Ohlone Center Therapeutics Program, June 2010

According to the journal, Hospital Pharmacist, one percent of the population will develop bipolarism in their lifetimes.  The World Health Organization lists it as the sixth leading cause of disability in the world and it affects approximately 5.7 million adult Americans.  This is not a modern affliction as the connection between states of depression and mania, which vastly defines bipolarism, has been noticed since the second century. It was first coined Manic Depressive Psychosis and defined as a psychiatric disorder in 1875 but it wasn’t until 1913 that it gained a clear distinction from schizophrenia (http://www.caregiver.com).  However, bipolarism didn’t become a major mental disorder diagnosis until the era of mental health medicalization and drug therapies was ushered in during the early 1950’s with the development of the Schizophrenic drug, Chlorpromozine (Whitaker). From this point on bipolarism, or Manic Depressive Disorder as it was known, became a much more common diagnosis and psychopharmaceuticals were considered the first line of treatment for diagnosable mental disorders and continues to be the main protocol in modern psychiatry.

In the United States, approximately 38 percent of adults (about 4 in 10) and approximately 12 percent of children (about 1 in 9) are using some form of Complimentary and Alternative Medicine (CAM). With the rising cost of health insurance, the increasingly dissatisfying results from pharmaceutical or surgical therapies, more Americans are looking for better and cost effective ways to take care of themselves. In 2007, Americans spent nearly 15 billion dollars on natural non-vitamin or mineral products like herbs and fish oil (http://nccam.nih.gov).  With this rise in the use of complimentary medicines to achieve and maintain health, and the potential increase in diagnoses of bipolarism there is a high likelihood that an herbal practice or clinic will include clients with a bipolar diagnosis. Though the advent of prescription psychopharmaceuticals has inarguably helped and even saved the lives of many people suffering from mental disorders, these “wonder drugs” do not come without cost.  Many have exchanged mental stability or functionality for a slew of serious, potentially lethal negative drug affects.  For most it is a barter that they will pay and see it as a necessary sacrifice. Yet, holistic herbal medicine has proved to be an excellent way for mental health clients to bring more balance to this pact. Most of these clients will seek out herbal medicine not necessarily to replace their pharmaceuticals but to address the side affects of these drugs and to “just feel better” all around.  Under the holistic guidance of a trained herbalist, these clients will be seen as a whole person and not simply a diagnosis. They will examine the effects not only of the drugs they are taking but the food they eat, their emotional and spiritual lives, and the way they relate to their world. This can enable the bipolar sufferer to see their health in a more holistic way as well.  In this paper, I will examine the current definitions and theories of causality of bipolar disorder, look at holistic therapies that herbalists can incorporate into their work that will address constitution and work with pharmaceutical therapies in order to reduce the side affects and enhance drug efficacy, and explore strategies to more sustainable community support for bipolar people, all in an effort to help clients achieve a broader sense of wellness.

According to the DSM, bipolar (BP) diagnosis is divided into BP I, BP II, and cyclothymic disorder (also known as “rapid cycling”) with the main differences being which altered mood, mania or depression, is more pronounced in the client and the length of each mood cycle.  However, each diagnosis must contain a certain amount of both states and fulfill the criteria for Major Depressive Episode and/or Manic Episode.[1] Bipolarism is diagnosed by a trained psychiatrist who examines the clinical symptoms and then determines if the client fulfills the necessary number of criteria for both manic and depressive states in order to distinguish it from ordinary mood swings or another psychiatric diagnosis. Startlingly, the DSM states that a person only needs one occurrence of these episodes to qualify for bipolarism.  Seemingly, the little diagnostic criteria and the money to be made by the pharmaceutical companies off drugs prescriptions may be important reasons why there is such a rise in incidents of the disorder.

As described by Bipolar Magazine, bipolar I disorder is characterized by one or more manic episodes or mixed episodes-symptoms of both mania and depression occurring nearly everyday for at least one week-and one or more major depressive episodes. Bipolar I disorder is the most severe form of the illness, marked by extreme manic episodes (extreme highs) and is also referred to as the classic Manic Depressive Disorder.  It usually has longer building cycles culminating in severe manic or depressive episodes.  Bipolar II disorder is characterized by one or more depressive episodes (extreme lows) accompanied by at least one hypomanic episode. Hypomanic episodes have symptoms similar to mania but are less severe and must be clearly different from a person’s non-depressed average mood.  This disorder is often characterized as more depressive and while the rates of BP I do not differ between men and women, the rates of BP II tend to be more prominent in women.  Cyclothymic disorder is characterized by chronic fluctuating moods with periods of hypomania and depression. The periods of both depressive and hypomanic symptoms are shorter, less severe, and do not occur with regularity as experienced with bipolar I or II. However, these mood swings can impair social interactions and work. Many people with cyclothymia develop a more severe form of bipolar illness.  Of course none of the cycles of bipolar disorder happen the same way for every person but it is important to understand the essential patterns of the different disorders.

Though this disorder has been studied by science for decades, much and little is known about the causes of bipolarism.  After hundreds of these medical studies, the scientific community seems to find a new link in the chains of bipolarism every year yet nothing comprehensive to connect them all.  The leading horse seems to be genetic theory.  From epidemiological and twin studies, the generally accepted theory is that a specific number of genes in combination with environmental factors are responsible for the disorder (Hunter 2004). Even with this tentative agreement on the theory of inheritance, the landscape remains murky and the genetic information elusive.  Many of these studies may contribute some new light, but most are quite speculative and end with “inconclusive results,” or requirements for “further study.”  As many do, if one surveyed the internet for comprehensive alternative theories on the causes of bipolarism they would find just as many notions with just as many flaws and “inconclusive results.”  These statements are not to diminish the efforts or work of those studying this disorder but to caution the practitioner against over simplification or grandiosity when thinking about bipolarism.  The answers seem to lie where they usually do – somewhere in the middle and all over.

My mother, Joanne Susan Geldner, was diagnosed with the classic Manic Depressive Disorder in 1975 after a complete mental break and institutionalization at age 30.  She had been in and out of institutions, received electric shock and had an over all unstable emotional life

since the age of 14.  In most ways she displayed classic symptoms of the disorder: wild visions of religious grandeur, psychotic episodes where she would wail and sing at the top of her voice, and times when she couldn’t be restrained unless straightjacketed. When she started having difficulties at age 14 the field of psychiatry had yet to embrace bipolarism like it has today and it took more than 15 years for her to get a diagnosis and a stabilizing drug regime that she would be on for the rest of her life.  In every sense of the word, my mother’s diagnosis and subsequent drug therapy literally saved her life and saved her from permanent institutionalization.  Unfortunately, this is often a typical scenario for many folks diagnosed with bipolar disorder.  Many may suffer years of mental distress or fluctuating mood cycles before some major episode catapults them into the world of psychiatry, a diagnosis and drug therapy. What I have experienced with those in my community who fall into this path is that their recovery tends to mimic the cyclical nature of their emotional states.  After a major episode, the drugs tend to stabilize and bring short-term relief for the bipolar person.  Then, since bipolar people are usually under the sole care of a psychiatrist and for many reasons often do not or can not seek out additional therapies to provide a holistic sense of health, the drug therapy tends to negatively affect their lives.  This picture can play out in many ways, but a frequent result is that the negative affects of the drugs will lead to such a serious decrease in quality of life that they can see the only way out as quitting the meds “cold turkey.”  Unfortunately, they are usually doing this without the guidance of a holistic practitioner or therapeutic counselor to help mitigate the problems that can arise, and after while can end up having another serious episode that lands them back where they started.

This cycling of relapses can be largely helped or altogether eliminated through the adjunct use of the holistic therapies of herbal practitioners.  Holistic practitioners take into account the whole person and their entire life when working with bipolar clients.  Since herbal clinicians do not diagnosis bipolarism, as it is both illegal and unethical to do so, they are freed to look at the larger picture of health for their clients and help to mitigate the negative affects of any drugs they may be taking. Many areas that a practitioner will address for any of their clients, such as chronic stress, diet and lifestyle will also be important to their bipolar clients.

Examining and understanding the impact of stress on hormone balance is extremely important in helping the bipolar client. Strong evidence links episodes of extreme stress to bipolar depressive onset and relapse, and to a lesser extent manic onset and relapse (Hunter 2004). The Sympathetic Nervous System (flight or fight response) is our involuntary nervous system.  We are not consciously in control of our heartbeat or our hormonal cascades; they operate involuntarily in response to our stress lives.  The Parasympathetic Nervous System (PNS) is like its subtle sibling, controlling our rest and relaxation/digest responses. The SNS releases adrenaline and cortisol into the bloodstream and the role of the PNS is to counterbalance these effects by calming the systems – slowing heart rate and breathing, calming the emotions and restoring spent energy.  Ideally, most of our time would be spent under the calming influence of the PNS with only occasional but essential stimulation of the SNS.  However, due to the chronic stress levels of the modern world, many people have over active SNS response and underactive PNS response.  Since the parasympathetic nervous system is responsible for alertness, cognitive processes, attention, emotional regulation and stress response it is no wonder that many mood disorders and cognition disorders are associated with a depressed PNS.  In fact, psychotropic medications used to treat mood disorders may lessen the sympathetic nervous system response but they have not been shown to strengthen the activity of the PNS and may dull cognition, blunt emotions, and interfere with mental functioning (Brown et al 2009).

Stress is managed by two different systems in the body:  the hypothalamic-pituitary-adrenal axis (HPA) and the sympathoadrenal system (SAS).  These two systems involve communication between the Sympathetic Nervous System and the endocrine system.  After a stressful event, the nervous system reacts and neurons will activate the HPA axis and the SAS.  If a stressor stimulates the hypothalamus it activates a cascade of stress-response hormones.  Under the influence of these hormones, the SAS interfaces with the sympathetic nervous system to create the flight-or-fight stress response in the body.  These reactions enact various changes, which cause the body to adapt and try to reestablish homeostasis.  This response usually elevates the heartrate while narrowing certain blood vessels so that more blood is sent to the brain, the lungs, and the muscoskeletal system while restricting blood and therefore functioning to the appendages, reproductive system, and digestive system. (Winston 2007).

There are many hormones involved in the stress response: cortisol, adrenaline, noradrenaline, DHEA, adrenocorticotropic hormone (ACTH) and aldosterone to name a few.  Three that have a large long-term impact on adaptive response are cortisol, adrenaline and nor adrenaline.  Cortisol, which is essential to metabolism, is released from the adrenal cortex (“outside”) in times of stress and is the most potent of the glucocorticoids.  When cortisol is released it causes a breakdown of muscle protein to be synthesized by the liver into glucose for brain function.  Under stress, this system increases glucose availability for the brain in the bloodstream by flooding it with this synthesized glucose and by reducing the uptake of glucose in other tissues for energy.  Cortisol also leads to an increase in blood triglycerides for muscle use.  It also regulates blood pressure and cardiovascular activity and as a steroid it aids in the inflammatory response.  However, too much chronic cortisol can adversely affect the immune system by suppressing its response.  Symptoms of elevated cortisol include anxiety, hypertension, sex hormone imbalance, insulin resistance (Type II diabetes), obesity, osteoporosis, insomnia, and polycystic ovarian syndrome.  Too little cortisol can cause symptoms of depression, chronic fatigue, hypotension, insomnia, PMS, infertility, impotence, and fibromyalgia (Winston 2007).

Adrenaline and noradrenaline are produced by the adrenal medulla (“middle”) and affect the sympathoadrenal system.  These are the “fight or flight” hormones and though normally present in the bloodstream in small amounts are secreted in larger amounts during stress response.  They stimulate the heart, blood flow to muscles and the brain, constrict blood flow to small blood vessels (i.e. in the appendages), raise blood pressure, increase blood glucose and impact nerve responses in the autonomic nervous system.  This impact on the nervous system can lead to a low functioning or damaged nervous system and symptoms of mood disorder.

According to Mark Hyman author of, the UltraMind Solution the following is a researched list of the effects of chronic stress (heightened SNS response/dampened PNS response/increased cortisol and adrenaline):

• Increases inflammation and inflammatory cytokines, which have all been linked to depression, bipolar disease, autism, schizophrenia, and Alzheimer’s.
• Reduces the natural relaxation and anti-inflammatory calming neurotransmitter called acetylcholine.
• Increases anxiety and depression.
• Damages the hippocampus, leading to memory loss and mood disorders.
• Increases the activation of NMDA receptors leading to brain cell death.
• Reduces serotonin levels.
• Lowers growth hormones.
• Reduces slow wave sleep.
• Reduces social interactions and sexual receptivity.
• Increases abdominal fat and insulin resistance (Type II diabetes)
• Interferes with thyroid function.
• Leads to the death of mitochondria and loss of energy production.
• Raises triglycerides and LDL while lowering HDL cholesterol.
• Increases stickiness of blood leading to clots (heart attack and stroke).
• Loss of muscle.

One of the most important things to address with a bipolar client is their own stress response and how it affects their hormone balance. Fortunately, herbal medicine is quite adept at helping the body balance these systems.  Adaptogens and tonics will be of utmost importance in any bipolar formula.  Adaptagens work by stimulating the body’s non-specific stress response through the HPA axis and SAS.  They help regulate the function of the central nervous system, endocrine secretions, and cardiovascular system, promote immune function and have an affect on stress response.  Since adaptogens tend to regulate the use of cortisol in the body they are great at reducing the negative affects of excess cortisol in bipolar people and helping to return the hormone levels to a more balanced place (Winston 2007).  Eleuthero Siberian Ginseng is an excellent choice for the bipolar client.  It is an adaptogen and a tonic that directly affects the hypothalamus and adrenals, addressing the hormonal imbalances at the very top of the cascade.  This works to help the body put itself back in line. It can help on a cardiovascular level by lowering LDL cholesterol and blood triglycerides while relaxing the arteries.  As spirit medicine, Eleuthero can melt one out of one’s mind or psyche and back into their body.  For a bipolar person who may feel trapped by their thoughts this can be especially helpful.  Holy Basil is another great adaptogen for this formula.  It reduces the stress hormone levels in the body, reduces blood sugar levels and helps to regulate blood pressure which all can be problems for chronically stressed bipolar people. In Ayurvedic medicine it is used to help clear mental fog (often a negative affect of bipolar drugs).  It is generally an uplifting herb, sweetly lifting the spirits without stimulating.  There are many useful adaptogens to help regulate the stress response but one that has been used for thousands of years is licorice.  This is an important herb in Traditional Chinese Medicine and is considered a balancer of the Five Organ Systems and has a synergistic affect on the other herbs in formula.  Licorice has a regulating affect on the HPA axis and specifically on cortisol levels.  It helps support and rebuild deficient adrenals and has hepatoprotective properties.  In large doses for long periods of time it can raise blood pressure and leach potassium so it is important to use in small amounts in formula and with caution for anyone who has hypertension.  Make sure that their diet is also including adequate amounts of potassium.   As a pre-cursor to steroids, it is also contraindicated with steroid use, like, Prednisone.  Other adaptogens may be appropriate in treatment, but with bipolar clients always be cautious about any herb that may have stimulating or antidepressant affects.  Rhodiola and St. John’s Wort, while excellent herbs for other forms of anxiety and depression, are both generally contraindicated for bipolarism because they run the risk of stimulation that can trigger a manic episode. Bipolar people are often very sensitive in general and do not need high doses of herbs as it can be harmful. With any herbal formula for bipolar clients you want to use low doses, tonifying or nourishing herbs, and go slowly and monitoring well. This way you can formulate with confidence and clarity for the best results for your client.

Another arm of treatment is including nervines to strengthen the parasympathetic response, promoting relaxation and reducing sympathetic system dominance.  Nervines, especially nourishing ones will help the CNS return to balance.  Skullcap is an excellent nervine for calming the SNS and for people who are very sensitive to stress.  It brings about a sense of calm and clarity without sedating. For those who have a difficult time shutting off their brains this can be extremely helpful.  The myelin sheath is extremely important in the regulation of neural firings in the nervous system. It has been hypothesized that irregular firings may be linked to states of mania and too rapid of firings linked to depressive states.  Wild Oats works directly on nourishing and building the myelin sheath and may have a direct affect on regulating these firings.  It is a sweet and gentle nervine that is helpful in a constitutional formula or in an acute attack formula or as a simple. Central nervous system stimulation can also affect the circulatory system with stimulation or agitation and the nervine Passion Flower can have a dual affect.  It relieves anxiety and restlessness and has a slight sedative property while also calming to circulatory excitation that is CNS influenced.  For cardiovascular toning, soothing and to lift heart energy, it is best combined with Hawthorne Berry.

While herbs will be invaluable in supporting a bipolar person, a more comprehensive evaluation of their diet will be essential. Evidence links many brain disorders, like bipolarism, to mitochondrial injury from oxidative stress, which can be triggered by poor diet and nutrient deficiencies, toxins, infections, allergens, hormonal imbalances, altered gut function and stress (Hyman 2009). Often allopathic therapies like mood stabilizers Depakote and lithium increase oxidative potential in bipolar people (Brown et al 2009). In evaluating this picture, blood work results can be an indispensable tool for the clinician.  It may be helpful for the client to keep a food diary, and a food and mood chart, writing down everything they eat and drink for at least a week to get a more complete picture of what their diet is really like and how it may trigger certain moods. Taking these results and a thorough health history, we can look at bipolarism and other brain/brain chemical imbalances from the vision of the whole person.  Here we can see how important diet changes may be to creating holistic wellness for that person.

Some of the most important vitamins and nutrients for mental health are those involved in the healthy functioning of nerve cells.  Depletions of these are most likely due to poor nutrition, or malabsorption from a poorly functioning digestive system (genetic deficiencies like missing enzymes, functional or structural dysfunction, “leaky gut”, Chrones Disease, etc.). The B vitamins, especially folate, are crucially important for nerve health and mood stabilization.  Dietary and supplemental folate/folic acid has to be converted into the useful form of L-methyltetrahydrofolate.  Either the reduced conversion or lack of folate in the diet can cause an increased level of homocysteine.  Increased levels homocysteine have been linked to increased cardiovascular risks that may develop as inflammation and elevated blood pressure.  Higher levels of inflammation can be a product of stress response or can trigger low-level chronic stress, which has been associated with chronic disease, circulatory issues, chronic pain and other disease symptoms.  Ultimately, the reduction of folate along with increase of homocysteine may contribute to depression and poor response to antidepressant medication.  Common causes of reduced folate levels include chronic disorder, diabetes, cancer, smoking, alcohol use, poor diet, and medications such as mood stabilizers, L-dopa, statin drugs, oral antibiotic drugs, and chemo drugs. (Brown et al 2009).  Since most bipolar clients are on at least one mood stabilizing drug, which alone is folate depleting, it may be necessary to supplement with a folate.  In addition, improving nutritional folate is essential. Vegetables, especially asparagus and dark leafy greens, and fruits like oranges, strawberries, and melons are excellent sources of folate. Meat, beans, liver, eggs, and sunflower seeds are also good sources. Since all B vitamins are very instable and susceptible to heat it may be better to eat raw fruits and lightly cooked or steamed vegetables as often as possible to preserve as many of the vitamins as possible (Pennington 2005).

Fat is a vital nutrient for bipolar health and specifically Omega-3 fatty acids.  Omega-3 fatty acids are essential to cell membrane construction and function.  They help provide the fluidity and flexibility of our membranes.  This impacts membrane proteins (enzymes, receptors, ion channels) that are intrinsically important in healthy neural transmission functioning. We need quality membranes for a healthy brain and a healthy nervous system.  Most cellular reactions require a flexible membrane to affect cellular metabolism, function and transmission.  If our membranes are not flexible or are damaged, there may be problems with functioning at all system levels but especially on a neural, brain chemistry level.  In a number of studies, bipolar participants who were supplemented with Omega-3 have shown significant improvement of membrane flexibility.  It has also been linked to lower lifetime prevalence of bipolar disorder, especially bipolar II and relapse rates (most participants are also on mood stabilizers).  For bipolar I clients, it has been shown to decrease depression.  For treating depression in bipolar clients doses of 1-2 grams/day of mixed Omega-3 fatty acids (EPA and DHA) have reduced symptoms but for clients with mixed symptoms of mania and depression or rapid cycling a higher dose is needed.  In Herbs, Nutrients and Yoga in Mental Health Care, Drs Brown recommend 8-20 grams/day of Omega-3 for these clients while acknowledging that most clients can only tolerate limits of 6g/day because of the digestive discomfort.  Omega 3 treatment is considered low-risk and can be appropriate for children, pregnant women and during breast feeding.

When choosing Omega-3 oil, is it important to select bioavailable oil from quality sources. Traditionally, EPA and DHA were nutritionally obtained through sources of fatty fish (salmon, trout, mackerel, herring, sardines, tuna, anchovies, etc.).  However, due to poor fish farming practices, environmental poisoning of the ocean, and mercury or PCB contamination, we are left with very few viable, safe, and ecological fish options. There are vegetable sources of Omega-3 oil like flax, walnut, primrose, and borage oil, which contain alphalinoleic acid (ALA).  Your body has to convert the ALA to Omega-3’s and this conversion is usually quite inefficient and varies greatly among individuals. There are many high quality, tested Artic Sea fish and cod liver oil supplements that have little to no mercury and PCB contamination, and this may be the most viable option.

Since there is an increase in oxidation in bipolar people, vitamin C is important to include in the diet or supplementation.  It is a strong antioxidant, protecting cell membrane function, increasing immune function, detoxing heavy metals, and improving stress response. Vitamin C levels are highest in the brain and adrenals, and psychiatric patients are often so low in vitamin C to approach scurvy levels.  There is continued research illustrating that adequate or higher levels of vitamin C has a supportive effect on bipolar healing. Because it is believed to occupy the same dopamine receptor sites as the pharmaceutical antipsychotics, it may be useful as an anti-psychotic/anti-mania agent.  There is some evidence that it may be useful as a main or sole treatment for bipolar mania but the doses have to be so high (at least 10grams/day) to be digestively cumbersome and incur absorption issues. But it may be helpful at slightly higher than normal supplement levels in conjunction with traditional treatments (Edelman 2001).  Dietary sources of antioxidants include bioflavonoid like the dark berries and also beans and artichokes.

Of course, building mitochondria through supplementation can only take a client so far.  If the causes of oxidative stress are not removed, these neuroprotective agents will not be useful as protectors but simply as minimizers.  Since clients will have personal stress triggers that bring on bipolar episodes and they must be able to recognize these triggers and begin to minimize their impact.  One way is to map out their moods and keep a record of the changes.  This provides a routine for the bipolar person and is extremely important to grounding them on a daily basis.  Often their shifting mood cycles will follow certain patterns and using tools like a Mood Chart will help them to recognize this pattern, predict stressors and strategize to minimize or diffuse them.  For example, they may drink a cup of coffee everyday and notice that around that same time their mood is extremely elevated, agitated and “high”. Many bipolar people feel that they are at the mercy of their emotions and can feel quite powerless in the face of extreme mood swings.  Having them keep track of their own moods, the stresses, foods, menstrual cycles and drugs that affect those moods, will help them have a more appropriate relationship to their emotions and give them more awareness and a tool to have more power over for moods.

Finding ways to regulate the parasympathetic nervous system is another important strategy.  The PNS main pathways are through the right and left vagus nerves.  The vagus nerves innervate the throat, heart, lungs, GI tract, liver, pancreas, genitals and blood vessels.  They carry messages from the body up to the brainstem and vice versa.  From the brainstem, the pathways ascend to the limbic system, thalamus, and cerebral cortex, impacting how we experience ourselves, our emotions and our state of consciousness (Brown 2009).  Increased vagus nerve stimulation leads to increases in PNS response.  One could have a pace maker implanted that stimulates the vagus nerve every few seconds but it would be much safer, cheaper, more realistic to be able to learn to do that ourselves.  Since the PNS is mostly involuntary we have a limited amount of control over the reflexes under its domain.  While breathing is fairly involuntary – we all breathe in our unconscious sleep – you can have some control over your breathing: the depth, the quality, the timing.  By doing some simple exercises one could begin to control the vagus nerve and therefore stimulate the PNS and reduce stress response.  Deep breathing practices expand the diaphragm, which stimulates the vagus nerve and is part of the relaxation response, which is necessary for the body and brain to heal, repair and renew (Brown 2009).  Deep breathing alone may not be able to bring a bipolar person down from a severe manic episode; it is one more strategy in combating the heightened stress response and helping a bipolar person strengthen their overall health.

It is important to have things that a bipolar client can do for themselves to take control of their health like diet, relaxation practices and lifestyle choices but having further support for this journey of emotional wholeness and balance is essential for the bipolar client.  A psychiatrist who only prescribes pharmaceuticals once every few months does not a support system make.  Recommending that they find a number of qualified professionals to support them like herbalists, nutritionists, a therapist or spiritual guide and any other practitioners they will need is invaluable to help them get a structured support network together outside of family and friends.  Having a round table of the practitioners working in communication and each other an efficient and effective form of support. This roundtable will be better equipped to track the client’s progress and hold them accountable to their healing plans. If the bipolar person cannot afford or doesn’t want to see that many different practitioners, a licensed therapist may be the most invaluable help they can get.  These professionals can work with them to unravel the core issues and are trained on dealing with and recognizing the mood cycles of bipolar people.  Since much of what disrupts a bipolar persons life is about the mind and emotions, they are often not aware of their bodies though their bodies are very impacted by their emotional cycles.  It may be helpful to them to seek out a somatic therapist, one who uses body-oriented approaches to counseling and psychotherapy. This therapeutic method uses developmental and psychodynamic approaches and addresses the crucial role of the body in the structure and process of the psyche (http://www.somaticpsychotherapycenter.org/). This form of therapy along with other body oriented modalities, like yoga, Feldenkries, or the Rosen Method may be very helpful to your bipolar client.

Even with these herbal, nutrition and therapeutic supports in place the bipolar client may find pharmaceuticals helpful or essential.  Usually after a psychiatric diagnosis, the client will be prescribed psychopharmaceuticals depending on the emotional state or needs of the client.  Whatever the presenting issue is, it will be addressed first with either antidepressants or antipsychotics.   Most commonly prescribed anti-depressants are SSRI’S (Selective Serotonin Reuptake Inhibitors) which block serotonin from being reabsorbed into the cells and allow for a higher amount of available serotonin in the blood that can alter mood.  If depression is the dominant issue and a maintenance antidepressant is needed, it’s usually given in low doses to ensure that it is tolerated. Antidepressants may cause some people with bipolar disorder to shift into a manic episode and because of this risk anti-depressant use, both pharmaceutical and herbal, should be monitored closely.  Antipsychotics work on changing the levels of neurotransmitters in the brain.  Typical antipsychotics affect dopamine transmission while atypical antipsychotics can affect dopamine and other neurotransmitters. Changes in neurotransmitter levels directly affect the transmission of nerve impulses from the brain. This dopamine blockage alters the pleasure signals and in essence curbs the euphoria and mania that is often present for bipolar people.  These types of medications are usually first line defense during serious bipolar episodes and may be used alone or in combination with other mood stabilizers in bipolar mania (http://www.webmd.com).

Mood stabilizers generally enter the picture after a more serious episode has been addressed and are used for mood maintenance and to prevent relapse. Though lithium salts are most often prescribed for mood stabilization, many of the mood stabilizing drugs are also anticonvulsants. These work by calming hyperactivity in the brain in various ways. These are most commonly used in seizure related disorders like epilepsy. Anticonvulsants were first used to treat bipolar disorder when it was noticed that epilepsy patients taking them had improved mood.  They are often prescribed for people who have rapid cycling (http://www.webmd.com).

