Fibromyalgia

Understanding the condition and standard, integrative, and herbal approaches to treatment
Katya Adachi, MD
Ohlone Center for Herbal Studies, August 2015

Understanding and Managing Polycystic Ovarian Syndrome (PCOS)

Understanding the condition and standard, integrative, and herbal approaches to treatment
Katya Adachi, MD

Polycystic Ovary Syndrome, more commonly referred to as PCOS, is an endocrine, reproductive and metabolic disorder that is characterized by diverse clinical symptoms including irregular menstrual cycles, infertility, hyperandrogenism with subsequent hirsutism, insulin resistance (IR), acne, weight gain and cystic ovaries. PCOS is the leading cause of infertility in women in the United States. In fact, between 2-18% percent of women in North America have PCOS (Stansbury 2012, 11), and because so many women with PCOS go undiagnosed, it’s hard to pin down a more precise percentage. Not only can PCOS lead to infertility but, if left untreated, it can result in a host of other serious health problems including type two diabetes, high blood pressure, high cholesterol, thyroid disease, cardiovascular disease and an increased risk for reproductive cancers. While there is not full consensus in the scientific community about the exact cause or cure for PCOS, there are ways that women can manage the syndrome so as to improve their health, reduce symptoms, boost fertility and increase the overall quality of their life. The aim of this paper is to clearly explain the pathology and physiological consequences of PCOS and discuss ways that women can use allopathic medicine, herbal medicine, diet and lifestyle strategies to keep symptomology to a minimum and improve health and vitality.

Andropause

Andropause

Analysis and treatment from an Herbalist perspective

Daniel Walsh

October 2014

What is Andropause (also known as male menopause or ADAM (androgen decline in the aging

The medical definition is ‘the natural decline in hormones that a man experiences as he ages’.

Unlike women, who go through a relatively well defined period of abrupt hormonal change and

symptomologies (menopause), men experience a gradual decline in androgens (overall

grouping of male hormones) often times with no abrupt symptoms. (1, 2)

The rate of decline has not been clearly defined, but a rate of about one percent a year after

the age of thirty seems to be generally accepted as normal (3). This is measured by testing free

testosterone against what is considered normal ranges. Every individual will vary a bit from the

normal range and other factors will play into a man’s testosterone levels including:

? other hormone levels including progesterone and DHEA, DHEA-S (all three anabolic in

nature), sex hormone binding globulin (SHBG) and thyroid. Serum levels of DHEA which

is vital as a precursor to androgen production drops under chronic stress conditions

? diet: whole foods verse standard American diet

? type of exercise and intensity as well as how often an individual exercises verses rest

? lifestyle factors such as sleep, alcohol consumption, medications, smoking and exposure

to chemical toxins and Xenoestrogens. Xeno’s exist in the environment and can mimic

Andropause can also be defined simply: as emotional and physical changes that men go

through as they age. We are all going to age of course. I don’t know anyone who has left the

planet alive, at least not in physical form! We know that we are programmed genetically and

that our genes to a large extent control how we age and how fast. It is generally accepted;

however, that this rate can be slowed down and optimized by modulating the factors

I will address the subject with the assumption that the individual involved is experiencing

undesirable symptoms prematurely in his life. Maybe, he is even at an advanced age and is

experiencing symptoms that would be considered normal but would like to optimize his health

and bring his body back into balance. Optimal aging is the goal.

Symptoms

*fatigue *decreased libido *depression *osteoporosis *loss of strength *erectile

dysfunction *decrease in nocturnal erections *decrease in intellectual activity *mood

changes *loss of lean muscle mass *loss of body hair

These symptoms are just guidelines. Andropause affects different men in different ways and to

different degrees. Each one of the above symptoms could also be caused by other factors. An

example would be erectile dysfunction which can be due to loss of circulation from

atherosclerosis. Depression can be caused by many mitigating factors that would lead to a loss

in sex drive. Loss of body hair may be due to toxic exposure. It is complicated and not always

Each of the above symptomologies usually show up one at a time. As a result, making a

correlation between fatigue, for instance, and androgen decline is not always apparent. What

ends up happening many times, is a man may be treated for the various symptoms that are

surfacing with allopathic medicine. Medications are given to treat each specific symptom while

the underlying cause is not detected or not even looked for. Take erectile dysfunction as an

example. It is easy to fix these days. Just take the blue pill and drive on! Treating this way leads

to a worsening of the underlying disease process that is causing the problem and the

development of more issues being born. Symptoms are the last stage of a disease process. Yep!

(Taking a little blue pill once in a while to enhance the fun factor could be ok, though! Just

Diagnosis

Of course an herbalist does not diagnose or treat disease, but your doctor can.

Your friendly neighborhood herbalist located at the Ohlone Center will assess your body’s

deficiencies and excesses by assessing your symptoms, reading your pulse, looking at your

tongue, eyes, skin, disposition and assessing energy. Hormone imbalance is one of the things

we consider and treat as part of our holistic approach.

The Ohlone Center does have an herbalist on board that can run hormone tests. Moi. These

tests would give us solid evidence that what we are seeing is real. Tests can be a very effective

tool used in determining treatment but should not be completely relied upon.

If you choose to test, the most telling one, in my opinion, is the cortisol rhythm test. It

measures the levels of cortisol throughout the day and measures levels of all the main sex

hormones, progesterone, DHEA, testosterone, estrogen, and total cortisol including melatonin.

From this test we can assess the ratios of your hormones, detect hidden stressors such as low

blood sugar, food sensitivities and it can even point the finger to parasites if properly

A free testosterone blood or saliva test will also work (though it won’t give us other pertinent

information) and that is what your doc will do in most cases. What is most important are the

ratios of the steroid hormones to each other. Not just specific levels of each or one.

Treatment

The standard medical treatment for Andropause is testosterone replacement therapy. TRT.

Testosterone is usually given in the form of a cream which is applied to the upper arms.

Oral testosterone can also be given but can be detrimental. The absorption pathway through

the duodenum into the hepatic portal vein takes it through the liver which will metabolize and

excrete much of it or may turn it in to estrogen. There is no way to predict what the body will

actually do with oral testosterone so spot checks of free testosterone levels are used in specific

intervals to monitor levels. This delivery method can also cause hepa-toxicity.

Testosterone cream is a very effective delivery method and results in an increase in free

testosterone without the complications of oral T. The absorption rate also mimics the body’s

own changing levels, i.e.., high in the morning then slowly declining through the day. This is a

very effective therapy for alleviating symptoms but has drawbacks as well.

