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Most of us know about vitamin D as vital for calcium metabolism and the importance of vitamin D for long term bone health. There are a number of indications for an association between vitamin D deficiency and infectious diseases from observational studies. This includes infectious diseases like tuberculosis, respiratory tract infections (RTI), influenza and sepsis. Other observational studies have been done in many other areas as well. Randomized controlled trials (RCT) with vitamin D supplementation for treatment and/or prevention of infections have not given conclusive results.

The current study is a five year intervention study with vitamin D subjects with prediabetes for the prevention of the progression of their type 2 diabetes. A part of that study included six month assessments of upper respiratory infections (URI) and urinary tract infections (UTI).

605754460Five hundred and eleven individuals with prediabetes were randomized to one capsule of vitamin D (cholecalciferol 20,000 IU) per week or placebo for 5 years. A questionnaire on RTI and UTI was done every 6 months. The average baseline serum 25 hydroxyvitamin D level was 60 nmol/L. One hundred and sixteen in the vitamin D group and 111 in the placebo group completed the 5 year study. In regards to UTIs, 18 in the vitamin D group and 34 in the placebo group reported UTI during the study. There were no significant differences for RTI. The effect for UTI was more pronounced in men. The effect of vitamin D on UTI was unrelated to the baseline serum vitamin D level.

Commentary:

To my knowledge, this is the first RCT reporting an effect on vitamin D and UTI although there are several observational reports showing an association between vitamin D deficiency to UTI. In one case control study, adults with UTI had 28% lower serum levels than controls. In another study, children with a UTI had serum vitamin D levels half that of the controls, which was also observed in a study of premenopausal women.

One wonders what the mechanisms might be for a protective effect of vitamin D on UTI. There are several possibilities. One could be that vitamin D can induce production and secretion of an antimicrobial peptide by bladder epithelial cells. Another might be that vitamin D is important for innate immunity in defending against bacterial infections by increasing white blood cell motility and phagocytic action. Vitamin D could also alter the chemical composition of the urine by increasing urinary calcium excretion. Vitamin D also has a direct effect on muscle function which can contribute to pelvic floor support and bladder emptying, especially in women.

There is a robust amount of observational studies noting the role of vitamin D on health and a possible association of reducing the risks of a wide array of diseases. It seems that higher serum levels of vitamin D provide benefits. However, we have a long way to go in proving the role of vitamin D supplementation as an intervention.

Reference: Jorde R, Sollid S, Svartgberg J, et al. Prevention of urinary tract infections with vitamin D supplementation 20,000 iu per week for five years. Results from an RCT including 511 subjects. Infections Diseases 2016;48 (11-12): 823-828.

The objective of this 8 week double-blind, randomized, placebo-controlled trial was to evaluate the safety and efficacy of a standardized extract of Ashwagandha for controlling weight and improving general well-being in adults with chronic stress.

644182104Individuals were selected from several outpatient clinics in Pune, India, for the purpose of addressing stress and being overweight. Inclusion criteria included: chronic/routine work stress; a Perceived Stress Scale (PSS) of 20 or more; between the ages of 18-60 years; and a body mass index between 25 and 39.9 kg/m2. All individuals had chronic stress symptoms and the majority were troubled with difficulties in concentration and insomnia. About 44% Ashwagandha group and 52% placebo group had problems with anxiety and restlessness. Other significant symptoms included physical exhaustion, mental fatigue and headaches. A total of 38 men and 14 women were enrolled in the study and randomized to either group.

Individuals were given either a standardized extract of Ashwagandha root extract (containing 5% withanolides) 300 mg twice per day or placebo for 8 weeks.

The primary outcome measures were the PSS, and the Food Cravings Questionnaire-Trait (FCQ-T). Secondary outcome measures included the Oxford Happiness Questionnaire (OHQ), the Three-Factor Eating Questionnaire (TFEQ), serum cortisol levels, initial and final body weight, and body mass index. The PSS is a measure of psychological stress and is a 14-item scale that determines general stress that is experienced in the previous month with scores ranging from 0 to 56 and higher scores representing higher stress. The PSS evaluates physical and mental symptoms of depression, the requirement for health services, social anxiety and life event scores that correlate. The FCQ-T is a 39 item, self-reported questionnaire and is used to measure food cravings in 9 domains. The OHQ consists of 29 questions and is a tool to measure happiness, well-being, and optimism. Serum cortisol levels are an indicator of stress and are associated with appetite. In this study, cortisol represents a measurement of the anti-stress effect of Ashwagandha in those individuals under chronic stress and the impact on weight gain. The TFEQ questionnaire is used to determine eating behavior and contains 18 items and scales to assess cognitive restraint, uncontrolled eating and emotional eating.

