts. Green tea and its main components, the catechins, including EGCG, are thought to influence body weight through mechanisms of thermogenesis and fat oxidation. The results of the current study with significant weight reduction and decreased ghrelin levels after EGCG treatment implies that a high dose of EGCG might increase energy metabolism and interrupt lipid accumulation and directly inhibit ghrelin secretion.

For perspective on dosing, one might look for a capsule of green tea extract of approximately 330 mg of which 45% is EGCG. If 2 capsules 30 minutes after each meal (three times per day), this would then be close to 900 mg of EGCG per day, slightly more than the 856.8 mg in the current study.


Chen I, Liu C, Chiu J, Hsu C. Therapeutic effect of high-dose green tea extract on weight reduction: a randomized, double-blind, placebo-controlled clinical trial. Clinical Nutrition 2015 1-8 (article in press)

Endometriosis is a disorder characterized by one or more of the following: pelvic pain with menstruation, pelvic pain during non-menstrual part of the cycle, pain with intercourse, pain with bowel movements, infertility women, and a change in the menstrual cycle. Conventional therapy often starts with birth control pills and pain pills but then can move on to surgery followed by oral contraceptive pills or gonadotropin-releasing hormone agonists (GnRH-a). The GnRH-a medication reduces estrogen levels, and puts the woman in at least temporary menopause, with subsequent symptoms such as hot flashes, night sweats, reduced libido, mood changes and more. Even though the medication is designed to lower estrogen, the conventional response to the onset of the menopause symptoms is to add back low doses of estrogen therapy. Herbal menopause support is however another option, and perhaps even preferred, because we are not adding back any estrogen. Black cohosh (Actaea racemosa syn. Cimicifuga racemosa, Ranunculaceae) rhizome has been shown to ameliorate menopausal symptoms in scores of studies of perimenopausal and menopausal women. Black cohosh does not have estrogenic properties.

The purpose of this prospective, randomized, controlled study was to evaluate the effect of black cohosh compared to tibolone (a synthetic steroid hormone that acts as a Selective Tissue Estrogenic Activity Regulator [STEAR]) and is used to treat perimenopausal/menopausal symptoms; not available in the U.S.)

There were 116 women, and an average age of 28.5 years old, who received GnRH-a after their endometriosis surgery. One week after laparoscopic ovarian cyst removal surgery, all patients were treated with the first GnRH-a injection and in total, received 3 injections. At the same time as the first injection, received either black cohosh standardized extract (20 mg twice daily) or tibolone (2.5 mg/day) for 12 weeks. At baseline, 4, 8, and 12 weeks after the first GnRH-a injection, menopausal symptoms were scored using the Kupperman Menopausal Index (KMI), and hot flash score was recorded.

At 4, 8, and 12 weeks after GnRH-a therapy, there were no significant differences between the black cohosh extract and tibolone groups’ KMI scores, hot flash frequency, or measures of endometrial thickness.

The levels of 17β-estradiol (E2), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) levels decreased in both groups after the GnRH-a injections. After 12 weeks of treatment, the black cohosh group had significantly lower E2 and significantly higher FSH and LH levels compared to the tibolone group. These findings indicate that black cohosh does not have an estrogen-like effect, as do other studies.

There were no adverse effects regarding liver function, renal function, or serum lipids in either group and the incidence of adverse events was significantly lower in the black cohosh group than in the tibolone group. The episodes of vaginal bleeding or spotting and breast distending pain were significantly lower in the black cohosh group than in the tibolone group.

Commentary: This study is one more positive representation of the value of black cohosh standardized extracts of 40 mg/day in the treatment of perimenopause/menopausal symptoms, even in the presence of drug induced menopause. It is also reconfirming that the black cohosh extract did not affect liver function, renal function, lipid profile, or hormonal levels, and was well-tolerated.


Chen J, Gao H, Li Q, et al. Efficacy and safety of Remifemin on peri-menopausal symptoms induced by post-operative GnRH-a therapy for endometriosis: A randomized study versus tibolone. Med Sci Monit. 2014;20:1950-1957.

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