1) It is hard to control the exact amount of hormone that will actually be absorbed.

2) Care must be taken to make sure the cream is not absorbed by family members.

3) Here is the big one. Ready? TRT is for the rest of your life because once you introduce

exogenous testosterone into the body the testes in most cases stop all production of

testosterone in almost all men. This may be a permanent effect. Men who have not had

children may want to take this into account.

Taking exogenous testosterone means your body is now being controlled by an outside force.

You are tied to the hip with that force if you want to live… well, like a man.

Other delivery methods are slowly dissolving tablets and injections.

TRT is also contraindicated where cancer of the prostate or breast has been detected. Studies

have indicated that an increase in testosterone will feed these hormone sensitive cancers and

increase the proliferation of cancer cells. The same is thought with BPH, (benign prostate

hyperplasia). There might be an increase in cell proliferation.

From Michael Werner MD who treats Men with TRT:

“Decreasing testosterone levels have been a method used to treat diseases related to

both the “benign” and the cancerous groups of cells, but it is still unclear whether

testosterone therapy for the older man places him at increased risk of developing

prostate disease (i.e., whether testosterone replacement therapy makes benign

prostatic hyperplasis progress or makes previously unknown prostate cancer spread).

The majority of studies following PSA (prostate specific antigen made by both cancer

cells at a higher rate and benign prostate cells) show that it does not increase

significantly with testosterone therapy. All of the short-term studies have shown no

negative effects on prostate size, maximum urination flow rates, and prostate

symptom scores. It appears that testosterone replacement therapy has little short-

term effect on the prostate. Long-term data, however, is not yet available.”

Quoting from Herbalist Stephen Buhner’s book ‘The Testosterone Plan’: French endocrinologist

and researcher Bruno de Lignieres suggests that the best treatment for an inflamed prostate

may, in fact, be DHT. A very potent form of testosterone produced by the body. His research

indicated that prostate problems may be occur4ing from the presence of DHT but from an

imbalance in the androgen/estrogen ratio.

Note the last sentence. It notes an imbalance in the ratio. So which is it? Treat or not to treat

when BPH or cancer is indicated. My opinion here is not to treat with TRT or DHT but use

herbal remedies to enhance your own body’s natural balance of steroid hormones and spot

Other problems that might be associated with TRT are increased blood platelet count, an

increased severity of sleep apnea, and tender or enlarged breasts due to the conversion of

Your doctor might also tell you to make some lifestyle changes such as losing excess weight and

getting more sleep etc., I will cover lifestyle and diet in the herbalist’s protocol.

One Herbalist’s Approach

Lab testing. Test results can be very helpful in identifying pathologies and validating onsite

examinations and assessments, but although helpful they are not mandatory. They usually tell

us what we already know, so the treatment will be fundamentally the same in most cases, with

variations dependent upon how symptoms are actually presenting, as well as other imbalances

A holistic approach that looks at all the foundational pieces of a man’s life is integral if real

lasting health is to be restored. If you use this approach, health will be restored in most cases.

There is not one “right” approach to this but the basic tenets of health building are the same.

I list them as diet, rest, exercise, stress reduction, and supplementation that includes herbal

Diet. This could be a whole book. I basically outline the basics of what I believe is being shown

nutritionally to work towards regaining and maintaining health. Finding the right diet for you

can be tricky. What it really comes down to is basically a mindful process of trial and error. As a

health practitioner I help people with this process. Here I present general guidelines and info.

A diet primarily consisting of whole foods is integral. Whole foods are food that remains in its

natural state unaltered and unpackaged. There are levels of compliance of course and it takes

time to form new healthy habits and release unhealthy ones. As a person moves toward eating

real food blood glucose levels stabilize and they develop a taste for the real stuff and processed

The ideal to shoot for is a food pyramid with the bottom consisting of a wide variety of

vegetables. Veggies pack the highest micro nutrient punch to feed your cells and enhance your

metabolic processes and they also tend to balance out glycemic issues and keep you detoxed.

Cooked (easier to digest) and raw eat as much as you like, then a little more.

Make sure to get a good balance of the macro nutrients; protein, carbohydrates and fats. The

ratio of macro nutrients you eat at meal time is very important and is different for everyone.

Some people will need a higher percentage of carbohydrates and some will do better on more

Meat and eggs for protein and fat, Fruits and vegies for carb’s, grains and beans for carb’s and

protein, nuts and seeds for fat and protein, whole yogurt has all three. The latter three groups

can actually cause a lot of problems for people due to intolerance of gluten and lectin’s. This

Eat only natural dietary fat that includes saturated fat to produce healthy hormones. The sex

hormones that include DHEA and testosterone are made from the LDL’s from cholesterol. Good

oils include olive, butter and coconut. (I actually think coconut which is relatively new and

popular to the diet seen is questionable. Time will tell.) Do not eat hydrogenated oil or

Protein of good quality eaten early in the day will also help you feel satiated and help with

Carbohydrates. This is where monitoring is important. If you have a sedentary lifestyle keep

your carb intake relatively low and eat carbs only from natural sources such as whole grains and

fruit. If you are an athlete then you will need plenty of carb’s.

Reduce or eliminate processed sugar intake. It is poison! Small amounts of honey or molasses is

Again eat whole foods. No low fat or diet anything. As a society we have been tricked into

thinking the fake food is going to save us from the real food! Not

Rest Sleep is when our tissues repair and our minds reset.

Sleep times that are in sync with our bodies own circadian rhythms are best. That would about

The hormones cortisol and melatonin largely control those rhythms. Cortisol which keeps us

awake and alert during the day is peaking in the morning and slowly diminishes throughout the

day while melatonin which keeps us asleep naturally rises at night and peaks between 11pm

Here’s a key fact to know. Your adrenal glands start producing and increasing cortisol output for

the day around five hours after we go to sleep then levels peak soon after we wake up. Peak

would be around 8 am if we maintain healthy sleep patterns. Knowing this, it’s not hard to

imagine how hormonal imbalances will occur with inadequate or erratic sleep patterns.

Sleep is when our tissues repair and our minds reset.

Exercise This is arguably one of the most important tenet’s for hormone stasis and overall

health in a man. Testosterone levels rise after exercise and stay high for several hours adding to

The other health benefits are well known. Ideal body weight, better circulation, endurance

overall vitality, youthful appearance etc..,

Stress Reduction Chronic stress is one of the main causes of steroid hormone imbalance in

males and females. Stressors whether mental, environmental or physical have the same impact

on the endocrine system. Cortisol levels remain abnormally high which leads to low levels of

DHEA. DHEA is the mother hormone to the androgens. Voila’!

