RESULTS: After 12 weeks of treatment, a non-significant difference in favor of the St. John’s wort group was observed in the daily hot flash frequency and the hot flash score. However, after those three months of treatment, women in the St. John’s wort group reported significantly better quality of life scores, and significantly fewer sleep problems compared to placebo.

Commentary: St. Johns wort research is expanding into the realm of use for perimenopause and menopause symptoms. Other recent studies have reported improvement in psychological, well-being and quality of life in symptomatic perimenopausal and menopausal women. In the current study, while not especially helpful for hot flashes, there was an improvement in quality of life scores and sleep problems. I commonly use St. Johns wort with black cohosh for women with hot flashes and mood issues during perimenopause and menopause. The research on each and even two studies using the combination of the two reveal that these two plants in combination are a premium option for perimenopausal and menopausal women with some of the most common of symptoms.

Reference

Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin S. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009 Mar-Apr;16(2):307-14

Pregnancy is demanding in it’s own unique way: hormonal changes, increased nutritional demands, changes in sleep and eating patterns. Regular exercise, good healthy eating habits, a prenatal supplement, regular sleep, and moderating one’s work load, are usually enough to maintain energy throughout the pregnancy. Some women may become anemic during pregnancy and simple tests can detect this followed by simple nutrients as supplementation. At times, other health problems emerge during the pregnancy that can cause fatigue such as hypothyroid and diabetes. With good prenatal care, these can be detected and treated appropriately.

The cycles or phases of hormonal change such as the monthly premenstrual time, and the perimenopause transition can challenge what is called our stress adaptation mechanisms. There are three phases to this stress response which are regulated in large part, by our adrenal glands. The initial phase is the alarm reaction, or fight-or-flight response. This is triggered by reactions in the brain that cause the pituitary gland to produce a hormone, which causes the adrenals to secrete adrenaline as well as other stress related hormones. The alarm phase is usually very short lived. The next phase is the resistance reaction, which allows us to continue to deal with stress, after the fight-or-flight response has worn off. Hormones such as cortisol and other corticosteroids secreted by the adrenal cortex are in motion here and responsible for the resistance reaction. These hormones stimulate the conversion of protein to energy so that we have adequate fuel, after our glucose reservoirs have been used. The resistance reaction provides the energy and stabilizes our circulation under times of stress, as well as enabling us to deal with the emotional aspects of stress, fight infections and continue to perform our tasks. If the stress insult is prolonged and the resistance reaction is extended beyond our body’s capabilities to maintain balance, we become at risk for significant health care problems and end up in the final stage of general adaptation syndrome— exhaustion. In the exhaustion phase, our adrenal glands
have become depleted of hormones called glucocorticoids, and our body has a loss of potassium. In this phase, the body’s cells and tissues do not receive enough glucose or other nutrients to function properly.

As the exhaustion phase continues, our cells and organs in general feel the tremendous demand, and our metabolism is extremely challenged. Now we enter what we might call cellular fatigue and literally, our cells don’t get enough fuel to drive their function. This stress to our system takes a toll and nutritional status declines and disease status increases.

Premenstrual syndrome and perimenopause are their own kind of stress on the system. During these times, many women find their threshold of tolerating stress decreases. The complicated interaction of our hormones and our brain chemistry challenges our stress adaptation mechanisms, and fatigue can result. These fluctuating levels, both decreases and increases, in hormones such as estrogen, progesterone, cortisol and thyroid, interact with brain neurotransmitters such as serotonin, dopamine, GABA, and others, that affect our emotional and physical responses to life, to stressors in our environment, to insults, and even to infections.

Different circumstances call for different approaches, and if persistent fatigue is something that plagues you, it is important to consult with a licensed health care practitioner to determine the cause. A good medical history, physical exam, and selected laboratory tests can determine if the cause is low thyroid, anemia, an infectious agent, low or high blood sugar, or a serious illness. Licensed alternative practitioners will also have tools and perspectives to consider food sensitivities, toxicities, neurotransmitter imbalances, hormonal status and something we call adrenal fatigue syndrome.

A condition alternative medicine often calls “adrenal fatigue”, is a unique contribution to understanding a sometimes elusive problem such as fatigue.