Lithium is one of the most common drugs for bipolar disorder. It is a naturally occurring metallic salt and has been used in medical practice for about 150 years. Lithium salts were first used to treat gout and its mood stabilizing affects were first utilized in the late 1800’s.  The way lithium works is not entirely clear, but it is probably due to its effects on other electrolytes such as sodium, potassium, magnesium, and calcium. Because it is a salt, it is important that patients have normal kidneys and thyroid if they are to take Lithium and have regular blood lithium monitoring to avoid toxicity (Raber 2010).  One of the most common and serious negative affects of taking lithium long term is kidney issue.  Due to the large amounts of lithium salts that clients generally take (600-2,400mg/day) the kidneys can easily become over loaded and have difficulty retaining water and sodium thus altering the sodium potassium balance. Often clients can combine lithium with another mood stabilizer to reduce the amount of lithium needed and reduce the affect to the kidneys.  It is extremely important for those on lithium to drink adequate amounts of water -  more than eight glasses a day- and have their blood lithium levels monitored. At least 30% of those taking lithium experience excessive thirst and urination. Considering a lower salt (but not no salt) diet may lessen the kidney load as well.  This is an area where dandelion leaf is recommended.  It is a diuretic, which is a contraindication for lithium use, and one study says that it may enhance other negative affects of lithium (http://www.umm.edu).  However, an herbal dosage in formula would be vastly lower than those used in experimental or clinical studies and should be considered generally safe in lower doses. It does not leach potassium further harming the kidneys like most diuretics and when used under the care of an herbal clinician who will monitor for any negative affects, it supports kidney function safely and effectively.  While the Nettle leaf, a vitamin and mineral rich green leafy plant, is a stronger diuretic the medicine of Nettle Seeds is a much safer and minimally diuretic specific for kidney healing.  It would be a great choice for building kidney strength and preventing nephron damage. Pam Fischer, director of the Ohlone Herbal Center and Clinic in Berkeley, California suggests the use of adaptogenic kidney tonic Guduchi.  She says that though it is very mildly diuretic as most kidney tonics are, it actually moistens the kidneys, drawing water to them instead of flushing them. Caffeine, as another mild diuretic, in long-term chronic use is known to exacerbate kidney problems. Avoiding or eliminating caffeine in coffee or soda, would not only help minimize simulating a manic episode but also help to reduce its impact on the kidneys.

A bipolar person should also be aware of their thyroid health. Studies have shown that there is a clear connection between hypothyroidism, especially autoimmune hypothyroidism and incidence of bipolarism, especially cyclothymic bipolarism.  There is also evidence that those bipolar people with a lower functioning thyroid even if their levels appear in the “normal range” are less likely to improve than those with higher levels of thyroid (Phelps 2009). Whether due to stress related disruption of the endocrine system taking its toll on the thyroid or the affects of lithium, this tiny organ will need special attention for the bipolar client.  Again, working with the endocrine system as a whole (the hypothalamus, pituitary and adrenals) with adaptogens will be the most important strategy.  Supporting the thyroid directly will also be necessary.  Fucus is a specific for low functioning thyroid and if there is a problem with low iodine, any seaweeds like, kombu or kelp will help increase iodine.  Coleus forsckoholii, an Ayurvedic herb, has traditionally been used for cardiovascular health and blood pressure regulation and recently has been shown to stimulate thyroid function.  A common dosage is 50-100mg TID of a 10-20% standardized extract.  It may have some antidepressant affects and so should be monitored with bipolar clients.   Certain other herbs known to help build the thyroid like Red Ginseng, Maca, or Gotu Kola may be too stimulating for bipolar clients and if added to a formula should be used with extreme caution.

Though lithium’s primary negative affects are on the kidneys and thyroid it also affects the liver, especially when used with other drugs.  The liver is our main metabolizing and detoxification organ and pharmaceuticals, especially at the bipolar dosages, will tax or damage the liver. They can also cause symptoms of liver deficiency like dry skin, eczema and allergies.  Hepatoprotectives like Oregon Grape Root, Yellow Dock and Milk Thistle are important additions for supporting the liver to take on the extra load and prevent liver damage.  In fact, Herbalist Matthew Wood testifies to using low dose Dandelion root, another liver herb, to help relieve the symptoms of bipolarism (Wood 2008). Reducing or eliminating other dietary liver toxins like alcohol is another way to reduce liver impact.  Many of the liver supportive herbs are also alterative and can help stimulate the body’s natural metabolism to remove toxins in the system.  Most alteratives like burdock, nettles, alfalfa, red clover and red raspberry leaf are gentle and safe tonics that are often best combined in a therapeutic tea that is drunk daily.  With the highly green nutritive herbs like nettles and alfalfa one should make sure to monitor for any diuretic affects while taking lithium.  If a client’s urination amount is regularly excessive for their liquid intake readjust the dosage or frequency or consider using other herbs.

In addition to a circle of professional support and assistance, the bipolar client will need other support in place for whatever therapies they are seeking out.  It is important for them to involve family and friends in an organized support network.  Often the bipolar person suffers alone or is reliant on one person like a partner for all their support.  This is often not sustainable for anyone in this scenario and can lead not only to further difficulties for the bipolar person but to alienating any existing support. Just like any health related matter, the bipolar client is in charge of their healing process.  There should be a clearly articulated directive from the bipolar person for their healing plan: strategies for daily mental health balance and support, what the bipolar person is doing on their own, and what they will need from their support system to help achieve this.  Developing a written plan for crisis (manic or depressive) is essential and making sure that the group has discussed and is clear about what the bipolar loved one does and does not want done in these situations (i.e. hospitalization is never ok or call my mother if I’m having a manic episode, etc) is crucial. In many friend and family circles of bipolar clients, there is a tendency for the support systems to be disorganized, take on too much, and to place the bipolar persons emotional needs above their own.  The support system should seek out education on bipolarism from qualified sources so they can begin to understand what is happening to their loved one.  Often for bipolar people, it is a daily struggle to simply remain functional in their emotional lives and many may need a lot of support to achieve this goal.  However, adult bipolar clients are the subjects of this paper and they are capable of making their own choices and taking responsibility for their lives.  It is not helpful to a bipolar person to not be held accountable for their actions or decisions.  When the support system focuses entirely on the supported person and has no plan for making sure that they are also getting their needs met it can lead to stress, anxiety or depression and also burn out, anger, blame and abandonment. They might think their problems are minor in comparison to what the bipolar loved one is coping with, but that doesn’t mean they are any less deserving of help and comfort.  It’s important for loved ones to build their own support system of people who will listen and be concerned about their well-being, including friends, relatives, and other professional healers.

Children are affected by a family member’s bipolar disorder or depression, even if they don’t understand exactly what is happening. They learn from observation very quickly when they are young and if they are not included in the discussion and support network for a bipolar family member they will devise their own coping skills that may have negative impacts on their development. It’s important to spend time with children, explain the situation and encourage them to share their feelings and questions. Talk to children at a level they can understand. Younger children might be satisfied with “Mommy (or other relative) doesn’t feel good right now but is getting help to feel better.” Older children may be given educational materials and encouraged to learn about bipolar disorder or depression and how they can help their family member. Reassure children that there will be someone to take care of them and that they are loved and prioritized by their family.  Parents should always apologize to children for any hurtful things they may have said or done during an episode of mania or depression and allow their children any reactions. Let children know their parent is working to keep these things from happening again. Appropriate child therapy models like, writing therapy, art therapy, play therapy and movement-based therapies may be helpful but it is important to emphasize that there is nothing wrong with them and that their family members disorder is not their fault.

A well-supported and organized circle of friends and family will enable the bipolar person to feel clearly supported and reduce the amount of stress and confusion for the whole group.  To help this process, it may be necessary for clinicians to see bipolar clients together with members of their support system or to see the support people separately. It is also appropriate to refer the loved ones to existing therapeutic support groups for friends and relatives of bipolar people. In helping the loved ones, adaptogens, nervines and adrenal tonics are useful because they will undoubtedly be undergoing heightened stress. Having loved ones keep a Mood Chart too may be helpful for their own tracking of emotional highs and lows and the situations that trigger them. Flower essence therapy may be one of the most important supportive measures that clinicians can utilize.  They are safe and have no interactions with any drugs or herbs and can be added to a family’s water, meals or spritzed into the air.  Many of the same flower essences that will be helpful for the bipolar client with also be helpful for their loved ones.  Using Self-Heal and Lotus Flower can start anyone off on the right foot with removing blocks that we put in the way of our own healing and instilling confidence in our own ability to heal.  Lotus also has a special affinity for bipolar people who can tend towards visionary or spiritual excess in that it can assist in learning the spiritual lessons of everyday life.  To ground in the path of healing Black Eyed Susan can help to accept that we need help and we need to heal.  Rock Rose can help both the supported and the supporters deal with the terror and panic of mental crises while Cherry Plum can be useful for the person who is displaying out of control or destructive behavior. To further protect against negativity on a psychic and psychological level and clear these poisoning affects from the body we look to Pennyroyal.  There are many essences for support in building and maintaining healthy boundaries, which can be extremely important for those supporting people with mental health issues.  Pink Yarrow enables us to maintain our self in all situations, helping those with a tendency to merge with other people or take on their issues to remember what is ours and what is theirs.  Essences of Rue or Ocotillo are the heavier hitters for psychic protection.  They are called on when we need to have major protection and act as psychic barbwire for our spirits.  The bipolar person may have difficulty trusting other people especially if they have been abused by the psychiatric industrial complex or been forced against their will into hospitalization.  Oregon Grape helps them to accept the love and good will of their support network and trust their intentions. Stress and exhaustion will play a huge part in all those involved in this work and many flower essences supply support and relief. For the supportive person who doesn’t know when to stop and pushes herself even when exhausted, Oak and Elm can be helpful.  Supportive people can often have an unbalanced need to care-take or serve others in need and Centaury can help bring balance.  Often since bipolar people are made reliant on psychiatrists and family members they can develop an over reliance on others advice.  Cerato aids them to make their own clear and confident decisions.  Simple lavender essence can be calming and rejuvenating when nervous tension leads to depletions and dandelion can help clear stress and anxiety that is held in the body and manifests as physical issues.  Of course, happiness, joy and fullness of life are important to any healing process.  Borage has been used to supply heart lightness and courage and optimism when facing difficulties.  Violet or Johnny Jump Ups provide springy, buyout joy and happiness while Mustard Flower can transform the gloom of depression into a balanced and contented happiness.  Lastly, for children helping them cope with a potentially dysfunctional family and the hurt is causes is a key affect of  Nettles flower essence.  These are but a few of the possibilities that you can call on from the flower essence repertoire and deep consultation with the individuals will reveal what specific needs they will have.

Whether due to over diagnosis or better diagnosis, an extreme rise in modern stress levels, environmental factors, dietary factors, genetic factors or any other reason, there is a consistent rise in the occurrence of bipolarism.  As an herbal clinician you will most likely see clients with this diagnosis and many of them will be seeking holistic help adjunct to their pharmaceutical therapies.  With the tools of the holistic Western herbalist  – in depth health and medical consultations, comprehensive constitutional and acute herbal formulas, diet, lifestyle, and supplementation evaluation and consultation, stress, mood and emotional evaluation, flower essences– combined with therapy and spiritual work, and a healthy and functioning support system, there is much to be offered the bipolar client.  These strategies combined can help to bring about a more full and secure sense of wellness for the bipolar person and hopefully lead to long lasting aid and support.

Footnotes: [1] Criteria for Major Depressive Episode (DSM-IV, p. 327) A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations. 1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). Note: In children and adolescents, can be irritable mood. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 4. Insomnia or hypersomnia nearly every day 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).  6. Fatigue or loss of energy nearly every day.  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.  Criteria for Manic Episode (DSM-IV, p. 332) A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary). B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 1.inflated self-esteem or grandiosity 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) 6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments) C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). E. The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

Bibliography

Mood Chart

Mood Chart and Diary Instructions

Ohlone Center of Herbal Studies Therapeutic Program

May 13, 2008

Introduction

Attention­ Deficit Hyperactivity Disorder (ADHD), also known by its older name, Attention Deficit Disorder (ADD), is distinctly a phenomenon of the late 20^th and early 21^st Centuries.  At no previous time in history have so many children been diagnosed with a psychiatric disorder and placed on medication on the basis of what could be characterized as unruly behavior.  Increasingly, children as young as three years old are being treated with stimulant medications.  ADHD is also a distinctly American phenomenon.  As of 1997, 90 percent of the Ritalin produced worldwide was consumed in the United States.¹ The rates of diagnosis are still much lower in Europe.

ADHD is classified as a neurological disorder, but it could just as easily be considered a neurological variant that is simply differently ordered.  People diagnosed with ADHD tend to creative, novelty­seeking types.  In the book Delivered from Distraction, Edward M. Hallowell, MD and John J. Ratley, MD describe ADHD as a “misleading name for an intriguing kind of mind.”² They go on to point out that it is a collection of symptoms, some positive, and some negative.  When it it impairs people’s lives, it becomes a disorder.  When people learn to manage the disorderly aspects, they can take advantage of their many unique gifts and talents.

The mainstream view of ADHD tends only to emphasize the negative aspects.  However, as Hallowell and Ratley point out, “The more you ephasize the downside, the more you create an additional pathology: a nasty set of avoidable, secondary problems, like shame, fear, and a sharply diminished sense of what’s possible in life.” Some of the upsides of ADHD include “originality, creativity, charisma energy, liveliness, a unusual sense of human areas of intellectual brilliance and spunk.”³

It is not clear that ADHD is always maladaptive or that, from an evolutionary standpoint, it should be considered pathological.  Nevertheless, it is a set of tendencies that does have significant disadvantages in today’s society, and these can cause significant difficulties for people attempting to cope in with modern life.  Regardless of whether genetics or our present environment are the cause of this, this can lead to significant distress that certainly should not be considered a normal and necessary part of human existence.  Herbal practitioners view health not simply as the absence of pathology, but as complete mental a physical well­being, and this is the standpoint from which I will be approaching ADHD.  As long as there is distress, then there is literally “dis­ease,” and it is the herbalist’s responsibility to address this.

For the sake of simplicity, although it could be debated whether ADHD is a true pathology or disorder, I am going to refer to it throughout this paper by its conventional name, ADHD.  Although this paper is geared towards herbalists and herbal students, I have attempted to make it at least somewhat accessible to medical professionals and the general public as well, so in places I elaborate a bit on things that would be obvious to someone with a basic knowledge of herbalism.

Background

ADHD is classified as a neurodevelopmental behavioral disorder (it has neurological, developmental, and behavioral aspects).  ADHD becomes apparent in some children in preschool and early school years.  These children may have a hard time controlling their behavior and/or paying attention.  The onset of some symptoms may occur before others.  The National Institute of Mental Health (NIMH) estimates 3 to 5 percent of all children in the U.S., or 2 million total, have ADHD.  In a classroom of 25 to 30 children, there would likely be at least one child with ADHD.

Since doctors in the United States do not have to report their diagnosis, the actual number of cases may be much higher.  Hallowell and Ratley think that in a random sample of children, 5 to 8 percent might have ADHD.⁴ Harvard ADHD researcher Joseph Biederman, puts this estimate even higher, at around 10%.⁵ There is also a wide gender gap: four out of five children with ADHD are boys.

ADHD is not only a childhood issue.  Many adults also cope with the symptoms of ADHD.  For 30 to 40 percent of children, their symptoms will disappear at the onset of puberty.  For the other 60 percent, ADHD will continue on into adulthood.  ADHD is considered a persistent, chronic condition, for which there is no cure.

In those with ADHD, learning disabilities, Tourette’s syndrome, Oppositional Defiant Disorder, Conduct Disorder, Anxiety, Depression, and Bipolar Disorder are all much more common than in the general population.

Symptoms

The symptoms of ADHD are divided into three groups: inattention, hyperactivity, and impulsivity.  Many normal children have these symptoms at a low level.  However, in children with ADHD hyperactivity, distractability, and poor concentration have significant negative impacts on school performance, social relationships, and behavior at home.

Inattention may manifest as follows:  Children with symptoms of inattention may have a hard time keeping their mind on a task and may get bored after only a few minutes.  Adults may have trouble focusing on task without becoming distracted as well.  This can also manifest as disorganization and forgetfulness.  However, this is not a complete deficit of attention:  People with ADHD do have great ability to focus on things of interest to them.  It is a popular misconception that, if you can pay attention to things when you are interested in them, then you must not have ADHD.  It is paying attention to things that one does not find interesting that is much harder for those with ADHD.

Hyperactivity and impulsivity may manifest as follows:  Children with symptoms of hyperactivity may be constantly in motion.  Teenagers or adults may feel internally restless.  Children with symptoms of impulsivity may be unable to curb their immediate reactions and to think before acting.  Even teenagers and adults may do things with small but immediate payoffs, rather than engaging in activities that take more effort, but have greater, delayed rewards.

Diagnosis

There is no definitive, objective, physical test for ADHD.  Instead, the diagnosis is made by a professional, based on a number of criteria.  The DSM­IV defines eighteen symptoms, of which six must must be present in order to qualify for a diagnosis of ADHD.  It defines three different patterns of behavior that indicate ADHD: predominantly hyperactive type, predominantly inattentive type, and combined type.  Those of the predominantly hyperactive type have predominantly symptoms of hyperactivity and impulsivity.  Those of the predominantly inattentive type have predominantly symptoms of inattention.  Those of the combined type have significant symptoms of hyperactivity and impulsivity, as well as inattention.

Not everyone who has these symptoms would qualify for a diagnosis of ADHD.  These behaviors must be demonstrated to degree inappropriate for the person’s age.  They must appear early in life, before age seven, and continue for at least six months.  They must also create a real handicap in at least two areas of a person’s life.

The diagnosis of ADHD may be made by a psychiatrist, psychologist, pediatrician, family physician, neurologist, or clinical social worker.  In making the diagnosis, the professional first attempts to rule out any other potential causes the symptoms.  The professional then interviews a child’s teachers and parents, and other people who know the child well.  For adults this can be a little more difficult, as it is necessary to go back through a person’s childhood history in order to establish patterns of behavior.

Physiology

There are significant anatomical and developmental differences in the brains of children with ADHD.  ADHD children have 3 to 4 percent smaller mass in the frontal lobes, temporal gray matter, caudate nucleus, and cerebellum than those without ADHD.  Those treated with medication have a similar amount of white matter to those without ADHD.  However, those not on medication have an smaller amount of white matter.  In children with ADHD, there is lag in development of the prefrontal cortex of three to five years.

It is theorized that differences in the functioning of neurotransmitters plays a role in ADHD. Either those with ADHD do not produce as many of certain neurotransmitters, or else they do not respond to as strongly.

The main neurotransmitter implicated is dopamine, and several possible genes have been identified that may play a role in dopamine differences in ADHD.  Dopamine affects feelings of happiness and satisfaction.  When you have enough dopamine, you feel satisfied.  ADHD may amount in part to a “reward deficiency syndrome,” in which lower levels of dopamine create the constant need for stimulation.⁶ Dopamine is most strongly connected to hyperactivity­impulsivity symptoms.

Another neurotransmitter implicated is norepinephrine.  Norepinephrine makes you feel alert, motivated, and energetic.  Norepinephrine is most strongly connected to inattention symptoms.

GABA may be another neurotransmitter that may be involved.  GABA is the brain’s main inhibitory neurotransmitter, and has calming effects.  A deficiency causes anxiety, restlessness, and obsessive behavior, all symptoms sometimes seen in ADHD.

It is not clear whether these neurotransmitter differences have causes on the molecular level or are merely the result of higher­level differences in neurological functioning.

Causes

ADHD cannot be neatly categorized as either a genetic disorder or an environmentally induced disorder.  Although genetics do seem to be the single most significant determining factor, genetics are not the only cause of ADHD.  There are probably several different causes, and many of these could be characterized as an interaction of both genetic and environmental factors.

Genetics

ADHD is a highly heritable disorder.  According to mainstream sources, genetic variation accounts for approximately 80 percent of the causes of ADHD, with environmental factors, such as trauma or toxic exposure accounting for 20 percent.  According to The National Institute of Mental Health (NIMH), 25 percent of close relatives in families of ADHD children also have ADHD, as opposed to 5 percent of the general population.

Nutrition

Nutritional issues may play a huge role in ADHD.  After genetics, diet may be the second most important factor.  Nutritional deficiencies and excesses, as well as food sensitivities can have a huge impact on ADHD symptoms.

Blood sugar issues are one of the most important of these nutritional factors.  Studies have shown that children with hyperactivity problems eat more sugar than other children.⁷ The problems that these children have with sugar do not seem to be a form of food sensitivity.  Rather, they are related to blood sugar regulation.  Hypoglycemia, which is normally unusual in children, is usual in children with ADHD.⁸ A study of 265 hyperactive children found more than three­quarters displayed abnormal glucose tolerance.⁹ Hyperinsulinemia has also been linked to ADHD,¹⁰ and to the extent that it is influenced by diet at least, ADHD could arguably be considered an offshoot of Metabolic Syndrome/Syndrome X.

What happens when the body is overloaded with simple sugars is a blood sugar peak, followed by a subsequent crash.  Since glucose is the main fuel for the brain, when blood sugar levels fluctuate widely, so will concentration, focus, and behavior.  Blood sugar peaks may cause hyperactivity; the crashes may cause attention problems.

It is also important to point out that is not just simple sugars as such that are the problem. Rather, it is high glycemic load.  A high­carbohydrate diet, whether it is based on sugary treats or whole grains, still has a high glycemic load.  This is arguably not very good for anyone, and may pose particular problems for those with a tendency attention problems and hyperactivity.

Similarly, a low­protein diet can cause ADHD symptoms.  This may also relate to blood sugar issues, since protein helps reduce the glycemic load of a meal, leading to better blood sugar regulation. In addition, it could be because deficiencies in specific amino acids, for which ADHD sufferers may have a greater need (based on variations in their genetics).

Other nutritional deficiencies can also cause of ADHD symptoms or contribute to them.  One of the most important of these is a deficiency in essential fatty acids, including the omega­3 fatty acids DHA and EPA, and the arachidonic acid (an omega­6 fatty acid), which are precursors to prostaglandins used for communication by the brain.  ADHD sufferers may have a greater need for these fatty acids.  This could be because their absorption is poor.  It may also be because they simply do not convert them into prostaglandins as well.  Part of this could be genetic.  Other dietary factors could also come into play.  Nutrient deficiencies that hinder conversion of essential fatty acids into prostaglandins include Vitamin B3, Vitamin B6, Vitamin C, biotin, zinc (a common deficiency in ADHD sufferers), and magnesium.

Research at Purdue University confirmed that children with ADHD had inadequate intake of nutrients required for the conversion of essential fatty acids to prostaglandins.  They had lower levels of had lower levels of EPA, DHA, and arachidonic acid.  Supplementation with these three fatty acids and GLA (an omega­6 fatty acid) reduced their symptoms.¹¹

Some people with ADHD are sensitive to salicylates, from both natural sources (such as foods and herbs) and from drugs.  A study at the University of Sydney, Australia found that 75 percent of children with ADHD reacted negatively in double­blind challenge to foods with salicylates.¹² Salicylates block the conversion of essential fatty acids into prostaglandins, which may be the mechanism of this sensitivity.

Deficiencies in nutrients involved in the production of norepinephrine can also present symptoms like those of ADHD.  Some of these nutrients include magnesium, manganese, iron, copper, zinc, Vitamin C, and Vitamin B6.¹³ Magnesium may be especially important.  Magnesium deficiency sypmtoms deficiency symptoms include excessive fidgeting, anxious restlessness, coordination problems, and learning difficulties, despite having a normal IQ.  Polish researchers examining the magnesium status of 116 children with ADHD found a deficiency occurred more frequently than in healthy children (95% of those with ADHD were deficient).  They also found a correlation between magnesium levels and severity of symptoms.  Supplementation of with 200 mg of magnesium for six months, improved the children’s magnesium status and significantly reduced their hyperactivity symptoms, which worsened in the control group.¹⁴

One way in which children may become deficient in important nutrients involves repeated courses of antibiotics in early childhood. In a study of 350 hyperactive children at the University of Surrey in England, a significantly higher percentage of children with ADHD were found to have taken several courses of antibiotics in early childhood than those without ADHD.  Further investigations found that children who had taken three or more courses of antibiotics before the age of three had significantly lower levels of zinc, calcium, chromium, and selenium.¹⁵

Food allergies and sensitives can also be an important factor in ADHD, a fact which has for the most part been accepted in the mainstream medical community.  Reactions to foods can cause both hyperactivity and difficulties with attention.  70 percent of children with ADHD react to food additives,¹⁶ and a study by Dr. Joseph Bellanti at Georgetown University found that 56 percent of children with ADHD tested positive for food allergies compared to 8 percent of controls.¹⁷ Another study by the Hyperactive Children’s Support Group found that 89 percent of children with ADHD reacted to food colorings, 72 percent to flavorings, 60 percent to MSG, 45 percent to all synthetic additives, 50 percent to cow’s milk, 60 percent to chocolate, and 40 percent to oranges.¹⁸

Chemical food additives in general seem to be problematic for many of those with ADHD. Some of the additives that can cause problems include preservatives such as BHA and BHT, flavorings such as MSG, artificial colors, and nitrates.  The yellow food dye tartrazine (E102) has been particularly problematic for those with ADHD.  In a double­blind, placebo­controlled study by Dr. Neil Ward, emotional and behavior changes were found in every child who consumed tartrazine.  The additive also reduced blood levels of zinc by increasing the amount excreted in the urine.¹⁹

Some of the foods that have caused a high incidence of allergic reactions, contributing to ADHD symptoms include dairy, wheat, corn, chocolate, citrus, yeast, soy, peanuts, and eggs.  Some of the associated symptoms linked to food allergies include nasal problems, excessive mucus, ear infections, facial swelling and discoloration around the eyes, tonsillitis, digestive problems, bad breath, eczema, asthma, headaches, and bedwetting.²⁰

Toxic Exposure

Some other factors which can cause ADHD symptoms are toxic elements and excess anti­nutrients.  The biggest problem here here is lead poisoning, which produces symptoms of aggression, poor impulse control, and short attention span.  Another problem is excess copper, which is found in some children with ADHD.  Studies have also linked high levels of aluminum with hyperactivity as well.  Many toxic elements deplete body of essential nutrients, such as zinc, and contribute to nutritional deficiencies.²¹

Environmental stress from pollutants may also play a role in ADHD.

Pregnancy Issues

Smoking and alcohol use during pregnancy can produce ADHD­like symptoms.  Prenatal trauma and oxygen deprivation at birth are also possible causes.

Injury

A small percentage of cases of ADHD may be caused by injuries to the brain.

Social Environment

Growing up in impoverished or abusive families may produce symptoms like those of ADHD. Recent research also suggests that watching too much television may permanently rewire the brain, reducing attentive capacity.²²

Conventional Treatment

Conventional treatments for ADHD fall into the class of medications and behavioral therapies. According to a study at the National Institute of Mental Health (NIMH), the most effective treatment was shown to be a combination of medication and behavioral treatments.  NIMH stresses that no single treatment is the answer for everyone, and different forms of treatment will work better for different people.  Despite this, in practice, large numbers of children in the United States end up being treated with stimulant medications alone, often by busy family physicians with little specialized knowledge of ADHD.

The main problem with this from a constitutional herbal perspective is that these medications stimulate the body’s adrenal stress response, creating a permanent state of stress and pushing and individual out of a state of constitutional balance.  These medications generally work by inhibiting the reuptake of dopamine and norepinephrine in the neural synapses; this leads to greater amounts of these neurotransmitters.  One of the results of increased levels of norepinephrine is stimulation of the adrenal gland, which in turn secretes greater amounts of stress hormones.  This in turn stimulates the sympathetic nervous system, which reduces the functioning of many organ systems not needed in a crisis situation (such as the digestive system).

In Michael Moore’s constitutional system of herbalism, most forms of physical imbalance center around some form of adrenal stress pattern.  The way we deal with this is by using adaptogenic herbs, which help reduce and modulate the effects of the body’s overactive stress response.  (Adaptogenic herbs will play a big role in the herbal treatment of ADHD, as I will go on to explain later.)  Stimulant medications have the exact opposite effect, an effect which could be described as anti­adaptogenic. This is not a good thing by any means.  The body’s stress response is meant to be turned on for a short amount of time, and then to turn off.  Chronic overstimulation of the body’s stress response mechanism can lead to all sorts of health problems.