Of the 52 originally enrolled, 1 each in the placebo and Ashwagandha group were not compliant with the protocol and data was analyzed for the 50 remaining individuals. The mean PSS score decreased in both groups but there was a significantly greater reduction in the treatment group decrease compared to placebo at week 4 and even more so at week 8 with a 22.1% reduction at week four and 32.7% reduction at week 8 in the Ashwagandha group. The mean FCQ-T “planning score” was lower in both groups but was significantly lower in the treatment group than the placebo group at the end of week 4 and 8. The FCQ-T “positive reinforcement” score at week 8 was significantly lower in the treatment group than that of the placebo group. The mean FCQ-T “negative reinforcement” scores of the treatment group did not show any significant difference compared to placebo at week 4 or 8. Lastly, the mean FCQ-T sores showed a significant reduction from baseline and compared to placebo for lack of control, emotion and environment although the thoughts about food, physiological and guilt components did not show any significant differences compared to placebo.

Of the secondary outcomes, I will just report on serum cortisol and weight loss here because I find it interesting and clinically useful. By the end of week 8, mean serum cortisol levels of the treatment group were significantly lower compared to the placebo group, after being the same at baseline. After week 4, there was a 16.05% reduction from baseline and after week 8, a 22.2% reduction in the Ashwagandha group. A reduction in 2.14% body weight was seen in the Ashwagandha group vs 1.09% in the placebo group at week 4, which was not statistically significant. However, after 8 weeks of treatment, the reduction in body weight for the treatment group was 3.03% and 1.46% for the placebo which was a significant difference in mean reduction of body weight, for both groups, although greater for Ashwagandha.

Commentary: As a quick summary, after 8 weeks, Ashwagandha was more effective than placebo in reducing PSS, several aspects of food cravings (although not thoughts about food or guilt about food), uncontrolled and emotional eating (but not cognitive restraint). A reduction in body weight, body mass index and serum cortisol were also observed in these stressed individuals who took Ashwagandha standardized to 5% withanolides and 300 mg bid for 8 weeks. Previous research, and decades if not generations of observations from users and prescribers of Ashwagandha, strongly support its anti-stress and anti-anxiety therapeutic influence. The results of the current study punctuate these reports and observations and take the evaluation several steps further, with the added feature of weight loss in those living with chronic stress. From this study, we can add to our body of previous knowledge about Ashwagandha and confirm its ability to reduce psychological and physiological markers of stress, improve well-being, reduce serum cortisol, reduce food cravings, improve eating behaviors and promote weight management in those men and women under chronic stress. Longer term studies would provide further insight and perhaps especially in the problematic area of weight gain caused by long term chronic stress.

Reference

Choudhary D, Bhattacharyya S, Pharm M, Joshi K. Body weight management in adults under chronic stress through treatment with Ashwagandha root extract: a double-blind, randomized, placebo-controlled design. J Evidence-Based Complementary and Alternative Medicine. Published in cam.sagepub.com August 10, 2016.

Current physical activity guidelines recommend moderate intensity exercise for 30 minutes most days of the week for a total of 150 minutes/week, or vigorous exercise for 75 minutes per week, spread out over at least 3 sessions per week. In a report published in January, 2017, researchers evaluated more than 63,000 men and women over age 40, inquiring about their moderate to vigorous physical activity. The research participants were classified into four groups: 1) individuals who did no moderate or vigorous physical activity 2) those who met the 150 minutes/week of moderate intensity or 75 minutes/week guidelines for of vigorous intensity and divided over at least 3 times weekly 3) those who met the total number of minutes per week but did so within 1-2 sessions/week and 4) and those who did some moderate to vigorous exercise but less than the guidelines.

The results demonstrated that all the active groups compared with those589558764 having no moderate to vigorous activity, had substantial reductions in cardiovascular disease and all-cause mortality. Those individuals who met the guidelines and exercised at least 3 sessions per week had a 35% reduction in all-cause mortality. All three active groups had approximately a 40% reduction in cardiovascular mortality compared with those who did not report any moderate to vigorous activity.