Adrenal gland function and its production of hormones are vital performance tasks in our response to stress and our larger responses in our general adaptation syndrome. Nutritional and herbal support for a person who displays symptoms of intense or prolonged stress, and/or a fatiguing of the ability to adapt to the stress, can play a critical role in supporting our adrenal glands to adapt. An abnormal adrenal response, whether it is deficient or excessive hormone release, can be in large part addressed with key nutrients such as pantothene, B6, zinc, magnesium and vitamin C. These nutrients play a critical role in the optimal function of the adrenal glad and in the manufacture of adrenal hormones. Levels of these nutrients can be diminished during times of stress. Urinary excretion of vitamin C is increased during stress. Pantothene is also important during times of high stress or in individuals with adrenal fatigue. A deficiency of pantothenic acid results in fatigue, headaches, insomnia and more. Notable botanicals can also support adrenal function and enhance resistance to stress such as Siberian and Panax ginseng. These ginsengs are referred to as general tonics or adaptogens. Both Chinese and Siberian ginseng can be used to restore vitality in individuals who are chronically fatigued or who have decreased mental and physical performance and/or stamina. These ginseng species have been shown to act as tonics and anti-stress agents, enhancing the ability to cope with both physical and emotional stressors., , Individuals who take ginseng often report an increase in vitality, well being, increased mood, competence at work, mental and physical performance and reduced feelings of stress and anxiety. Rhodiola is well known amongst the Eastern Europeans for its ability to enhance energy, stamina and endurance. rhodiola appears to increase the chemicals that provide energy to the muscle of the heart and to prevent the depletion of adrenal hormones induced by acute stress.

Ashwagandha is also a significant adaptogen providing adrenal and immune support, , for increasing resistance to environmental stressors and as a general tonic. Ashwagandha contains several important active constituents including withanolides. Its mechanisms of action include pain relief, antioxidant effects, reducing inflammation, stimulating thyroid function, as well as respiratory and immune function. Some researchers have claimed that ashwagandha as an antistressor effect. It appears that it may suppress stress induced increases in dopamine receptors in the brain.

Astragalus has been used historically for strengthening and regulating the immune system, as a tonic, antioxidant, anti-inflammatory, antibacterial antiviral and to protect the liver. A lengthy list for sure. Although there is insufficient evidence to support the effectiveness of all of these uses, there is preliminary research that it is positive in some areas. Astragalus extracts seem to be able to restore or improve immune function in immune deficient cases. It may be able to restore suppressed T-cell function in cancer patients.7 Abnormal liver enzyme tests have improved in people chronic hepatitis when taking Astragalus. Astragalus is also thought to increase cardiac output and may be beneficial in individuals with congestive heart failure and compromised blood flow to the heart muscle. 8

We’re all familiar with our favorite spaghetti sauce that contains basil, but we may not know that this same plant, also known as Holy basil is a rich source of vitamin C, calcium, magnesium, potassium and iron. Holy basil has been gaining some attention due to experimental studies in humans on blood glucose. Elevated glucose levels were lowered by 21 mg/dl and lowering glucose after a meal, was also a positive effect of the basil. Many individuals with adrenal dysfunction, have increased glucose levels due to the increased cortisol as a result of stress.

Shisandra is plant most familiar to those who use Chinese herbs. In traditional Chinese medicine, schisandra is used for many common problems, including physical fatigue. Schisandra is used for improving immune function, recovery after surgery, increasing physical performance and endurance, and for increasing resistance to disease and stress. Schisandra is also possibly effective for improving concentration. It is thought that the variety of lignans found in the fruit, are the active constituents in schisandra.

Maca, or Peruvian Ginseng, may be one of the most important plants having a diverse effect on the female reproductive system. Traditionally, it has been used for chronic fatigue syndrome, enhancing energy, stamina and overall energy. In the female reproductive system, its use for enhancing fertility, regulating the menstrual cycle, treating common menopause symptoms and to increase libido has been familiar to the traditional peoples of Peru and elsewhere, for many a generation. Studies soon to be published, will be able to document some of its specific effects for menopausal women.

This type of herbal/nutritional support is especially helpful for those who have been determined to have adrenal fatigue. Symptoms such as fatigue, low vitality, low libido, depression, anxiety, poor memory, low stamina, and difficulty handling the premenstrual phase and the perimenopausal transition are key indications of adrenal fatigue.

Some women who have premenstrual fatigue or perimenopausal fatigue, may need additional hormonal support as well. This may include actually using hormones as medicines, but also may involve improving the metabolisim of our hormones. These considerations can best be addressed utilizing a comprehensive approach with a licensed naturopathic physician who has both the alternative medicine perspective, as well as the ability to prescribe various hormones such as progesterone, estrogen, testosterone, cortisol and thyroid.

