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157431721I’m regularly looking for more satisfactory results for treatment of acne vulgaris— those nasty pimples most commonly on the facial area. There are multiple factors that cause acne, but a few of those factors includes and excessive production of sebum, an immune response to the bacteria called Propionibacterium acnes, inflammation and abnormal cell turnover of skin cells.

Tea tree leaf oil is one of those plant compounds that has demonstrated both antimicrobial and anti-inflammatory properties. Previous studies have shown effectiveness of tea tree oil in treating acne but they used higher concentrations of the oil (up to 5%) that are currently not available in commercially available products. The purpose of this study was to see if a commonly available tee tree oil gel and facial wash might work for mild to moderate acne.

Both men and women with mild to moderate acne were recruited in Australia. They were ages from 16-39 y.o. Study participants received 200 mg/g of a Tea Tree medicated gel and 7 mg/g Tea Tree Face Wash for Acne. Study subjects used the products twice daily on their face. They applied 1 pump of the face wash, patted it dry, and then applied a small amount of the gel in a thin layer on the acne areas and leave it on for at least 6 hours and then wash it off right before the next application.

The total number of acne lesions were recorded and scored at baseline, 4, 8 and 12 weeks. The amount of skin oiliness was also recorded by the researcher at those same time intervals. Patients also kept a diary and at the end of each week, they recorded their acne on a 5 point scale ranging from worse to significantly better. Tolerance to the tea tree applications were also scored by the investigator. A laboratory testing of the susceptibility of the acne bacteria to the oil and gel and face wash was also done and the minimum inhibitory concentration (MIC) of each product was determined. The MIC of the unformulated oil ranged from 0.25% to 1% which means that 90% of the isolates were inhibited by 1%. The MIC of the gel ranged from 0.062-0.5% and the MIC of the face wash was < 0.25%.

Results: Mean total lesion count significantly decreased at each visit with a 25% decrease at 4 weeks, 37% decrease at 8 weeks and 54% decrease at 12 weeks. The investigator assessment score was significantly better at weeks 8 and 12 compared to baseline. Facial oiliness was significantly improved at week 12 compared to baseline. Clinical efficacy of 40% or greater in lesion count at 12 weeks occurred for 79% (11/14) of the individuals. The weekly opinion of almost half of the men and women with acne was that their acne was about the same or slightly improved by 43%.

No serious adverse events occurred but there was one person who reported minor itching, one with moderate scaling and 1 had moderate peeling and 1 had moderate dryness. The average tolerability scores for erythema and peeling were significantly decreased by the end of the 12 weeks.

Summary and commentary: The use of the gel and face wash containing tea tree oil for 12 weeks did seem to significantly reduce the number of acne lesions and was pretty well tolerated in men and women with mild to moderate acne. Both the gel and face wash showed significant antibacterial activity in the laboratory part of the study which would imply that this mechanism is at least in part, how tea tree works for mild to moderate acne.

Acne is a very common skin condition and I welcome some confirming evidence for tea tree gel and face wash that may help more folks with this pesky problem. It won’t be as simple as that to cure this type of acne. Other influences and strategies that might need to be addressed would include hormonal, diet and stressors.

Reference

Malhi HK, Tu J, Riley TV, Kumarasinghe SP, Hammer KA. Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open-label phase II pilot study. Australas J Dermatol. March 21, 2016; [epub ahead of print]. doi: 10.1111/ajd.12465.

In the last 3.5 decades, research has proposed a link between several cancers and lower serum levels of vitamin D. Multiple epidemiologic studies have found inverse associations between serum levels of 25-hydroxyvitamin D [25OH)D] concentration and the risk of many cancers including breast cancer, colorectal cancer and prostate cancer. In one randomized controlled trial, women who were given vitamin D and calcium had a 60% reduced incidence in all non-skin cancers compared to those women in the placebo group.[i]

The purpose of the current study was to be more precise in determining any association between 25(OH)D concentration and the risk of non-skin cancer in women 55 years and older. Two different cohorts were used. The first, N=1,169, was one from a randomized controlled clinical trial in Nebraska with a median level of serum vitamin D of 30 ng/mL. The second was from a prospective cohort study of individuals living in 52 countries although 90% were in either the US or Canada, N=1,135, with an average serum D level of 48 ng/ml. By using this approach, the analysis was able to be done across a broad range of 25(OH)D serum levels.