Supplementation Dietary supplements and foods that are specific to male reproductive

health and normal hormone balance as well as being good for overall health. Note that not all

supplements are good for all individuals

? Pumpkin seeds are zinc and mineral rich for enhanced spermogenisis and testosterone

? Apple Cider vinegar to balance ph and clear out mineral deposits in joints and arteries

? Dietary fiber from psyllium husk or flax seeds enhances detoxification

? Pregnenalone and DHEA are hormone supplements that can be bought OTC and safely

taken under the guidance of a practitioner to monitor hormone levels

? Zinc for testosterone production and vitamin B5 to help the body synthesize hormone

production from cholesterol. Take zinc with copper for most people not all

? Turmeric is an anti-inflammatory and helps the liver and blood

? L-arginine precursor to nitric oxide helps with erections ( only take as needed) taking

free amino’s can have undesirable side effects

? L-carnitine helps with sperm production (only take as needed)

Herbal protocol

An herbalist will consider your specific constitution and symptoms before coming up with a

specific formula for an individual. Here are some of the herbs that are specific to help people

with Andropause and will help to reverse the condition if administered properly:

? Pine pollen Actually has androsterone as a constituent and will increase levels of free

testosterone For extreme cases, not forever, to send a person back in the right

? David’s Lily also contains testosterone

? The Ginseng’s Asian, Tienchi, and Eleutherococcus stimulate production of

? Tribulus and Tonkat ali also stimulate testosterone production the former being a

? Aralia Ca spikenard is considered an adaptogen by many herbalist and has been shown

? Saw Pawmetto is specific to prostate issues including BPH and is considered androgenic

? Nettle root will block the conversion of testosterone to estrogen and is also specific to

prostate health Also inhibits binding of DHT to SBHG increasing free testosterone

? Yohimbe For erectile dysfunction Many side effects including cardiac Not

recommended but I felt the need to mention this

? Sarsparilla, Wild Yam, and Aralia contain phytosteroids that the body can transmute into

Final Note

Andropause is a natural process that we men will inevitably face with age. With a proper diet

and lifestyle adjustments and the liberal use of herbs specific to, we can maintain a vigorous

healthy lifestyle well into advanced age. I myself have faced and overcome many of the issues

mentioned in the article and am glad to help anyone in need.

Alzheimer’s: Herbal and Nutritional Support

Alzheimer’s: Herbal and Nutritional Support

Kelsey Barrett

October 2013

Introduction

According to the Alzheimer’s Association is a growing epidemic. More than 5 million Americans now have Alzheimer’s disease. By 2050, nearly 14 million (13.8 million) Americans could be living with the disease, unless scientists develop new approaches to prevent or cure it according to the Alzheimer’s Foundation of America. Alzheimer’s is the only leading cause of death that is still on the rise.

It is estimated that more than 200,000 people have early onset, early onset is considered to be people 65 years and younger.

Alzheimer’s is projected to cripple America’s healthcare system. Total payments for health care, long-term care, and hospice for people with Alzheimer’s disease and other dementias are projected to increase from $200 billion in 2012 to $1.1 trillion in 2050 (in 2012 dollars). This dramatic rise includes a six-fold increase in government spending under Medicare and Medicaid and a five-fold increase in out-of-pocket spending.

PHISIOLOGY

PROGRESSION

Alzheimer’s has a distinct progression of disease generally starting in the hippocampus.

BRAIN 75% of our brain weight is myelin, fatty matter that creates each nerve fiber.

HIPPOCAMPUS

The hippocampus is part of the limbic system, and located in the inner temporal lobe. Limbic is a Latin term which means border. Like the word “limbo”, it means an intermediate or transitional state, which is a border. The limbic system is particularly important in producing emotion, converting short-term memory to more permanent memory, and for recalling spatial relationships in the world around us. Here long term memory is stored, and is a compilation of data in our conscious memory and all of our gathered knowledge and experiences. The hippocampus is influenced by stress. Small changes in the blood flow or oxygenation levels of this region of the brain can serve as quantifiable markers for the emotional recognition of and response to stress. In addition, some neurons in the hippocampus are continually being formed. Therefore the hippocampus is one of only a few regions of the brain that serves as a source for neural stem cells.

PLAQUE

Plaques form when protein pieces called beta-amyloid (BAY-tuh AM-uh-loyd) clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells. Beta amyloid is a peptide of short chain amino acids. Beta-amyloid is chemically “sticky” and gradually builds up into plaques. Evidence has been found that A? is a highly multifunctional peptide with significant non-pathological activity.

The most damaging form of beta-amyloid may be a group of a few pieces rather than the plaques themselves. The small clumps may block cell-to-cell signaling at synapses. They may also activate immune system cells that trigger inflammation and devour disabled cells.

http://www.alz.org/braintour/plaques.asp

TANGLES

The transport system is organized in orderly parallel strands somewhat like railroad tracks. Food molecules, cell parts and other key materials travel along the “tracks”. A protein called tau helps the tracks stay straight. In areas where tangles are forming: tau collapses into twisted strands called tangles. The tracks can no longer stay straight. They fall apart and disintegrate. Nutrients and other essential supplies can no longer move through the cells, which eventually die.

LESIONS

Two types of abnormal lesions clog the brains of individuals with Alzheimer’s disease: Beta-amyloid plaques—sticky clumps of protein fragments and cellular material that form outside and around neurons; and neurofibrillary tangles—insoluble twisted fibers composed largely of the protein tau that build up inside nerve cells. Although these structures are hallmarks of the disease, scientists are unclear whether they cause it or a byproduct of it.

DISEASE

Alzheimer disease is not a single disorder in spite of a common clinical phenotype. At its origin, two different types or even more exist. As Alzheimer’s progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen.