KEEP ON TRUCKIN!!! And LET’S ALL GET MOVING MORE

Reference: O’Donovan G, Lee I, Hamer M, Stamatakis E. Association of weekend warrior and other leisure time physical activity patterns with risks for all cause, cardiovascular disease and cancer mortality. JAMA Intern Med 2017; Jan 9. Epub ahead of print.

Researchers in this study examined the use of fish oils during pregnancy and if it could prevent asthma in their children. A total of 736 pregnant Danish women were randomized to receive 2.4 gm per day of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) derived from a fish oil supplement or a placebo during the third trimester. Their children, 695 of them, were then followed for 5 years. The children of the mothers who received fish oil had a relative reduction of 30.7% in asthma, or persistent wheeze. Fewer lower respiratory infections also occurred in the fish oil group. There were no differences in eczema or allergic sensitization between the groups. The most significant results in prevention of asthma or persistent wheeze were seen in the children of mothers who had the lowest dietary intake of EPA and DHA.

Commentary: Childhood allergies and asthma are on the rise in western countries and it is thought to be due in part to diet, including deficiencies of omega 3 polyunsaturated fatty acids and/or an excess of omega 6 polyunsaturated fatty acids. Supplementing the diet with 2.6 gm per day of fish oils in the third trimester is currently not the norm, both for consumers and clinicians who advise their patients. However, given this study, I think we should reconsider our habits, and increase the dosing recommendations of fish oils to women, at least during the third trimester.

Reference: Bisgaard H, et al. Fish oil derived fatty acids in pregnancy and wheeze and asthma in offspring. NEJM 2016 Dec 29; 375: 2530

Vulvovaginal thinning, known as atrophic vaginitis, or more recently, genitourinary syndrome of menopause, is the thinning and drying of vulvovaginal mucosa associated with lower estrogen levels, often seen in perimenopause and menopause. Symptoms include vulvovaginal discomfort, dryness, burning, itching, and dyspareunia. Intravaginal and/or topical vulvar estrogen is the conventional treatment of choice. Sea buckthorn (Hippophae rhamnoides, Elaeagnaceae) oil has been used in studies for dry eye syndrome, a frequent symptom also associated with menopause. Historically, sea buckthorn oil has been used in Central Asian medicine to treat inflammations of the genital organs and uterus.

614144390A randomized, double-blind, placebo-controlled study was conducted to investigate the effects of oral sea buckthorn (SB) oil on vaginal atrophy among postmenopausal women. The study was conducted at a private clinic in Finland. One hundred sixteen postmenopausal women aged 55 to 75 years, reporting moderate or severe dryness/burning/itching of vaginal mucous membranes, were enrolled. In the sea buckthorn group, 46 of 57 completed the study. In the placebo group, 52 of 59 completed the study. Study visits were baseline and after 3 months.

The important measures of atrophy include vaginal pH, moisture, vaginal elasticity, vaginal maturation index, epithelial integrity/moisture/fluid volume and symptoms of vaginal atrophy. In this study, vasomotor symptoms, psychological symptoms associated with menopause, skin health and the health of other mucous membranes were also evaluated, as well as serum markers associated with cardiovascular disease and metabolic syndrome.

Women were given 3 g of sea buckthorn oil or placebo oil in doses of 3 capsules twice daily for 3 months. Vaginal elasticity, epithelial integrity, moisture, and fluid volume were scored from 1 to 5, and were evaluated at baseline and 3 months. The pH of the vaginal wall was measured and scored from 1 to 5. A higher value on the vaginal health index (VagHI), calculated as the sum of scores for elasticity, epithelial integrity, moisture, fluid volume, and pH, indicates less atrophy. The vaginal maturation index (MI) was evaluated from Pap smears but was only taken from a random sample of 15 patients using SB oil and 15 patients using placebo.

Women evaluated the severity of vaginal dryness, burning, and itching on a scale from 0 (none) to 3 (severe) at baseline, 6 weeks, and at the end of the intervention. They also recorded daily symptoms, measuring each symptom on a scale from 0 (none) to 3 (severe).

Results: Sea buckthorn oil consumption led to an increasing trend on the Vaginal health index; a decreasing trend was seen in the placebo group. Women in the sea buckthorn group also had a significantly better rate of improvement for vaginal epithelial integrity compared with placebo. A nonsignificant trend for enhanced epithelial integrity was observed in the sea buckthorn group. The average changes in the scores for vaginal epithelial integrity from baseline to the end of the 3 months were significantly better in the sea buckthorn group compared with placebo. The effect on epithelial integrity change was also in favor of the sea buckthorn oil. There were also less night sweats in the sea buckthorn group compared to the placebo group.