The incidence of all invasive cancers excluding skin cancer was evaluated over several years with a median of 3.9 years was compared in relationship to 25 (OH)D concentrations. The incidence of cancer was lower at higher concentrations of 25(OH)D levels and women with concentrations of 40 ng/ml or more had a 67% lower risk of cancer than women with levels < 20 ng/ml.

506609568Commentary: The results of this analysis support the importance of serum levels and cancer risk and thus direct us more precisely to a target serum level of vitamin D to optimize cancer prevention. The significant risk reduction comes at levels that are considerably higher than the >20 ng/ml considered adequate for bone health, which is the minimum recommended by the Institute of Medicine. I urge patients and practitioners to pay close attention to the units used by their labs. For example, 12-20 ng/ml = 30-50 nmol/L.

References

Sharon L. McDonnell, Carole Baggerly, Christine B. French, Leo L. Baggerly, Cedric F. Garland, Edward D. Gorham, Joan M. Lappe, Robert P. Heaney. Serum 25-Hydroxyvitamin D Concentrations ≥40 ng/ml Are Associated with >65% Lower Cancer Risk: Pooled Analysis of Randomized Trial and Prospective Cohort Study. PLOS ONE, 2016; 11 (4): e0152441 DOI: 10.1371/journal.pone.0152441


[i] Lappe J, Travers-Gustafson D, Davies K, et al. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85(6):1586-1591.

This randomized double-blind clinical trial was conducted in Iran in women with97623506 cervical intraepithelial neoplasia (CIN) I, as diagnosed with pap smear, colposcopy and biopsy. Women were between the ages of 18 to 55 and had proven CIN 1 based on pap smear cytology and then colposcopy and biopsy. Only those with biopsy proven CIN 1 were included. Women were excluded if they had a history of cervical cancer, other cancers of the lower genital tract, hysterectomy, past treatment of the cervix with cell destructive therapy (ex/ cryotherapy, cautery, conizations), pregnant women or if they were using anti-folate medications.

Women were randomly assigned to receive 5 mg/day of folate (n=29) or placebo (n=29) for 6 months. While the study reports “folate”, it does not clarify if it was in fact folic acid or a form of folate, however, compliance was assessed measuring plasma homocysteine levels. Women were advised not to change their diet or physical activity during the 6 months.

The primary outcome was histology proven CIN 1 and was determined through pap smear cytology, colposcopy and cervical biopsy. Secondary outcomes were glucose homeostasis, lipid profiles, inflammatory factors and biomarkers of oxidative stress.

Four women in the folate group and 5 in the placebo group did not complete the trial, although all 58 women were included in the final analysis. After 6 months of 5 mg/day of folate supplementation or placebo, a greater percentage of women in the folate group had a regression of their CIN 1. (83.3% vs. 52.0%). One patient in the each group progressed to CIN-II. Folate supplementation resulted in a significant decrease in serum insulin, homocysteine, HOMA-B and plasma malondialdehyde, and increased glutathione levels, but it did not affect lipids, reduce fasting glucose, or affect inflammatory or oxidative stress markers.

Commentary: CIN develops in a linear fashion and those with CIN are susceptible to cervical cancer, with greater risks for those who have higher grade lesions (CIN-II, CIN-III), and those with the high risk human papilloma virus (HPV) types, especially HPV 16 and 18. The current study reports that women taking folate (unknown form) at 5 mg/day for 6 months resulted in more women having regression of their CIN 1 to normal, than those in the placebo group. However, it is important to keep in mind that the rates of spontaneous regression of CIN 1, with no treatment, are between 60% and 85% within a 2-year time period. The question in my mind is: Were these results meaningful and due to folate supplementation or within the range of normal regression, whether folate or placebo? Select previous research has found an inverse association between folate levels in the serum and folate in the diet and CIN, while other research did not find a significant relationship. In controlled clinical studies, folic acid supplementation (10 mg/day) has resulted in the improvement or normalization of cytology smears in patients with cervical dysplasia. When patients were treated with folic acid, the regression-to-normal rate, as determined by colposcopy/biopsy examination, was observed to be 20% in one study, 63.7% in another, and 100% in yet another.