The best approach to fatigue is to find out the cause. Don’t just ignore your fatigue and “gut it out” and don’t make assumptions about the cause of your fatigue. With good health care team approach utilizing your insights, your reading and natural foods store resources, a naturopathic physician, and possibly medical doctor or other allied practitioners, you can be more assured of understanding the cause and therefore the best solutions.

ReferencesÂ

• Farnsworth N, et al. Siberian Ginseng: Current status as an adaptogen. Economic Medicinal Plant Research 1985;1: 156-215.
• Hikino H. Traditional remedies and modern assessment: The ase of Ginseng. In R.O.B. Wijeskera, ed. The Medicinal Plant Industry (Boca Raton, FL: CRC Press, 1991), 149-166.
• Shibata S, et al. Chemistry and Pharmacology of Panax. Econ Med Plant Research 1985;1:217-284.
• Hallstrom C, Fulder S, Carruthers. Effect of Ginseng on the performance of nurses on night duty. Comp Med East and West 1982;6:277-282.
• Maslova L, Kondrat’ev B, Maslov L, Lishmanov I. The cardioprotective and antiadrenergic activity of an extract of Rhodiola rosea in stress. Eksp Klin Farmakol 1994;57:61-63. (Article in Russian).
• Upton R, ed. Ashwagandha root (Withania somnifera): Analytical, quality control, and therapeutic monograph. American Herbal Pharmacopoeia 2000;April: 1-25.
• Sun Y, Hersh E, Talpaz M, et al. Immune restoration and/or augmentation of local graft versus host reaction by traditional Chinese medicinal herbs. Cancer 1983;52(1): 70-3.
• Upton R, Ed. Astragalus Root: analytical, quality control, and therapeutic monograph. Santa Cruz, CA: Am Herbal pharmacopoeia; 1999; 1-25.
• Agrawal P, Rai V, Singh R. Randomized placebo-controlled, single blind trial of holy basil leaves in patients with noninsulin-dependent diabetes mellitus. Int J Clin Pharmacol Ther. 1996;34(9): 406-409.
• Upton R, ed. Schisandra Berry: Analytical, Quality and Control, and Therapeutic Monograph. Santa Cruz, CA: American Herbal Pharmacopoeia 1999; 1-25.

How does a migraine occur?

The process resulting in a migraine begins in the nervous system. Rather than a vascular or muscular disorder, as we thought in the past, migraines are a neurological condition. It begins when the sensitive nervous system of a migraine sufferer is faced with an environmental stressor that can reduce their migraine threshold. These risk and trigger factors include hormonal changes, alcohol consumption, skipping meals, sleep deprivation and medications. Under these circumstances, the neurochemical balance of the nervous system changes, and prodromal symptoms can occur. If this state progresses, the migraine threshold is crossed, and the “migraine generator” area of the brainstem is now activated. A wave like effect occurs across the surface of the brain; nerve cells, selected nerve branches and the vascular structures they supply are activated, releasing neuropeptides from the nerve. These then produce an inflammation of small arteries which stimulate blood platelet “stickiness” and serotonin release. Nerve impulses are transmitted back to the brainstem and as the process continues, brainstem reflexes are activated that produce the migraine related symptoms, ex/ nausea, vomiting and photophobia. Pain fiber activation can also result in nasal congestion and pain in the sinus cavities.

What can trigger a migraine?

For women, proper management of migraines would include the consideration of their hormonal situation. Migraines can be related in timing to the menstrual cycle, when there are fluctuations in our hormones, which affect the brain chemistry and vasculature. Migraines tend to reduce in frequency in postmenopausal women, when estrogen levels decrease significantly and stabilize (without monthly fluctuations.) The majority of women experience no change or even improvement in their headache pattern with oral contraceptives. Although many women experience relief from headaches during pregnancy, others find that migraine symptoms stay the same or worsen. As with menstrual migraines, migraines at perimenopause may require balancing or stabilizing the hormonal environment.

A holistic approach to improving migraines would include reducing or avoiding common triggers: dietary amines (chocolate, cheese, beer, wine). Reduce or avoid the most common foods that induce migraines (cow dairy, wheat, chocolate, eggs, fish, coffee, nuts), and known or suspected individual food allergens. Consider nutrient deficiencies, stress, skeletal misalignments and muscle tension. As always, eat a whole foods diet free of preservatives, white sugar, white flour and fried foods.