On the other hand, sea buckthorn oil did not significantly affect vaginal pH, vaginal maturation index, vaginal elasticity, fluid volume, moisture, or the symptoms of vaginal dryness, burning, or itching. Vaginal pH was not affected by the SB oil, indicating a lack of estrogenic effect. No significant differences were observed in cholesterol, triglycerides, C-reactive protein, or liver enzymes during the study

Commentary: The observed positive effects on vaginal epithelium was likely due to select compounds in sea buckthorn oil, rather than an estrogenic effect. Even though vaginal epithelial integrity and was improved in the sea buckthorn group, the fact that there was no improvement in vaginal pH, elasticity, fluid volume, moisture or the vulvovaginal atrophic symptoms of dryness, burning and itching, I think this treatment is not a good alternative to the safe local use of vulvovaginal estrogen products.

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Reference: Larmo PS, Yang B, Hyssälä J, Kallio HP, Erkkola R. Effects of sea buckthorn oil intake on vaginal atrophy in postmenopausal women: a randomized, double-blind, placebo-controlled study. Maturitas. 2014;79(3):316-321.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women, which includes metabolic changes of hyperinsulinemia, insulin resistance, hyperandrogenism and dyslipidemia. Newer research also demonstrates an inflammatory component as well. PCOS is significant not only in day to day manifestations and experiences such as acne, hair thinning, hirsutism, abnormal menstrual cycles, infertility, and overweight issues, but is also a significant risk factor for type 2 diabetes, coronary heart disease, hyperlipidemia and endometrial cancer.

Dietary and supplemental soy isoflavones have a growing body of evidence in animal and human studies in areas of relevance to women with PCOS such as protective effects against coronary heart disease and hyperlipidemia and in addition, protective effects in areas of osteoporosis, various forms of chronic renal disease and a modest effect on hot flashes associated with menopause. These favorable effects and the metabolic effects of soy isoflavones on women with PCOS is the subject of this study.

This prospective, randomized, double-blind, placebo-controlled clinical trial was conducted in 70 women with PCOS, aged 18-40 yeas, in Iran. Women were matched for body mass index, phenotypes of PCOS and age and then were randomized to receive either soy isoflavone supplement (n=35) or placebo (n=35) for 12 weeks. No change in physical activity, or other nutritional supplements was allowed. Food and physical activity records for 3 days were done at baseline, 3, 6, 9 weeks and at the end of the intervention.

Women in the intervention group received 50 mg/day soy isoflavones in capsule form containing 37.5 mg genistein, 10 mg daidzein and 2.5 mg glycitein for 12 weeks.

All women completed the trial and food records were similar throughout the trial in mean dietary macro and micronutrient intake between the two groups. After 12 weeks, compared to the placebo group, soy isoflavones significantly decreased circulating serum insulin (-1.2 vs + 2.8), and improve insulin sensitivity with 3 other measurements: HOMA-IR (-0.3 vs + 0.6) and HOMA-B (-4.4 vs + 10.7) and increased QUICKI (+0.0009 vs -0.01). Soy isoflavone supplementation also resulted in significant reductions in total testosterone (-0.2 vs + 0.1) free androgen index (-0.03 vs + 0.02), triglycerides (13.3 vs + 10.3) and VLDL cholesterol (-2.7 vs + 2.0) vs placebo. There was a significant increase in sex hormone binding globulin (SHBG) (+ 3.9 vs – 1.3), total plasma glutathione and a significant decrease in malondialdehyde.

614142546Commentary: It is clear, soy isoflavones at 50 mg/day for 12 weeks in women with PCOS had beneficial effects on markers of insulin resistance, total testosterone, SHBG, free androgen index, triglycerides, VLDL, glutathione and malondialdehyde, however it did not have any effect on fasting plasma glucose and biomarkers of inflammation and oxidative stress. This improvement in insulin resistance and lowering of androgens is the most compelling impact for these women given the key underlying mechanisms of PCOS. Based on previous research, I have long included soy isoflavones as part of my dietary and supplemental approach in women with PCOS. The traditional soy foods (tofu, tempeh, soy milk, edamame) are also good sources of vegetable protein, monounsaturated fats and complex carbohydrate. I consider including soy in the diet of women with PCOS, most days, a fundamental aspect of reducing her risk of type 2 diabetes and coronary heart disease.