FAMILIAL ALZHEIMER’S DISEASE, GENETIC: In a minority of about 5% or less of all cases, Alzheimer disease is due to mutations of three genes, resulting in the permanent generation of ?A4.
Familial Alzheimer’s Disease (FAD) is caused by any one of a number of different single-gene mutations on chromosomes 21, 14, and 1. Each of these mutations causes abnormal proteins to be formed. Mutations on chromosome 21 cause the formation of abnormal amyloid precursor protein (APP). Scientists know that each of these mutations plays a role in the breakdown of APP, a protein whose precise function is not yet known.
SPORADIC ALZHEIMERS DISEASE, INSULIN: The great majority (95% or more) of cases of Alzheimer disease are sporadic in origin, with old age as main risk factor. However, disturbances in the neuronal insulin signal transduction pathway may be of central pathophysiological significance. Disturbances in the neuronal insulin receptor-signaling pathway are associated with reduced neuronal glucose/energy metabolism and work in a detrimental concerted action in sporadic Alzheimer disease. Neuronal insulin receptor dysfunction may result in the intracellular accumulation of A? and in subsequent cellular damage (and/or disruption of the metabolism of proteins). One of the important pathogenesis in Alzheimer’s disease is the chronic inflammation of nerve cells. Several studies have demonstrated the associated inflammatory changes such as microgliosis, astrocytosis and the presence of pro-inflammatory substances that accompany the deposition of amyloid-? (A?) peptide. (Patients with the prolonged use of certain nonsteroidal anti-inflammatory (NSAID) drugs such as ibuprofen have been shown to have a reduced risk of developing the symptoms of AD; however, the chronic use of NSAID can cause a toxic effect on the kidneys, liver and GI track.)
What is amyloid beta (A?)? A peptide of 36–43 amino acids that is processed from the amyloid precursor protein (APP).
It was found, over twenty years ago, that patients with Alzheimer’s disease had elevated levels of cortisol in their blood streams, compared to healthy patients. This elevation correlated with the degree of memory impairments that the patients had and appeared early on in the disease progression.
“diabetes of the brain’ “brain starvation”: In Alzheimer’s brain insulin receptor sites have a problem uptaking insulin, and they’re dying off. Given this description the consequences of the inhibition of neuronal insulin signal transduction may be largely identical to those of disturbances of oxidative energy metabolism. In late-onset sporadic Alzheimer disease changes in the brain are similar to those caused by non-insulin-dependent diabetes mellitus (disorder of carbohydrate metabolism).
75% of our brain weight is myelin, fatty matter that creates each nerve fiber. Our body can only make 10% of our daily need of cholesterol, and then 90% comes from food. If people cut out cholesterol after 6-10 years people cannot keep up with the repair needs of the myelin sheath. Dr. Joel Wallach calls this physicians caused disease as related to common dietary suggestions of reducing fat from diet.
SPORADIC ALZHEIMERS DISEASE, CNS: It is believed that too much stimulation of nerve cells by glutamate (an amino acid: key elements of an amino acid are carbon, hydrogen, oxygen, and nitrogen) may be responsible for the degeneration of nerves that occurs in some neurological diseases such as Alzheimer’s disease. Amino acids re the basis of proteins, and proteins comprise the tangles and plaque found in Alzheimer’s. Nerve degeneration is dangerous as the nervous system sends synapses, structures that permit a neuron (or nerve cell) to pass an electrical or chemical signal to another cell (neural or otherwise). Like other neurotransmitters, glutamate is produced and released by nerve cells in the brain. The released glutamate then travels to nearby nerve cells where it attaches to a receptor on the surface of the cells called the N-methyl-D-aspartate (NMDA) receptor.

WESTERN/PHARMACETICUAL TREATMENT AND SIDE EFFECTS

The U.S. Food and Drug Administration (FDA) has approved two types of medications — cholinesterase inhibitors (Aricept, Exelon, Razadyne, Cognex) and memantine (Namenda) — to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer’s disease. While current medications cannot stop the damage Alzheimer’s causes to brain cells, they may help lessen or stabilize symptoms for a limited time by affecting certain chemicals involved in carrying messages among the brain’s nerve cells. Doctors sometimes prescribe both types of medications together. The body has a natural system of creation and decay. From my research it appears that pharmaceuticals reduce the rate of decay of specific chemicals, leaving old chemical compounds in the body/brain to function

Medications for early to moderate stages

Cholinesterase Inhibitors: Cholinesterase inhibitors prevent the breakdown of acetylcholine (a-SEA-til-KOH-lean), a chemical compound that works as a neurotransmitter in the Central Nervous System. People with dementia usually have lower levels of this chemical, which is important for the processes of memory, thinking, and reasoning. Cholinesterase inhibitors slow the breakdown of acetylcholine. It does this by preventing the action of acetylcholinesterase, the compound that normally breaks it down. Delays worsening of symptoms for 6 to 12 months, on average, for about half the people who take them. Are generally well tolerated. If side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements.

Donepezil (Aricept) SIDE EFFECTS

Donepezil (Aricept) is the only cholinesterase inhibitor approved to treat all stages of Alzheimer’s disease.

Mild side effects: Nausea, vomiting, diarrhea, loss of appetite/weight loss, dizziness, drowsiness, weakness, trouble sleeping, shakiness (tremor), or muscle cramps may occur as your body adjusts to the drug. These effects usually last 1-3 weeks and then lessen. Serious side effects: slow/irregular heartbeat, fainting, trouble urinating, severe stomach/abdominal pain, black stools, vomit that looks like coffee grounds, seizures. A very serious allergic reaction to this drug is rare: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Rivastigmine (Exelon) SIDE EFFECTS

Side effects are more common with oral forms of rivastigmine than with the patches.

Common side effects: nausea, vomiting, loss of appetite/weight loss, diarrhea, indigestion, weakness, dizziness, drowsiness, and shakiness (tremors), sleepiness, headache, increased sweating, fever, skin reactions such as irritation, worsening of Parkinson’s symptoms, anxiety or agitation, depression, difficulty sleeping (insomnia), hallucinations, delirium, fainting, ulceration in the stomach or intestines, seizures, chest pain (angina), abnormal heartbeats, increased blood pressure (hypertension), pancreatitis, hepatitis.

Patches side effects: itching or redness at the site of application of patch, rash, shaking, usually of the hands (tremor),

Galantamine (Razadyne) SIDE EFFECTS. Mild side: feeling tired, dizzy, or light-headed; nausea, vomiting, gas, loss of appetite; weight loss; or headache.

Serious side effects: chest pain, slow heart rate, black, bloody, or tarry stools; coughing up blood or vomit that looks like coffee grounds; weakness, confusion, decreased sweating, extreme thirst, hot dry skin; or urinating less than usual or not at all.

Medication for moderate to severe stages

Regulates the activity of glutamate, a different messenger chemical involved in learning and memory. Delays worsening of symptoms for some people temporarily.