Given the totality of the research on folic acid, I will continue to use 5-10 mg/day. As part of my total treatment plan for CIN 1, I typically use 10 mg/day for 6 months, and if cytology/pathology results are then normal, I adjust the treatment plan, including reducing the folate to 5 mg/day for another 6 months. There is a small amount of evidence that women with MTHFR mutations that affect folate metabolism, may have higher risk of cervical cancer. Practitioners could consider testing MTHFR in those women with abnormal pap smears, to determine if supplementation with folic acid or the more expensive folate is an important part of the treatment plan based on MTHFR results.

Reference

Asemi Z, Vahedpoor Z, Jamilian M, et al. Effects of long-term folate supplementation on metabolic status and regression of cervical intraepithelial neoplasia: A randomized, double-blind, placebo-controlled trial. Nutrition 2016; 32 (6): 681-6

Menstrual cramps are one of the most common gynecological problems in reproductive aged women. Menstrual cramps due to primary dysmenorrhea (the type of menstrual cramps that are due to a physiological problem, rather than a medical condition such as endometriosis). Primary dysmenorrhea starts after the release of prostaglandins from endometrial cells (those cells that line the inside of the uterus). The target of treatment of acute primary dysmenorrhea has focused on the suppression of the synthesis or function of these prostaglandins. These treatments include non-steroidal anti-inflammatory drugs (NSAIDS), herbal extracts, nutritional supplements and hormonal contraceptives. Most of us are familiar with the role of vitamin D in calcium homeostasis, bone mineralization and immune function. But, vitamin D reduces the expression of cyclooxygenase-2 and thus reduces prostaglandin production, increases prostaglandin inactivation, regulates the expression of prostaglandin receptors, targets the endometrium and thus reduces the intensity of pain as well as possibly has anti-inflammatory effects.

Vitamin DWith the prevalence of primary dysmenorrhea (between 45% and 95%), the prevalence of vitamin D insufficiency, and the influence of vitamin D on prostaglandins, it seems logical that someone would choose to evaluate the effect of vitamin D supplementation on primary dysmenorrhea in women with a vitamin D deficiency.

This randomized double-blind placebo-controlled clinical trial was conducted on 60 Iranian with primary dysmenorrhea and vitamin D deficiency. Women had to have at least four recent consecutive menstrual cycles with painful cramps during the previous 6 months. Women also had to have a serum vitamin D level < 50 ng/ml. (Severe deficiency = < 10 ng/mL; moderate deficiency = 10-19 ng/mL and mild or insufficient = 20-29 ng/mL.) Women in the treatment group (n=30) received 50,000 oral vitamin D once per week for 8 weeks and 30 women received a placebo once weekly for 8 weeks. In the end, 23 women remained in the vitamin D group and 27 women in the placebo group. Among these 50 women, 31 had severe vitamin D deficiency and the remaining 19 had moderate vitamin D deficiency.

After 2 months of treatment, those in the vitamin D group had significant increases in serum levels of vitamin D and none in the placebo group. In the vitamin D treatment group prior to treatment, pain was mild in 3 (13%), moderate in 16 (69.6%) and severe in 4 (17.4%) of the women. After treatment, 22 (95.7%) had mild pain, 1 (4.3%) had moderate pain and none had severe pain. In the placebo group, after the two months of no treatment, 4 (14.8%) had mild pain, 17 (63%) had moderate pain and 6 (22.2%) had severe pain. Pain intensity significantly decreased in the treatment group after 8 weeks of treatment with a significant difference in pain intensity between the two groups after the 8 weeks of treatment and one month after the end of treatment.

Commentary: A weekly dose of 50,000 IU Vitamin D for 8 weeks in women with primary dysmenorrhea and recently determined vitamin D deficiency is a safe, simple, inexpensive strategy to reduce mild, moderate and severe menstrual pains. In a previous 2012 study (Lasco et al.) on vitamin D for primary dysmenorrhea, women received a single dose of 300,000 IU Vitamin D before the beginning of their menstrual cycle and was done in women with low normal vitamin D levels but not deficiency. In the current study, the serum levels of vitamin D increased to sufficient levels (approx. 55 ng/mL). This approach with vitamin D could go a long way to decreasing the need for NSAIDS or even prescription pain pills for women with acute primary dysmenorrhea and a vitamin D deficiency.

