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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:

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I hope to see you at the summit!

Psoriasis is an autoimmune disorder that causes inflammatory scaling, thickened lesions of the skin. Conventional treatment for mild to moderate psoriasis included topical and systemic medications, but all are fraught with potential side effects. Several other studies have shown that turmeric extract applied topically can reduce the severity of psoriasis lesions. The current double-blind, placebo-controlled study measured the efficacy of turmeric extract in a gel, in patients with mild to moderate plaque psoriasis.

applying creamForty patients were recruited and 34 completed the study. Patients were between the ages of 18 and 60 years of age and had mild to moderate psoriasis on their legs and arms. They were eligible for the study if their psoriasis had been stable for at least 2 months and only included if they were not taking topical psoriasis treatments. Patients applied a placebo cream to one side of either right or left arm and leg and then the turmeric treatment cream applied to the opposite side and similar size and severity of lesions. The placebo and turmeric were applied twice per day for 9 weeks.

 

The placebo contained the microemulgel, and the treatment product contained the microemulgel plus 0.5% of turmeric extracted with water and alcohol. The Psoriasis Area and Severity Index(PASI) measured the redness, thickness, scaling and area of the lesions every 3 weeks. Quality of life was measured as well.

Redness, thickness, and scaling of lesions on the arms decreased significantly with turmeric treatment and the scaling of lesions on the legs decreased significantly over the 9 weeks with turmeric treatment. The mean PASI score decreased from 3.6 to 1.4 with turmeric treatment and was significantly lower than with placebo. There were some adverse effects of dryness and burning, which was similar with the turmeric treatment and the placebo.

Commentary:

Successful natural medicine topical and systemic treatments for plaque psoriasis are limited, so this study is a welcomed report. The turmeric microemulgel significantly reduced the symptoms of psoriasis while also improving quality-of-life indices. While there were minimal adverse effects of drying and burning, it seems as though it was due to the carrier, rather than the turmeric. Psoriasis patients have higher phosphorylase kinase (PK) expression and curcuminoids are known to inhibit PK activity, which should result in a decrease in inflammation.

A comprehensive natural medicine approach would include diminishing triggers, stress management, anti-inflammatory diet, an elimination or rotation diet, potential gluten free diet, sunshine, therapeutic fasting, fish oils, vitamin D, topical treatments including the curcumin gel, aloe vera cream , berberine cream and other historical, empirical and creative approaches.

Reference: Sarafian G, Afshar M, Mansouri P, Asgarpanah J, Raoufinejad K, Rajabi M. Topical turmeric microemulgel in the management of plaque psoriasis; a clinical evaluation. Iran J Pharm Res. Summer 2015;14(3):865-876.

Menstrual cramps are classified as primary dysmenorrhea or secondary dysmenorrhea. Your average case of menstrual cramps is referred to as primary dysmenorrhea, meaning they are due to a functional mechanism such as abnormal prostaglandin production from the uterine endometrium, especially PGF 2 alpha, increased inflammatory substances or lack of ovulation. Secondary dysmenorrhea is due to conditions such as endometriosis and/or uterine fibroids.

Menstrual cramps on or just before menses can interfere with life in such a way as to cause missed work, missed responsibilities, and is usually managed with over-the-counter, non-steroidal anti-inflammatories or prescription pain medications, which can sometimes lead to over-use and even abuse.

Cinnamon sticks and powder, studio shot, wood background,Cinnamon is not an herb that we would normally think of as being used for menstrual cramps. None the less, these researchers conducted a randomized, double-blind clinical trial to assess the effects of cinnamon on menstrual bleeding and systemic symptoms in Iranian college aged women students suffering from menstrual cramps due to primary dysmenorrhea.

Women were selected who had moderate menstrual cramps and regular menstrual cycles. Use of hormonal contraception and pain management medications were not allowed during the study.

Thirty-eight women received a placebo and 38 received 420 mg capsules of dried cinnamon bark powder and the dose given was two capsules three times daily during the first three days of their menses.

Pain severity at several points within the 72 hours, nausea severity, vomiting episodes and amount of bleeding were recorded and evaluated. A visual analogue scale was used to determine the severity of pain and nausea.