All of the commonly used non­stimulant medications for ADHD inhibit the reuptake of norepinephine as well, and presumably they work similarly in terms of their effect on adrenal stress response.  They have some of the same side effects as the stimulant medications, such decreased appetite and insomnia, symptoms of an overactive adrenal gland and sympathetic nervous system.

Stimulant Medications

There are several stimulant medications approved in the United States for the treatment of ADHD.  These are all classified by the DEA as Schedule II Controlled Substances, indicating the highest potential for abuse of all substances with a recognized medical use.  With long­term use, these medications may cause dependency.  Aside from their overstimulation of the body’s stress response, the potential for abuse and addiction is the biggest problem with these medications.

Some of the general side effects of this class of medications are as follows:  By far the most common side effect of these medications is appetite suppression.  Less frequent side effects include headache, elevated blood pressure, elevated heart rate, nausea, vomiting, insomnia, tics or twitching, feelings of jitteriness or anxiety, feelings of agitations or even mania, and feelings of depersonalization or paranoia.

The following is a summary of the main stimulant medications used for ADHD:

Amphetamine/Dextroamphetamine Brand Names: Adderall, Dexedrine Mechanism of Action: norepinephrine and dopamine reuptake inhibitors Side Effects:

• More common: anxiety; crying; depersonalization; dry mouth; dysphoria; euphoria; fast, pounding, or irregular heartbeat or pulse; hyperventilation; irritability; mental depression; nervousness; paranoia; quickness to react or overreact emotionally; rapidly changing moods; restlessness; shaking; and shortness of breath; trouble in sleeping
• Less common: chills; cold and flu­like symptoms; cough or hoarseness; difficult or labored breathing; lower back or side pain; painful or difficult urination; tightness in chest; wheezing; constipation; cramps; diarrhea; difficult, burning, or painful urination; difficulty in speaking; dizziness or lightheadedness; dryness of mouth or unpleasant taste; fast or pounding heartbeat; frequent urge to urinate; headache; heavy bleeding with menstrual period; inability to have or keep an erection; increased sensitivity of skin to sunlight; increased sweating; itching, redness or other discoloration of skin; loss of appetite; lower back or side pain; nausea or vomiting; pain; severe sunburn; sleepiness or unusual drowsiness; stomach cramps or pain; tooth disorder; twitching; weight loss

Dexmethylphenidate Brand Name: Focalin Mechanism of Action: norepinephrine and dopamine reuptake inhibitor Side Effects:

• More common: fear; nervousness; acid or sour stomach; belching; dry mouth; headache; heartburn; indigestion; stomach discomfort, upset, or pain; loss of appetite; nausea; throat pain; weight loss
• Less common: fast, pounding, or irregular heartbeat or pulse, Fever; sleeplessness; trouble sleeping; twitching; inability to sleep

Methylphenidate Brand Names: Ritalin, Concerta, Metadate ER, Metadate CD Mechanism of Action: norepinephrine and dopamine reuptake inhibitor Side Effects:

• More common: Fast heartbeat; increased blood pressure; loss of appetite; nervousness; trouble in sleeping
• Less common: chest pain; fever; joint pain; skin rash or hives; uncontrolled movements of the body; anger; dizziness; drowsiness; fear; headache; irritability; nausea; nervousness; scalp hair loss; stomach pain; talking, feeling, and acting with excitement; inability to sleep

Pemoline Brand Name: Cylert Mechanism of Action: Pemoline has pharmacological activity similar to that of other known central nervous system stimulants; however, it has minimal sympathomimetic effects.  Studies indicate that pemoline may act in animals through dopaminergic mechanisms; the exact mechanism and site of action of the drug in humans is not known.

Side Effects:

• More common: Loss of appetite; trouble in sleeping; weight loss
• Less common: dizziness; drowsiness; headache; increased irritability; mental depression;

stomachache Warnings: Pemoline can cause hepatic failure.  This is a rare, but life­threatening situation, and the FDA has discouraged the use of pemoline as a first­line agent for ADHD for this reason.

Non­Stimulant Medications

The following is a summary of some of the non­stimulant medications used for ADHD:

Atomoxetine Brand Name: Strattera Mechanism of Action: norepinephrine reputake inhibitor Side Effects:

• More common: acid or sour stomach; belching; bleeding between periods; change in amount of bleeding during periods; change in pattern of monthly periods; cough ; decreased appetite; decreased interest in sexual intercourse; decrease in frequency of urination; decrease in urine volume; difficulty having a bowel movement (stool); difficulty in passing urine [dribbling]; dizziness; dry mouth; fever; headache; heartburn; heavy bleeding; inability to have or keep an erection; indigestion; irritability; loss in sexual ability, desire, drive, or performance; nausea; painful urination; pain or tenderness around eyes and cheekbones; shortness of breath or troubled breathing; sleepiness or unusual drowsiness; sleeplessness; stomach discomfort, upset, cramps, or pain; stuffy or runny nose; tightness of chest or wheezing; trouble sleeping; unable to sleep; unusual drowsiness, dullness, tiredness, weakness or feeling of sluggishness; unusual stopping of menstrual bleeding; unusual tiredness or weakness; vomiting
• Less common: hives or welts; irregular heartbeat; itching; large, hive­like swelling on face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs; redness of skin; skin rash; abnormal dreams; abnormal orgasm; back pain; blistering, crusting, irritation, itching, or reddening of skin; bloated, full feeling; burning, crawling, itching, numbness, prickling, ”pins and needles” or tingling feelings; change in hearing; change or problem with discharge of semen; chills; cold sweats; confusion; cough; cracked, dry, scaly skin; crying; decreased weight; diarrhea; difficulty in moving; dizziness, faintness, or lightheadedness when getting up from lying or sitting position; ear drainage; earache or pain in ear; excess air or gas in stomach or intestines; feeling of warmth redness of the face, neck, arms and occasionally, upper chest; feeling unusually cold; frequent urination; general feeling of discomfort or illness; groin pain; increased or sudden sweating; joint pain; loss of appetite; mood swings; muscle aches, cramping, pains, or stiffness; pain or burning with urination; passing gas; shivering; sinus headache; sleep disorder; swelling of skin; swollen joints; swollen, tender prostate

Warnings: Atomoxetine is associated with increased incidence of suicidal thoughts in children an adolescents.  The FDA recommends careful monitoring of any psychological symptoms.

Bupropin Brand Name: Wellbutrin Mechanism of Action: Bupropin is an antidepressant of the aminoketone class.  It is chemically unrelated to tricyclic, tetracyclic, selective serotonin re­uptake inhibitor, or other known antidepressant

agents.  Its exact mechanism of action is unknown, but it is a weak inhibitor of the neuronal uptake of norepinephrine and dopamine.

Side Effects:

• More common: agitation; anxiety; abdominal pain; constipation; decrease in appetite; dizziness; dryness of mouth; increased sweating; nausea or vomiting; trembling or shaking; trouble in sleeping; weight loss (unusual)
• Less common: buzzing or ringing in ears; headache (severe); skin rash, hives, or itching; blurred vision; change in sense of taste; drowsiness; feeling of fast or irregular heartbeat; frequent need to urinate; muscle pain; sore throat; unusual feeling of well­being

Venlafaxine Brand Name: Effexor Mechanism of Action: strong inhibition of reuptake of serotonin and norepinephrine, weak inhibition of dopamine

Side Effects:

• More common: changes in vision, such as blurred vision; headache; high blood pressure; abnormal dreams; anxiety or nervousness; chills; constipation; decrease in sexual desire or ability; diarrhea; dizziness; drowsiness; dryness of mouth; heartburn; increased sweating; loss of appetite; nausea; stuffy or runny nose; stomach pain or gas; tingling, burning, or prickly sensations; trembling or shaking; trouble in sleeping; unusual tiredness or weakness; vomiting; weight loss
• Less common: chest pain; fast or irregular heartbeat; mood or mental changes; ringing or buzzing in ears; change in sense of taste; muscle tension; yawning

Non­Medication Treatments

Other, non­medication treatments that are part of the conventional treatment protocol for ADHD are as follows:

• Psychotherapy can help people like and accept themselves despite their disorder and deal with related emotional issues.
• Behavior therapy can help people develop more effective ways to deal with immediate issues.
• Social skills training can help people learn new behaviors.
• Parenting skills training can help the parents of children with ADHD learn techniques for managing their child’s behavior
• Education and professional coaching can help adults with ADHD find ways to emphasize their strengths and strategies to deal with their weaknesses.

Controversies

ADHD is a condition that had generated much controversy.  Some people still insist that it does not even exist, while others question its conventional understanding.  It would be impossible for me to summarize all the controversies related to ADHD here.  However, here are some of what I think are the most relevant criticisms of the mainstream view:

Criticisms of Classification and Diagnostic Criteria

The diagnostic criteria for ADHD have been widely criticized for being overly subjective and arbitrary.  It is not clear why six symptoms must be present for a diagnosis, rather than five or seven. This seems to be a purely arbitrary dividing line.  Rather than looking at ADHD as condition that one either has or does not have (like pregnancy), it probably makes much more sense to look at it as part of a continuous spectrum of varying neurological functioning, at which someone with no symptoms of ADHD is on one end and someone with every symptom would be on the other.  There is evidence that people do in fact fall at every point along this spectrum without any particular clustering at certain points.  There definitely are people with “ADHD tendencies” who would not qualify as having full­blown ADHD.

Another criticism is that the diagnosis is based on the severity symptoms, which is rated entirely subjectively, often by individuals like teachers, with no formal training in making a psychiatric diagnosis.  Often, this is based on questionnaires that ask people to rate symptoms on a numerical scale, such as zero to three.  However, there are no objective criteria given that would give any insight into how severe a behavior would have to be to qualify, for example, as a “two” rather than a “three.” Those answering the questionnaires are left to wonder where the dividing line between “very sqirmy” and “somewhat squirmy” is supposed to be.  As Aviva and Tracy Romm put this in their book ADHD Alternatives, how many squirms are too many?²³ The criteria for diagnosis would not seem to be very solid, as they are based on the subjective perceptions of teachers, parents, and other laypersons.

Yet another criticism is that this set of diagnostic criteria is merely an arbitrary collection of symptoms without much in common, which may have entirely different causes.  This criticism questions whether the inattentive and hyperactive symptoms of ADHD truly have a common cause, and whether it makes sense to group them together in one disorder with three different subtypes.  It may make more sense to view the inattentive and hyperactive symptoms as two different syndromes with a possible overlay, rather than the result of a single cause.  Again, the way this is presently defined seems arbitrary.

Pathology or Variant?

Another criticism of the conventional understanding of ADHD is that it does not meet the criteria of a pathology or a disorder, and is better understood as simply a neuropsychological variant. From an evolutionary frame of reference, it is not at all clear that the set of tendencies described as ADHD are abnormal or maladaptive.  One would expect natural selection to eliminate most of the genes responsible for a condition that lead to significant impairment and had no counterbalancing advantages.  One would expect the incidence of to be somewhere around 0.5 percent of the population. ADHD, however, has an incidence of somewhere between 3 to 5 percent, by low estimates, and 10 percent, by high estimates, a figure out of line for a genetic abnormality.

One theory for the persistence of the ADHD phenotype is that these symptoms may represent biologically based traits that served people in prehistoric environment.  In the dangerous, food­scarce evolutionary environment, hyperactivity would have fostered effective exploration of potential threats and opportunities.  Rapidly shifting attention and impulsive responses would have aided in locating threats and defending against them.²⁴

A more complex theory attempts theory of the evolutionary reason for these traits attempts to explain why ADHD­like traits only occur in a minority of the population in every geographic location where they are observed.  If those with ADHD­like traits were simply better adapted to the evolutionary environment, this theory holds, natural selection would select for such traits, eventually one would expect to see them present in nearly the entire population.  The simple theory that these are adaptive traits does not explain why they always occur in a minority of the population.

An alternate explanation is that although these traits are individually impairing, and would be selected against on the individual level, it nonetheless benefited groups of humans in the evolutionary environment to have individuals with a wide variation of neurological types, including those with ADHD tendencies.  In this theory, such traits are the result of group selection: although within a group, individuals with such traits would be at a disadvantage, groups that had a minority of individuals with those traits would be at an advantage.  Therefore, groups with ADHD­like individuals would persist.

One of the ideas behind this theory is group exploration activities, such as foraging for food, were characterized by risk­taking, in which the costs were borne mostly by individuals, and information­sharing, in which the benefits accrued to the group.  In order for such activities to succeed, there needed to be some sort of motivating factor that compelled people to take individually risky actions with group payoffs.  ADHD­like tendencies could be seen a such a motivating factor.  The ADHD type of person is compelled to risk­taking, novelty­seeking behavior.  Such individuals might have been extremely useful to groups foraging for new food sources in the prehistoric environment, even if they occasionally engaged in risks that were costly on an individual level.²⁵

Based on this theory, the difficulties that people with ADHD have coping with modern life are not simply the result of our modern environment.  They are, in fact, real difficulties, based on differences in cognitive functioning.  However, simply medicating away these tendencies in order to allow people to function better would be very harmful to society as a whole.  It might get rid of some of our most creative and innovative thinkers.  A better approach would be for society simply to provide support such individuals, not expecting them necessarily to function as highly in all areas as everyone else, while at the same time valuing their unique contributions in terms of innovation and exploration.

Natural Treatment

The natural treatment for ADHD centers around treating the person as a whole, rather than the pathology.  This approach is especially suited for a nebulous neuropsychological syndrome like ADHD, where there are probably as many different underlying causes as there are individual symptom pictures.  Compared to the conventional medical treatment, which centers around small handful of different medications (mostly stimulants), the natural approach is far less one­size­fits­all and offers a wide array of different options.  There are nearly as many different herbs available as there individual symptom pictures, and by combining herbs in an individualized formula, it is possible for a treatment to be much more targeted to the individual.

By treating the person as a whole, rather than just focusing on the pathology in a limited sense, a natural treatment for ADHD can be more effective still.  A natural approach has much more to to offer than the conventional treatment, in terms of supporting general health and well­being, and in helping the individual cope with stress, which can impact attention, focus, and hyperactivity in important ways.  By dealing with individual’s mind­body health holistically, rather than dealing with each issue in isolation, a natural approach is able to offer a much more well­integrated and complete treatment.

The very foundation of this holistic approach is proper nourishment.  Nutritional factors can play huge role in ADHD, and changes in diet alone can make much bigger difference than any other intervention.  Herbs should be viewed as a secondary treatment that build on top of this foundation. Stress, lifestyle factors, and a sleep can all be important as well.

In addition to dietary changes and herbs, there are some other modalities of treatment that can be useful as well.  There are many nutritional supplements that can have a positive impact on ADHD symptoms.  Flower essences may help deal with emotional factors that may impact attention and hyperactivity.  Some practitioners of natural medicine, like Jane Oelke, ND swear by homeopathic treatments for ADHD, as well, but this is beyond the scope of this paper, and I will not discuss it further here.²⁶

It is also important to point out that the distinction between conventional and natural treatments is not an either­or proposition.  Natural treatments do not necessarily need to be used as an alternative to the conventional treatment to be effective.  They will still do some good when used as a complementary therapy, in conjunction with medication.

Addressing the Root Causes

An effective natural treatment for ADHD depends on properly identifying the causes of the problem.  Aside from genetic variations in neuropsychological functioning, there several other possibilities, including a wide array of nutritional issues, the possibility of toxic exposure, possible brain injuries, and factors related to the social environment.  All of these possibilities need to be considered, and those issues identified need to be dealt with appropriately.  Other conditions that can present symptoms similar to those of ADHD need to be ruled out as well.

As opposed to the conventional treatment approach, which is primarily concerned with a reduction in symptoms, the natural approach seeks to address these issues on the deepest level possible

– preferably at the root causes.  Because of this, identifying causes of the symptoms takes on additional importance in a natural approach.

While conventional treatments may amount to mere “health maintenance” that must continue for the rest of the patient’s life, by addressing issues on a deeper level, the natural approach is able to create more fundamental improvements.  By addressing nutritional issues, it is possible to remove some of the actual biochemical deficits that were causing ADHD symptoms, returning the body to a proper state of functioning with no side effects.  In addition, through the long­term use of tonifying herbs, such as adaptogens, it is possible to create lasting improvements in ADHD symptoms that persist even when the herbal treatments are discontinued.

Dealing with nutritional issues is fairly straightforward.  Any deficits or excesses in the diet need to be identified and dealt with.  Food sensitivities and allergies need to be identified, and problem foods need to be removed from the diet.  Toxic exposure can be identified through lab tests for things like lead, and if detected, then the environmental source of exposure needs to be dealt with.  Brain injuries can usually be identified from past medical history.  An approach for that would probably involve nervous system tonics, such as St. John’s Wort (Hypericum perforatum), but is beyond the scope of this paper.

A mismatch between genetics and our present environment can be a bit of a trickier issue to deal with at the root level – there is no natural way to change somebody’s genetics.  Arguably, the best way to deal with this would be to change society and the way it treats people with ADHD­like tendencies, but a change of social setting may not be a realistic option on the individual level.  It can be debated whether or not ADHD is pathological or maladaptive from an evolutionary standpoint, and whether the problem truly lies with people’s genes or their present environment – regardless ADHD symptoms can make it difficult to cope with living in today’s society, and can lead to a great deal of stress.

As holistic health practitioners, it is not our role to judge whether or not people’s brains ought to be functioning the way they are – rather it is our responsibility to help people cope with the problems that they are having and help them achieve greater overall mind­body health, regardless of the causes. Herbs can help children and adults achieve greater mental focus, calm down hyperactivity, and reduce stress.  Focusing on nutrition can ensure that people’s diet does not negatively interact with their genetic tendencies and make their symptoms even worse than they would otherwise be.

Nutritional Treatment

The nutritional treatment of ADHD is the cornerstone of a natural treatment approach, and is by itself the single most effective intervention available.  An analysis by Dr. Humphrey Osmond of a study by Dr. Bernard Rimland found that vitamin supplementation had a relative efficacy ratio approximately 18 times better than stimulant drugs.  (The “relative efficacy ratio” is the number helped by a given treatment divided by the number worsened.)²⁷ In study by Abram Hoffer, a pioneer of orthomolecular medicine, large amounts of Vitamin C (3 g), and Vitamin B3 (1.5 g or more) significantly improved the behavior of 32 out of 33 children with ADHD.²⁸

Even without supplements, improving diet can lead to significant improvements in behavior. This was confirmed by in a study by Dr. Stephen Schoenthaler at the Department of Social and Criminal Justice at California State University on the link between poor diet, nutrient status, and bad behavior.  In several placebo­controlled trials, in different states, involving over a thousand long­term young offenders, improvements in their diet were found to improve their behavior by 40 to 60 percent. Blood tests showed that approximately one­third of the participants had low levels of vitamins and minerals before the trial, and those whose levels had become normal by the end had a 70 to 90 percent improvement in behavior.²⁹

The foundation of the nutritional treatment for ADHD involves improving diet.  There are some supplements that may be useful, but you should always think about trying a whole foods approach first. It is much better to start with a good diet, and then to address any additional needs that may be present, than to start with poor diet and to try to address all of the resulting deficiencies.

Diet for ADHD

One of the most important things in a diet for ADHD is to eat whole, natural, unprocessed foods, free artificial additives.  This is important because of the sensitivity of many ADHD sufferers to chemical food additives.  It is also important to identify food allergies and sensitives and to eliminate these problematic foods.  This can be done through an elimination diet, in which potentially allergenic foods are eliminated for two weeks, and then carefully reintroduced, one at a time.  These foods include include dairy products, gluten­containing grains, legumes (including peanuts and soy), citrus, yeast, and eggs.  Because this is not conclusive, it is also good to have an IgG blood test.  (Most food intolerances are IgG mediated, but some are also IgE mediated, so it is good to have an IgE test as well.) Up to 90 percent of hyperactive children benefit from eliminating foods that contain artificial colors, flavors, and preservatives, processed and manufactured foods, and problematic foods identified by an exclusion diet or blood test.³⁰

Because blood sugar issues also have a big impact on ADHD, it is also important to eat a diet with a low glycemic load (those with ADHD benefit from the same diet that helps diabetics and others with insulin resistance issues).  The glycemic load of a meal is the total grams of carbohydrates times the glycemic index, an measure of how quickly each gram of carbohydrates raises blood sugar levels. The glycemic index differentiates between simple sugars (which raise blood sugar quickly), complex starches (which do so more slowly) and indigestible fiber (which do not raise blood sugar levels at all, and actually slow down the digestion of other carbohydrates).

The glycemic index is an older way of looking at blood sugar issues, and it is still common advice to eat more complex and fewer simple carbohydrates.  However, this advice is overly simplistic. The type of carbohydrates eaten does not matter so much as the total impact on blood sugar levels. Eating a high­carbohydrate diet is still going to raise blood sugar levels a lot, even if the glycemic index of those carbohydrates is fairly low.  Because of this, the glycemic load was devised as a more accurate measure of the potential of a food to raise blood sugar levels.  The higher the glycemic load of a serving of food, the easier it is to eat enough of that food to raise blood sugar levels to problematic levels.

Both the glycemic load of individual meals and the total daily glycemic load are important. Keeping the glycemic load of individual meals low helps keep blood sugar levels stable.  However, keeping the overall daily glycemic load low is also important, because it keeps insulin resistance down (and prevents hyperinsulinemia).

It is possible to look up the glycemic load of a serving of many of the most commonly eaten foods, but luckily there is an easier method than this.  There are some simple rules that you can follow to keep the glycemic load of your diet low.  The very most important thing you can do is to keep both refined sugar and natural sweeteners to a minimum (except for stevia).  Avoiding refined flour and starches can also make a big difference.  Another good rule is to eat more non­starchy vegetables and fruits, and to eat fewer grains and tubers.

Both grains and potatoes were not part of the original evolutionary human diet and contain much more concentrated stores of carbohydrates than what was typically available to prehistoric humans.  Consequently, these foods have the potential to raise blood sugar levels beyond what some people’s bodies are genetically equipped to deal with, and they can be problematic.  It is a misconception that whole grains are healthy foods for people with blood sugar problems.  Although they are certainly better than refined sugars and flours, they are marginal foods at best, compared to fruits and vegetables.  Some people cannot handle any amount of grains and would benefit from eliminating them from their diet entirely.

It is also important to balance carbohydrates with fats and proteins.  People with ADHD benefit from a low­carbohydrate, high­protein diet.  It is especially important to eat a high­protein breakfast. This helps balance blood sugar levels and prevent carbohydrate cravings throughout the day.  The best form of protein is animal protein from clean, natural sources, such as wild cold­water fish, 100% grass­fed meat, and organic, free­range poultry and eggs.  This should be complemented with good fats from natural sources (avoid hydrogenated oils and trans fats).

It is especially important to get enough essential fatty acids, because those with ADHD may have an increased need for them.  These include the omega­3 fatty acids DHA and EPA, and the omega­6 fatty acid arachidonic acid.  DHA and EPA are found in wild, cold water fish (e.g. tuna, salmon, herring).  Salmon and sardines are particularly good sources.  Arachidonic acid is found in high quantities in white meat and eggs.  (DHA and EPA are not present in any commonly eaten plant foods, so strict vegetarians will have to supplement.  The body can convert between these two fatty acids fairly easily, so a DHA supplement should be sufficient.)

It may be desirable to include foods rich in the amino acid tryptophan, which has calming effects.³¹ Some foods high in tryptophan include turkey, tuna, wheat germ, yogurt, and eggs.

Feingold Diet

An additional dietary approach to ADHD, which may prove useful is the Feingold Diet.  This diet eliminates natural sources of salicylates, in addition to artificial chemical food additives.  The list of foods prohibited is so long, however, that this should only be considered as a second resort, and should be carried out with the aid of a nutritionist.  Although many people with ADHD are sensitive to salicylates, which inhibit the conversion of essential fatty acids into prostaglandins used by the brain, eliminating the inhibitor is only one approach to dealing with this.  Increasing the precursors, by increasing essential fatty acid intake may also produce satisfactory results.  Nonetheless, this does not work, the Feingold diet is worth considering.

Some of the foods containing natural salicylates, which are prohibited on this diet are the following: apples, almonds, apricots, cherries (canned), chiles (red), coffee, cola drinks, cucumbers, currants, black, curry powder, dates, dill, dried fruits, endives, fruit juices, grapes, honey, oranges, oregano, paprika, pineapple, plums, prunes, radishes, raisins, raspberries, rosemary, strawberries, thyme, tomato sauce, and zucchini.

Supplements

The following supplements may be beneficial for ADHD:

Most important Supplements:

These are some of the very top supplements for ADHD:

Essential Fatty Acid Supplements

If wild cold­water fish is not included in the diet, supplementing DHA is important.  Fish oil is the best way to do this.

DMAE

Other than essential fatty acids, this is probably the most important supplement to consider, and if you had to choose one single supplement, this one might be the best.  DMAE boosts the production of dopamine.  It aids in concentration by improving nerve impulse transmission in the brain, and may also produce antidepressant effects.³²

Some authors caution that this should only be used for adults.³³ However, others recommend it for children.  A children’s dose is 100 to 500 mg daily.³⁴

Other supplements:

These supplements may also prove useful:

Vitamins:

Vitamin C

Vitamin C is an anti­stress vitamin.  The dosage for adults and children over 12 years old is 1000 mg, three times daily.³⁵

Inositol

Inositol is a B­complex vitamin.  The dosage is 20 mg per pound of body weight.³⁶

Minerals:

Chromium Polynicotinate

This supplement helps regulate blood sugar levels.  The dosage is 4 mcg per pound of body weight.³⁷

Amino acids:

L­Cysteine

Use this if hair analysis reveals high levels of metals.  Take on an empty stomach with water or juice.  Take with 50 mg Vitamin B6 and 100 mg Vitamin C for better absorption.

L­Glutamine

Dosage: 10 mg per pound of body weight.³⁸

Phenylalanine

Dosage: 10 mg per pound of body weight.  Phenylalanine is contraindicated in in phenylketonuria³⁹

Taurine

Taurine has calming effects.  The dosage is 500 mg, for children,⁴⁰ or 50 mg per pound of body weight.⁴¹

5­Hydroxy­Tryptophan

This supplement is only available by prescription in the United States.  The dosage is 2­3 mg per pound of body weight.⁴²

N­Acetyl­Tyrosine

This is used by herbalist and nutritionist Donald Yance as part of his protocol for ADHD.  It is a precursor to dopamine and norepinephrine.  The dose is 6­8 mg per pound of body weight.⁴³

Lipid nutrients:

Evening Primrose Oil

Evening primrose oil reduces inflammation and oxidative stress.  A children’s dose is 500 mg daily.

Phosphatidylserine

This is a phospholipid nutrient found in fish, green leafy vegetables, soybeans, and rice.  It is essential for the normal functioning of neuronal cell membranes.  It may aid in balancing neurotransmitters in the brain, and may alleviate depression.⁴⁴ Phosphatidylserine improves behavior problems in children.  Results take up to four months.  The dosage is 100 mg daily for young children, and 300 mg daily for children over 50 pounds, ⁴⁵ or alternately 2­3 mg per pound of body weight.⁴⁶

Neurotransmitters:

Acetylcholine

Acetylcholine can can improve memory and attention.⁴⁷

GABA

GABA improves behavior problems in children.  The children’s dosage is 100 mg daily,⁴⁸ or 6­8 mg per pound of body weight.⁴⁹

Miscellaneous supplements:

NADH

NADH improves behavior problems in children.  The dosage is 2.5 mg daily.⁵⁰

Octacosanol

Octacosanol is derived from wheat germ and associated with vitamin E.  It was not specified how this may be helpful.  The dosage is 100 mcg/lb. of body weight.⁵¹

Herbal Treatments

Few scientific studies have been done on the use of herbs for ADHD.  However, there are many herbs with a traditional history of use for attention, focus, mental clarity, memory, hyperactivity, overexcitement, and stress.  Any of these herbs would be a good potential choice for ADHD.  In clinical settings, practitioners have had achieved good results with these herbs.  In addition, those few studies that have been done produced promising results.

Herbal Actions

Few authors who write about herbal treatments for ADHD seem to have systematically divided these herbs into categories with different actions.  However, the vast majority of the herbs for ADHD seem fall into a few different categories, suggesting a simple protocol.  Most of these herbs are adaptogens, nootropics, and nervines.