Memantine SIDE EFFECTS
Common side effects: fatigue, pain, increases in blood pressure, dizziness, headache, constipation, vomiting, back pain, confusion, somnolence, hallucination, coughing, and difficulty in breathing. Memantine may cause a serious skin reaction called Stevens-Johnson syndrome.
VIT. E

Some doctors prescribe high doses of vitamin E for cognitive changes of Alzheimer’s disease.

HARM REDUCTION

Galantamine: 75% is metabolized in the liver

Rivastigmine: Metabolized by enzymes in the liver

Donepezil: Metabolized by enzymes in the liver

Memantine: Metabolized in the liver

Herbal hepatic, alterative, cholagogue, and bitters can aid in harm reduction and the metabolism of Alzheimer’s medication. All nutrition suggestions apply.

Alterative: burdock, wild indigo, black cohosh, Echinacea, cleavers, goldenseal, chaparral, Oregon grape, bog bean, poke, pasqueflower, yellow dock, figwort, sarsaparilla, red clover, nettle

Cholagogue: wild indigo, barberry, celandine, artichoke, wild yam, boneset, gentian, rosemary, yellow dock, sage dandelion, lemon balm

Bitters: mugwort, yarrow, boneset, centaury, gentian, goldenseal, horehound, chamomile, rue, tansy, dandelion

Hepatics: Dandelion, verbena, milk thistle, artichoke, yarrow, aloe, celery seed, wormwood, horseradish, turmeric, cleavers, gentian, goldenseal, motherwort, oregon grape, yellow dock, prickly ash, dandelion, wild yam

Antihepatotoxic: licorice, milk thistle, schisandra

HERBAL AND NUTRITION COMPLIMENTARY MEDICATION

VIT. E/ANTIOXIDANTS Vitamin E refers to a group of fat-soluble compounds with strong antioxidant properties. An antioxidant is a substance that reduces oxidative damage, damage caused by oxygen, which can harm human tissue, cells and organs.

FOODS HIGH IN VIT. E Almonds, asparagus, avocados, blue crab, brazil nuts, broccoli, cod liver oil, egg yolks, green leafy vegetables, like lettuce, spinach, turnip, beet, collard, and dandelion greens, hazelnuts, mangoes, mayonnaise, olives, papayas, pine nuts, pumpkin, grape seed oil, rockfish, sweet potato, tomato, walnut, wheat germ oil.

HERBAL ANTIOXIDANTS Hawthorne, green tea, ginkgo, elderberry, cinnamon, ginger, burdock, turmeric

TURMERIC A study conducted at UCLA found that curcumin may help the macrophages to clear the amyloid plaques found in Alzheimer’s disease. Macrophages are white blood cells within tissues, suggesting weakened immune system. Due to the lipophilic (tending to combine with or dissolve in lipids or fats) nature of curcumin, it crosses the blood brain barrier and binds to plaques.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/Ann Indian Acad Neurol. 2008 Jan-Mar; 11(1): 13–19. doi: 10.4103/0972-2327.4022

Coconut Oil

The vast majority of the fats and oils eaten, whether they are saturated or unsaturated or come from an animal or a plant, are composed of long-chain triglycerides. Probably 98 to 100% of all the fats we eat consist of LCT. Coconut oil is unique because it is composed predominately of MCT. The size of the fatty acid is extremely important because physiological effects of medium-chain fatty acids in coconut oil are distinctly different from the long-chain fatty acids more commonly found in our diet. Almost all of the medium-chain triglycerides used in research, medicine, and food products come from coconut oil. Unlike other fats, they put little strain on the digestive system and provide a quick source of energy necessary to promote healing.

Medium chain triglycerides (MCT) are not processed by your body in the same manner as long chain triglycerides. Normal fat metabolism depends on bile salts that have been released from your gallbladder before it can be broken down in your digestive system. MCTs bypass bile metabolism and go directly to your liver where they are converted into ketones, MCTs do not require bile salts for digestion. The liver then immediately releases the ketones into the bloodstream where they are transported to the brain to be used as fuel. Research has shown that the ketone bodies produced by MCTs provide a stable source of energy for the brain during periods of low blood sugar without the neurological risks associated with high blood sugar.
“Keytosis” creates circulation to the brain.
In feast the brain feeds off of sugar. In famine the liver converts body fat into ketone bodies, which are fuel for the brain cells.
Ketones in mice allow new neurons to grow and new nerves to grow, reversal.

MAGNESIUM

Magnesium protects and restores synaptic density. In a series of laboratory experiments, a highly absorbable form of magnesium was shown to not only increase magnesium blood levels, but it also substantially increases magnesium brain concentrations. In response to this elevation in cerebral magnesium, there were significant increases in synaptic density and corresponding improvements in synaptic functioning and neuronal signaling. These improvements in synaptic structure and function translated into improvements in measurements of cognitive function.

Breaking the Itch-Scratch Cycle: Research and treatment for Eczema/Atopic Dermatitis

Breaking the Itch-Scratch Cycle: Research and treatment for Eczema/Atopic Dermatitis

Krista R. Herbe, Western Herbalist

October 2011  

“The immune system has an incredible capacity for balance and counterbalance

to maintain optimal and properly tuned immune responses,”

John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology. F1  

Definition

Eczema, also known as Atopic Dermatitis, and Atopy, is very common worldwide. It affects more than 15 million people in the United States, and the number of people diagnosed with Eczema is growing every year. The National Eczema Association describes this dis-ease as an itchy rash or inflammation of the skin that is long-lasting and often accompanied by, or induced by allergies or asthma. The itchy rash causes scratching and the scratching creates redness and swelling. These rashes and inflammations can occur on any area of the skin yet, most commonly occurring near the joints, on the arms and legs and on the face.
KEY SIGNS, SYMPTOMS AND COMPLICATIONS

Eczema is most common in infants and children. The research organization, Atopic Dermatitis Vaccinia Network F1a, states that Eczema that is widely prevalent over the body occurs most often in infants. Older children and adults most commonly get eczema at the joints, face and on hands and feet. People often experience initial symptoms intermittently until the disease becomes acute with increased intensity. Over time, specific symptoms can change, and become more severe, then ‘hibernate’ and flare up again.  The primary complaint is on the skin; however symptoms can affect all body organs.