Results: The mean pain severity score and the mean duration of pain were less in the cinnamon group than in the placebo group at all measured times. The amount of bleeding decreased significantly at 24 hours and 48 hours in the cinnamon group but not in the placebo group.

The mean severity of nausea and the number of vomiting episodes significantly decreased in the cinnamon group at 24, 48 and 72 hours and greater than when compared with placebo.

Commentary:

The results of this study suggest that cinnamon capsules of two capsules three times daily for the first 3 days of the menses can play a significant role in reducing menstrual pain, heavier menstrual bleeding, nausea, and vomiting associated with primary dysmenorrhea. It is not clear from this study if the product used was a standardized extract of cinnamon or plain cinnamon powder. Other prominent research on botanicals and primary dysmenorrhea have included ginger root powder and valerian root powder. A comprehensive holistic approach would be to try to address the underlying mechanisms of primary dysmenorrhea which would mean to restore prostaglandin balance within the uterine endometrium. This approach would likely include therapeutic dietary recommendations as well as higher EPA fish oils.

Reference

Jaafarpour M, Hatefi M, Najafi F, Khajavikhan J, Khani A. The effect of cinnamon on menstrual bleeding and systemic symptoms with primary dysmenorrhea. Iran Red Crescent Med J. 2015;17(4):e27032.

Fiber and omega-3 fatty acids have been shown to have at least modestwhole and crushed flax seeds antihypertensive benefits but research on flax seeds for this purpose have been conflicting. Flax seed constituents include fiber, an omega-3 fatty acid alpha-linolenic acid (ALA), the peptide KCI-F1, and perhaps its most well-known component, the lignans. The purpose of this research was to do a systematic review and meta-analysis to evaluate the effect of flaxseed on blood pressure in humans.

Databases were searched for randomized trials and blood pressure, using flaxseeds. Studies that were selected for inclusion in the review and meta-analysis were those that had a flaxseed and a control group, a duration of at least 2 weeks and those with a case-control or crossover design.

Out of the 622 studies that the search yielded, 15 studies met the inclusion criteria and were thus included in the meta-analysis which then had a total of 1302 subjects. A total of 618 were treated with flaxseed, 140 were treated with other therapies and 544 with placebo. Studies included spanned Canada, Brazil, China, India, Australia, Denmark, Finland and Greece.

The formulas used in these 15 trials were either 1.2-15 gm/day of alpha linoleic acid (ALA) flaxseed oil, 360-600 mg/day of flax lignan extract or 28-60 gm/day of flaxseed powder and studies ranged from 4 to 12 weeks.

Commentary: This meta-analysis showed that only the flaxseed powder treatment had a significant reduction in systolic and diastolic blood pressure and that the flaxseed powder and flax oil had a significant effect on reducing diastolic blood pressure. Lignan extract therefore had no effect on either systolic or diastolic blood pressure and that the flax oil only had an effect on reducing diastolic blood pressure.

Some of the studies had a small number of individuals in the studies, a lack of homogeneity in the study subjects, and the variety of doses and forms and even kind of flax seeds used (brown or golden seeds)

In this meta-analysis, there was a decrease of 2.85 systolic pressure and 2.39 diastolic pressure with the flax seeds. A decrease of 3.3/1.4 mmHg has been associated with a 22% decline of relative risk of cardiovascular mortality and this meta-analysis is showing the flax seeds could be meaningful in reducing death from cardiovascular disease.

There are many reasons to include flaxseed powder in the diet (ex/constipation, irritable bowel, breast health, cardiovascular mortality, polycystic ovarian syndrome, insulin resistance), and specifically a small but meaningful effect on lowering both systolic and diastolic blood pressure. An easy method of delivery is to add 30 gm-60 gm/day(2-4 Tablespoons) to your smoothie.

Reference
Ursoniu S, Sahebkar A, Andrica F, Serban C, Banach M; Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. Effects of flaxseed supplements on blood pressure: A systematic review and meta-analysis of controlled clinical trial. Clin Nutr. May 29, 2015; [epub ahead of print]. doi: 10.1016/j.clnu.2015.05.012.

stomach discomfortThe term functional dyspepsia refers to indigestion problems that are unrelated to esophageal reflux, heartburn or irritable bowel syndrome. Symptoms typically occur with eating and include upper abdominal discomfort or pains, bloating, nausea, lack of appetite and feeling full quickly when eating. Ginger and artichoke have a long traditional history of being used to treat these kinds of complaints. The current randomized, placebo-controlled, double-blind trial was done to investigate this botanical combination in men and women with functional dyspepsia.