It is not surprising that these are also the three classes of herbs discussed in David Winston’s book, Adaptogens: Herbs for Strength, Stamina, and Stress Relief. These three classes of herbs are not only useful in conjunction with one another for ADHD, but offer a wide range of benefits for stress relief and general mental/physical health.  David Winston’s book is a good reference for all three classes of herbs, and any of the herbs listed in his book would be good choices for ADHD.

Adaptogens modulate stress hormones and reduce the impact of stress on the body.  They may improve ADHD symptoms through this mechanism.  It is also possible that they may modulate neurotransmitters in the central nervous in ways that we do not presently understand as well.  The adaptogens that seem to be the most useful for ADHD are ones that also improve energy and focus, such as American ginseng (Panax quinquefolium), Rhodiola (Rhodiola rosea), and ashwaganda (Withania somnifera).

Nootropics are herbs that improve cognitive function.  They may impact attention, focus, concentration, learning, memory, and mental acuity.  These herbs may help ADHD by improving mental functioning.  One of the prime herbs in this category is Ginkgo biloba. Some other examples of herbs with this action are rosemary (Rosmarinus officinale), gotu kola (Centella asiatica), and brahmi (Bacopa monnieri).

Nervines calm the nervous system, reducing overexcitation, which may be helpful when hyperactivity is present.  Since these herbs have sedating effects, it might seem like this would

counteract the effects of nootropic herbs that enhance mental performance.  However, this is often not the case.  Although it may seem paradoxical, nervines may work even better when they are combined with herbs that stimulate mental functioning, like gotu kola (Centella asiatica). Instead of simply counteracting one another, these two classes of herbs may produce the synergistic result of increased focus without hyperactivity.  It is quite possible that these two classes of herbs may be working by entirely different mechanisms.

A few of the herbs used fall into other categories, suggesting some secondary actions that may be useful.  These are as follows:

Anti­inflammatories: Inflammation may be important because of the link between allergies and ADHD.  Anti­inflammatory herbs will reduce allergy symptoms.  Some anti­inflammatories work in a different way, crossing the blood­brain barrier, and protecting the central nervous system from oxidative stress and toxins.  These include grape seed extract (Vitis vinifera) and pine bark extract (Pinus spp.)⁵²

Stimulants: Donald Yance, an herbalist and nutritionist based in Ashland, Oregon, uses green tea in his practice for ADHD.  He finds that people with ADHD need a little bit of caffeine, in addition to adaptogenic herbs.⁵³ This works in a similar way to the conventional treatment, but is milder, with less potential to push people into an outright stress response (green tea has mild adaptogenic effects).

A traditional Italian treatment for fidgety children who could not sit still was a shot of espresso. This would probably work as well, but it also has the same drawbacks as the conventional stimulant treatment, plus some of its own.  The only advantage might be all the additional antioxidants in the coffee and the fact that this comes from natural sources with a lower environmental impact.  It is probably not the best idea to rely too much on strong stimulants, except maybe as a last resort (when nothing else works, and the damage done to someone’s life by their ADHD symptoms is severe enough that the benefit outweighs the costs).  Whenever possible, it is better to cover all other bases first and use as small a dose of a dose of stimulants as possible, in order to achieve the desired effects.

Scientific Studies

One of the few clinical studies on herbal treatments for ADHD was carried out at the Oceanside Functional Medicine Research Institute in Nanaimo, BC, Canada.  In a pilot study, 36 children between the ages of 3 to 17 who fit the diagnostic criteria for ADHD were given a proprietary extract, AD­FX, containing American ginseng (Panax quinquefolium), 200 mg, and Ginkgo biloba, 50 mg, twice a day, for four weeks.  (The American species of ginseng [Panax spp.] was chosen because it contains a higher concentration of a particular ginsenoside suspected of having a positive effect on cognitive performance.)  At the end of the trial, there was a significant improvement in ADHD symptoms, including social problems, hyperactivity, and impulsivity in a majority of the children.⁵⁴

Another study, using the herb Rhodiola (Rhodiola rosea) showed therapeutic effects in ADHD patients exhibiting mental and physical fatigue, lack of concentration and hyperactivity.  There was a decrease in symptoms within three weeks, with results so successful that the dosage was cut in half.⁵⁵

Energetic Understanding

Looking at the energetic understanding of ADHD in traditional systems of medicine can lead to additional insights about which treatments may prove helpful.  In the Ayurvedic system of medicine, problems with attention and hyperactivity are divided as follows:  ADHD, characterized by disordered nervous energy is a Vata disorder.  Attention dysfunction with the additional problem of excess/disordered energy or inflammation is a Vatta­Pitta disorder.  Sometimes poor mental performance is also related to Kapha, with signs of poor digestion (dampness), sluggishness, and perhaps a greasy coating on the tongue.⁵⁶

In Traditional Chinese Medicine, problems with attention can be linked a deficiency in Yin. Herbs that help this nourish the Yin energy, especially the kidney Yin, which is linked to the brain. Some examples of herbs that nourish the Yin energy are Lycium berries (Lycium barbarum/L. chinense) and Rehmannia rhizome (Rehmannia glutionosa).⁵⁷

Specific Herbs for ADHD

Adaptogens

Shilajit (Asphaltum bitumen) Other names: shilajatu, mumie Part used: pitch

This is a mysterious tar­like substance that oozes out of hot rocks in the Himalayas.  It has adaptogenic effects⁵⁸ and improves memory and concentration.⁵⁹

Eleuthero (Eleutherococcus senticosus) Part used: root

David Winston uses this herb for stressed out Type A people who don’t get enough sleep and for ADHD.⁶⁰

Lycium (Lycium barbarum/L. chinsese) Part used: berry

This berry is an adaptogen and nourishes the Yin energy, which is considered useful for the brain.⁶¹ It also a tasty, and highly nutritious food, loaded with antioxidants.

Asian ginseng (Panax ginseng) Part used: root

Ginseng has a long history of traditional use for boosting energy, and may be useful for increasing mental focus.  It also has has anti­anxiolytic effects.⁶² Its ability to increase energy and focus, while simultaneously calming is one of the hallmarks of a good treatment for ADHD.

American ginseng (Panax quinquefolium) Part Used: root

This is one of the prime adaptogenic herbs for ADHD.  Its effectiveness in improving ADHD symptoms has been scientifically validated.⁶³ Out of all the Panax (ginseng) species, American ginseng has the highest concentration of the ginsenosides suspected to improve cognitive performance.⁶⁴

Like its Asian cousin (Panax ginseng), American ginseng has a long history of traditional use for boosting energy levels.  Like Asian ginseng, it also has anti­anxiolytic effects,⁶⁵ and can boost energy and focus, while simultaneously calming, which may be one of the keys to why it works so well.

Rhodiola (Rhodiola rosea) Part used: root

This is also a prime adaptogenic herb for ADHD, used for centuries in Russia.  It is reported to have influenced focus and learning in ADHD patients.  Rhodiola’s effectiveness in treating ADHD has been scientifically validated as well. One of its active constituents, salidroside has ability to regulate norepinephrine and dopamine.⁶⁶

Ashwaganda (Withania somnifera) Part used: root

This is a calming adaptogen that also improves focus.  It has agonist acitivity at GABA receptors,⁶⁷ suggesting that it may be useful in reducing hyperactivity.

Nootropics

Acorus (Acorus gramineus) Other names: shi chang pu Part used: rhizome

Ayurvedic doctors use this herb as brain tonic and for memory problems.⁶⁸ It also has calming effects, suggesting that it may be very useful for hyperactive­type ADHD (see nervines).

Bacopa (Bacopa monnieri) Other names: brahmi Part used: herb

This herb improves attention and retention of new knowledge.⁶⁹ It improves memory and concentration,⁷⁰ shortens learning time, and especially improves memory in elderly.⁷¹ Bacopa also has nervine effects, making it very useful for hyperactive­type ADHD (see nervines).

Gotu Kola (Centella asiatica) Part used: herb

Gotu kola improves memory and concentration⁷² and is excellent for mental fatigue.⁷³

Ginkgo (Ginkgo biloba) Part used: leaf

Ginkgo is one of the very best nootropic herbs for ADHD.  It’s effectiveness has been scientifically validated,⁷⁴ and it is one of the best herbs for both adults⁷⁵ and children.⁷⁶ Ginkgo improves focus, memory, cognition, knowledge retention, and perception.  It boosts blood flow to the brain and increases the brain’s ability to utilize oxygen.  It also protects the brain against toxins.⁷⁷

Basil (Ocimum basilicum) Part used: herb

This kitchen spice has a long history of use in memory difficulties (also see Rosemary).  It is mildly sedative.

Rosemary (Rosmarinus officinalis) Part used: herb

Like Basil, this in another kitchen spice that has a long history of use in memory difficulties. It is mildly stimulating.

Guduchi (Tinospora cordifolia) Part used: stem

This herb improves memory and concentration.⁷⁸

Valerian (Valeriana officinalis) Part used: root

Studies have shown that Valerian produced a marked increase in concentration and abilities and energy levels.⁷⁹ Valerian is also a nervine, making it a versatile herb for hyperactive­type ADHD (see nervines).

Lesser Periwinkle (Vinca minor) Part used: leaves, aerial parts; in some cases, whole plant

This is one of the prime herbs for children with ADHD.⁸⁰ It has a history of use for dementia caused by insufficient blood flow to the brain.  It also has sedative effects, making it a versatile herb for hyperactive­type ADHD (see nervines).

Nervines Acorus (Acorus gramineus)

Other names: shi chang pu Part used: rhizome

In Traditional Chinese medicine, this herb is used to calm the spirit.⁸¹ It also as effects that improve mental functioning, suggesting that it may be very useful for ADHD (see nootropics).

Wild Oats (Avena sativa) Part used: fresh milky seeds

Wild oats are are a nervous system nutritive, and tonic for mental stress, nervousness, overwork, exhaustion, weakness.  They improve mental concentration and focus.  They are excellent for weaning off medications for ADHD, such as methylphenidate (Ritalin), and can help reduce withdrawal symptoms.⁸²

Bacopa (Bacopa monnieri) Other names: brahmi Part used: herb

Bacopa is a sedative and improves anxiety and hyperactivity.⁸³ It also improves memory and concentration, making it very useful for ADHD (see nootropics).

Hawthorn (Cratageus spp.) Part used: berries/flowers

Hawthorn relieves acting out, anxiety and unrest in children.  It also stops inflammation caused by allergies.⁸⁴

California Poppy (Eschscholzia californica) Part used: whole plant

California poppy is gentle sedative, relieves psychological and emotional disturbances in children.  It soothes and balances an overactive nervous system and reduces anxiety and tension in overactive states.  It also helps with sleep problems – difficulty falling asleep, or frequent, regular waking.

Longan (Euphoria longana) Part used: berry

Longan berries are a gently sedating remedy for nervousness and anxiety.⁸⁵

Hops (Humulus lupulus)

Part used: female flower bracts and pollen

Hops are indicated for nervous tension, excitability, restlessness, irritability. They are fast acting and calm and improve mood, but should not be used in depression.⁸⁶

St. John’s Wort (Hypericum perforatum) Part used: tops

St. John’s wort is a nervine tonic, anti­depressant, and prime herb for ADHD.  It regulates mood and attention is a good for hyperactive children.⁸⁷ There is evidence that, in addition to inhibiting the reuptake of serotonin, St. John’s wort inhibits the reuptake of norepinephrine and dopamine with equal affinity.  It also has an affinity for GABA receptors.⁸⁸ Many people have found St. John’s wort both to be calming and to increase their attentive capacity.

Wild Lettuce (Lactuca virosa) Part used: dried leaf

Wild lettuce induces sleep and lessens the excitability of nerves and nerve centers.⁸⁹

Catnip (Nepeta cataria) Part used: leaf

Catnip relives anxiety, restlessness, tension, stress, and hyperactivity.  It balances mood swings or hysteria.⁹⁰

Chamomile (Matricaria recutita) Part used: flower

Chamomile relieves allergies, inflammation, and insomnia.⁹¹

Lemon Balm (Melissa officinalis) Part used: herb

Lemon Balm is a gentle, safe calming children’s herb for anxiety and depression.  It relaxes nervous system, and eases agitation.⁹² In combination with valerian (Valeriana officinalis), it hastens sleep, and relaxes muscle tension.⁹³

Passion flower (Passiflora incarnata) Part used: herb

Passionflower is a calming sedative that causes less drowsiness than drugs.

Kava (Piper methysticum)

Part used: root

Kava is indicated for aggressive and agitated children.⁹⁴

Skullcap (Scutellaria lateriflora) Part used: aerial parts/whole plant

Skullcap is a prime herb for children with ADHD.  It is indicated for aggressive and agitated children.  It helps reduce helps anxiety, restlessness, crying spells, irritability, and nervousness.  It is a useful daytime sedative that works without drowsiness.  It also prevents allergic reactions.⁹⁵

Wood Betony (Stachys betonica) Part used: herb

This is a prime herb children with ADHD.  It is calming, and is recommended for anxiety associated with digestive discomforts, headaches, forgetfulness, and lethargy.⁹⁶

Valerian (Valeriana officinalis) Part used: root

Valerian is a relaxant that eases anxiety.  It also improves memory and concentration (see nootropics).  In combination with Lemon Balm, it hastens sleep, and relaxes muscle tension.⁹⁷

Blue Vervain (Verbena hastata) Part used: herb

This herb seems to calm excessive mind­chatter, and racing thoughts.  This would make it a prime herb for ADHD, where lack of focus is an issue.  In my experience, this herb also has an interesting synergistic effect with Rhodiola: together the two herbs produce a profound state of calm, focus, and directedness.

Lesser Periwinkle (Vinca minor) Part used: leaves, aerial parts; in some cases, whole plant

This is one of the prime herbs for children with ADHD.⁹⁸ It is a sedative, and also increases, blood flow to the brain, making it a versatile herb for ADHD (see nootropics).

Zizyphus (Zizyphus spinosa) Part used: seed

Zizyphus seed is good for anxiety reduction.⁹⁹

Anti­inflammatories

Many of the herbs listed in the previous sections also have anti­inflammatory actions, and would be good choices.  In addition, the following herbal remedies that are specific for ADHD work primarily though their anti­inflammatory action:

Uña de Gato (Uncaria tomentosa) Other names: Cat’s Claw

This herb enhances the immune system, acts as an anti­inflammatory, and improves the regulation of the digestive system.  It improves intestinal absorption and can reduce the passage of partially digested peptides, fugus, bacteria, and parasites (“leaky gut”), which can trigger the constant activation of the immune system resulting in an inflammatory response.  This can manifest as mental symptoms in the case of ADHD.¹⁰⁰

Oligomeric Proanthocyanidins

Found in grape seed (Vitis vinifera) extract (GSE) and Pine Bark (Pinus spp.) extract (pycogenol), oligomeric proanthocyanidins (OPC’s) are bioflavonoids with the most potent antioxidant effects known.  They reduce inflammation and oxidative stress and are able to cross blood­brain barrier, protecting the brain against a wide variety of toxins and free radicals.¹⁰¹ OPC’s have an anti­depressant effect that does not cause emotional changes, hyperactivity or drowsiness,¹⁰² and they also seem to help improve the symptoms of ADHD.

Stimulants

Green Tea (Camellia sinensis) Part used: green leaves

Green tea boosts norepinephrine and dopamine levels, and works in a similar way to the stimulant drugs used in the conventional treatment.  According to Donald Yance, people with ADHD need a little bit of caffeine.¹⁰³ However, unlike the drugs, green tea is mildly adaptogenic, and not so stimulating that it will push people into an outright stress response.

Flower Essences

The following flower essences may be useful for emotional issues related to ADHD:¹⁰⁴

• Chestnut bud: for repeating the same mistakes.
• Clematis: for daydreamers with short attention spans.
• Gentian: for those who are discouraged and give up too easily.
• Larch: for those lacking confidence.
• White Chestnut: for concentration hampered by persistent, unwanted thoughts.
• Wild Rose: for those lacking motivation and initiative for no apparent reason.

Lifestyle Considerations

Stress can play a huge role in ADHD, and stress reduction strategies can lead to an improvement in symptoms.  Biofeedback can reduce ADHD symptoms for 85% of sufferers.  Full­spectrum lighting can improve mood.¹⁰⁵ Spending less time watching television or playing video games can help increase attentive capacity, and spending time in nature seems to help as well.

Example of a Natural Treatment Protocol

Herbalist and nutritionist Donald Yance uses a combination approach for ADHD:  For inattentive­type ADHD, he uses adaptogens, N­acetyl­tyrosine, a little bit of green tea, and essential fatty acids (including DHA and EPA).  (He says people with ADHD need a little bit of caffeine, which is why he includes the green tea.)  With hyperactivity, his protocol is a bit more complicated:  Herbs he uses for this include Bacopa monnieri (Brahmi), Centella asiatica (Gotu Kola), and Melissa officinalis (Lemon Balm).  He also includes glycine powder.  Yance reports good results using this protocol.¹⁰⁶

Conclusion

With rates of diagnosis of ADHD and the use of stimulant medications to treat it on the rise, further explorations into natural treatments for ADHD are badly needed.  Natural remedies offer an impressive range of options, and few scientific studies have been done on their use to treat ADHD. Few studies, in particular, have been done on the use of herbal treatments, and more are needed.

More work also needs to be done in the area of developing more complete, and effective natural treatment protocols.  Many of the published works on natural treatments for ADHD present a slew of different individual remedies, but very few provide any kind of overarching organization to these lists or any kind of general principles for treatment.  My description of the general herbal actions for ADHD was my best attempt to organize this chaos; however this was done very quickly without any kind of clinical experience behind it.  With time and experience, I might choose to rethink this.  More herbalists need to try out different treatment protocols for ADHD, so that we can have a better idea of what works and what does not.

As we gain a better scientific understanding of ADHD, its biological basis, and its evolutionary context, hopefully we will also be able to come up with better ways of dealing with it as a society, and better treatments for it, when necessary.  Hopefully, further scientific studies will give us a better understanding of how some of these herbal treatments work, which ones work, and which ones do not. The current conventional treatment for ADHD with stimulant medications is still a very crude, brute­force way of dealing with things, like the biochemical equivalent of a sledgehammer.  Hopefully, in the future, those looking for ways to deal with the problems in life caused by the symptoms of ADHD will have options that are both more respectful towards their uniqueness as individuals and more conducive to their complete mind­body health.

References

1. Romm, Aviva Jill, and Tracy Romm. ADHD Alternatives: A Natural Approach to Treating Attention­Deficit Hyperactivity Disorder. (North Adams, MA: Storey Books, 2000), 1.

2. Hallowell, Edward M., and John J. Ratley. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood. (New York: Touchstone, 1994), 4.

3. Hallowell, 4.

4. Hallowell, 8.

5. Romm, 1.

6. Holford, Patrick. Optimum Nutrition for the Mind. (Bergen, NJ: Basic Health Publications, 2004),

236.

7. Holford, 234.

8. Rector­Page, Linda G.  Diets for Healthy Healing: Healing Diets for America’s Top 10 Health Problems. (Del Rey Oaks, CA: Healthy healing, 2005), 219.

9. Holford, 234.

10. Balch, Phyllis A.  Prescription for Nutritional Healing. (New York, Avery 2006), 198; Hershoff, Asa, and Andrea Rotelli. Herbal remedies: A Quick and Easy Guide to Common Disorders and Their Herbal Treatments. (New York: Avery, 2001), 229.

11. Holford, 231.

12. Holford, 233.

13. Holford, 229.

14. Holford, 229.

15. Holford, 229.

16. Rector­Page, 220.

17. Holford, 232­233.

18. Holford, 233.

19. Holford, 233.

20. Holford, 233.

21. Holford, 232.

22. Balch, Nutritional, 229.

23. Romm, 5.

24. Bower, Bruce.  “Evolution of attention – evolutionary view of attention deficit­hyperactivity disorder.” Science News. 31 Jul. 1993: 70.

25. Williams, Jonathan, and Eric Taylor.  “The evolution of hyperactivity, impulsivity and cognitive diversity.” Journal of the Royal Society: Interface. 2006: 399­413.

26. For more information, see: Oelke, Jane.  Natural Choices for Attention Deficit Disorder: For Adults and Children Who Want to Achieve Mental Clarity. (Stevensville, MI: Natural Choices, 2005.)

27. Holford, 230.

28. Holford, 228­229.

29. Holford, 230­231.

30. Holford, 233.

31. Rector­Page, Linda G.  Diets for Healthy Healing: Healing Diets for America’s Top 10 Health Problems. (Del Rey Oaks, CA: Healthy healing, 2005), 220

32. Balch, Nutritional, 231.

33. Balch, Nutritional, 231.

34. Rector­Page, 220.

35. Balch, Nutritional, 231.

36. Romm, 58.

37. Romm, 58.

38. Romm, 58.

39. Romm, 58.

40. Rector­Page, 220.

41. Romm, 58.

42. Romm, 58.

43. Romm, 58.

44. Balch, Nutritional, 220.

45. Rector­Page, 220.

46. Romm, 58.

47. Balch, Nutritional, 231.

48. Rector­Page, 220.

49. Romm, 58.

50. Rector­Page, 220.

51. Romm, 58.

52. Balch, Nutritional, 93; Tillotson, 343.

53. Yance, Donald.  “Neurological Health – Part II.”  Northwest Herb Fest 2007, Wise Acres Farm. Pleasant Hill, OR, 21 July 2007.

54. Greenwood­Robinson, Maggie. 20/20 thinking: 1,000 powerful strategies to sharpen your mind, brighten your mood, and boost your memory. (New York: Avery, 2003), 353; Lyon MR, Cline JC, Totosy de Zepetnek J, Shan JJ, Pang P, Benishin C.  Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention­deficit hyperactivity disorder: a pilot study.  Journal of Psychiatry and Neuroscience. 2001 May;26(3):221­8

55. Anderson, Nina, and Howard Peiper.  A.D.D.: The Natural Approach. (Sheffield, MA: Safe Goods, 1996), 29.

56. Tillotson, Alan Keith, Nai­shing Hu Tillotson, and Robert Abel, Jr.  The One Earth Herbal Sourcebook: Everything You Need to Know About Chinese, Western, and Ayurvedic Herbal Treatments. (New York, NY: Twin Streams, 2001), 342.

57. Tillotson, 343.

58. Winston, David.  Adaptogens: Herbs for Strength, Stamina, and Stress Relief. (Rochester, VT: Healing Arts Press, 2007), 201.

59. Tillotson, 343.

60. Winston, 160.

61. Tillotson, 343.

62. Romm, 92.

63. Lyon.

64. Greenwood­Robinson, 353.

65. Romm, 92.

66. Anderson, 29.

67. Romm, 91.

68. Tillotson, 343.

69. Balch, Herbal, 198.

70. Tillotson, 343.

71. Hershoff, 92.

72. Tillotson, 343.

73. Romm, 110­111.

74. Lyon.

75. Balch, Phyllis A.  Prescription for Herbal Healing. (New York: Avery, 2002), 198.

76. Anderson, 27.

77. Hershoff, 93.

78. Tillotson, 343.

79. Anderson, 26.

80. Anderson 27.

81. Tillotson, 343.

82. Balch, Herbal, 198; Hershoff, 93.

83. Hershoff, 92.

84. Balch, Herbal, 198

85. Romm, 92.

86. Anderson, 26; Hershoff, 93.

87. Hershoff, 93.

88. Butterweck V.  Mechanism of action of St John’s wort in depression: what is known? CNS Drugs. 2003;17(8):539­62.

89. Anderson, 26.

90. Hershoff, 92.

91. Balch, Herbal, 198.

92. Hershoff, 93.

93. Balch, Herbal, 198.

94. Tillotson, 342.

95. Balch, Herbal, 198.

96. Romm, 89.

97. Balch, Herbal, 198.

98. Anderson, 27.

99. Romm, 92.

100. Anderson, 27

101. Hershoff, 93.

102. Balch, Herbal, 198

103. Yance, “Neurological Health.”

104. Anderson, 26.

105. Rector­Page, 220.

106. Yance, “Neurological Health.”

Bibliography

Anderson, Nina, and Howard Peiper. A.D.D.: The Natural Approach. Sheffield, MA: Safe Goods, 1996.

Balch, Phyllis A.  Prescription for Herbal Healing. New York: Avery, 2002.

Balch, Phyllis A.  Prescription for Nutritional Healing.  New York, Avery 2006.

Bower, Bruce. “Evolution of attention – evolutionary view of attention deficit­hyperactivity disorder.” Science News. 31 Jul. 1993: 70.

Brown, Thomas E.  Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, Yale University Press, 2005.

Butterweck V.  Mechanism of action of St John’s wort in depression: what is known? CNS Drugs. 2003;17(8):539­62.

Cordain, Loren.  The Paleo Diet: Lose Weight and Get Healthy by Eating the Food You Were Designed to Eat. Hoboken, NJ: Wiley & Sons, 2002.

Cordain, Loren, and Joe Friel. The Paleo Diet for Athletes: A Nutritional Formula for Peak Athletic Performance. Emmanus, PA: Rodale, 2005.

Eades, Michael R., and Mary Dan Eades.  The Protein Power Lifeplan: A New Comprehensive Blueprint for Optimal Health. New York: Warner, 2000.

Greenwood­Robinson, Maggie. 20/20 thinking: 1,000 powerful strategies to sharpen your mind, brighten your mood, and boost your memory. New York: Avery, 2003.

Haas, Elson M.  Staying Healthy With Nutrition: The Complete Guide to Diet and Nutritional Medicine. Berkeley, CA: Celestial Arts, 1992.

Hallowell, Edward M., and John J. Ratley. Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood. New York: Touchstone, 1994.

Hallowell, Edward M., and John J. Ratley. Delivered from Distraction: Getting the Most Out of Life With Attention Deficit Disorder. New York: Balantine Books, 2005.

Hershoff, Asa, and Andrea Rotelli. Herbal remedies: A Quick and Easy Guide to Common Disorders and Their Herbal Treatments. New York: Avery, 2001.

Holford, Patrick. Optimum Nutrition for the Mind. Bergen, NJ: Basic Health Publications, 2004.

Lyon MR, Cline JC, Totosy de Zepetnek J, Shan JJ, Pang P, Benishin C.  Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention­deficit hyperactivity disorder: a pilot study.  Journal of Psychiatry and Neuroscience. 2001 May;26(3):221­8.

Moore, Michael. Principles and Practice of Constitutional Physiology for Herbalists. Albuquerque, NM: Southwest School of Botanical Medicine.

Oelke, Jane.  Natural Choices for Attention Deficit Disorder: For Adults and Children Who Want to Achieve Mental Clarity. Stevensville, MI: Natural Choices, 2005.

National Institutes of Health. NIH Consensus Statement: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). Bethesda, MD, 1998.

National Institute of Mental Health, National Institutes of Health. Attention Deficit Hyperactivity Disorder. Bethesda, MD, 3 Apr. 2008.

Rector­Page, Linda G.  Diets for Healthy Healing: Healing Diets for America’s Top 10 Health Problems. Del Rey Oaks, CA: Healthy healing, 2005.

Romm, Aviva Jill, and Tracy Romm. ADHD Alternatives: A Natural Approach to Treating Attention­Deficit Hyperactivity Disorder. North Adams, MA: Storey Books, 2000.

Tillotson, Alan Keith, Nai­shing Hu Tillotson, and Robert Abel, Jr.  The One Earth Herbal Sourcebook: Everything You Need to Know About Chinese, Western, and Ayurvedic Herbal Treatments. New York, NY: Twin Streams, 2001.

Winston, David.  Adaptogens: Herbs for Strength, Stamina, and Stress Relief. Rochester, VT: Healing Arts Press, 2007.

Williams, Jonathan, and Eric Taylor.  “The evolution of hyperactivity, impulsivity and cognitive diversity.” Journal of the Royal Society: Interface. 2006: 399­413.

Yance, Donald.  “Neurological Health – Part II.”  Northwest Herb Fest 2007, Wise Acres Farm. Pleasant Hill, OR, 21 July 2007.