Common Symptoms:

  • Red, white, to brownish-gray colored inflammations or patches
  • Small, raised bumps that may ‘weep’ fluid
  • Itching, sometimes worse at night
  • Dry, thickened, cracked, raw or scaly skin
  • Irritability and depression

Other possible symptoms:

  • Gastro-Intestinal symptoms like bloating, diarrhea, acid reflux
  • Respiratory Symptoms related to Allergic rhinitis including reddening of nose, itchy/watery eyes, and excessive mucus.
  • Possible cardiovascular symptoms including heart palpitations.
  • Headache and sinus congestion

Complications F1a:

  • People with eczema are susceptible to recurrent viral infections of the skin such as eczema herpeticum (a widespread herpes skin infection) and pearly wart like lesions called molluscum contagiosum.
  • People with eczema should not avoid receiving smallpox vaccinations, even if the symptoms have been dormant for years. The ADVN reports an increased risk of a serious and potentially fatal complication called eczema vaccinatum. This needs to be researched more fully.

 

CAUSES

There is still no single cause of eczema; however it is generally accepted that triggers can be either exogenous (external) or endogenous (internal) and that people can suffer from both at the same time. Eczema affects everyone differently so identifying specific triggers is essential in easing and eliminating symptoms. Researchers and some medical practitioners are now viewing Eczema as an autoimmune disease that is caused by the over-activity, or hyper-sensitivity, of the immune system, where the immune system attacks itself.

Autoimmune dis-ease is a grouping of more than 80 chronic illnesses including dis-eases of the nervous, gastrointestinal, and endocrine systems as well as skin and other connective tissues, eyes, and blood.  In all of these dis-eases, the body’s immune system (including B and/or T immune cells) begins attacking the very organs it was designed to protect. F2

 

Exogenous Causes
External causes include the environments we are exposed to, the stress we experience in our lives and the way we treat our skin.

Skin

Although, to one with active symptoms it seems impossible to avoid, scratching the skin can make the rashes worse. Bacteria, especially Staphylococcus aureus a natural member of our skin flora, can enter through broken skin and become a minor skin infection, boils or even pneumonia. Barbara S. Baker discusses research findings in which patients with eczema exhibit defects in innate and acquired immune responses resulting in a heightened susceptibility to bacterial, fungal and viral infections (Baker F2b). Allergens released by the yeast Malazessia furfur, a common normal skin flora, have also been causal in disease development. Exercise is great in many ways. It gets blood flowing, moves the lymph, and can even lead to reduced stress. However, with the friction of movement, sweat dampened clothes can also irritate sensitive skin. Try to avoid wool or synthetic fabrics and choose natural fabrics like cotton, hemp, or linen to allow the skin to breathe. Taking very hot and long baths and or showers can dry out and irritate the skin as well. Keep skin moisturized using emollient lotion.

 

Environmental

Some studies attribute the increasing prevalence of Eczema to decreased exposure to microorganisms during early life. This correlation needs to be studied further but may result in an altered Th-1/Th-2-balance and/or reduced T cell regulation of the immune response F2b. The Mayo Clinic also suggests environmental factors can play a role in eczema flare-ups, as well. Some factors mentioned on their website include rapid changes in temperature, dust or sand, exposure to solvents, cleaners, soaps or detergents, cigarette smoke, low humidity, and living in cities where pollution is high. Based on this, people who live in larger cities or who earn their living using toxic solutions need to take extra precautions. Other allergens common to most homes include dust mites, animal dander, and pollen.  The findings of a study printed in ScienceDaily in early 2010, and funded by the NIH/National Institute of Allergy and Infectious Diseases F2a found a genetic disposition where excess stimulation of T-Cells are present in the epidermis, making the skin more permeable to irritants like detergents and dust mites. See below for Immune System physiology.

 

Stress

The term stress includes a whole spectrum of situations; worrying, anxiety, fear, depression, oppression, and misery are all stressful conditions that affect the body. The daily stress of dealing with our personal responsibilities in our relationships, and commitments to home, work and/or school can leave us feeling stressed out. Most people experience symptoms of stress that come from commuting, loud noises, paying bills, arguments with family and friends. Each one of us deals with stress differently and we each need to find ways to identify and manage our stress so that we can maintain optimal health and keep Atopic dermatitis in an un-inflamed state. Deeper stresses come when people have experienced more traumatic situations in their life including being a witness or survivor of violence or natural disasters. Our life experiences definitely have an impact on our stress levels.
Endogenous Causes
Internal causes of eczema include the food we put into our body as well as our acquired and innate immune system functions.

Auto-Immune Function

In order to understand the endogenous causes of eczema, we must look deeper into the immune system and understand how the body reacts to allergens. An analogy of this system given by dermatologist Dr. Victoria Lewis F4, is of a lock and key. The invading foreign protein or ‘antigen’ is the key and the body’s immune system must manufacture a lock, or ‘antibody’ to trap it. The immune system first reacts to the allergen by activating the T-lymphocytes (T-cells), which activate the B-lymphocytes (B-cells) to release substances called immunoglobulin E (IgE) antibodies and prostaglandins. These IgE antibodies attach to the mast cells, stimulating them to release inflammation activators and soluble granule remnants, including cytokines, and anti-allergen mediators such as histamine, tryptase, and chymase, to destroy the foreign antigens. In the case of hypersensitivity, the mast cells that originally released the histamine to react to the antigens, over-react, creating excessive inflammation, redness, and itching F5.

 

Allergies develop slowly. Before acute symptoms of allergy become apparent, the immune system has been assessing antigens that the body has come in contact with and producing antibodies to fight off intruders. The immune system of allergic individuals produces IgE antibodies against harmless environmental antigens, called allergens. When the body identifies an allergen the generation of IgE producing long-living B-lymphocytes (plasma cells) is coded in the memory of the cells and kicks into full production. These coded, allergen-specific, plasma cells sit in lymphatic organ tissues and are prepared to react immediately. Over several years, these cells secrete large quantities of IgE antibodies even without the presence of the coded allergen. The ‘sensitization’ of the surface of the mast cells occurs when the IgE antibodies bind to the high affinity IgE receptors. The sensitized mast cells lay in wait and do not cause allergic reactions. As soon as the allergen binds to receptor-bound IgE antibodies, stimulation of mast cells and release of inflammatory mediators occurs within minutes and results quickly in clinical signs of allergy. Allergic reactions can occur immediately, once the allergen is identified in the system, even when individuals have been asymptomatic for years.F6.