Other evidence based natural ingredients to explore for PCOS, some of which have appeared on my blog, include: N-acetyl cysteine, myo-inositol, D Chiro inositol, black cohosh, spearmint tea, cinnamon, licorice root and more, as well as lifestyle interventions of regular aerobic exercise, and low carb diets. Please read the research in these areas, which has become very reliable in our ability to help women with PCOS, and please be sure to investigate the importance of addressing the underlying insulin resistance and androgen excess, as well as target the therapies to the specifics of the issues of the case… ex/ infertility, irregular menses, acne, hirsutism, overweight.

Reference:

Jamilian M, Asemi Z. The effects of soy isoflavones on metabolic status of patients with polycystic ovary sundrome. J Clin Endocrinol Metab. 101:0000-0000, 2016.

In the last 6 years, there have been published trials raising concerns regarding511052570 calcium supplementation and excess risk for myocardial infarction and stroke, although the findings have not been consistent. An updated systematic review and meta-analysis of evidence on the effects of calcium intake from diet and from supplements, either alone or with vitamin D on the risk for cardiovascular disease in generally healthy adults, was conducted. There were four randomized trials and 27 observational studies that were analyzed. Calcium supplementation ranged from 400 mg/day to 1,600 mg/day.

The key points of the analysis were the following:

· Calcium intake with or without vitamin D, and either from food or supplements had no helpful or harmful risk for cardiovascular events in healthy adults.

· Calcium from either food or supplements, that does not exceed the “tolerable upper level of intake” is safe in relationship to cardiovascular health.

· These conclusions were primarily from observational studies. The two previously published meta-analyses that showed some excess risk in randomized trials were considered unreliable by the current authors and reviewers.

· Dietary sources of calcium may be preferred over supplements because it is easier to avoid an excess. Excess calcium may cause gastrointestinal side effects, increase the risk for kidney stones and interfere with absorption of medications.

Commentary: This issue has been confusing the last several years. But for those consumers and providers who have understood the guidelines from the Institute of Medicine, of 1,000 mg-1,200 mg/day of calcium, and understood this number is a total of dietary and supplemental calcium, there was never reason to be concerned. Most adults in the U.S. have a dietary calcium intake of 500mg-1,000 mg/day. These then requires supplementing on average, an additional approximate 500 mg/day in pill form. It was never intended that we eat 1,000 mg/day and then take another 1,000 mg-1,200 mg/day. Don’t forget to look at the amount of calcium in all your dietary supplements, per the serving size on the label, and then determine what it is based on the number of pills you are actually taking. Estimating your daily dietary calcium intake can be done by looking at charts on food sources of calcium. A general guideline has been to count 250 mg/day for the non-dairy and non-soy foods and then allow 300 mg per serving of dairy or tofu or soy milk.

References:

Chang M, et al. Calcium intake and cardiovascular disease risk: An updated systematic review and meta-analysis. Ann Intern Med 2016; Oct 25 (epub)

Kopecky SL, et al. Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults. A clinical guideline from the National Osteoporosis Foundation and American Society for Preventive Cardiology. Ann Intern Med 2016;Oct 25 (epub)

Margolis K and Manson J. Calcium supplements and cardiovascular disease risk: What do clinicians and patients need to know? Ann Intern Med 2016; Oct 25 (epub)

468985537During this darkest day of winter, the winter solstice, and the holiday seasons that we each celebrate uniquely… I enjoy reflecting on the year…..my personal life, those of my loved ones, and those near and far whom I do not know, but share a life with on this planet of ours.  I remind myself that we are of one planet, of one mother earth, of one human kind and all are children of the universe and of those who came before us. 

I hold special thoughts for the flora and fauna of our wild places, the tribal and native peoples of our world, children, and those refugees and peoples struggling to survive amidst fear and trauma and devastation of their homes and lives.

May we all strive for in our lives and in the lives of others: safety, decent food, clean water and air, home, wellbeing, a chance to thrive, and to know and share love and kindness.

Menstrual cramps, when due to functional problems and the release of635787428 prostaglandin F2alpha in the menstrual fluid, are a common monthly problem in menstruating women. The usual immediate treatments are anti-inflammatory drugs and prostaglandin inhibitors. One such nonsteroidal anti-inflammatory (NSAID) is mefenamic acid.