Introduction This paper will cover basic herbal and nutritional support for transgender and gendervariant folks specifically on the transmasculine spectrum. Historically, transpeoples’ accessto health care is limited for multiple reasons and information regarding the long term sideeffects of hormone therapy is miniscule, so it is profound to be able to support the health and well being of transgender folks with herbs and nutrition, which tends to be moreaccessible and affordable.

Many transpeoples’ experience with the medical community has been negative- from the complicated diagnoses of Gender Dysphoria to the extreme medicalization of gender tohumiliating and horrifying exams, it is easy to see why many trans folks choose not toengage with health care system at all. As herbalists, we are in the unique position of offering holistic care and education to individuals in a manner that honors the whole person.

So then, this is not exactly a traditional pathology paper, which would indicate that we are dealing with a disease that needs treatment; it is my opinion that trans people arechallenging us all to re-examine our assumptions about gender and live more authenticallyand that the disease to be treated lies in society.

This paper will look at some health needs specific to transgender folks and offer accessible,practical, and herbal recommendations for healing and support.Because this is such a huge topic, this paper will cover people on the transmasculinespectrum (taking or not taking testosterone).

Much gratitude to my co-facilitator Kara Sigler, local herbalist, Joshua Muscat, Dr. Nick Gorton, fairy lawyer, Dean Spade, Esq., Pam Fischer, and Luke Woodward.Some of the medical text is taken from the very thorough book, Medical Therapy andHealth Maintenance for Transgender Men: A Guide For Health Care Providers, R. Nick Gorton MD, Jamie Buth MD, & Dean Spade.

OUTLINE:

• Overview: definitions & medical treatment
• Holistic support for Surgery
• Endocrinology Basics
• Hormone Replacement Therapy: herbs for support (male spectrum)
• Emotional/Spiritual Support
• Resources & bibliography

OVERVIEW

Gender identity is a complicated topic and I won’t attempt to unravel it all here. I will present some information for practitioners specifically with the intent of helping people servetransgender patients with respect and understanding, which means being aware of language andword choices. One definition of transgender is: “individuals, behaviors, and groups involving tendencies thatdiverge from the normative gender role (woman or man) commonly, but not always, assigned at birth, as well as the role traditionally held by society.”

“A transgender individual may have characteristics that are normally associated with a particular gender, identify elsewhere on the traditional gender continuum, or exist outside of it as “other,” “agender,” “Genderqueer,” or “third gender”. The term transgender (TG) was popularised in the 1970s (but implied describing peoplewho wanted to live cross-gender without sex reassignment surgery.) In the 1980s the term was expanded to an umbrella term, and became popular as a means of uniting all thosewhose gender identity did not mesh with their gender assigned at birth. In the 1990s, theterm took on a political dimension as an alliance covering all who have at some point notconformed to gender norms, and the term became used to question the validity of thosenorms or pursue equal rights and anti-discrimination legislation, leading to its widespreadusage in the media, academic world and law. The term continues to evolve.”The extent to which intersex people (those with ambiguous genitalia or other physicalsexual characteristics) are transgender is debated, since not all intersex people disagreewith their gender assigned at birth. The current definitions of transgender include all transsexual people, although this has been criticized.The term transman refers to female-to-male (FtM or F2M) transgender people, andtranswoman refers to male-to-female (MtF or M2F) transgender people, although sometransgender people identify only slightly with the gender not assigned at birth. There is a school of thought that says terms such as “FtM” and “MtF” are subjugating language thatreinforces the binary gender stereotype.”

●Consider adding to your intake form, rather than asking your client to check M or F, leave roomfor multiple gender expressions by writing Gender __(blank)__. Your intake form might also ask for the person’s pronoun preference, so you don’t assume how they identify. Some common pronouns used are: zi or they.

MEDICAL TREATMENT

If you are working with a transgender or gender variant person, do not assume that theynecessarily want to address this with you or that this is the main issue, they may indeed just beinterested in getting general herbal/health support!

Mental healthcare

Often, therapy is recommended for all people who are working/playing with their gender, especially if they desire to transition, as usually a diagnosis is required to access the medical caredesired.

Physical healthcare

Medical and surgical procedures exist for transsexual and some transgender people.

Surgery

female spectrum: surgical changes to face, body,  adam’s apple, breasts, waist, buttocks andgenitals. Orchiectomy-testes, Penectomy, Vaginoplastymale spectrum: top surgery (chest-Keyhole, Periaereolar, Double incision), bottom surgery (genitals) and partial or entire hysterectomy.

Hormone replacement therapy

Testosterone: hair growth, rougher skin, lowers voice and changes fat distribution.

Estrogen: skin, voice, lessens hair growth, changes fat distribution and develops breasts.Sex reassignment therapy (SRT) is used as an umbrella term for physical procedures required for transition. Availability of these procedures depends on degree of diagnosed gender dysphoriaand standards of care in the relevant jurisdiction.

HOLISTIC SUPPORT FOR SURGERY

Most people have a lot of anxiety about surgery, even if it is elective. Creating a plan a month before can really help both emotionally and physically.Having a surgery team is especially helpful- friends and family willing to help with food and daily tasks, bring entertainment over, etc..The following is a suggested protocol for surgery in general:

PRE-OP:

• Start herbal regime up to 1 month before surgery
• Stop most herbs 2-3 days before surgery to insure no interactions with drugs(mostly to appease your physician/surgeon, since they most likely know little about herbs)
• Stop herbs and supplements with salicylates that effect platelet function (bloodthinning)1 week before through 2 days after surgery to avoid increased risk of bleeding; these include:Aspirin, Alcohol,  Vitamin E oil, Evening Primrose oil, Red Clover  Hawthorn,Garlic, Ginkgo, Feverfew, Willow, Meadowsweet,  St. John’s Wort (not an exhaustive list)

NUTRITIONAL SUPPORT 1) eat a clean, simple, whole foods diet, preferably organic. See food suggestions below.

2) Avoid Alcohol-at least one week prior- inhibits tissue regrowth and may cause extended bleeding3) Increase B vitamins- helps deal with stress4) AntiOxidants- support the immune system, decrease inflammation, and speed healing- antioxidants are found in the rainbow of fruits and vegetables with red, blue, yellow, purple, and orange pigments.5) Vitamin C- (ascorbic acid) assists the body in the production of collagen, a basic component of connective tissues that aids wound healing and bruising. It also helps thebody’s immune system and is thought to be the safest anti-viral. It is used intravenouslyduring surgery in Europe. DOSE: 1000-2000mg 3-6x/day week before and week after surgery to BOWELTOLERANCE.  Third week titrate to 500mg 3x/day.  Best buffered or time-released. 6) Probiotics- important to replenish gut bacteria and flora after surgery, especially if taking antibiotics, may halt yeast infections and bowel irritability: acidophilus andbifidus, yogurt, fermented foods like sauerkraut or kim chi.7) Hydrate- increase water intake to heal faster and aid elimination of toxins.Your doctor may ask you to keep a log of your I&O (input and output).

PREPARING EMOTIONALLY FOR SURGERY

Support network: friends to visit and bring foodLaughing helps you heal faster: books and moviesMusic: make a mix tape to listen to while in surgeryVisualize your surgery going smoothly and your recovery easy every day Ritual to say goodbye to whatever is getting removed: get closure with body. Write letter, go to the ocean, have a bonfire, have a farewell party/funeral, bury something, plant atree. Let it go. Honor your scars.Breathe, meditate & relax.Stones for surgery: Malachite, rhodonite, obsidian, amber, clear quartz, aquamarine.Flower and gem essences for surgery: *Five –Flower Remedy (rescue remedy) every hour. On pulse points or under the tongue.

POST-OP:

Homeopathy: Arnica 1M every hour 1^st day after surgery, then 3x a day for 1 ● Sore throat from anesthesia tube: Sage tea with honey

NUTRITIONAL SUPPORT: Since surgery is such a stress on the body, it helps to reduce stress in all other areas of your life, including food. Eating is a cheap and simple way to take medicine! Most of thisregime can be followed for 2 -4 weeks prior to surgery and 2-4 weeks after. (Careful withgarlic a week before & 2 days after surgery)

• Drink at least 8 glasses of water a day to support your body flushing out toxins  and rehydrate after surgery.
• ●Eating things that are somewhat pre-digested like soups and porridge are best  after surgery so your body can focus on healing and not digesting.
• Miso soup with seaweed (or other broths, like bone broths) are easy on thestomach and full of nutrients that help your body heal. Seaweed helps yourbody recover from the anesthesia and pain meds.
• Try to add more of these spices into your diet, which are all anti-inflammatory and anti-microbial: cinnamon, horseradish, mustard, rosemary, ginger, garlic,  turmeric, coriander, onions, honey and lemon.
• Add more: whole grains, especially oatmeal. Whole grains (or psyllium husk) can help clean out your colon when things feel stuck, which often happens post-surgery.
• Lots of fresh organic fruits and vegetables— especially seasonal foods that are  the color of the rainbow (blueberries, strawberries, squash, oranges, dark-leafygreens, beets etc.) Eat lots more (pesticide –free) shiitake mushrooms, garlic,& dark leafy greens!
• Eat plenty of pectin-rich foods (such as apples, carrots, and cilantro) as they will bind with toxins, and help flush them out of the body. (Be sure the  cilantro is organic because just like in your body, it attracts & pulls out the  toxins in the environment. When non-organic, it will be  concentrated in pesticides.)
• Sauerkraut, yogurt, and other fermented foods have natural pro-biotics to helpespecially if taking anti-biotics and prone to yeast infections.
• Eliminate (or reduce) foods that you know stress out your body. For most people  these are: dairy, sugar, anything refined (flour, sugar, etc),  coffee, alcohol, and  fried stuff.  It’s hard, but worth it.

●Mushrooms, Seaweeds, and Miso are SUPER-FOODS packed with micro-

nutrients. Mushrooms have been proven to boost immunity and fight  cancers. Seaweeds contain iodine which connects to receptors in the body that keep toxic ionizing radiation from taking hold, from x-rays, electronics, uv rays, airplanes, and other environmental exposure.

• Supplements:Vit C 1000- 2000 mg/3 x a day (to bowel tolerance) 1 week before & 1 week after, 3^rd week lower to 500 mg/3 x day. Best buffered or time released.QuerctinEvening Primrose Oil (and fish oil if not vegetarian): 1500 mg as needed forinflammation.
• Hot/Cold therapy: ice for 1^st 24 hrs, then alternate hot and cold
• Baths: Epsom or sea salt scrubs (to eliminate toxins)Add lavender , chamomile oils or flowers for relaxing & sleepingAdd rose geranium, bergamot for post- surgery depression
• Massage (after incision has healed) with Vit E, castor oil, gotu kola, comfrey calendula, yarrow or Poultices

*COUNTER INDICATIONS WITH ANAESTHESIA AND HORMONES Specifics-St. John’s Wort and Ginkgo- are incompatible with most drugsincluding hormones and anaesthesia. The liver detoxifies/breaks-down hormonesand drugs in the body through the production of enzymes. These herbs specifically induce the liver to create more P450 enzyme which changes the halflife and thus reduces the effectiveness of the drugs.  They also inhibit otherenzymes which may allow toxic drugs to circulate in the system longer.

HERBAL STRATEGIES FOR SURGERY

BRUISING AND HEALING: start pre-op 1) Immune System Modulators- best used over a period of time to increase deepimmunity at the level of the bone marrow-Astragalus, Ashwaganda/Withania, most mushrooms including Reishi/Ganoderma lucidum, Maitake, Shitake, Turkey Tales, Lion’s Mane 2) Surface Immune Tonics- increase immunity and white blood cell proliferation quickly for the onset of colds etc-Echinacea, Yarrow/Achillea milefolium 3) Vulneraries- usually applied externally to heal cuts and wounds -

Comfrey/Symphytum, St. John’s Wort/Hypericum perforatum, Calendula, Plantain/Plantago, Lavender essential oil, Chickweed/Stellaria media, Mullein/Verbascum thapsis, Yarrow/Achillea milefolium, Horsetail/Equasetum, Gotu Kola/Centella asiatica4) Bruises-Arnica homeopathic tablets and salve(never on open wounds), or 2-3 drops tincture internally5) Anti-Microbials- in case of infection or preventatively-Yarrow/Achillea milefolium, Echinacea, Myrrh/Commifera myrrha, Thyme, Rosemary, Garlic, Calendula, Lavender and Tea Tree essential oils

MITIGATING DRUG EFFECTS:

1) Hepatics- for liver toxicity and regeneration-Milk Thistle seeds/Silybum marianum, Turmeric root/Curcuma longa

2) b- cleanse and increase the bloods capacity to carry toxins out of the system-Dandelion root/Taraxecum, Red Clover/Trifolium, Yellow Dock/Rumex crispus, Oregon Grape Root/Mahonia, Burdock root/Arctium 3) Lymphatics- clear toxins, increase white blood cell count-Red Root/Ceanothus, Cleavers/Galium aparine

POST-OP PAIN AND INFLAMMATION- 1) Nerve Regenerators-St. John’s Wort/Hypericum, Wild Oats/Avena 2) Anti-Inflammatories-Turmeric/Curcuma longa, Bromelain plus Quercetin (supplement taken away from food ), Black Cohosh/Cimmicifuga racemosa, Lobelia inflata (at high dose is an emetic- causes vomiting), Evening Primrose Oil-1500mg every 3 hours, Willow bark, Meadowsweet, Cayenne/Capsicum marianum- depletes Substance P- a neurotransmitter- cuts the nerve firing response to pain, Chamomile/Matricaria or Anthemis nobilis, Calendula, Violets/Viola odorata, Indaian Warrior/Pedicularis spp. 3) Rubifaciants- increases circulation to the area for faster healing-Cayennepepper/Capsicum marianum, Ginger/Zinziberis (fresh not as hot as dry), Cinnamon, Prickly Ash Bark/Zanthozylum, Peppermint, Rosemary, Horseradish, Mustard- internally as food or tincture, or in oil- spread overthin cloth  4) Demulcents/Emollients- moisturizing herbs with mucilage for soothing inflamed tissue-Marshmallow root/Althea, Slippery Elm Bark/Ulmus fulva, California Slippery Elm/Fremontia californica, Flax seeds

SCARRING  Gotu Kola/Centella asiatica, Vitamin E oil, Castor Oil- rub in forcefully tobreak up scar tissue

BOWEL IRRITABILITY (surgery may cause constipation)1) Bitters- increase the flow of bile and hydro-chloric acid to aid digestion; mild laxative effect- Dandelion root/Taraxecum, Yellow Dock/Rumex crispus, Burdock root/Arctium lappa 2) Carminatives-decrease gas-Cinnamon, Peppermint, Chamomile, Ginger, Fennel, Anise 3) Laxatives- should only be used for a short period of time as a last resort-

Senna, Cascara Sagrada/Rhamnus persiana, Turkey Rhubarb/Rheum palmatum 4) Bulk fiber- flax, psyllium

EXAMPLE OF AN HERBAL REGIME FOR SURGERY Beginning one month before surgery, and continuing through healing stages after- • Eat shitake mushrooms and seaweed 2x per week • 1 Tbs. ground Milk Thistle seeds 1x daily  • Vitamin C- TITRATE TO BOWEL TOLERANCE 1000-2000 mg  • Homeopathic Arnica tablets 3x/day • Increase water intake to 6-8 cups daily; avoid alcohol• Bromelain plus Quercetin- supplement taken away from food• Evening Primrose Oil- 1500mg 3-6 x daily (stop one week before, continue 2- 5 days after surgery)  • Tea or tincture of  1 part Turmeric/Curcuma longa  1 part St. John’s Wort/Hypericum (unless on hormones)  2 parts Wild Oats/Avena sativa 2 parts Siberean Ginseng/Eleutherococcus senticosis1 part Echinacea purpurea or angustifolia1 part Red Root/Ceanothus spp. _ part Yarrow/Achillea millefolium _ part Licorice root/Glycyrrhiza (may raise blood pressure)_ part Cayenne pepper/Capsicum Tea- drink 2-4 cups daily; Tincture- 30 drops 3x per day.  • eat only broths for first 3-5 days, such as Miso soup• Hydrotherapy- cold for first 24-48 hours, then alternative with Hot• Salves and Sitz baths with vulneraries for topical healing• Pro-biotics if antibiotics taken

ENDOCRINOLOGY

Steroid Hormone

Steroid hormones are derived from cholesterol. They include sex steroids (estrogen,progesterone, testosterone,) glucocorticoids (cortisol, prednisone, hydrocortisone,) andmineralocorticoids (aldosterone.)

Androgens: produces typical male “sexual” characteristics, stimulates bone & muscle growth.Some androgens are: testosterone, androstenedone (andro), DHT (dihydrotesterone), DHEAThe precursor to all these hormones is cholesterol (grandparent) then pregenolone(parent).Testosterone gets converted into estradiol (a kind of estrogen) and DHT (by enzymes) sothe emzyme that converts T into DHT is important here.Estradiol: supports health and growth of neural filaments in brain (connects brain cells) andcreates neurotransmitters, supports sexual health, blood and arterial flow, skin health etc…

The classic definition of androgen is simply a substance that stimulates the growth of thereproductive tract. In general however, the term androgen is used to refer to sex steroids whether synthetic or naturally occurring that exert their effects primarily at the androgen receptor.

Androgens have two primary effects: anabolic and androgenic. Androgenic effects produce the typical male sexual characteristics. Anabolic effects primarily result in stimulation of muscle andbone growth as well as metabolic changes. While testosterone exerts both effects, certain synthetic androgens have differing relative anabolic and androgenic effects. The majority of androgen in blood is bound to protein, chiefly Sex Hormone BindingGlobulin (SHBG) with the remainder bound primarily to albumin. Only 1-2% is unbound, ‘free’androgen. Androgen bound to SHBG is neither bioavailable to exert androgenic and anabolic effects nor vulnerable to metabolism. In individuals with high levels of SHBG such as cisgender (non-transgender) women, the free androgen level is lower, but hormones have a longer half life. Conversely in an individual with lower levels of SHBG more free androgen is bioavailablehowever, metabolism and destruction occur more rapidly. Normally, women have about twice thecirculating levels of SHBG that men do.

HORMONE REPLACEMENT THERAPY: MALE SPECTRUM

This section will focus more on the male spectrum, with more to come about transgender folkson the female spectrum. On the whole, there is a lot more information (online) about herbs forM2Fs than for F2Ms, so I have chosen to start with F2Ms to try to fill the gaps.

“Overall, testosterone therapy is far more successful at producing desired secondary sexcharacteristics in transmen than hormonal manipulations are in transwomen. This is due to the fact that in general, the biological plan for the human body is ‘Eve’ and adding testosterone,whether endogenous or exogenous, will produce significant reversible and irreversible changes toa person’s body. With regards to secondary sexual characteristics, going from Eve to Adam is relatively easy, but as transwomen are painfully aware, once you arrive at Adam, going back is difficult if not impossible. So while testosterone is effective and very helpful for transmen, it alsorepresents a more significant commitment to permanent assumption of the male gender role thandoes estrogen in transwomen.” (Gorton and Spade)

TESTOSTERONE People desiring more masculine characteristics take Testosterone. Usually, it is taken as an injection of T-cypionate (Depo-T) or T- enanthate (Delatestryl). They are mixed with some kind of oil and taken at doses usually ranging from 50-150 mg/week. Peak serum levels are achievedwithin 2-5 days after injection and return to baseline after 10- 14 days. Some adverse effects may be ameliorated by using a shorter dosing interval with lower peaks and higher trough levels(weekly instead of every other week.) Other forms of testosterone include transdermal (patchesand gel) and oral, but they are less common than injecting. From a herbal/holistic perspective,injecting is the preferable method as it is less stress on the liver.

POSSIBLE EFFECTS OF HRT- Testosterone:

Cessation of menses, deepened voice, increased facial and body hair, clitoromegaly (enlargementof the clitoris), male pattern baldness, acne, redistribution of fat, coarser skin, higher bloodcholosterol levels, increased libido.Risks: possible increased risks of ovarian or uterine cancer, changes in uterus and ovaries (fibroids, cysts), possible increased risk of osteoporosis, possible increased rsk of heart disease.

While these risks are important to be aware of and monitor, it is also essential that as a practitioner, you support the choices of your patient and understand that their mental health and well-being may depend on their gender presentation, and therefore it is a healthy choice for themto take steroids. However, studies on the long-term side effects of HRT are not available, so I suggest using complementary herbs to both support the use of HRT and also to achieve masculinization, so patients can lower their doses.

If a person has chosen not to take Testosterone, but still desires masculine characteristics, it’s possible to play with the herbs. A possible treatment plan (harm reduction style) would be to takeHRT until the desired characteristics are achieved (lower voice, hair growth, muscle build-up) and then titrate off the steroids, using herbs and then only taking herbs that are supportive to the constitution, but also are androgenic.I am experimenting with Vitex with a great deal of success with this- if you use it, please email me- I’d like to begin to compile a study!

HERBS for support

Androgenic Herbs and Food

Many herbs and plants a)contain phyto-testosterone (identical molecularly to humantestosterone) b) possess androgens or androgen analogues or c)stimulate T production in body. By increasing progesterone & testosterone naturally- you can increase masculine characterstics, including hair growth, lower voice, muscle build, but can’t stop manstruation.

Examples: pine pollen (Pinus sylvestris), Sarsparilla (Smilax officianalis), Sassafras(Sassafras albidum), Damiana (Turnera diffusa), Ashwagandha (Withania somnifera), Ginsengs (Panax), Oats (Avena sativa), He Shou Wu (Polygonum multiflorum), Rosemary?

Kidney and Adrenal Tonics

It’s vital  to nourish the kidneys and adrenals, which produce 90% of your testosterone,DHT, DHEA, cortisol, and aldosterone.  The adrenals also responsible for flight or fightstress response- which releases coritsol and adrenaline. Therefore, under constant stress,coritsol and adrenaline are constantly surging (in the old days being chased by a tiger, butpresent day stressors include: poverty, gender identity anxiety, family or relationship problems, etc….). Designed for short bursts of energy,  high levels are not sustainable:raises heart rate, glucose production, and metabolism. As cortisol rises, the DHEA goes down and suppressing androgen production. So both NERVINES and ADRENAL/KIDNEY tonics are important.

Examples: He Shou Wu, california poppy, catnip, chamomile, hypericum, lavender, lemonbalm, oats, passion flower,  skullcap, valerian, vervain, wild lettuce. Adaptogens: reishi,  schizandra, ashwaganda, astragalus, aralia, ginseng, tulsi

Liver tonics/detoxifiers/AlterativesBecause people using HRT are processing pharmaceutical drugs through their bloodstream, is is important to consider liver supportive herbs and alteratives, withoutremoving the substance completely and nullifying the desired effect.

Examples: Nettle, bladderwrack, burdock, cleavers, echinacea, garlic, red clover, yellow dock.

ANDROGENIC HERBS: (can be used instead of HRT)

Damiana: (Turnera diffusa) Calms mind, relaxes body, lifts mood, superlative sexual tonic. Good esp. for anxiety and depression related to sex.

Ashwaganda (Withania somnifera): translated as “strong horse medicine” or “sweat of ahorse” or gives the virility of a horse.Adaptogen – increases body’s ability to adapt to and resist stress. Both energizing and soothing, classic reproductive tonic & aphrodiasiac.Powdered, taken in milk with cinnamon and cardamom or ghee- gives strength of a horse.Good for fatigue and debility, nervous tension and stress.

Sarsparilla: (Smilax ornata): mild androgenic effects, sexual tonic,anabolic toner (good with Echinacea and saw palmetto) blood purifier for genito- urinary system, liver andgallbladder. Rich in  steroidal saponins to support producing steroidal hormones. Great asa tea with dandy root tastes like vanilla-y.

Ho Shou Wu also known as Fo Ti, (Polygonum multiflorum): “the black haired Mr. Wu” restores vitality, said to turn grey hair black again…longevity tonic-normalizes actions of the kidney and liver,  increases sperm count. Rejuvenating tonic- safé for long term use.You can make a powder, blend with cinnamon, ginger, and cardamom and make a paste with honey and eat it.

Wild Oats: nerve tonic and cardiac herb- depression ,fatigue, irritability,  rich in silica and calcium- great for bones. Soothing.

Garlic: immuno-stimulant, aphrodisiac, cardio-tonic, lowers bp, choleserol, more infounder food.

Ginseng: promotes energy, stamina, and endurance. Nourishes kidneys. Revitalizes and restores energy. Use regularly for 3-4 months.(Panax: ancient plant in Chinese medicine. Stimulates LH which increases T. don’t overdo! Eleuthro/siberian: immune tonic and adaptogen, helps withstand stress oftransition.)

Pine pollen: (Pinus sylvestrus, Pinus nigra) Pine pollen actually contains testosteroneand androstenidione Pulp mills- downstream female fish transform into males. (also pulpand bark, but mostly pollen) take in tincture- available online- Chinese markets.

Vitex (Vitex agnus-castus): (it’s called chaste tree- was once used to suppress monk’s libido) Endocrine/reproductive normalizing. – will either suppress or stimulate hormoneproduction as necessary- pms, enhance or calm sexual vitality. boosts progesterone levels but lowers Testosterone levels and libido helps with muscle build-up (Joshua muscat.)

Prickly ash (Zanthoxylem): circulatory stimulant- warms the body, helps muscle and joint pain- not for when there is chronic inflammation- too hot. Could be supportive inlowering voice (Joshua Muscat)

NUTRITIONAL SUPPORT:

Celery: contains androgen-like chemicals, lowers blood pressure, helps circulation 2 stalks of celery contains: 275 mg potassium, 30 mg magnesium, 35 mg calcium, 225 IUvitamin A.  Anti-microbial, Anti-bacterial,. Helps kidneys remove toxins, supports filtration and helps maintain electrolyte balance. Also considered a sexual tonic.Supposedly a male steroid, related to Testosterone and androstenedone has been found in celery that elevates sex hormonesCucumber: tonic for kidneys, good for skin, contains 260 IU Vit A, potassium and

folic acid.  Corn Leafy greens: Kale, collards, Chard, SpinachRadishes: help normalize thyroid hormones and liver detox.Garlic: long history as a sexual tonic. In studies, garlic consistently increases T levels,

sexual desire, and stimulates immune system and supports cardiovascular system. Must be eaten raw for medicinal effects or take garlic capsules if irritates stomach. Avoid  taking it if on blood thinners.

Rosemary, Parsley, Thyme

Oats: fresh oats (milky oat tops) have been found to increase T levels (tincture). Dried  oats increase LH (luteinizing hormone) and stimulates release of T.  Known as a sexual  tonic and stimulant. Nervous system relaxant- good for stress and anxiety, nervous  tension and exhaustion. 70% fiber, so lowers cholesterol.

Pine nuts: (latin name is Pinus semen) Highly nutritional and aphrodisiac food. In the

roman and greek pharmacopeia as a sexual stimulant and  increasing virility. Pine

nuts actually  contain Testosterone. Also high in omega 3s (and have some estrogen

and estradiol).Meat: If not vegetarian, meat (must be hormone free- organic or wild) small

amounts frequently, esp. wild red meat- lamb, beef, buffalo, venison. Keeps T levels

high. Oysters: high in zinc.

AVOID:

• Herbs: licorice (contains estrogenic compounds, increases cortisol levels, lowersproduction of T, increases estrogen), Black Cohosh, Hops.
• Beer: HIGHLY ESTROGENIC. 100 gm (3.5 oz of hops contains 30, 000- 300,000 IU of estrogen, including estradiol, which lowers T and binds to free T in bloodstream, making it unavailable. {Before the German Beer Purity Act in 1516,  beer was a medicinal drink made by peasants with herbs called gruit (made from yarrow, rosemary, bog myrtle) which was sexually and mentally stimulating. The Catholic church got monopoly on gruit and ordered that all sexually stimulating herbs be removed, replacingthem with hops, a well- known sedative/nervine herb. The German beer makers noticed that the women who worked in the hops fields got their periods early and developed sexcharacteristics early…}
• Soy: contains estrogens, often is really processed and genetically modified.