 

A defining characteristic of the atopic immune system is the capacity to generate elevated IgE antibodies. When looking to regulate immune imbalance we look at the differentiation pathway of T-helper 0 (Th0) cells. These precursor Th0 cells are induced to differentiate into T-helper 2 (Th2) cells that typically produce IL-4, IL-5, and IL-13. The Interleukins (Il-4, IL-5, etc.) are a group of cytokines produced by leukocytes to act on leukocytes, stimulating or silencing growth or differentiation of T and B Lymphocytes. Th2 cells control the synthesis of IgE [1] F7. Understanding allergy and immune system disease requires balancing mast cell regulation and understanding the inherent self-regulation of the immune system including the part of interleukins F1.

 

(Above)Release of histamine (that contributes to the ‘symptoms’ of allergies) by mast cells requires the production of antibodies (IgE) by B-cells and that process is regulated, in part, by cytokines produced by basophils (Bischoff 2007).http://people.eku.edu/ritchisong/301notes4.htm
Diet

Eczema is a skin dis-ease that is associated with atopic conditions such as asthma and IgE-mediated food allergy and whose skin lesions are characterized by a Th-2 cell-mediated response to environmental antigens (Baker F2b). It has become much more widely accepted that food intolerance may play a big part in triggering eczema outbreaks. It is generally acknowledge that between 10-25% of those with Atopic Dermatitis have food sensitivities. Additionally, some eczema is associated with celiac disease, Irritable Bowl Syndrome F3 and asthma F2. The most common trigger foods are chicken eggs, cow’s milk, shell fish, peanuts, wheat, nuts, rice, codfish, food additives and some fruit, alcohol and coffee.

 


TESTS AND DIAGNOSIS

There is no definitive test for diagnosing eczema. A primary care physician or dermatologist may ask you questions about your medical history, including your family, and examine the visible symptoms on your skin in order to diagnose you based on their professional experience. Most people diagnosed with, or experiencing symptoms of eczema, have a family history of allergies, hay fever, and or asthma. It is possible to get skin tests and blood tests for food and environmental allergies, though they are not always definitive. One such blood test is called the RAST (radioallergosorbent test). Both skin and blood testing look for elevated levels of immunoglobulin (IgE) antibodies F8.

 

Skin Prick Testing

This test measures specific IgE attached to Mast cells in the skin. See diagram below F9:

 

 

Allergen solutions for skin prick testing:

  • Positive control (histamine)
  • Occupational allergens may be present (ammonium persulphate, platinum salts, antibiotics, and latex)
  • Negative control (diluent), no direct comparison
  • Inhaled allergens (house dust mite (HDM), grass pollen, cat dander, dog hair)
  • Food allergens

 

Disadvantages of skin prick test:

  • Food allergens (less standardized), less reliable than inhaled allergens
  • Itching and pain at site
  • Skin conditions (eczema or dermatographism) interfere with interpretation
  • Histamine antagonists (antihistamines) suppress skin reaction

 

TRADITIONAL MEDICAL TREATMENT
Treatments for eczema by medical doctors are focused preventing contact with external allergens and alleviating inflammation and itching. Common methods of treatment for eczema include:

  • Environmental protection from or elimination of known allergens
  • Use of emollients
  • Corticosteroids
  • Light therapy (phototherapy)
  • Antibiotics
  • Antihistamines
  • Immonomodulators

Exogenous Methods

Environmental
If, allergens such as dust mites, detergents, or foods are known, than it is important to eliminate contact. If it is necessary to come into contact with toxic chemicals while at work it is necessary to use protective measures such as gloves, goggles and or masks to protect our skin and our internal systems as well.

Emollient Lotions
It is important to keep skin moisturized and protected using emollient lotions and oils. Medical practitioners may recommend different brands, but do your own research and read the labels for inactive ingredients like alcohol that may be drying to the skin.

Corticosteroids
The leading prescribed treatment is Corticosteroid creams or ointments to relieve the itching feeling on the skin and break the itch-scratch cycle. These topical treatments vary in potency. Low dose corticosteroids, like hydrocortisone, are available over-the-counter. Hydrocortisone is most similar to the naturally occurring corticosteroid cortisol produced by the body. Higher dose synthetic corticosteroids need prescriptions and include betamethasone, fluticasone, mometasone, prednisone (brand names, such as Deltasone and Sterapred), methylprednisolone (Medrol), prednisolone (Prelone, Pediapred), dexamethasone (Decadron, Hexadrol), and higher dose hydrocortisone (Acticort, Cortef) F10. The steroids are absorbed into the skin to stop T-cells from producing inflammation-causing chemicals, like IgE and prostaglandin.

For more severe cases, doctors sometimes prescribe oral corticosteroids, such as prednisone, or an intramuscular injection of corticosteroids to reduce inflammation and to control symptoms. These medications are often also prescribed to treat arthritis and other rheumatic dis-ease. They are more powerful than lower dose steroids and should not be used long term because of increased risk of serious side effects.

 

Local Side Effects
Local side effects of long-term or repeated use occur in the areas treated with the steroid and can include skin irritation or discoloration, thinning of the skin (atrophy), permanent stretch marks (striae), temporary pigment changes, and permanent appearance of swollen of fine blood vessels under the surface (telangiectasia). If the eczema appears to get worse, there may be a skin allergy to the steroids, the skin may bruise easier or become more prone to infection.

To minimize the risk of steroid side-effects, Helen Marshall, a registered pharmacist in the United Kingdom, with a background in hospital pharmacy, recommends taking these precautions F11:

  • Use the least potent steroid possible to control the inflammation.
  • Only apply the steroid to affected areas of skin.
  • Use the steroid prescribed by your doctor sparingly, and no more than once or twice a day.
  • Avoid using steroids on large areas of skin for long periods of time.
  • Certain areas of skin – the face, genitals, raw skin, thin skin and areas of skin that rub together, such as beneath the breasts or between the buttocks – absorb more steroid than other areas.
  • Ask your medical professional if applying dressings over the area of skin treated with the steroid will increases the absorption into the skin.
  • Stop using steroids once the inflammation is under control.
  • Compliment steroid use with skin moisturizers and emollients to help prevent flare-ups.

Systemic Side Effects
A systemic side-effect is one that occurs within the body. If used on large areas of skin for prolonged periods of time, potent steroids can be absorbed into the bloodstream and affect other areas of the body. This may lead to suppression of adrenal glad function leading to additional illness and dis-ease. The adrenal glands are responsible for producing the body’s own steroid hormones (cortisol, etc.). Children’s systems are still developing and more sensitive, and therefore have a higher risk F11.