A prospective, randomized, crossover study was conducted for 2 months in 122 Iranian women aged 18-25 who had functional menstrual cramps, called primary dysmenorrhea. Group 1 received 3 peppermint oil capsules once daily for 3 days after the onset of the menses, followed by no treatment the next menstrual cycle. As best can be determined from the published study, one capsule contain 187 mg of peppermint oil. During the third menstrual cycle, these women were given 1 capsule of mefenamic acid every 8 hours for 3 days. Group 2 received these same treatments, but in reverse order: mefenamic acid cycle one, then no treatment, then peppermint oil for the third menstrual period.

Pain intensity, pain timing and bleeding amount were assessed. Both mefenamic acid and peppermint oil significantly reduced the severity of pain and there was no significant difference between the two. They also both reduced the duration of pain although mefenamic acid reduced duration more than the peppermint oil. Mefenamic acid significantly reduced bleeding, with a non-significant and slight increase with peppermint oil. Mefenamic acid did not improve nausea and vomiting, while peppermint oil significantly decreased both. Lastly, peppermint oil reduced diarrhea about four times greater than mefenamic acid.

Commentary: Peppermint contains the important active constituent, menthol, which exerts its effect on the myometrium (muscle wall of the uterus) contractions by inhibiting prostaglandin F2alpha and oxytocin. Peppermint also has analgesic and anti-inflammatory activity which explains its effect on improving vomiting and diarrhea. Drugs like mefenamic acid have potential complications such as gastrointestinal bleeding, gastrointestinal ulcers, flatulence, indigestion, stomach pain, and the worsening of colitis. While the average pain intensity and bleeding was significantly lower in the mefenamic acid group, the small difference was such that many women will gain sufficient relief with peppermint oil. I am especially familiar with using peppermint oil for the smooth muscle contractions of irritable bowel syndrome but am eager to recommend it for primary dysmenorrhea, although I will look closely at the dosages of peppermint oil products, and consider different regimens rather than the 3 capsules all at once of 187 mg per capsule, once per day during the first 3 days of the menses that was used in this study.

Reference: Masoumi S, Asi H, Poorolajal J, et al. Evaluation of mint efficacy regarding dysmenorrhea in comparison with mefenamic acid: A double blinded randomized crossover study. Iran J Nurse Midwifery Res 2016;21(4):363-367.

495119012This randomized, double-blind placebo-controlled clinical trial was conducted in women between the ages of 40 and 70 who reported menopausal symptoms. Women were evaluated using two conventionally recognized scales of menopause symptoms, the Kupperman Index (KI) and the Menopause Rating Scale (MRS). Women were randomized to receive either placebo or an extract of Schisandra chinensis… with each pill containing 196 mg of natural extract, and 2 pills twice per day. Women received the treatment for 6 weeks, and then were followed for 12 weeks.

Daily diaries, questionnaires and laboratory studies were performed at baseline, 6 weeks and 12 weeks.

The primary endpoint was the average interval change in KI score from baseline to week 12 with secondary outcomes including laboratory studies and the MRS for sexual and bladder problems. Thirty six women completed the study.

Results: In the Schisandra group, the KI score decreased by 21.6% at the 6 week visit and by 41.2% at the 12-week visit. In the placebo group, the KI score decreased by 12.6% at the 6 week visit and 27.2% at the last visit. The specific symptoms for which Schisandra helped were hot flushes, sweating and heart palpitations and the rates of reduction were about 50% from the beginning to the end. The MRS scores for sexual problems and urinary problems revealed no significant differences between the herbal group and the placebo group. Estradiol serum levels were slightly increased in the herbal group, but was not statistically significant compared to placebo.

Commentary: Schisandra chinensis is a berry whose name means “five flavors” in Chinese: salty, sour, bitter, spicy(pungent) and sweet. In traditional Chinese medicine, it has been used for thousands of years for the common cold, kidney diseases and memory improvement. Modern research has investigated it’s use in vascular diseases and Alzheimer’s disease. Schisandra chinensis should be added to the list of botanicals demonstrating some scientific efficacy for menopausal related hot flushes/ night sweats and heart palpitations.

References: Park J, Kim K. A randomized, double-blind, placebo-controlled trial of Schisandra chinensis for menopausal symptoms. Climacteric. 2016 Dec;19(6):574-580.

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