●Reduce plastic use

Environmental estrogenic pollution/industrial substances:

●cause more T to convert into estradiol

●interfere w/production of T (by binding free T)

●are xeno-estrogens (mimic estrogens)The balance is shifted towards the estrogen side (which we all have; femalebodied young people are getting more female sex characteristics early, especially low income and pop of color in more polluted areas) SERIOUSLY disrupting the androgen/estrogen balance. Many studies show that sperm counts are down,higher incidences of testicular cancer, undescended testes in adolescents, impotence rates are higher.) This is also affecting panthers, birds, fish, alligators, frogs, and bats….Endocrine-disrupting chemicals in the environment are in the soil, air, and water due to estrogenic pharmaceuticals, DDT (pesticides), PCBS (polychlorinated biphenyls), phlthalates (makes plastic flexible), dioxins (in bleach, tampons),bisphenol-A (in dental fillings & tin cans), car exhaust. *Perhaps one approach would be to eat plants and take herbs that have morephyto- estrogens AND Androgens- helps fill up those holes so we don’t absorb all the endocrine disrupting hormonal mimics and avoid plastic and chemicals listedabove.

SUPPORT FOR SIDE EFFECTS OF HRT

Of course eating whole foods will support anyone: Bone broths, fermented foods. Freshvegetables, limit sugar and other stressful foods

HAIR THINNING/LOSS: caused by pressure on blood capillaries affected by the membrane onthe scalp getting thicker with age (more DHT- dihydrotestosterone) which impairs blood circulation which feed the hair follicles necessary for hair growth. 50% of people on Texperience hair loss. The scalp/follicles can be regenerated… ●Massage daily with Rosemary hair oil- 2x day & brush often! ●Use herbal vinegars: horsetail, nettles, rosemary, sage  ●He Shou Wu as tea or tincture  or Saw Palmetto

• Borage seed oil (gamma linolenic acid and alpha linolenic acid- fatty acids)- work likePropecia- block androgen receptors in hair follicles)
• Cut down on salt, eat seaweed (iodine), vit B, E, A, D
• Teas of silica rich herbs: horsetail, oats, nettles
• More protein in diet
• Nourishing the kidneys with: asparagus, artichoke, celery, aduki beans, parsely. Inversions- hang off bed & rub

ACNE: due to more sebum, oil and sweat production. Treat liver, but not too hard so that it removes the T itself! Hormone herbs should help too. ●fresh veggies, no dairy &sugar, drink lots of water  ●Herbs: (alteratives and anti-microbials) dandelion leaf and root (Taraxacum officinalis) , Red Clover (Trifolium pratense), Burdock (Arctium lappa), Cleavers  (Galium aparine), Echinacea (Echinacea purpurea), Yellow dock (Rumex crispus),Oregon Grape ( Mahonia aquifolium).  ●Externally: Scrub of oats, almonds, calendula, lavender, clay , astringents: witch hazel,calendula, tea tree, lavendar, steams and masks with honey.

GYNECOLOGICAL EFFECTS: (fibroids & cysts, PCOS, Ovarian cancer) ●Uterine tonics and stimulants: Vitex agnus castus, ginger (Zingiber officinale), Ceanothus, Chapparal (Larrea), Ocotillo

●Seaweed  ●castor oil packs or green clay packs ●Bladder relaxation and kegels*A possible plan could be to go off  (titrate) Testosterone every 4-6 months, take Vitex or mugwort to stimulate menses and then go back on to clear out build up?

MUSCULOSKELETAL:

Inflammation (when taking steroid), tendonitis- due to muscle build up on small frame, structuraldelicacy- anabolic hormones building tissue. ●Stretching, hot/cold packs, massage & body work  ●Anti-inflammatories: Turmeric, Echinacea Chamomile, chickweed,  mallow,  calendula, echinacea, hypericum, witchhazel, meadowsweet, willow bark, yerba mansa,licorice root, stachys (hedgenettle), aloe, arnica, chickweed, ginger.  ●Oil of st johns wort, ginger poulticesPossible risk of osteoporosis: ●Dark leafy greens, nuts, seeds, seaweed, molasses ●Exercise! Most effective against osteoporosis  ●Reduce: coffee, sugar, salt, alcohol  ●Herbs high in Cal:Oats, horsetail, nettles

Slower wound healing: oil w/calendula, st johns wort, arnica. EO of lavender, Injection site care: Lavender oil, oil of calendula, Salves w/ calendula, st johns wort, chamomileetc…arnica homeopathically for bruising.

CARDIOVASCULAR:

It is projected that higher levels of T have greater and earlier risk of Cardiovascular disease, but it hasn’t been studied enough. Not definite for trans men- 20-40%. Increased insulin sensitivity and greater risk of hypertension. *Careful of Tobacco abuse.  ●Exercise & diet: see above Plus EFAs

• Herbs: Hawthorn (Crataegus) : cardiovascular tonic, Gingko (Gingko biloba): vasodilator, Passionflower (Passiflora incarnata): calming; Garlic (Allium sativum): normalizes blood pressure and ushers out LDL; Ginger (Zingiber) & Cayenne (Capsicumannuum): circulatory stimulants,; Yarrow (achillea millefoilum): vascular tonic, haltsbleeding
• Laughing (increases O2 exchange, stimulates catecholamines (what exercise does) thatspeeds healing process and reduces inflammation, reduces hormones that suppressimmunity function.

KIDNEY AND LIVER SUPPORT:

careful treating liver- don’t want to change metabolism of hormones ●Hepatics: Dandelion root (Taraxacum officianale), Yellow dock (Rumex crispus), Burdock ( Arctium  lappa), Oregon grape (Mahonia aquifolium). Milk thistle  (Silybum marianum): 200-300 mg a day- low dose. ●Bitters: make digestive juices flow, self repair in intestines, supports assimilation of nutrients- healthy liver assists proper hormonal function and supports detox (Next paper: Progesteronics, Estrogenic herbs & Estrogenic foods)

EMOTIONAL AND SPIRITUAL SUPPORT

• Magic and energy work to support genderqueer and transgender people
• Honoring people who walked this path before- feeling the support of ancestors
• Rituals
• FLOWER ESSENCES: flower essences are remedies that address emotional or spiritual crises or imbalances. There are thousands of remedies made from flowers, trees, gems, environments…Basic dosage is 2-4 dropsin mouth or in glass of water 4 x a day.

Saguaro: takes 30 years to grow roots, 40 years to grow trunk, 75 years to grow arms. Inprocess of becoming. Claiming one’s own inner authority and presence. Ancient and strong masculine energy. Sense of tradition and elders.Walnut: transition essence. Freedom from limits, courage to follow one’s own path. Letting go of family/societal expectations or beliefs.Arnica: conscious embodiment, recovery from old trauma- unlocks and releases oldwounds/shock/trauma held in body.Bleeding heart: strength in the heart, love based on self- respect and love. tendencytowards co-dependence.Calla Lily: shame or guilt about gender identity, sexual expression, finding ones own truth in gender and sexuality.Borage: gives buoyancy and courage in dark times, all purpose tonic for facingchallenges.Pine: guilt, feeling overly responsible for others, filled with “should”, self-blame intoself-forgiveness.Yarrow: inner radiance, inclusive sensitivity, strength of boundaries. Feeling absorptive, vulnerable to others and environment. Shooting star: feeling of alienation, like you don’t belong here on earth, finding purpose Manzanita: leaving one’s body, revulsion towards one’s body. Embodiment- acceptance.Mariposa Lily: healing from sexual abuse, not getting what you needed from mother. maternal nurturing, to mother and be mothered. feelings of Abandonment. Alpine Lily: feminine energy- sexually and spiritually Pretty face: self hatred, feeling unlovable. finding your beauty

Sunflower: self- radiance, shining your particular light, masculine energy- w/o inflated ego.Gold: like you are a precious gem. Self-worth. Solidity of self.Pyrite: individuation, true to one’s own values. living the life you want no matter what.

BIBLIOGRAPHY AND RESOURCES

Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers, R. Nick Gorton MD, Jamie Buth MD, & Dean SpadeThe Male Herbal, James Green The Natural Testosterone Plan, Stephen Harrod BuhnerSacred and Healing Beers, Stephen Harrod BuhnerThe Family Herbal, Rosemary GladstarHolistic Herbal, David Hoffman Prepare for Surgery, Heal Faster, Peggy HuddlestonFlower Essence Repertory, Katz and Kaminiski Joshua Muscat, San Francisco Botanical Medicine Clinic 415.759.1886

Lisa Beard

Ohlone Center

11/04/08

The female reproductive system and its menstrual cycle is often studied and explained in the domain of the endocrine system.  As we know in holistic medicine, body systems are fundamentally interrelated.  In my own journey of healing extreme intestinal discomfort at the time of menses, it has become important to look at the interrelationship between the female reproductive system and intestinal activity. In this paper, I will investigate the effects that the menstrual cycle has on the lower gastrointestinal system.  I will review the two systems, identify how and when they interact and create intestinal distress, and present options for balancing and healing.

Systems overview:

The hormone chain of communication begins in the hypothalamus and goes to the pituitary where follicle stimulating hormone (FSH) and luteinizing hormone(LH) are secreted.  These two stimulate the ovaries to produce the two main female reproductive hormones, estrogen and progesterone, respectively.  The first approximately fourteen days of the cycle is estrogen dominated.  When estrogen peaks, ovulation occurs, and the luteal phase begins.  The luteal phase is dominated by progesterone.

The lower gastrointestinal system includes the stomach, duodem, large intestine and colon. The small intestine sorts the pure and impure, clarifies and filters.  Energetically, problems in the small intestine can relate to difficulty discerning between choices.  Some people take in everything so as not to have to choose.  The small intestine energetically helps us assimilate our life experiences.

In large intestine, water is absorbed as the feces travels through.  Also, B vitamins, Vitamin K and electrolytes are synthesized.  Microflora are abundant in the large intestine, and there is a great quantity of lymph tissue.  If there is stagnation in the large intestine, substances in the fecal matter that are intended for excretion can be reabsorbed into the body.  Energetically, large intestine imbalances can be related to pack rat energy or to holding on to too much (Swiecicki, lecture).

Interrelationships:

In female-bodied people, there is an important interrelationship between the levels of reproductive hormones and the behavior of the intestinal tract.  Progesterone is known to delay gastric emptying and cause constipation (Cheung, 13).  During the luteal phase, women can tend to excrete hard stools and have delayed transit time.  At the time of menses, stools are looser and more frequent (Jackson et all).  To investigate this pattern and understand how to rebalance when the related symptoms are causing discomfort, literature about healing irritable bowel syndrome (IBS) becomes valuable.

Irritable bowel syndrome is a family of symptoms, dominated by a tendency to alternate between constipation and diarrhea.  While someone may not have IBS for the whole month, they may have symptoms at one part of the month, so it is useful to study the reasons, patterns and treatment as outlined by IBS experts who have thoroughly researched the interrelationship between the female reproductive system and the bowels.

IBS occurs in more than two times as many females than males, and tends to follow a cyclical pattern with aggravation pronounced during the progesterone-dominated phase of their menstrual cycle.  During this luteal phase, a common symptom for people with IBS is constipation with straining, and the frequent passage of hard stools.  At the end of the luteal phase, progesterone levels suddenly drop.  Estrogen will begin to build at the onset of menses.  In contrast with progesterone, estrogen has not been associated with the exacerbation of IBS symptoms (Cheung, 14).

In one study, high levels of LH (responsible for triggering progesterone production in ovaries) were found in females with IBS.  In that study, drugs that lowered LH levels, and consequently suppressed progesterone production, resulted in improved IBS symptoms[1].   The cycling symptoms of IBS and PMS involve increased bloating and constipation one week before menses and looser bowel movements during menses (Cheung, 14).

It may be helpful to contextualize intestinal pain at menses in this IBS investigation.  To be able to design treatment, we will then need to understand the possible causes of the IBS behavior.  One cause can be an overgrowth of bacteria in the small intestine, an area that is normally relatively free of bacteria.  This can cause excess gas, bloating, abdominal distension and pain, and altered gut motility.  This overgrowth in bacteria can be caused by decreased gastric acid secretion, decreased bile flow, and decreased pancreatic enzymes[2] with resulting undigested and unabsorbed carbohydrates in the small intestine and colon.  The undigested carbohydrates can cause excess fermentation that encourages bacterial growth, which then produces an abundance of gas and short-chain organic acids (i.e. lactic acid).  These acids can damage the stomach lining of the intestines and further cause poor carbohydrate absorption.  Meanwhile, the putrification of stagnant proteins in the small intestine produces substances called vasoactive amines, which can affect the intestinal muscles.  Abdominal pain is caused by mini-spasms from the buildup of gas in the intestines (Cheung, 15).

In Traditional Chinese Medicine, another layer of explanation is offered about stool activity and the menstrual cycle.  Depending on the constitution, the constipation-diarrhea cycle may appear.   In one TCM reference, a relevant set of imbalances appears: watery stools accompanied by stomach distention, fullness, discomfort that is worse in the afternoon, fatigued spirit, lack of strength… after the period ends, the stools improve” (Kurtz, 1).  Treatment involves boosting the qi, fortifying the spleen, and regulating the menses.

PMS symptoms can be more pronounced in women with deficient livers (Fischer, lecture).  That these symptoms can include change abdominal discomfort and changes in gut motility is relevant to this discussion.  Indeed, in a Japanese study on the subject, women who tended to be more constipated showed more dramatic changes in bowel activity before and at the time of menses (Fukuda, et al.).

Allopathic Treatment:

Ibuprofen or birth control pills are often given to people with menstrual pain.  Antacids, Tylenol and sometimes aspirin or anti-inflammatory drugs can worsen some types of abdominal pain (Cheung, 101).  Ibuprofen is contraindicated with IBS (wikipedia.org).  In this situation, allopathic treatment focuses on suppressing the symptoms without addressing the underlying imbalance.

Holistic Treatment:

• Essential Oils  — rose geranium, chamomile, neroli, thyme, tea tree, lavender, peppermint, ginger.  Put into a carrier oil and rub on abdominal area when there is abdominal pain.
• Diet: remove food allergens, beginning with dairy and wheat.  Increase fiber and water intake to decrease intestinal transit time and to increase overall hormone excretion rates through urine and bowel movements (Greenlee, et al).
• Supplements
  • Increase calcium-magnesium supplements, especially in luteal phase.  Calcium is responsible for smooth muscle contraction.  Sugar makes you excrete calcium through urine.
  • Probiotics, as supplements or as fermented foods
• Additional treatment for acute pain: use a hot water bottle, or a warm bath with lavender EO.

Herbal Actions: To do hormone balancing, and to reduce IBS symptoms.  Herbal actions for treating IBS symptoms include (for both tonic and acute formulas): anti-inflammatory, antispasmodic.  If stress related: nervine, adaptogen and a bitter (Swiecicki, lecture).

• • Adaptogens – if the imbalance is stress-related
  • Anti-inflammatory herbs — in acute formula
    • Kava
    • Nuphar – astringent to the colon, cools heat in the colon if there is diarrhea (which is an inflammatory condition).  Nuphar also cools reproductive excess (Fischer, lecture).
  • Anti-spasmodic herbs – in acute formula
    • Ginger
    • Kava
    • Chamomile
  • Carminatives
    • Fennel
    • Chamomile
    • Ginger
  • Digestive bitters – in tonic formula, to increase bile production and overall excretion of hormones and toxins.
    • Taraxacum root – increases rate at which endogenous hormone metabolites are excreted.
    • Rheum – warming bitter
    • Angelica – warming bitter
  • Female Reproductive Tonic herbs: estrogenic herbs (appropriate if the person has a progesterone-dominant cycle)
    • Dong Quai – warming, reproductive tonic, moisturizing, can relieve constipation, clears liver stagnation, great for women with low estrogen (Fischer, lecture).
    • Black Cohosh – cooling, anti-spasmodic, opens the heart
    • Mitchella – cooling
    • Vitex –  has a normalizing effect by normalizing secretions to the ovaries, but it is progesteronic in effect.  It may be useful to include it in a formula for the first two weeks of a cycle, then phase it out in favor of an estrogenic herb during the luteal phase.
  • Hepatic herbs – as a tonic formula
    • Liver health is key to proper production and processing of hormones.  Supporting healthy liver function can help with hormone balancing. Liver herbs can neutralize liver toxins, reduce and repair liver damage, act as antioxidants, and increase beneficial liver enzymes.  A liver cleansing diet or herbal formula can help lessen PMS symptoms.
    • Milk thistle – heals the liver so that it can detoxify more effectively! (Greenlee, et all).
    • Bitters (see above)
  • Lymphatic herbs – in a tonic formula.  Bloating is an indicator for lymphatics
    • Red root – affinity with the trunk of the body and the pelvic floor.
    • Ocotillo – “ “
  • Nervines – if the imbalance is stress-related, use a nervine with affinity to the gut
    • Chamomile
    • Melissa
    • Catnip
  • Warming CVS stimulants
    • Ginger
    • Cinnamon
    • Prickly Ash

Sample Bitters Formula – before meals, all month long

0.5 Taraxacum

1 Angelica

0.5 Black Pepper

1 Chamomile

Sample Bitters Formula #2 (Fischer, lecture)

2 Rheum  — used a lot during eclectic times.  Fabulous plant.  Warming bitter.  Not so over-the-top bitter that makes ppl nauseous.

½ Cinnamon  — curve sugar cravings, good carminative

½ Peppermint — anesthetizes tissue (quiet the nerve firing in the gut).  Peppermint E.O. is used in IBS which stops the pain in the tissue.

Sample Acute Formula #1 – take starting day before menses

1 Fennel – carminative, antispasmodic, anti-inflammatory, galactagogue, hepatic

1 Chamomile – nervine, anti-spasmodic, carminative, anti-inflammatory, bitter

1 Passionflower – nervine, anti-spasmodic

1 Ginger – warming stimulant, anti-emetic, carminative, anti-spasmodic

1 Kava – antispasmodic, anti-inflammatory

1/2 Peppermint – carminative, anti-inflammatory, antispasmodic, antiemetic, nervine

Sample Constitutional Formula

Follicular Phase

2 Eleuthero

2 Vitex

1 Red Root

1 Rheum

1 Prickly Ash

Luteal Phase

2 Eleuthero

1 Dong Quai

1 Red Root

1 Rheum

1 Prickly Ash

Bibliography

Cheung, Theresa.  The IBS Healing Plan: Natural Ways to Beat Your Symptoms.  Hunter House, Inc. Publishers.  London, 2008.

Fischer, Pam.  Lectures 4/08-11/08.  Berkeley, CA.

Fukuda, et al. “Bowel Habits before and during Menses in Japanese Women of Climacteric Age: A Population Based Study.” http://www.jstage.jst.go.jp/article/tjem/206/2/206_99/_article

Greenlee, et al.  http://celp.aacrjournals.org/cgi/content/full/16/8/1601

Hoffman, David.  Medical Herbalism

Kurtz, Andy.  “Menstrual Diarrhea and Menstrual Constipation.”  Seattle Institute of Oriental Medicine.

Swiezicki, Atava Garcia.  Lectures 4/08-11/08.  Berkeley, CA.

[1] Conversely, in male bodied people, LH makes testosterone and high levels of LH tends to be protective from IBS symptoms.

[2] A decrease in pancreatic enzymes causes poor absorption of carbohydrates, fats, proteins.

Spring 2008

Ohlone Center

Hypothyroidism

The Thyroid Gland: Anatomy & Physiology

The thyroid gland is butterfly shaped and sits on the trachea, in the anterior neck. It is comprised of two lobes connected in the middle by an isthmus. Inside, the gland is made up of many hollow follicles, whose epithelial cell walls (also known as follicle cells) surround a central cavity filled with a sticky, gelatinous material called colloid. Parafollicular cells are found in the follicle walls, protruding out into the surrounding connective tissue.

The thyroid is the largest exclusively endocrine gland in the body.  The endocrine system is the body’s communication hub, controlling cell, and therefore organ, function. A primary goal of the endocrine system is to maintain homeostasis within the organism, despite external fluctuations of any sort.  Hormones, which act as chemical messengers, are the mechanism for this communication.

The hormones secreted by the thyroid gland are essential in this process, targeting almost every cell in the body (only the adult brain, spleen, testes, and uterus are immune to their effects.)  Inside cells, thyroid hormone stimulates enzymes involved with glucose oxidation, thereby controlling cellular temperature and metabolism of proteins, carbohydrates, and lipids.  Through these actions, the thyroid regulates the body’s metabolic rate and heat production.  Thyroid hormone also raises the number of adrenergic receptors in blood vessels, thus playing a major role in the regulation of blood pressure.  In addition, it promotes tissue growth, and is particularly vital in skeletal, nervous system, and reproductive development. [See Handout 1 & 3, taken from Human Anatomy and Physiology; Marieb & Hoehn, 620-21, for anatomical drawings and details of thyroid’s effect on specific body systems.]

The two major thyroid hormones (TH) are unique in that, unlike most hormones, they are neither protein nor cholesterol based.  Instead, they incorporate iodine as an active constituent; the amount of iodine differentiates between thyroxine (also known as tetraiodothyronine or T4) with four iodine molecules and triodothyronine (T3) with, predictably, three iodine molecules. While T4 exists in greater abundance than T3 in the body- thought to be at a fifty to one ratio, T3 is considered to be ten times more active. There is much debate about the physiological difference between the two hormones.  It is currently thought that T4 may act as the reserve form, having a more direct role in the hypothalamus/pituitary negative feedback loop, while T3 has a more dynamic physiological effect in the body.  Others suggest that both have a critical part in physiological activity.

TH (particularly T4) is synthesized in the gland’s colloid filled lumen from the combination of the glycoprotein thyroglobulin and stored iodine atoms.  This process involves six interrelated steps that are initiated when thyroid stimulating hormone (TSH), released by the pituitary gland, binds to follicle cell receptors.  Thyroglobulin is then made in the follicle cells from tyrosine amino acid and discharged into the lumen where it becomes part of the colloid mass.  Follicle cells are simultaneously trapping iodide (the element’s form most readily available in food) from the blood stream- retrieving it via active transport from the lumen.  There, the iodides are converted to iodine as electrons are removed through oxidation.  Within the colloid, the iodine then attaches to tyrosine amino acid on the thyroglobulin molecules. When one iodine attaches to the tyrosine, monoiodotyrosine (T1) is formed; the bonding of a second iodine creates diiodotyrosine (T2).  Enzymes then link T1 and T2- two T2 makes the hormone T4, while a T1 and a T2 leads to the hormone T3.  Follicle cells then recover the hormones, where they pass through an enzymatic process and are then released into the bloodstream.  However, the majority of the body’s T3 is made directly on the tissue level, as target cells use enzymes to remove one iodine atom from the T4 molecules made in the thyroid, converting them to T3 before use.   Most of the alteration occurs in the liver, using enzyme 5-deiodinase. (See Handout 2 for a diagram of TH production (taken from Human Anatomy and Physiology; Marieb & Hoehn, 622.)]

In its behavior, TH functions somewhat similarly to steroid hormones.  As it  is not water soluble, it requires a protein-based molecule for transport throughout the blood stream. T3 and T4 will generally pair with thyroxine binding globulin (TBG) for this purpose, though they can also use albumin and prealbumin.  At any given moment, the vast majority of TH in the body is in this bound, and essentially inactive, state, either in route or awaiting transport.  The small percentage of unbound, physiologically active hormone is called “free” T3 or T4.   It appears that TBG and albumin have higher affinity for T4, which could explain T4’s higher levels in blood and its slower metabolism, and perhaps account for free T3 being the more physiologically active substance.   The main site of TH degradation is in the liver and its primary elimination is via kidneys (80%, the other 20% is via the colon.)  (http://www.levoxyl.com/pi.asp.)

When TH enters a cell, it attaches to receptor sites in various locations. Within the cytoplasm, it primarily connects to the mitochondria, where it helps control cellular metabolism through oxidative phosphorolation.  During this process the mitochondria use oxygen to generate energy as ATP (Adenosine triphosphate); heat is released as a byproduct of this reaction.  Thus, the thyroid (under higher regulation as we will see below) controls body temperature and food metabolism through its role in stimulating mitochondrial activity.  TH also enters the cell nucleus where it binds to DNA; here it precipitates gene transcription, and the synthesis of messenger RNA and cytoplasmic proteins.  Other hormones, including Growth Hormone (GH) and Prolactin, also depend on the presence of TH to exert their own effects on cells; the absence of TH inhibits their activity. (E. Kopf, “The Thyroid Gland,” p. 5-6 and http://www.levoxyl.com/pi.asp.)

Messages from the anterior pituitary gland are the main stimulus for the action of the thyroid gland.  The pituitary gland, in turn, is triggered from above by the hypothalamus.  The three organs are connected in a negative feedback loop that involves their vigilant monitoring of and response to the levels of TH in the blood, as well as other internal and external stimuli; this relationship is sometimes referred to as the hypothalamic-pituitary-thyroid axis.  The hypothalamus secretes protein hormone thyrotropin-releasing hormone (TRH), which heads directly to the pituitary gland via the hypophysial portal blood system, stimulating the release of TSH.  TSH then moves through the bloodstream, binding with receptors in the thyroid gland, prompting the secretion of TH into the blood.   Both T4 and T3 then exert a negative feedback effect on the hypothalamus and pituitary- an increase in their blood levels lowers the amount of TRH and TSH secreted and a decrease in their levels causes a rise in the TRH and TSH. Stimuli to the higher brain including temperature and stress can also effect TRH production in the hypothalamus; for instance, cold temperatures can increase the body’s requirements for TH as more internal heat will be need to maintain homeostasis and the hypothalamus reacts accordingly. Stress affects the thyroid gland not only through the hypothalamus, but also directly via the sympathetic nervous system.  There are sympathetic nerves that connect with the gland; during their stimulation in times of stress, they trigger increased TH release. In addition, it appears that epinephrine from the adrenal gland can also act directly on the thyroid.  (E. Kopf, p. 3)

Diet can effect thyroid function, as a high calorie/high carbohydrate diet can lead to increased conversion of T4 to T3- a mechanism that likely assists in keeping an organism’s weight stable.  Meanwhile, prolonged fasting can result in a decrease in T3 production- which may be adaptive for conditions of food scarcity, slowing down the body’s metabolism and energy consumption. (E. Kopf  p.6)

(Marieb & Hoehn were referenced in the section above, unless otherwise cited.)

Hypothyroid: Signal Lost

If the thyroid gland produces too little or too much TH, a number of the body’s functions will be adversely affected. The production of excess TH is called hyperthyroid; corresponding to the hormonal overabundance, the pituitary will generally slow secretion of TSH, as the blood levels of T4/T3 signal the presence of too much of the hormones.  Here, the focus is on the opposite condition, hypothyroid, when the thyroid is not releasing enough TH to satisfy the body’s needs.  In this case, the pituitary increases discharge of TSH, in an attempt to stimulate the thyroid to provide more TH- a demand it is unable to fulfill.  It has been estimated that 13 million people in the U.S. suffer from hypothyroidism; the condition is more prevalent in women (approx. 5-8 times more likely than men), among whom it is estimated that a minimum of 1 in 8 will develop a thyroid disorder in her lifetime. (http://utdol.com; & M. Shomon, p.1)   The incidence increases with age; approximately 20% of post-menopausal women are diagnosed with hypothyroidism.  Further, these statistics can be somewhat misleading, as many cases go undiagnosed and/or a person may have subclinical hypothyroidism, where one may suffer associated symptoms despite having a technically “normal” T4 level and only “mildly” elevated TSH. (http://www.womentowomen.com/hypothyroidism/)

A hypothyroid pathology can be broken into three different categories: primary, secondary, and tertiary. Primary hypothyroidism (which will be the main concern of this paper) is when the root of the dysfunction lies within the thyroid gland itself.   Though pituitary and hypothalamic action will certainly still impact the condition, they are not the primary cause. Secondary hypothyroidism is when the problem can be traced to the pituitary gland, and tertiary is when the hypothalamus is causing the condition.  Primary hypothyroidism is significantly more common, comprising approximately 95% of cases.