Herbs and supplements that can help

Butterbur, specifically the extract of the rhizome of the plant, when standardized to contain 15% petasins, reduces spontaneous activity and spasms in the smooth muscle of the vascular walls. It also reduces leukotrienes and thus provides an anti-inflammatory effect as well. Numerous research reports have demonstrated that butterbur reduces the frequency and intensity of migraine attacks.¹ More recently, a randomized, double-blind, placebo-controlled clinical trial for migraine prevention was conducted on 229 migraine patients. Petasites extract was found to be safe and effective in reducing the frequency of migraine episodes, the number of days of migraine per month, and the intensity of the headache itself.² Ginger is an excellant anti-inflammatory, and reduces blood platelet stickiness. Feverfew is rich in compounds known as sesquiterpene lactones, which inhibit platelet stickiness and histamine release, regulate serotonin release and is an anti-inflammatory. Of 270 migraine sufferers who had eaten feverfew daily, 70% had a decrease in the frequency and/or intensity of their attacks.³ Several clinical studies have shown an improvement in attacks and symptoms.⁴ Riboflavin has the potential of increasing energy efficiency within the cell, possibly stabilizing cerebral blood vessels. 49 migraine patients were treated with 400 mg per day of riboflavin for 3 months, showing a 68% reduction in the migraine severity score.⁵ Low magnesium levels have been detected in sufferers of both migraine and tension headaches.^6,7,8,9 In one study, patients had a 41% reduction in frequency by week nine when taking magnesium daily.¹⁰ It may be that only those who have low magnesium levels in the tissue or blood may benefit from taking magnesium. 5-hydroxytryptophan (5-HTP) modulates serotonin levels and increases endorphin levels, making it especially helpful for sufferers of headaches accompanied by sleep disorders. In one of the largest clinical trials, 124 patients received either 5-HTP or methysergide for six months,¹¹ with comparable results. Two other studies demonstrated that 5-HTP was superior to the pharmaceutical prescription.^12,13

Note: If you are taking SSRI anti-depressants or have reduced kidney function, you should consult your physician before taking these herbs/supplements. These herbs/ supplements should be avoided if an individual is on anti-coagulant therapy, barbiturates, or blood sugar lowering medications and if pregnant, nursing or has liver disease.

References

1. Gruia F. Biological treatment of pain. Results of a doctors’ practice study with a phytopharmaceutical. Erfarungsheilkunde 1986;35:396-401. (article in German)
2. Lipton R, Gobel H, Wilks K, Mauskop A. Efficacy of Petasites ( an extract from Petasites rhizome) 50 and 75 mg for prophylaxis of migraine: results of a randomized, double-blind, placebo-controlled study. Neurology 2002;58:A472.
3. Johnson E, et al. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985;291:569-573.
4. Schoenen J, Lenaerts M, Bastings E. High dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalalgia 1994;14:328-329.
5. Schoenen J, Lenaerts M, Bastings E. High dose riboflavin as a prophylactic treatment of migraine: Results of an open pilot study. Cephalalgia 1994;14:328-329.
6. Mazzotta G, et al. Electromyographical ischemic test and intracellular and extracellular magnesium concentration in migraine and tension-type headache patients. Headache 1996:357-361.
7. Swanson D. Migraine and magnesium: eleven neglected connections. Perspect Biol Med 1988;31:526-527.
8. Ramadan N, et al. Low brain magnesium in migraine. Headache 1989;29:590-593.
9. Gallai V, et al. Magnesium content of mononuclear blood cells in migraine patients. Headache 1994;34:160-165.
10. Peikert A, et al. Prophylaxis of migraine with oral magnesium: Results from a prospective, multi-center, placebo-controlled and double-blind randomized study. Cephalagia 1996;16:257-263.
11. Titus F, et al. 5-hydroxytryptophan versus methysergide in the prophylaxis of migraine: Randomized clinical trial. Eur Neurol 1986;25:327-329.
12. Bono G, et al. Serotonin precursors in migraine prophylaxis. Adv Neurol 1982;33:357-363.
13. Maissen C, Ludin H. Comparison of the effect of 5-hydroxytryptophan and propranolol in the interval treatment of migraine. Med Wochenschr 1991;121:1585-1590.