Reference: Moini A, Ebrahimi T, Shirzad N, et al. The effect of vitamin D on primary dysmenorrhea with vitamin D deficiency: a randomized double-blind controlled clinical trial. Gynecological Endocrinology 2016, Early Online: 1-4

Cervical dysplasia is a potentially pre-cancerous condition and in many cases can resolve on its own, but in others, can progress to more severe dysplasia and even cervical cancer. The likelihood of regression of mild dysplasia, called cervical intraepithelial neoplasia grade 1 (CIN1), is 60%. The likelihood of progression to cervical cancer if it does not regress or is not treated, is 30-50%. The main risk factors for CIN1 are the human papilloma virus (HPV), HIV and nicotine. There are now studies that have shown that increased inflammatory cytokines and oxidation may result in higher concentrations of HPV in the cervicovaginal secretions which then make the cervical cells more vulnerable.

Several studies have shown a potential for select antioxidants in the treatment of CIN including vitamin C, vitamin A, beta carotene and selenium. While not all studies are consistent or conclusive, there has been an inverse relationship seen between serum selenium levels and CIN or cervical cancer. In addition, in one study, the tissue concentrations of selenium are significantly lower in cervical cancer tissues compared to non-cervical cancer tissues.

SeleniumIn the current randomized, double-blind clinical trial, 58 Iranian women ages 18-55 with biopsy proven CIN 1 were included. Women were randomized to take 200 mcg selenium per day or placebo for 6 months. The selenium group had regression of their CIN1 compared with the placebo group. In addition, those in the selenium group had improvements in metabolic profiles compared with placebo including decreases in fasting glucose and insulin, improved insulin resistance, increased total antioxidant capacity, increased HDL levels and decreased triglycerides levels.

Commentary: To my knowledge, this is the first randomized controlled clinical trial using selenium for CIN1. Other studies have been done but not a clinical trial. In a study by Kim et al, (Kim S, Kim J, Ko Y, et al. Changes in lipid peroxidation and antioxidant trace elements in serum of women with cervical intraepithelial neoplasia and invasive cancer. Nutr Cancer 2003;47:126-130) selenium levels were significantly lower in women with CIN or cervical cancer. In another study, a combination of 50 mg selenium, 60 mg vitamin C, 10 mg vitamin E and 303 mg vitamin A significantly lowered levels of apoptosis and lipid peroxides in women with cervical cancer after receiving radiotherapy compared with non-users of the antioxidant combination. (Ismail M, Amer A, Wahba O, et al. Effect of antioxidants on markers of apoptosis in postoperative radiotherapy of cancer cervix. Gulf J Oncolog 2010;7:8-13.)

Unfortunately, this study did not address the HPV effects of selenium. It would ultimately be clinically useful to know if selenium caused resolution of high risk strains of HPV and in particular type 16 and/or 18.

Reference: Karamali M, Nourgostar S, Zamani A, et al. The favourable effects of long-term selenium supplementation on regression of cervical tissues and metabolic profiles of patients with cervical intraepithelial neoplasia: a randomised, double-blind, placebo-controlled trial. Brit J Nurtition 2015;114:2039-2045.

I want to introduce you to a project that I was privileged to be a part of at our last national naturopathic convention. These are video interviews of practitioners who have insightful and potent messages to patients, medical students and practitioners. Friends and colleagues of mine Integrative Wisdom Video Series embarked on a project they call “Integrative Wisdom“. If you are reading my blog, you are likely an individual person seeking health education for you and your loved ones, or a student of some type of medicine, or a practitioner. These interviews will knock your socks off and I encourage you to view selections in any of the categories because the information can be relevant for all of us.

Integrative Wisdom is a collection of insights from individuals across the integrative medicine community, who share this common mission: making integrative medicine part of every healthcare discussion. They offer insights for patients, students, and practitioners, to help increase awareness of, and access to, integrative medicine.