There are several conditions that can result in primary hypothyroidism.  The main cause worldwide, though it is often considered to be of lesser concern in the U.S. (a position sometimes disputed, as discussed below) is iodine deficiency. As the thyroid depends upon ingested iodine to form TH, a shortage of iodine in the diet can result in hypothyroidism.  It is estimated that over 200 million people around the world are hypothyroid for this reason.  Too much iodine, on the other hand, can also be problematic, as it can be a signal to inhibit the conversion of T4 to T3- ultimately, resulting in hypothyroidism as well.

Thyroiditis- of which there are several types- is another leading cause.  Thyroiditis is a general term for an inflammation of the thyroid gland.  The inflammation destroys thyroid cells (at a varying rate depending upon the condition), rendering the gland unable to produce the necessary amount of TH, thus leading to hypothyroidism.  Thyroiditis is often caused by an autoimmune condition- by far the most common of which in the U.S. is Hashimoto’s Thyroiditis- also know as chronic lymphocytic thyroiditis.  Women are fifteen to twenty times more likely than men to develop this condition. An autoimmune thyroid condition occurs when the immune system mistakenly attacks healthy thyroid cells.  Cases of thyroid autoimmunity generally start with T and B white blood cells- the primary infection fighting immune cells: 1) first, T and B immune factors enter the thyroid gland; 2) T cells mistakenly identify molecules that are part of the body’s own cells as invaders; B cells then produce autoantibodies that attack these cells; 3) usually these antibodies then attack thyroid peroxidase, a thyroid protein, and this seems to result in the destruction of thyroid cells.  There are many theories- but few solid conclusions- as to why this undesirable process begins.   Some current ideas include:

-          Antibodies, used during an infection by a virus that has a protein similar to a thyroid protein, may then mistakenly target the body’s own thyroid cells that too closely resemble the invader.

-          A gene may interact with thyroid cells triggering a self-destructive response, inflammatory or other.

-          Fetal cells accumulated in a mother’s thyroid gland may precipitate an immune response, leading to autoimmune thyroiditis during or following pregnancy.

-          Excess iodine is sometimes thought to trigger the process leading to Hashimoto’s.

(http://www.umm.edu/patiented/articles/what_causes_hypothyroidism_000038_2.htm)

Subacute thyroiditis is a temporary condition that occurs in three phases: hyperthyroidism, hypothyroidism, followed by a return to normal thyroid function.  In such cases, a person may feel extremely sick and exhibit symptoms of both hypo and hyperthyroidism.  Symptoms generally last 6-8 weeks, but in about 10% of cases chronic hypothyroidism may result.  This condition occurs in up to 10% of pregnant women, manifesting around 4-12 months after pregnancy.  It can also occur on occasion in men and women of all ages.

A goiter may occur in hypothyroidism whether caused by iodine deficiency, an autoimmune condition, or another less common cause.  Goiters are enlargements of thyroid glands that appear as cyst-like or fibrous growths on the neck; they can vary greatly in size.  Treatment of the underlying condition can reduce the goiter’s size, but will not often lead to its total disappearance. If goiters pose a threat of constricting the airway, they are usually surgically removed.  (www.thyroid.org)

Hypothyroidism also commonly results from the treatment of hyperthyroidism or thyroid cancer. Hyperthyroid individuals often receive radioactive iodide treatments in an attempt to ablate the gland- stemming the oversecretion of TH.  More than half of the patients in this category develop permanent hypothyroidism within a year of therapy, and up to  65% do after five years.  These individuals require thyroid replacement therapy for the rest of their lives; it is important to note that no alternative therapies can substitute for hormone replacement in such situations.  Other treatments for hyperthyroid include surgery or antithyroid drugs and can result in hypothyroidism as well.  In cases of thyroid cancer that involve total removal of the gland, lifetime treatment with thyroid hormones is also necessary.  When only one of the two thyroid lobes is removed, hypothyroidism is less common, as the remaining portion of the gland can sometimes compensate for the loss.

Certain drugs will trigger hypothyroidism by various physiological mechanisms.  Lithium, for example, affects thyroid hormone synthesis and secretion. 50% of people who take lithium may develop a goiter- 20% of those likely have symptomatic hypothyroidism, and 20-30% asymptomatic. See Handout 4 (from http://www.levoxyl.com/pi.asp) for a fairly comprehensive list of drugs that impact thyroid function.  Radiation treatments (due to cancers of the head and neck) and congenital hypothyroidism in babies are two other possible causes of hypothyroidism.

(Except where otherwise noted, the information on hypothyroid pathology referenced: http://www.umm.edu/patiented/articles/what_causes_hypothyroidism_000038_2.htm)

A Broad Spectrum of Symptoms…

When the body does not produce adequate levels of thyroid hormone to fulfill its needs, a host of major, but sometimes hard to categorize, symptoms can occur.  Advanced hypothyroid syndrome leads to myxedema, which literally means “mucous swelling.”  The term was coined in 1877, when a doctor in London performing an autopsy first recognized the connection between mucous logged tissue, atherosclerosis, and an enlarged, non-functioning thyroid gland. (Stephen Langer & James Scheer, The Riddle of Illness, p. 8)  The other most prominent symptoms of this condition are graver versions of those found in many mildly hypothyroid individuals, including: thick, dry skin and puffy eyes, lethargy, low metabolic rate, coldness, constipation, and mental sluggishness.  Handout 2 gives an overview of the physiological effects of TH secretion- the following is a more specific summary of the effects of hypothyroidism, grouped by body system:

-          The body’s inability to promote normal hydration and regular skin secretions leads to pale, thick, dry skin, edema- all over, but particularly in the face, and coarse, thick hair and nails. Loss of head hair and lateral eyebrows can occur.  Skin is often pale or yellow toned. There is decreased sweating.

-          The following signs occur due to a decreased basal (resting) metabolic rate, inability to use oxygen effectively, and decreased action of the sympathetic nervous system:  body temperature is low, accompanied by cold intolerance; weight gain occurs despite a decreased appetite; there is reduced sensitivity to catecholamines. Generalized lethargy and fatigue are common.

-          There is decreased efficiency of the heart’s pumping mechanism, leading to a lower heart rate (bradycardia) and, commonly, low blood pressure.  Breathing can be labored and shallow.  Heart palpitations and irregular extra beats may occur.  (Note: on some occasions, mild high blood pressure can also present, due to slowed pumping combined with increased stiffness of blood vessel walls.) Poor circulation is frequent and, correspondingly, cold hands and feet. There is a common overlap between hypothyroidism and heart problems.

-          There is a disruption of carbohydrate, lipid, and protein metabolism; thus glucose metabolism is decreased, cholesterol and triglyceride levels may be elevated in the blood, and protein synthesis is decreased. The overall increase in cholesterol can transpire as an increase in LDL and decrease of HDL; this increase in blood cholesterol, combined with decreased efficiency of the heart/circulation, leads to an increased rate of atherosclerosis in hypothyroidism. (http://jcem.endojournals.org/cgi/content/full/88/6/2438)

-          GI motility, tone, and secretions are decreased, leading to possible constipation and malabsorption.

-          In a child’s nervous system, lack of TH can lead to deficient brain development; in adults, there can be a slowing of mental processes and a lack of clarity, slow speech, memory loss, nervousness, and depression.

-          Muscular development and function is impaired (in part due to decreased protein synthesis) leading to sluggish muscles action, cramps, and myalgia. There is increased incidence of fibromyalgia and carpal tunnel syndrome.

-          Skeletal growth and maturation is impaired in children; joint pain occurs in adults.

-          In women, ovarian function and lactation are depressed.  This can lead to sterility. Menstruation may be painful and excessive. Overall reproductive function may be suppressed in men as well.  Libido in both may be decreased (related to lack of energy and the involuntary prioritization of body functions in times of metabolic scarcity.)  Sexual sensation may also be decreased as a result of poor circulation.

-          Changes in vocal cords (and overall system dryness) may lead to a characteristic hoarseness of the voice.

-          Headaches, possibly related to several of the above physiological changes, are also common.

(Marieb & Hoehn, p.621; Eric Kopf, M.D. “The Thyroid Gland”, p. 8)

Given the vast array of symptoms, it is critical to recognize that a given individual is not likely to show all of them, and certain signs may be more or less prominent in any specific case.  In addition, people may manifest opposite symptoms.  For example, one endocrinologist noted that at certain times, individuals of a smaller overall body type may lose, instead of gain, weight when their thyroid is underactive. Further many of the symptoms, particularly those associated with mental function, are extremely subjective in nature.  That said, it is critical, as always, to treat the individual, using the above as a general guideline to body systems that may indicate thyroid dysfunction, rather than a road map to what hypothyroidism should look like.  Perhaps the most important point is to notice the possible connection between so many seemingly unrelated symptoms.  Hypothyroid individuals, particularly those with subclinical hypothyroid, may undergo the experience of being told that their symptoms are psychosomatic, simply part of aging, or totally unrelated, before they are officially diagnosed as being hypothyroid- and this can be very frustrating, indeed. The wisdom of a person’s own experience of her condition is often going to be the most effective guide to treatment.

Screening for Thyroid Dysfunction

In the late 1930’s, before the advent of assessing thyroid levels through blood testing, Broda Barnes M.D. initiated the use of the Barnes Basal Temperature test.  This simple test is easily performed on oneself at home.  First, shake down a standard thermometer before going to bed; immediately after waking, leave the thermometer under an armpit for ten minutes.  If the temperature is between 97.8 to 98.2, thyroid function is probably normal.  If the temperature is lower, retest the following day.  If the temperature is again low, the thyroid gland is likely under functioning. Dr. Barnes reported tremendous success using the outcome of this test to identify hypothyroidism in individuals exhibiting common symptoms.  (Langer & Scheer, p. 3)  There is some controversy surrounding the accuracy of the test.  One endocrinologist states that the amount of thyroid replacement hormone that would be needed to raise one’s basal temperature would far exceed an adequate replacement dose.  Thus, a low basal temperature will probably persist in some individuals despite the taking of thyroid replacement. (Kopf, p. 3)   Current proponents of the Barnes Basal Temperature test nonetheless see it as a useful mechanism to discern a low functioning thyroid, particularly in cases where the symptoms are present, but clinical tests may not register the dysfunction- or may label it as subclinical.

Thyroid stimulating hormone (TSH) level is the most frequently used laboratory test for gauging thyroid function.  As discussed earlier, when the thyroid gland produces inadequate supplies of TH, the pituitary secretes a greater amount of TSH in an attempt to increase the TH level.  Thus, in someone who is hypothyroid, the TSH value would be higher than “normal”. In adults, many western doctors rely exclusively on this test, checking other levels only when the TSH is high or low.  In children, it is most likely combined with “free” T4 screening from the outset.  (http://www.levoxyl.com/pi.asp)   The problem with this test is primarily the range of “normal” TSH; for many years anything between .2 and 5.5 was seen as the desired level.  In recent years, some endocrinologists have begun to think of 2.5 as a more accurate upper limit. It is likely that the range of the test may eventually be moved to reflect this opinion.  Suddenly many people who were previously seen as euthryoid (having a “normal” functioning thyroid) will be clinically hypothyroid.  In fact, many of these people may have suffered symptoms related to hypothyroidism for years and gone undiagnosed.

Further, some doctors believe that 1 is actually the target level for TSH, which suggests that patients suffering from hypothyroid symptoms with TSH levels hovering around 2.5 may even be hypothyroid.  Another major concern is the variability among individuals.  The optimal TSH for one person may be .8, such that if it goes up to 2.0, he will experience the discomfort of hypothyroid symptoms; where as 2.0 might be standard for another person.  Ideally, there would be routine screening so that a norm would exist for the individual and it would, therefore, be noticeable when deviation occurs.  However, this is not likely to happen in the age of insurance companies and for profit medicine.  Of further concern are natural variations in one’s TSH level, which are rarely accounted for in screening or treatment. These include fluctuations based on the season, time of day, and, for women, place in the menstrual cycle.  (Shomon, p. 253)

In hypothyroid individuals who are just beginning thyroid hormone replacement therapy, doctors generally test TSH (and possibly T4/T3) every six to eight weeks until the person appears to be stable at a particular dose.  At that point, screening usually occurs every six to twelve months, unless there is a resurgence of symptoms. The reappearance of common hypothyroid symptoms may indicate that the medication dose is too low, while the presence of hyperthyroid symptoms suggests that the dose may be too high; the individual will then receive blood work to explore these possibilities.

Free T4 and free T3 tests assess the level of unbound thyroid hormones in the body.  As the majority of TH is bound, these test are assessing the smaller percentage that is more biologically active.  Often doctors, after receiving high or low TSH results, will order only free T4, through which they will confirm a hypo or hyperthyroid diagnosis (though symptomatic or developing subclinical cases can exist regardless of a normal free T4 level.) (Kopf, p. 7.)   In a medical environment where there is pressure from insurance providers to keep screening to a minimum, this has become the routine.  However, it is probably ideal to run all three tests (TSH, free T4, and free T3), at least when initially diagnosing a condition, and then on occasion, if not every time, when monitoring someone already known to have thyroid issues.  For example, some individuals may specifically have trouble converting T4 to T3, a condition that will go unnoticed without free T3 screening.  The current range for free T4 is .8-1.8 and free T3 is 230-420.

There are several other thyroid tests used somewhat less commonly and for more specific diagnosis. The radioactive iodine uptake scan (RAIU) uses radio labeled iodine molecules that can be followed as they mass in the thyroid gland.  A normal reading will have homogenous distribution of the molecules throughout the gland.  In abnormal scans, there will be either areas with increased uptake- possibly signaling cancer or a hyperfunctioning condition- or spots with decreased accumulation- which can indicate benign cysts or hypo functioning problems.

Thyroid auto-antibody screening, exactly as it sounds, checks for the presence of the antibodies that would signal an auto-immune thyroid condition.  The most common anti-bodies in this case are those found in either Hashimoto’s thyroiditis or Grave’s disease (an auto-immune hyperthyroid condition.)  The thyroid stimulating antibodies test (TSAb) identifies the agent found in Grave’s disease that mimics TSH behavior by binding to cell receptors and stimulating excess TH production.  There is also screening for antithyroglobulin antibody and antithyroid peroxidase, antibodies commonly present in Hashimoto’s and sometimes occurring in Grave’s disease.  (Kopf, p. 7-8)

Thyroid releasing hormone, the hypothalamic secretion that controls TSH release, can also be screened to differentiate between primary, secondary, and tertiary hypothyroidism.  This test measures the response of the anterior pituitary when TRH is administered.  In primary hypothyroidism, there is a two to three times increase in TSH when the TRH appears; in secondary hypothyroidism, there is no rise in TSH, and in a tertiary condition there will be a noticeable delay in the rise of TSH.

The Meds

The most common course of action after a diagnosis of hypothyroidism is thyroid hormone replacement therapy.  There are several main categories of drugs that doctors may prescribe:

- Levothyroxine is the generic of synthetic thyroxine (T4).  Brands in the U.S. include Synthroid, Levothyoid, Levoxyl, Eltroxin, and PMS-Levothyroxine.  (Doctors often prefer brands over the generic due to well-founded concern over the consistency of the generic.  For the same reason, patients are generally counseled to stick to one brand once their dose is established.)

- Liothyronine is synthetic triiodothyronine (T3).  Cytomel is the brand name in the U.S.

- Liotrix is a synthetic T4 and T3 combination drug.  Thyrolar is the brand name in the U.S.

- Natural thyroid is a non-synthetic hormone composed of desiccated pig thyroid glands.  It contains T4 andT3, as well as other components found naturally in the thyroid gland.  Armour Thyroid, Naturethroid, and Westhroid are the brands available in the U.S. (Shomon, p. 65.)

From the beginning of Dr. Broda Barnes pioneering work on hypothyroidism in the 1930’s-40’s until the 1970’s, natural thyroid supplements were the primary treatment.  In the 1970’s, synthetic T4 took over as most commonly prescribed. The main argument for this change was that the natural hormone therapies were not adequately standardized and that their T3/T4 ratio might not be optimal.  (Langer & Scheer, p. 168.) Pharmaceutical companies then primarily invested in T4 replacements, throwing their tremendous force behind popularizing this treatment option.  Synthroid manufacturers in particular aimed to dominate the market.  They falsely claimed their product to possess an advantage over other brands, in an attempt to win over doctors/patients and justify Synthroid’s significantly higher cost.  This assertion bought them a major lawsuit in 1997, which cost the company billions of dollars. (Shomon, p. 256.)

In 1999, Lithuanian endocrinologists published a groundbreaking study that proved that combination T4/T3 therapies offer better results in treating hypothyroidism than T4 alone. (Langer and Scheer, p. 168)  To this day, significant controversy exists around this issue.  There have been subsequent studies that confirmed the importance of combination therapy.  There are now several treatment options involving both hormones: natural, combined Cytomel and Levothryoxine, or Thyrolar.  According to my endocrinologist’s  experience, approximately one quarter of her patients feel better on joint therapies; some other doctors would argue that the percentage is higher.   T3 seems to be primarily useful in alleviating symptoms related to mental function that persist when solely T4 is replaced.  Since it is known that some people have problems with the T4/T3 conversion, it certainly follows that the addition of readily available T3 could have a profound effect.  In cases where it is used, the T3 comprises a small percentage of the overall therapy, corresponding to the naturally occurring ratio between the two hormones in the body.   It is worth noting that Cytomel and Thyrolar are considerably more expensive than all T4 brands and there is no generic for either medication.  This likely makes the exploration of joint therapy difficult for many people as the out of pocket cost can be prohibitive and insurance companies may be less enthusiastic about this treatment approach.

It can take anywhere from several weeks to several months for a significant change in symptoms to occur once treatment begins.  As the predicable consequence of an excessive dose of TH replacement is hyperthyroidism, the beginning of treatment can be a bumpy road for many people, leading to a seesaw between hypo and hyperthyroid states until the appropriate dose is determined. It also important to note that different life phases can result in the need for more or less medication; pregnancy, for instance, usually requires women to increase their dose.

Other than symptoms associated with hyperthyroidism (which can be major), possible temporary partial hair loss during adjustment is the main short term side-effect of thyroid hormone replacement.  Loss of bone mineral density (which can contribute to osteoporosis) and heart complications are the two main long term effects of TH replacement (the latter of major concern in geriatric hypothyroid patients.) Further research is needed on both of these to determine the real risks involved.  Patients with adrenal insufficiency should be treated for that condition before beginning thyroid replacement; individuals with diabetes, heart disease, clotting disorders, and pituitary dysfunction may require adjustments of their other medications when on T4 therapy.

Doctors usually recommend that thyroid medication be consumed first thing in the morning, at least a half hour before breakfast, with a full glass of water.  However, in Living Well With Hypothyroidism, Mary Shomon suggests that if one is not feeling up to par with a current regimen, perhaps splitting the dose throughout the day could help to maintain a more consistent hormone level. A high fiber diet or fiber supplements can interfere with the bioavailability of levothyroxine.  An increased intake of dietary fiber can necessitate a higher dose of medication and can explain the need for greater than expected amounts of  replacement hormone in some people. (http://www.ncbi.nlm.nih.gov/pubmed/8636317?dopt=Abstract)

Levoxyl manufacturers offer some general information on the medication:

-There is usually 40-80% absorption of the medication (increased by fasting and adequate water to accompany the dose.)

- If lab tests continue to indicate hypothyroidism despite an apparently adequate and normally potent dose, malabsorption or drug interactions may be occurring.  See Handout 4 for a complete list of possible drug interactions.

-  Iron and Calcium supplements should be taken as far apart as possible from thyroid hormone medication as they can severely interfere with absorption.  (My dose  dropped when I followed this advice from my doctor.)

- Many of the foods listed as possible hypothyroid hazards in the nutrition section of this paper can also interfere with thyroid hormone medication. Soy poses a particular risk.

The key is consistency, such that once the appropriate dose is established other factors remain the same- or at least their potential effect is recognized and leads to a reevaluation of the thyroid medication dose if symptoms reappear.

Cause: A Macro View

There are myriad ideas about what causes the thyroid to function at a less than optimal level.  As explained above, there are a number of different physiological conditions, and each of those may be precipitated by a variety of different factors.  As in any discussion of its kind, there is much speculation and disagreement. Here is a look at several theories that may offer some insight into an overall understanding of cause.

First, the toxicity of our environment no doubt has a significant impact on the thyroid gland.  Ryan Drum has done groundbreaking work in this area and most of the following section is drawn from several essays available on his website: “Environmental Origins of Thyroid Disease-Part 1”,  “Environmental Origins of Thyroid Disease-Part 2”,  and “Thyroid Function and Dysfunction.”  Drum notes that there has been a significant increase in the number of reported thyroid cases in recent years (in cats and dogs, as well, the former tending more towards hyperthyroid, the latter more likely hypothyroid.) While this may be due to higher recognition of the condition lately, it also seems likely that environmental changes have had an impact on this phenomenon. Drum cites as several major areas of concern: radiation, intake of chemical iodide displacers, and consumption of thyroid suppressive or disruptive substances.  His position is partially based on the idea that iodine deficiency in the U.S. is actually far more prevalent than often stated.

Iodide 127 is the element that the body naturally takes in for use in TH production; it is a chemically stable element, which is significant for its physiological uses, and has no natural isotopes. With the unfortunate advent of nuclear radiation, uranium fission produced iodide 131- an artificial radioisotope (by definition maintaining an unstable nucleus) that has been routinely released into the environment. Its instability means that I-131 has a half-life of eight days.  Drum posits that six plus decades of the diffusion of this isotope through nuclear explosions, accidents, and general operation of nuclear facilities is connected to the increase in thyroid pathology.

When the body has an ample stock of I-127, it is not likely to uptake I-131; it is only in cases of iodide deficiency that the body will readily accept the isotope.  As it is not naturally occurring and did not exist prior to the 1940’s, animals do not have any mechanism for dealing with it.  The I-131 moves into molecules, cells, and tissue where I-127 would normally be present. Drum explains, “When a thyroid hormone molecule experiences radioactive decay of one of its iodine atoms, that atom disappears with an inert gas [Xenon] suddenly left in its place; any functional event involving the thyroid hormone molecule with Iodine 131 decay will experience at least structural disruption and possibly destruction. All of the intended subsequent hormone-dependent functions will be terminated prematurely.” Since iodide deficiency world-wide is fairly routine, I-131 poses a significant danger.  Here, Drum points to the therapeutic value of maintaining an ample store of I-127 through regular seaweed consumption (see “Herbs” section for detail.)

One can imagine the devastating impact of massive amounts of I-131 dumped into the environment in cases of nuclear explosions (whether during tests or through their malicious intended use) and accidents. Following the Chernobyl disaster in 1986, there was a steady increase of thyroid disease.  The positive measures taken in Poland at the time also corroborate this scenario, as Polish citizens were supplied with various forms of I-127 supplementation and suffered a remarkably low incidence of nuclear related thyroid disease.  Yet, nuclear facilities continually emit I-131 into the environment.  This primarily occurs in periodic bursts, after which the radioactive iodide pollutes air and water, and lands on plants, where it is regularly consumed by all herbivores/omnivores.  It’s eight day half-life means that the I-131 will pose a threat as a thyroid hazard for approximately eight weeks (at which point it will have decayed.)  This also means that if incorporated into the body, its toxic decay is likely to occur internally, rather than after excretion.

Though I won’t go into detail here, X-rays should also be noted as another potential thyroid hazard.  The most flagrant use of high dose X-rays on the upper part of the body has been cut back in recent years, but many suffer thyroid disease as a result of past, now outdated, treatments for dermatological concerns and asthma/bronchitis.  The thyroid has little structural protection and is particularly at-risk to X-ray damage – something to consider as the frequent use of dental and chest X-rays and CAT scans persists.   (Drum, “Environmental Origins of Thyroid Disease- Part 2”, p. 5-6 )

Drum also points out the thyroid sabotaging effects of a variety of chemicals in the modern industrial environment.  One category is iodine displacers, which are other elements in the same family as iodine- halogens: fluorine, chlorine, and bromine.  These elements can displace or interfere with iodine metabolism.  Fluorine is commonly found in toothpaste and water supplies, chorine in water supplies and cleaning agents, and bromine in industrial emissions, pesticides, and preservatives.  Much like I-131, these had no occasion to enter the body in the past, and hence animals have developed few protection mechanisms to counter their effects.  They may put a considerable strain on thyroid metabolism.

Likewise polychlorinated biphenols (PCBs- now mostly banned, previously used in a variety of industrial applications and still present in the environment), Poly-bromated di-ethyl ethers (PBDE’s- found in flame retardants), Dihydroxybenzene (resorcinol- used in the production of rayon and nylon, and in furniture glue) , and MBTE (gasoline additive) all have a devastating effect on thyroid function.  PCB’s are thyroid hormone mimetics whose chemical structure closely resembles TH.   The other three substances are endocrine disruptors that can be strongly thyroid disruptive.  The ubiquitous presence of these chemicals in today’s environment may have a considerable connection to the growing incidence of thyroid disease.  (R. Drum, “Environmental Origins of Thyroid Disease- Part 1”, p. 4-8.)  Similarly, the widespread consumption of thyroid suppressive foods, particularly endocrine disruptors such as soy isoflavones, may have a significant effect; this will be covered in more detail in the section below on diet.

Another area in need of further exploration is the connection between the thyroid gland and other non-thyroid hormones, particularly estrogen and progesterone. There are estrogen receptors in the thyroid and, as a result, excessive estrogen can inhibit TH secretion.  It appears that the balance between estrogen and progesterone is critical; in a condition of either too much estrogen, too little progesterone, or a combination of both, estrogen dominance may occur.  Hypothyroidism is sometimes classed as a side effect of estrogen dominance.  Post-pregnancy, peri/menopause, and during the use of birth control pills or hormone replacement, instances when estrogen dominance is common, are also times in which hypothyroidism is more prevalent.  In addition, there also seems to be a link between excess estrogen and general auto-immune disease (Mary Shomon, Living Well With Hypothyroidism, p. 268 and http://www.womentowomen.com/hypothyroidism)  It might also be interesting to compare the rates of hypothyroidism between men and women, when only the latter who do not fall into any of the above groups are included in the calculations; perhaps the incidence would be more equal, confirming the heavy impact of hormonal factors upon the development of thyroid dysfunction.

Stress also has a known impact on thyroid function. Three main ways in which this can occur are through the stress response of the hypothalamus that may alter TRH secretion, from direct contact between the thyroid gland and the sympathetic nervous system, and through the effect of other hormones whose levels fluctuate in times of stress (estrogen/progesterone being no exception to this.)  Herbalist Michael Moore specifically refers to a Thyroid Stress Pattern, in which constant overtaxation of the thyroid gland to meet the body’s elevated requirements for TH due to stress, can lead to either a depressed or overstimulated state (or often a fluctuation between the two. )  Not insignificantly, these conditions may tie into either of his other two stress patterns, Adrenalin Stress or Adrenocortical Stress, both of which involve the body’s over dependence on other hormones- epinephrine or adrenal cortical and gonadal steroids, respectively.  (Michael Moore, Herbal Energetic in Clinical Practice, p. 83)  Indeed, the connection between hypothyroidism and adrenal fatigue is finally becoming more recognized within the medical establishment.  The symptoms of the two conditions are very similar and it seems that a state of adrenal exhaustion will undermine the effectiveness of commonly prescribed hypothyroid treatments. (Langer & Scheer, p. 168)  One theory holds that “adrenal stress impairs thyroid function because it causes overproduction of cortisol, blocking the efficient conversion and peripheral cellular use of the thyroid hormones…” (http://www.womentowomen.com/hypothyroidism/)

The role of reverse T3 also demands research.  Reverse T3 is an inactive form of T3, which the body seems to opt for converting to, instead of T3, during times of physical stress. It appears that both pregnancy and estrogen replacement therapy are instances associated with increased T3 concentration. There has not been sufficient research in this area, but it seems that this could be another link between stress, varied hormone balance, and thyroid activity.  (M. Shomon, p. 262-263.)