This study, conducted in Italy, assured that the participants did not have heartburn or irritable bowel syndrome, were not taking nonsteroidal anti-inflammatory drugs, had no history of gastrointestinal surgery, gastrointestinal ulcers, Helicobacter pylori nor were pregnant. The treatment protocol included 100 mg of artichoke and 20 mg of ginger in a gelatin capsule. Each participant took 1 capsule before lunch and one before dinner or placebo for 4 weeks. Patients rated their symptoms as no improvement or worse, slight improvement, marked improvement or completely improved, and they noted changes in stomach fullness, bloating, feeling full easily, nausea, vomiting and upper stomach pain. They had 4 clinic visits over a period of 4 weeks.
A total of 126 met the entrance criteria including 19 men and 46 women in the treatment group and 20 men and 41 women in the placebo group. All participants completed the study. The placebo group did have higher ratings of bloating, easy satiety and stomach pain scores before the study started.
Results: After 4 weeks of treatment, 63.1% in the ginger-artichoke group showed functional dyspepsia scores of marked or complete improvement compared with 24.6% of participants in the placebo group. After 2 weeks, the herbal group showed a significant improvement in the overall functional dyspepsia score and there was no improvement in any of those in the placebo group. There was also a significant reduction specifically in both nausea and stomach pain scores in the botanical group while symptoms actually increased in the placebo group, and especially for vomiting.

Commentary: The study results clearly show the effectiveness of the combination of ginger and artichoke in alleviating symptoms of functional dyspepsia, and those symptoms improved after 2 weeks and continued to the end of the 4 week study. It is thought that these herbs improve motility in the digestive tract, improve the emptying of the stomach and decrease nausea/vomiting. The gingerol compounds in ginger have previously shown to have this effect on nausea and vomiting— due to multiple causes (dyspepsia, pregnancy, motion sickness, medications and post-surgery). My clinical experience with these two herbs, and often in combination with broad spectrum digestive enzymes in combination with other traditional gastrointestinal herbs such as milk thistle, gentian, dandelion root, yellow dock root, burdock root, fennel, chamomile and cardamom holds a lot of relief and treatment for most individuals when functional dyspepsia is the accurate diagnosis.

Reference
Giacosa A, Guido D, Grassi M, et al. The effect of ginger (Zingiber officinalis [sic]) and artichoke (Cynara cardunculus) extract supplementation on functional dyspepsia: a randomised, double-blind, and placebo-controlled clinical trial. Evid Based Complement Alternat Med. 2015;2015:915087

Premenstrual syndrome (PMS) is defined as the cyclic physical symptoms andGround turmeric and rhizomes mood change which start sometime from mid-cycle to the end of the menses but then ends either with the onset of menses or by the end of menses. Changes in neurotransmitters and prostaglandins are the primary physiological issues of PMS. Curcumin studies demonstrate its ability to reduce prostaglandin synthesis and animal studies demonstrate an action of curcumin in modulating serotonin, dopamine and norepinephrine thus exerting an antidepressant effect. Based on these observations of curcumin and the role of prostaglandins and neurotransmitters in the etiology of PMS, a study on curcumin was conducted to evaluate the effects on the severity of premenstrual mood, behavior and physical symptoms.

This randomized, double-blind, placebo controlled study was in healthy 21-35 years old women with regular menstrual cycles who had at least 5 symptoms of 19 on a PMS questionnaire. The women who met the criteria for a PMS diagnosis, were then randomly assigned to two groups with 35 in each. Group one received curcumin 100 mg every 12 hours from 7 days before and until 3 days after the onset of menstrual bleeding and for 3 consecutive menstrual cycles. Group two received placebo in the same regimen. Four women in the placebo group and 3 in the curcumin group did not complete the study.

Total severity of PMS score reduced from 102.6 to 42.47 with a mean change of 59.59 in the curcumin group. In the placebo group, the total severity of PMS score changed from 106.06 to 91.60 with a mean change of 14.45. The difference between the two was significant.