I have three interviews that I hope you will view, in addition to the many others. Here are my 3:

In my now over 31 years of clinical practice, I have been driven and inspired and taught by my patients, the general public of health care consumers, students of many health care disciplines and practitioners across the medicine spectrum. These video interviews are beautiful, powerful, insightful messages honed by experienced and committed clinicians. May we all learn from them, grow from them, make the changes within ourselves, offer insights and education to others, and strive for robust and productive healthier peoples of this world with safe and supportive places to live in order to reach their full potential. Get ready to sit back, watch, listen, and be moved, motivated and wowed by this project done by my friends at Integrative Therapeutics. And I hope you like my humble 3 as well!!!

Click to see Dr. Tori Hudson’s Speaker Bio on the Integrative Wisdom site.

I’ve written numerous other blogs and given many lectures on natural medicine and polycystic ovary syndrome (PCOS). I consider this a strong area for natural medicine in the areas of addressing the underlying endocrinologic disorder and improving the many manifestations of PCOS. In the not so distant past, I’ve written about N-acetyl cysteine, myo-inositol vs. d-chiro-inositol, black cohosh, licorice root, and Maitake mushroom, all in the treatment of PCOS, which are posted on this website.

Here we have yet another new botanical study, using berberine to improveoregon grape root plant menstrual patterns and rates of ovulation in women with PCOS. Berberine is a compound found in the roots and stem bark of many plants, including goldenseal, goldenthread, barberry and my local favorite, Oregon grape root. Berberine has some compelling research in the areas of improving cholesterol profiles, improving cardiac function in those with congestive heart failure, improving blood sugars in those with type 2 diabetes, treating H pylori, inhibiting candida albicans and E coli and more.

In the current study, 102 women with an average age of 22, who had infrequent menstrual periods or anovulation, clinical and/or biochemical hyperandrogenism or ultrasound features of polycystic ovaries, were recruited for the study and 98 completed the study. Approximately 70% of the women were normal weight and 29% were overweight or obese. Women were given berberine hydrochloride tablets, 400 mg three times daily for 4 months. Women recorded their menstrual cycles, and blood levels of progesterone and human chorionic gonadotropin were collected weekly to confirm ovulation and to assess pregnancy status, along with lipid profiles, sex hormone binding globulin and measures of insulin resistance. All of these were also repeated after 4 months of treatment.

Fourteen of the women regained a regular menstrual cycle after the berberine treatment which was similar in the normal weight and overweight/obese women. The ovulation rate improved with a result of 25% of the women over the 4 months, with more improvement in the overweight group of 31% and 22.5% in the normal weight group. Other parameters improved in the normal weight group only: sex hormone binding globulin, insulin resistance, triglycerides, total cholesterol and low density lipoprotein cholesterol. The only laboratory change in the overweight/obese women was a decrease in total cholesterol.

Commentary: This is the first study to my knowledge that has evaluated the effects of berberine as a single agent on the menstrual pattern, rates of ovulation, and hormonal and metabolic profiles in women with PCOS. While this study did not include a placebo group, and did not assess pregnancy rates, I would still want to consider the addition of berberine in women with PCOS. In addition, I especially use berberine in treating dyslipidemia, pre-diabetes and type 2 diabetes, congestive heart failure, and in Candida albicans and E coli infections.

Reference

Li L, Li C, Pan P, et al. A single arm pilot study of effects of berberine on the menstrual pattern, ovulation rate, hormonal and metabolic profiles in anovulatory Chinese women with polycystic ovary syndrome. PLOS One. Dec 8, 2015;10(12)

Hello blog clinician visitors, friends and colleagues,

Have you heard about TAPintegrative.org? If not, I would love for you to learn about it. I am a member of this nonprofit practitioner-only educational resource. I wanted you to know about TAP because it really is an amazing resource for practicing integrative clinicians. This is an up-to-date clinician-tested, evidence based source of information that you can access in lots of diverse ways – audio, written, video, etc. One of the member benefits is that you can order the pdf of any published study that you want – as often as you want! There is a dynamic and lively member-only forum too.