Ryan Drum offers another perspective on the stress factor: “I further believe that the situational low thyroid presentations (hypothyroidism) which seem to be initiated by a known life trauma, particularly loss of a loved one or similar grief-inducing events, are completely normal thyroid responses and very desirable components of the grief response…”   He holds that such cases should not involve thyroid specific treatment unless they are life threatening or last for more than one year.  He adds that as the understandable outcome of a culture that does not allow for a natural grief process, individuals suffer from “chronic secondary grief” in which one laments the lack of grieving, which can lead to a hypothyroid response. (R. Drum, “Thyroid Function and Dysfunction, p. 9)

The accepted medical treatment for hypothyroidism has long been the popping of a daily pill for life- a treatment that certainly benefits the drug companies and seems to stabilize the condition enough so that life threatening cases are now rare, while delivering a questionable quality of life and possibly posing some long term health risks.  The result of this scenario is that there has not been extensive research into the myriad factors that may contribute to the condition- as it is seen as neither a pressing situation nor of economic benefit (to pharmaceutical companies.)  Thus, there are many inconclusive (due to lack of research), but valid, theories as to why hypothyroidism may begin- more than there is space here to mention.  One final idea that may indicate the variety of possible triggers is the Epstein-Barr virus.  Epstein-Barr (EBV) is the virus that causes mononucleosis.  Some doctors now believe that there may be a connection between having had EBV (whose antibodies remain for the duration of one’s life) or full-blown mono and later developing autoimmune hypothyroidism.  It is unclear whether the overall exhaustion brought on by the virus may simply weaken one’s immunity or whether there is a more direct link.  In either case, the incidence of those who have had both seems to be high.  In fact, there is now some thought about the existence of other viral causes and a link to anti-viral agents or vaccines.  (M. Shomon, p. 27 & 272-273.)

Another Approach

Most of the understandings presented above use western physiology as their base; traditional Chinese medicine (TCM) has a very different take on the situation.  In classical TCM, what is identified in western medicine as thyroid dysfunction is seen as a symptom of imbalance between various organ systems.  Organs themselves are seen as part of functional systems rather than as anatomically isolated (and for this reason referred to in capital letters), so when one speaks of the Heart, Kidneys, Lungs, etc., it encompasses a broader physiological understanding than simply the organ itself.  In The Web That Has No Weaver, Ted Kaptchuk explains that instead of treating the thyroid, “[t]he Chinese physician, however, might effect a cure through treatment of the Heart or, depending on the total configuration of signs, through treatment of the Liver, Spleen, Kidneys, or some combination of these Organs.”  (Kaptchuk, p. 77)   An essential aspect of this approach is seeing each person as an individual- rather than a recognizable pathology (certainly a position shared by western herbalists).  As TCM does not necessarily identify thyroid dysfunction as such, it does not seem appropriate to offer any generalizations of TCM approaches for “hypothyroidism”.  One integrative practitioner, who combines TCM, Ayurvedic Medicine, and western physiology, uses a treatment plan that may integrate diet, exercise, herbs, medications, environment, lifestyle, and acupuncture.  She suggests four main areas that she tends to focus on herbally: 1) liver cleansing; 2) regulation of digestion and elimination; 3) spleen and stomach tonification; 4) kidney and adrenal tonification. (http://www.thyroid-info.com/articles/shasta.htm)   It appears that while Ayurvedic medicine has some similarities with TCM’s view of the body, emphasizing overall balance and harmony over the identification of specific pathologies, an Ayurvedic understanding of thyroid function/dysfunction is also somewhat more compatible with a western physiological understanding of the gland.

Herbs & Hypothyroidism

When using many of these herbs with clients on thyroid medication, blood levels must be carefully monitored, as the required medication dose may shift over time concurrent with herb use.  Herbs, like all food substances and supplements, should not be taken at the same time of day as thyroid hormone medication.

These herbs, while having the potential to help someone with a hypothyroid condition, are only one part of a multifaceted approach.  Diet and lifestyle (exercise, sleep habits, stress reduction, etc) are essential components of one’s thyroid health. Some  people will not be able to stop taking thyroid medication completely, no matter what degree of other approaches they are using; for such individuals, a decrease in med dose, through herbs, diet, and lifestyle changes may be the optimal outcome. Of course the situation varies between individuals, but it is important that neither the herbalist nor the client have rigidly unrealistic expectations.

See bibliography for complete information on sources, but for this section citation abbreviations are as follows: (DH)=David Hoffmann, Medical Herbalism; (MH)=Matthew Wood, The Practice of Traditional Western Herbalism; (RD)= Ryan Drum from his fantastic website- http://www.ryandrum.com/; (MH)=Maude Grieves, A Modern Herbal.  In addition, other websites are cited below.

General herbal actions that may be indicated (depending on individual case): thyroid tonics/stimulants, adaptogens, nervines, circulatory stimulants, bitters, hepatic and/or specific hepatic laxatives, cardiovascular tonics, nutritives, emollients.

Photo- www.ne.jp/asahi/marine/algae/Fucus.html

Seaweed- Others are useful as well, but specifically for thyroid, Fucus vesiculosus (Bladderwrack/Kelp)- Whole plant is used.  It is antihypothyroid and antirheumatic. It is most appropriate when iodine deficiency is involved- but can be of some use to hypothyroid/goiter conditions in general.  It  helps to regulate thyroid function, improving  all types of symptoms.  If obesity associated with thyroid is present, it can help weight loss.  Also used in relieving symptoms of rheumatoid arthritis- both internally and externally.  It is taken as tablet or infusion (1 cup boiling water over 2-3 tsp, 3x/day.) CAUTION: Its iodine content can also potentially cause hyper & hypothyroidism and it may interact with other thyroid treatments. Elevated urinary arsenic levels have been associated with it.  Prolonged use may reduce gastro-intestinal iron absorption (because of fucoidan’s binding properties), which can slowly reduce hemoglobin, packed cell volume, and serum FE concentrations.  Overtime can also affect NA & K absorption and cause diarrhea. Constituents: phenolic compounds, mucopolysaccharides, ester diglycerides, polar lipids, trace metals. (DH)

Charcoal derived from bladderwrack used in goiter; good for obesity associated w/ thyroid. (MG)

Ryan Drum sings the praises of seaweed consumption like no other, see his website for more detailed information. He notes that because it may take people some time to build up proper internal flora for seaweed digestion, it makes sense to eat small amounts daily over time, rather than large occasional doses. For the most part, he recommends eating it raw.  One of its major contributions to overall health, is its high nutrient content (including potassium, selenium, phycopolymers, algin, B vitamins, omega-3 fatty acids, among others.) Its iodine content and iodine protective potential (see section on Environmental Causes for more info) are unsurpassed.  The US RDA for iodine is 150 micrograms; while not everyone is in need of this level of supplementation, and over-supplementation carries the aforementioned risks, maintaining this amount from whatever combination of sources should be recognized as a mechanism to prevent I-131 intake.  On seaweeds specific thyroid effects, Drum writes:

“Brown seaweeds are the only known non-animal sources of thyroid hormones. Fucus spp of brown seaweeds have been used as treatment for thyroid disorders . The thyroid hormone present in Fucus is Di-Iodothyronine (DIT); it is weakly active if at all as a thyroid hormone in the mammalian body. Two DIT molecules are condensed in an elegant esterification reaction to produce tetraiodotyrosine(T4, Thyroxine). The organically bound iodine in Fucus may enhance T4 production by providing some prefabricated portions of T4. I have not seen any studies tracing Fucus-sourced DIT to either the thyroid gland or circulating T4.  The therapeutic effects of using powdered Fucus, 3-5 grams daily resemble the therapeutic effects of thyroxine medications: shrinking of goiters, weight loss, resolution of symptomatic non-autoimmune hypothyroidism, return of vim and vigor, lessening of psychiatric disruptions, and resolution of eczemas. This is especially true of women enduring postpartum physiological depression after several years of being pregnant and nursing one or more children.  I have seen no reports of thyrotoxicity from Fucus consumption. Women with low thyroid function, according to thyroid panel blood tests report improved test results. Any similar results from using Fucus teas will be due to inorganic iodine supply increase and probably not from DIT. DIT is not very water soluble.  Fucus is used to wean mildly hypothyroid patients off thyroid hormone medication. This can work only if the patient has a thyroid gland mass capable of making T4 and T3 in sufficient quantities to supply body needs. Those without a thyroid gland may be helped by the iodine from Fucus, alleviating the need to mine thyroid medications for iodine. This may also explain in part the alleged weight loss results from ingesting Fucus.”

On other Seaweeds, he says, “T4 and T3 have been found as the main organically bound iodine compounds in several brown seaweeds, notably Laminaria sp. and Sargassum sp. Up to 10% of Lamiarian iodine may be in MIT, DIT, T3, orT4. Even more in the less commonly available Sargassum (less commercially available; it is a rapidly expanding invasive of all temperate coasts; this may be good news for thyroid sufferers) (Kazutosi 2002). Kombu is one of the top 5 most consumed seaweeds in Japan and USA. The physiological effects of regular kombu consumption can be: resolution of coronary artery disease, healthier liver function, higher metabolic rate, faster food transit time, lower LDL cholesterol,, higher HDL cholesterol blood levels. If the thyroid hormones in kombu and Sargassum are available from food, this could turn out to be an effective treatment to replace both synthetic thyroxines and animal-thyroid medications. I assume at least some T4 and T3 get into the human body from dietary Kombu and stimulate more rapid clearing of fatty wastes from the liver, enabling more rapid removal of blood borne fatty wastes.  T4 and T3 are biphenols and are not water soluble. Oil extractions of Kombu may provide T4 and T3 as well as DIT and MIT(Mono-iodotyrosine) and be an effective thyrosupportive medicine. Powdered Fucus is mixed with olive oil as a vegan replacement for cod liver oil and seems to work as well or better than cod liver oil.”

He adds the caution that some individuals are extremely sensitive to iodine and too much may push them into hyperthyroid symptoms.  As for David Hoffman’s mention of potential problems from fucoidan, Drum mentions that the constituent can be cooked out of most edible brown algae, in necessary cases, by simmering it for 20-40 minutes in water.  Though he adds that fucoidan can be useful in reducing the intensity of inflammatory responses and promoting rapid tissue healing after wound or surgical trauma. His dosage for bladderwrack is up to 5 grams daily, one hour before regular meals. (RD)

Photo:www.dkimages.com/…/Withania-

Ashwagandha-5.html

Withania somnifera (Ashwagandha)-

Ashwagandha is hearty shrub in the nightshade (Solanaceae) family.  Medicinally, the root and berries are most widely used.  The root is utilized extensively in Ayurvedic medicine to increase overall health and longevity, while the fruit, seeds, and leaves are also applied as aphrodisiacs, diuretics, and treatments for  memory loss.  Outside of Ayurveda as well, Ashwagandha is viewed as an adaptogen, reproductive stimulant, anti-caricinogenic, and is also seen to provide symptomatic relief for arthritis.  It can also have sedative properties. Energetically, it is considered to be ‘horse medicine’, correlating with the translation of it Sanskrit name- “horse’s smell.”  Its main constituents are alkaloids and steroidal lactones. (http://en.wikipedia.org/wiki/Ashwagandha)

According to a study (on mice) at a University in India, ashwagandha root extract stimulates thyroidal activity (primarily by raising T4 levels) and also enhances the antiperoxidation (reduces the amount of lipid peroxides) of hepatic tissue. (http://www.ncbi.nlm.nih.gov/pubmed/9811169.)

Other studies have shown  that ashwagandha can maintain normal antioxidant function even during intentionally induced stress trauma, not only boosting antioxidant protection but also reducing the amount of cortisol that is released in response to stress. Excess cortisol can exacerbate a thyroid condition. In addition, ashwagandha supports antioxidant enzymes so they are less taxed, which can have a sparing effect on selenium, also indirectly supporting healthy thyroid function. (http://www.ei-resource.org/articles/related-conditions-articles/herbs-and-thyroid-function/.)

Michael Tierra’s wonderful monograph on ashwagandha (http://www.planetherbs.com/articles/ashwagandha.htm) gives the following Ayurvedic dosages: powder- 3-6 grams daily or up to 5 to 10 grams as an occasional tonic; decoction-16 to 31 grams added to heated milk; alcoholic Extract: 2 Tbsp., 2-4 times daily; mixed with ghee or honey-1 tsp. 2 times daily.

In my own personal use of the herb (at much smaller doses- approx 15 drops 2-3x/day), it does seem to have helped with some symptoms associated with hypothyroidism, as well as having ‘possibly’ contributed to lowering the required dosage of synthetic T4.

Photo:www.chilebosque.cl/herb/ceasia.html

Centella asiatica (Gotu Kola)- Gotu Kola has been used traditionally in Ayurveda for hypothyroidism. It stimulates circulation, and particularly improves mental function/clarity and memory, which may be slowed in cases of hypothyroidism. It is also helpful to the nervous system generally and can act as an adaptogen.  Should used in fresh preparations.  (See Christopher Hobbs: http://www.foundationsofherbalism.com/HerbWalk/Integ/GotuKola.html)

May also help normalize nail and hair growth.

According to Michael Moore, Centella can have a pituitary/hypothalamic “potentiating” and thyroid stimulating effect.

Photo: www.aridlands.com

Commiphora mukul (Guggul)-

Guggul is another herb used widely in Ayurveda; it is warming, anti-inflammatory, believed useful in cases of obesity, and cholesterol lowering.  As many cases of hypothyroidism can involve elevated cholesterol, the last effect may be particularly helpful in such cases. Guggul is specifically indicated for prevention of sluggish metabolism.  Studies have shown that once of its constituents, Z-guggulsterone, can increase the thyroid’s ability to uptake enzymes needed for effective hormone conversion.  It also increases oxygen uptake in muscles. (Shomon)

Lepidium meyenii (Maca Root)- “Used successfully by indigenous peoples of Peru to help with hormonal imbalances, menstrual irregularities,fertility, and menopausal symptoms, including hot flashes, vaginal dryness, loss of energy, libido and depression. Its action relies on plant sterols, which act as chemical triggers to help the body itself produce a higher level of hormones appropriate to the age and gender of the person taking it. Clinical case studies have shown that maca can be effective for premenstrual syndrome (PMS), as well as menopausal symptoms, and may help symptoms of hypothyroidism as well.” http://www.thyroid-info.com/articles/macahrt.htm

Photo: www.rain-tree.com/maca-powder.htm

Photo: www.atlas-roslin.pl/…/Mahonia_aquifolium.htm

Mahonia aquifolium (Oregon Grape)-

The rhizome and root are used; constituents are alkaloids of isoquinoline type.  It is an alterative, cholagogue, laxative, antiemetic, anticatarrhal, and tonic.  Useful in chronic, scaly skin conditions. Tonic to liver and gallbladder. Useful as laxative in chronic constipation.  Tincture- 1-4 ml 3x/day or decoction 1-2 tsp root in 1 cup water. (DH)

Improves kidney and liver excretory function- which can be useful in keeping these organs clear of toxins and better able to process thyroid (and other hormones.)   May also be a mild thyroid stimulant. (RD)  It is blood building, stimulates glands of the body (particularly lymph and liver), and aids digestion; it can be helpful in diabetes and rheumatoid arthritis (which can sometimes be associated with hypothyroid.)  5-30 drops of tincture/fluid extract- the smaller effective dose, the better. (MW)

Avena Sativa (Oats)- Oats are a nervine tonic, antidepressant, nutritive, demulcent, and vulnerary.  The seed and whole plant are used; constituents are proteins, flavones, avenacosides, fixed oil, vitamin E, and starch.  Oats feed the nervous system when one is under stress; it’s specific for nervous debility and exhaustion associated with depression (both of which can be associated with hypothyroidism.) Dosage can be 3-5 ml 3x/day of tincture or one cup boiling water infused with 1-3 tsp. of straw 3x/day. (DH)  Can help with low libido and may be useful in lowering cholesterol.

Oats are tonic in cases of dryness and atrophy; this remedy has an  affinity for nerves (sympathetic excess), skin, hair, nails, and connective tissue.  It is useful when there is an inability to keep the fixed on one subject, a lack of focus and memory.  It can be helpful in insomnia associated with depression and nervous exhaustion.  (MW)

Photo: http://www.interhomeopathy.org/images/gallery/186-Avena-Sativa.jpg

Juglans nigra (Black Walnut)- hulls of walnut, leaves; It is VERY astringent, alterative, laxative, antibacterial, antiparasitic, (good for gallstones).  It acts on the thyroid- good for hypothyroid and high in iodine.  It is a traditional remedy for goiter in the south.  (Helpful in fibromyalgia, which can be associated with hypothyroid.) (MW)

Photo: www.botanic.cam.ac.uk/juglands.htm

Personal use: I have had positive results in my own use, as hypothyroid, of a combination of  Withania Somnifera, Centella Asiatica, Avena Sativa, and Mahonia aquifolium. Obviously any individual’s constitutional needs will vary, but as a side note, these four herbs could combine well to support a broad spectrum of hypothyroid related issues.  (However, Centella can be quite stimulating and may be too much for some people.)

Other herbs to consider for Hypothyroid:

The first three are sometimes part of TCM formulas for imbalances that may be seen as relating to a Western diagnosis of hypothyroidism.  Because TCM primarily uses formulas and has a very different understanding of this western defined pathology, it is hard to say for certain if these herbs would be applicable individually in such cases, but they are worth considering- and perhaps consulting a TCM practitioner for further information.

Astragalus membranaceus- Root is used; it is primarily an immunomodulator, as well as tonic (spleen, kidneys, lungs, and blood), stimulant, and diuretic.  Strengthens many functions of immune system, anti-cancer, hepatoprotective. (DH)  Note: Many cite it for use in hypothyroid, but others mention it for hyperthyroid- or even as contraindicated in hypothyroid.

Panax (Red Ginseng)- Root; adaptogen, tonic, stimulant, hypoglycemic. Very stimulating; good for general use in weak or elderly people.  Do not use in acute inflammatory condition or bronchitis.  (DH)  Can help build libido, as general builds energy level- both of which can be low in hypothyroid.

Polygonum multiflorum (He Sho Wu/ Fo ti)- Kidney and liver tonic, works on  symptoms associated with these deficiencies including insomnia, grey hair/hair loss, memory loss, lower back pain, low energy/libido, amongst others.  (contraindicated in cases of poor/damp digestion.)

Also: Crataegus spp. (Hawthorn), Cimicifuga racemosa (Black Cohosh), Ginkgo Biloba (Ginkgo), Allium sativum (Garlic), Medicago Sativa (Alfalfa), Serenoa repens (Saw palmetto), Rumex crispus (Yellow Dock), Coleus forskohlii, Triphala (Ayervedic formula), Schizandra chinensis, Anemone (Pulsatilla), Phytolacca (Poke root), Iris, *Oplopanax (Devil’s Club).

Note- Oplopanax was a traditional indigenous remedy on the west coast for symptoms resembling hyperthyroid.  For this reason, it is unclear if it would perhaps be contraindicated for hypothyroid (though perhaps its use was for an overall tonic effect on the gland, rather than thyroid cooling.)  In that vein, an herbalist that I spoke with recently has found much use for it in hypothyroid cases and has never seen any negative effects from it.

Herbs contraindicated in Hypothyroid:

It is important to be aware that some of the herbs that would be considered specific to hyperthyroid should be avoided for those with hypothyroid conditions, especially those herbs that have a definite thyroid suppressive action. The following list contains some herbs that fall into this category.

Melissa officinalis (Lemon Balm), Lycopus virginicus or europaeus (Bugleweed), Ocimum Sanctum (Holy Basil), Leonurus cardiaca (Motherwort), Trigonella foenum vulgare (Fenugreek) (unclear if it would be indicated for hyper, but said to have thyroid suppressive effects so to be avoid for people with hypo.)

Nutrition: Diet & Supplements

Diet is absolutely essential in the maintenance of thyroid health. Having an overall balanced food intake, based on whole, ideally organic, foods and drinking sufficient water is key to general health, and the thyroid is no exception.  However, specific foods can be thyroid suppressive or supportive.  Beginning with the former, soy comes up as a primary offender.  Soy contains high amounts of isoflavones, which are a member of the flavanoid family- a known category of endocrine disruptors.  These act as hormones, specifically phytoestrogens in the case of isoflavones, disrupting the normal activity and balance of natural hormones in the body.  Flavanoids are anti-thyroid agents; they inhibit thyroid peroxidase (TPO), an enzyme that frees up iodine for its use in the production of TH. (www.wikipedia.org)   While this can be particularly dangerous in soy based infant formulas,  overconsumption of soy in any form can cause significant problems.  For people with possible hypothyroid issues, it is probably best to avoid soy altogether.  Millet similarly has a high flavanoid content; hypothyroid is common in places where this grain is a dietary staple.  (M. Shomon, p. 269-270)

Cruciferous vegetables (broccoli, brussels sprouts, cauliflower, cabbage, rutabagas, turnips, kohlrabi, kale- and any other vegetables in the brassica family), particularly raw, are goitrogenic (thyroid suppressive) due to  their content of goitrin,  which impedes the body’s use of iodine.  (Langer and Scheer, p. 37)   There is some debate about whether cooking or fermenting these vegetables can decrease this effect.  It seems that these processes will likely cut down on the negative impacts, but it probably still wise to use moderation in cases of pre-existing hypothyroidism.

Other foods that should be avoided or reduced (for similar reasons) are:

Walnuts, peanuts, almonds, peaches, strawberries, cherries, apricots, prunes, garlic, lima beans, sweet potatoes, corn, and peas. (This list is not necessarily comprehensive.)

If they aren’t already being reduced for their other nasty effects, white sugar, white flour, caffeine, alcohol, and cigarettes should be cut down as they all have a negative impact on thyroid function.

As for thyroid stimulating/supportive foods, first: seaweed, seaweed, seaweed.  See the section above under herbs for more details (here we encounter the perennial line between herbs and food, and it should simply be acknowledged that herbs ARE food- and the exact classification varies on a cultural and individual basis.)  On his webpage, Ryan Drum offers a significantly longer discussion on the value of different species of seaweed and their exact nutritional content and recommended dosages.  Apparently garlic and root crops, such as turnips, carrots, potatoes, parsnips, sweet potatoes can contain some iodine, depending on the content in the soil in which they are grown; this can be increased greatly through fertilization with seaweed.  (R. Drum, “Thyroid Function and Dysfunction”, p. 5) (However- as seen above- others note garlic and sweet potatoes as potentially goitrogenic.)  Other sources of dietary iodine that may be appropriate for omnivores are red meat, seafood, eggs, and dairy. Some commercial baked goods may be due to their manufacture process.  Like a few seaweeds, red meat can also contribute to raising thyroid levels directly; in this case through globulin bound thyroid hormones in the animal’s blood.  Drum encourages consumption of the animal raw or as rare as possible (though I must admit that my vegetarian self cringes at writing this.)  (R. Drum, “Environmental Origins of Thyroid Dysfunction, p.4-5)

Hypothyroid individuals may benefit from certain supplements.  There are sometimes conflicting opinions on this topic, and again, not always adequate research to back a particular theory; but the following are some suggestions that may be worth incorporating to see for oneself if there is positive effect:

- L-tyrosine is a  precursor to thyroid hormone and low levels are sometimes found in conjunction with hypothyroidism, in which case supplementation may be of benefit. (Shomon, p. 123)

- Brewer’s/Nutritional Yeast can be an invaluable supplement of B vitamins (particularly B-12) and other nutrients, including selenium (depending on the brand).   This is particularly valuable to vegans/vegetarians who may not otherwise have ample sources of B-12.

- Overall B-complex vitamin- particularly B1 (Thiamin), B2 (Riboflavin), B3 (Niacin), B6 (Pyridoxine) , and B12 (Cobalamin).  B1 and B2 are connected to metabolism- B1 to carbohydrate metabolism and B2 to thyroid hormone metabolism specifically, catalyzing the  conversion of T4 to T3.  (Shomon, p. 124)  B3 assists cells in respiration and the metabolism of carbohydrates, fats, and proteins. B6 deficiency can lead to problems in the utilization of iodine to produce TH. B12 absorption is tied to proper thyroid function and it is not uncommon that an underactive thyroid can lead to malabsorption of this vital nutrient. (Langer and Scheer, p. 29-30.)

-Vitamin A- if the thyroid gland is underactive, there is not an efficient conversion of carotene (the source found in many foods- particularly vegetables) to usable vitamin A.  (Langer and Sheer, p. 26)

- Vitamin C deficiency can place strain on the thyroid (and in long term cases, even cause the thyroid cells to multiply at an abnormal rate and oversecrete- essentially ignoring signals from the pituitary.) (Langer and Scheer, p. 30)

- Vitamin E deficiency appears to also cause rapid thyroid cell multiplication, and also inadequate synthesis of TSH in the pituitary. (Langer and Scheer, p. 31)

Though both C and E deficiency seems to lead to conditions akin to hyperthyroidism, and thus would be indicated in such cases, adequate supply of these vitamins also helpful in hypothyroidism to promote overall healthy thyroid function.

- Selenium helps control the conversion of T4 to T3 by activating an essential enzyme. It seems that selenium also has a balancing effect in conjunction with iodine- too much iodine without adequate selenium can lead to thyroid damage. Stress and injury appear to decrease selenium levels and make the thyroid especially vulnerable. (Shomon, p. 172)  See Langer and Scheer 171-172 for a more in depth consideration. Selenium supplements are not recommended in women who are or are considering becoming pregnant. As excess selenium can be damaging, the dose in conjunction with adequate iodine should be carefully measured.

- Copper and Zinc can impact production of T4 and effect metabolism of TH in cells. It is critical that these two trace minerals be in balance within the body and that neither is excess nor deficient. (Langer and Scheer, p. 59)

- Essential fatty acids (EFAs) are critical for thyroid function. (Shomon, p. 123)  Evening primrose oil, particularly, can be useful.  Its essential fatty acids are precursors to prostaglandins, which are vital to all cells. They are critical to blood circulation, metabolism, growth and reproduction, and immune function.  (Langer and Scheer, p. 150.)  EFAs can be particularly supportive in hypothyroid, where the same body functions may not be carried out with maximum efficiency.

In most cases, supplement dosages are not included as they will vary based on an individual’s body size, age, and diet. It, therefore, seems most appropriate to research supplementation amounts on a case by case basis, using the above information as guideline for what nutrients might be called for.

Bibliography

(not including some specific URL’s which are cited in paper where appropriate):

Drum, Ryan. “Thyroid Function and Dysfunction,” “Environmental Origins of Thyroid

Disease- Part 1,” and “Environmental Origins of Thyroid Disease- Part 2.”

Available at http://www.ryandrum.com/.

Eng, Grace, M.D. – personal conversations

Fischer, Pam – class lectures.

Grieve, Maude.  A Modern Herbal. 1971 (1931), Dover Publications, New York, NY

Hoffman, David. Medical Herbalism. 2003, Healing Arts Press, Rochester, VT.

Kaptchuk, Ted J.  The Web That Has No Weaver. 2000, Contemporary Books, New

York, NY

Kopf, Eric, MD. “The Thyroid Gland.” Ohlone Center Lecture Paper, April 17, 2007.

Levoxyl_WebPl available at http://www.levoxyl.com/pi.asp.

Langer, Stephen E. and Scheer, James F.  Solved: The Riddle of Illness. 2000, Keats

Publishing. Lincolnwood, IL.

Mareib, Elain N. RN, PhD & Hoehn, Katja MD, PhD. Human Anatomy & Physiology;

Seventh Ad., 2007, Pearson Education, Inc. San Francisco, CA.

Moore, Michael. “Herbal Energetic in Clinical Practice”, Available at

http://www.swsbm.com

Muscat, Joshua – personal conversations

Shomon, Mary J. Living Well With Hypothyroidism. 2000, Avon Books, NY, NY;

(http://www.thyroid-info.com/index.htm)

University of Maryland Medical Center:

http://www.umm.edu/patiented/articles/what_causes_hypothyroidism_000038_2.htm

UpToDate site: http://www.utdol.com

Women to Women, http://www.womentowomen.com/hypothyroidism/

Wood, Matthew. The Practice of Traditional Western Herbalism. 2004, North Atlantic

Books, Berkeley, CA.