Commentary: PMS is one of the most common health problems in women of reproductive age. Premenstrual mental/emotional symptoms of irritability, anxiety, aggression, depression and changes in concentration and are thought to be primarily due to the central role of serotonin changes in PMS. The normal progesterone and estradiol decline in the luteal phase of the menstrual cycle result in withdrawal of the hormonal effects on serotonin, dopamine and norepinephrine.

Laboratory studies and animal studies have confirmed that curcumin is able to modulate norepinephrine, dopamine and serotonin and affect the inflammatory pathways. In addition to the neurotransmitters, the production of prostaglandin E2 is likely involved in some of the physical PMS symptoms such as pain, swelling and inflammation such as breast pain and engorgement, headaches, extremity edema and others. It is the understanding of the role of neurotransmitters and prostaglandins in PMS, and the observation of the influence of curcumin on neurotransmitters and prostaglandins that led to the theory that curcumin could be helpful in treating PMS.

Curcumin has not been on my treatment option list for PMS. We have many excellent natural therapies that have been researched with good effects in PMS including calcium, vitamin B6, St. John’s Wort, Chaste tree berry, evening primrose oil, and tryptophan. I will now be thinking of PMS cases in which I might add curcumin to my use of the other nutrients and herbs. I will likely start with cases in which there is significant premenstrual physical pains.

One of the disappointments of this study was that no information was given as to the amount of curcuminoids in the product, only that it was 100 mg of curcumin.

Reference

Khayat S, Fanaei H, Kheirkhah M, et al. Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complementary Therapies in Medicine 2015; 23: 318-324

clip_image002Simple respiratory infections include sinus infections and the common cold and up to about 80% of the time they are self-limiting. Up to 20% are complicated and lead to bronchitis, pneumonia, tonsillitis, conjunctivitis, otitis, pharyngitis or bacterial sinusitis. Prevention of respiratory tract infections is a desired goal of course but often frequent hand washing, healthy eating, regular exercise and fresh air and not smoking are not enough. Here is where one of the valued aspects of Echinacea comes in. Echinacea (Echinacea spp.) is used for the prevention and treatment of respiratory tract infections, as well as some other uses, and previous published studies have shown that Echinacea has anti-inflammatory, antiviral and immunomodulatory effects.

The purpose of this current meta-analysis was to evaluate the efficacy of Echinacea on respiratory tract recurrent and complications from these infections and specifically to see if 2-4 months of Echinacea products could prevent recurrent respiratory tract infections which of course then also prevents complications.

A comprehensive literature search was done and specifically randomized, placebo-controlled trials using Echinacea preparations in healthy individuals over 2-4 months for prevention of respiratory tract infections. Of the 101 clinical trials that were found, 89 did not meet the full inclusion criteria. Of the 12 remaining, 6 were eliminated due to methodology or test materials. Two of these 6 studies reported significant benefits of Echinacea treatment, with a relative risk of 0.663 and 0.734 (a relative risk of < 1 means that a respiratory tract infection is less likely to recur in those taking Echinacea vs. those taking placebo). In four studies that included cases and data on those having at least one recurrent respiratory tract infection, the relative risk was also < 1. When comparing the alcohol extracts with the pressed Echinacea juices, there was a more pronounced effect from the alcohol extracts. In the largest study, there was not only a reduction in respiratory tract infections, there were less viral infections in the nasal passages and corresponded to a 58% reduction in the risk of viral re-infection. In individuals with recurrent respiratory tract infections and who had risk factors such as stress, poor sleep and were active smokers, the benefits were even greater. Data from 3 of the studies also demonstrated that there was a statistically significant relative risk for complications such as conjunctivitis, otitis media, tonsillitis and sinusitis and even a 64.9% reduction in pneumonia in those taking Echinacea products. Of additional importance, antibiotic use declined in three studies in those using Echinacea compared with control groups or standard treatments.

In summary, this meta-analysis demonstrates that Echinacea containing products significantly reduce the risk of recurrent respiratory tract infections in healthy individuals and in those with risk factors.

Reference: Schapowal A, Klein P, Johnston S. Echinacea reduces the risk of recurrent respiratory tract infections and complications: a meta-analysis of randomized controlled trials. Adv Ther. 2015;32(3):187-200.

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