I think you would really enjoy TAP (“teach, apply, practice”), it will help your clinical practice for sure, which will assist you in helping more patients in more successful ways, more of the time. Because I am a “TAP Expert” on the topic of Perimenopausal Insomnia, I have been given a promo code that you can use for a discounted annual TAP membership of only $99 a year (regular membership price is $149)! You can learn more at www.tapintegrative.org/membership. Use this Code for your discounted $99 membership: HUDSON

And, you can check TAP out here: http://tapintegrative.org/tapsneakpeek

Here is a link to a couple of segments of my TAP interview on Perimenopausal Insomnia:

https://www.youtube.com/watch?v=SsvGoaxX5DE

https://www.youtube.com/watch?v=4qkgwPvI_fs

I hope you enjoy TAP Integrative!

Heart palpitations are a fairly common symptom of the women patients in my practice. While they need to be investigated with a good history, medical exam, and potential testing with heart monitors and/or electrocardiograms or a referral to a cardiologist, fortunately, in my practice, most of them are what are called benign heart palpitations and most are due to anxiety or panic disorder and sometimes just too much caffeine. My most common natural therapies are relaxation techniques, magnesium and hawthorn berry.

Lemon balm (Melissa officinalis, Lamiaceae) leaf extracts are traditionally usedLemon Balm as a heart tonic, and to help relieve tension, restlessness, irritability, and even in some modern research, for depression. While it has been used traditionally for heart palpitations, there have not been any published trials to my knowledge, until this double-blind, placebo-controlled study.

In this study, individuals ages 18-60 were included if they had heart palpitations as a main complaint for 3 or more months. Patients received placebo or 1,000 mg/day of lemon balm extract for 2 weeks. A lyophilized aqueous extract of 100 g lemon balm leaves was prepared, yielding 20.9 g (20.9%) dried extract. Capsules were filled with 500 mg of the dried extract and patients took one capsule twice daily.

The primary outcome was a change in the frequency and intensity of the palpitation episodes over 24 hours. Patients completed a questionnaire about their symptoms each day, along with a report on any adverse effects.

The average duration of occurrence of palpitation episodes was 65 months in the placebo group and 60 months in the lemon balm group. There were eight patients in each group who discontinued treatment resulting in 27 placebo and 28 lemon balm patients who were included in the final analysis.

After the 2 weeks of treatment, the lemon balm group had 36.8% fewer palpitation episodes compared to baseline, and there was no significant change in the placebo group. Both the lemon balm group and the placebo group had a significant and similar decrease in intensity of palpitations. Other benefits found in the lemon balm group were that anxiety and insomnia were significantly decreased while not decreased in the placebo group. Other than an increase in appetite in the lemon balm group there were no other significant differences in frequency of adverse effects.

Commentary: After 2 weeks of treatment, lemon balm extract at 500 mg twice daily significantly decreased frequency of episodes of benign heart palpitations and anxiety. While this was a small study of short duration, clinical results within 2 weeks are what I would be looking for in a patient with heart palpitations, and anxiety. I look forward to using lemon balm even more, for heart palpitations that in particular seem to be associated with anxiety disorders.

Reference
Alijaniha F, Naseri M, Afsharypuor S, et al. Heart palpitation relief with Melissa officinalis leaf extract: double blind, randomized, placebo controlled trial of efficacy and safety. J Ethnopharmacol. 2015;164:378-384.

I’d like to introduce a colleague, and good friend of mine, Dr. Michael Murray. You may have heard of him through his over 35 books, including the The Encyclopedia of Natural Medicine, product formulations or speaking engagements.

His latest project is to provide education on line through a summit, which I participated in. Dr. Murray is hosting one of the largest healing and wellness online summits… and you can participate…. and for free. It is scheduled for March 14-22.

Sign-up FREE, for this life-changing event, by clicking the following link:

Register for Summit

For the summit, Dr. Murray is personally interviewing 30 of the world’s top leaders in natural medicine, health and wellness.

Join me and other experts such as:
• Dr. Daniel Amen
• Dr. Mark Hyman
• Dr. Stephen T. Sinatra
• Dr. Joseph Mercola
• and… MANY MORE

I think you will find the interviews useful to you and some of your important health concerns, and you can attend and listen right at home.

And again, you can check out the all-star cast and sign up ABSOLUTELY FREE by clicking here:

Register for Summit

I hope to see you at the summit!

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