Dr. Theodore R. Fields, MD, FACP Attending Physician, Hospital for Special Surgery, Professor of Clinical Medicine, Weill Cornell Medical College reports that long-term use of corticosteroids can result in the many side effects, including (see Appendix A):

  • Altered Response to Physical Stress
  • Steroid Withdrawal Syndrome
  • Infection
  • Gastrointestinal Ulcers or Bleeding
  • Osteoporosis
  • Weight gain
  • Insomnia
  • Mood Changes
  • Fluid Retention and Elevated Blood Pressure
  • Elevated Blood Sugar
  • Eye Problems

Light therapy (phototherapy)
In the age of sunscreen it may seem unwise to prescribe light therapy for the treatment of skin dis-ease like eczema however, exposure to controlled amounts of natural sunlight has been beneficial in alleviating symptoms of eczema. If getting sunlight the natural way is not comfortably possible due to climate or other factors, doctors can prescribe session of exposure to artificial ultraviolet A (UVA) or ultraviolet B (UVB) light either alone or with medications. Long-term exposure to UV rays has harmful effects, including premature skin aging and an increased risk of skin cancer.

Endogenous Methods

Antibiotics
Scratching can lead to bacterial infections on the skin. Some doctors will recommend antibiotics to treat these acute infections or over longer periods to reduce the amount of bacteria residing on the skin to prevent future infections as well.

Antihistamines
The role of antihistamines is to block the action of histamines at its receptors (on the mast cells) and thus decreasing the body’s reaction to the allergen. This will reduce the itching, swelling and redness associated with the eczematic flare. Antihistamines can be pills, liquids, nasal sprays and even eye drops. Commonly, antihistamines are taken before bed to relieve night-time symptoms. Many people experience greater itching at night, and through the night, resulting in trouble sleeping or feeling well rested. Lower dose Antihistamines are available over-the-counter without prescription. Common side-effects include dry mouth, urine retention, blurred vision, and the ability to concentrate and stay awake, and should not be used simultaneously with monoamine oxidase inhibitors (MAOI) F13. Antihistamines only treat symptoms and do not attempt to treat the cause of the eczema. Commonly used antihistamines include F14:

Immunomodulators
Instead of prescribing steroids or in addition, medical practitioners are prescribing medications called Immunomodulators. These include tacrolimus (Protopic) and pimecrolimus (Elidel) which affect the immune system and in order to help maintain normal skin texture and reduce flares. There are concerns about long-term effects of these medications on the immune system. The Food and Drug Administration (FDA) states, “Although a causal relationship has not been established, rare
cases of malignancy (e.g., skin and lymphoma) have been reported in patients treated with topical calcineurin inhibitors, including ELIDEL Cream” F15.

 

 

HERBAL ALTERNATIVES AND COMPLIMENTARY THERAPY

Our body wants to keep us healthy and is constantly working to keep us in balance. Western Herbal Medicine provides many insights into healing the symptoms and causes of eczema. Each herb has specific properties and reactions in the body. Using herbs to support, tone, and strengthen the systems of our body, can help us heal our dis-ease.

 

Western Herbal Approach
From a Western Herbalist perspective it will be important to treat eczema both internally and externally with herbs and supplemental therapies. It is important to support the healing of the skin as well as the digestive system and liver, immune system, and nervous system.

 

Herbal actions specific to treating eczema include:

  • Alterative – support organ function and elimination.
  • Antipuritic – treat itch sensation to break itch-scratch cycle.
  • Anti-inflammatory – Topically and Internally
  • Astringent – topically on weeping sores.
  • Emollient – topically to soothe entire affected area.
  • Lymphatic – move lymph and eliminate waste.
  • Nervine Relaxant – relieve anxiety and relax peripheral nerves and itch feeling.
  • Diuretic – support elimination of waste and detoxification.
  • Hepatic – support liver and digestion.
  • Vulnerary – topically for wound healing.

 

Exogenous Treatments
We may not be able to identify all the allergens that affect us because we do not have financial resources or access to health care professionals. That does not mean that we cannot take steps to reduce the amount of allergens that live in or enter our space. Since many people display allergic responses to dust mites, it can be beneficial to take inventory in your house on where they might live and eliminate them. Occasionally, items that trap dust, such as down pillows and comforters, mattresses, carpeting and drapes, can worsen the condition. So, replace these items with hypoallergenic materials, or get covers for your mattress and pillows. Invest in a hepa-filter air purifier or vacuum cleaner to clean drapes and carpets. You can even remove carpets altogether.

 

Emollients
It is important to keep the skin moisturized by applying emollient lotions, creams or oils at least twice a day and immediately after taking bathing. I have found Coconut Oil, chamomile infused Jojoba oil, and chaparral (larrea tridentata) infused olive oil (and alcohol tincture) to be helpful during acute skin flares. An ointment recipe on Eczema.Net F16 uses Golden seal root powder with vitamin E oil and honey, mixed into paste and applied to affected regions. Golden seal is antibiotic, working to heal skin and prevent infection, Vitamin E is a natural astringent soothing the skin, and honey is widely valued for its anti-inflammatory and anti-allergenic properties.

During acute flares it can be helpful to take an Oatmeal bath. Place approximately 2 cups of oats in an old sock or towel with a rubber band around the end. Cook on the stove in a pot with water while you fill the bath. Place both the ‘broth’ and sock in the bath tub. This will make it easier to clean up after you have calmed your skin and your nerves. The sock can be applied and held to specific areas of inflammation and the ‘milk’ can be squeezed out of the sock to create a really soothing milky bath. As hot water will aggravate the inflammation, do not make the bath too hot. If using this method just before bed, add nepeta cataria (catnip) or matricaria recutita (chamomile) to the mixture to increase the calming affect on the nerves and welcome sleep. Applying a cool compress to the affected areas can also reduce irritation and inflammation during acute attacks.

 

Other Herbs for Topical Use Include:
Calendula Officinalis (calendula)
Hydrastis canadensis (goldenseal)
Plantago spp. (Plaintain)
Stellaria media (chickweed)
Urtica dioica (nettle)

 

Endogenous Methods

Three main systems where the outside world comes in contact with the inside world of our bodies are the skin, respiratory tract, and the gut. Immune response is heightened in these areas to protect us from foreign invaders like bacteria, pollen, viruses, etc.

 

Digestive

Our digestive system speaks to us. It gives us clues as to its function. Sometimes we have gas or bloating. Sometimes we are constipated or have diarrhea. If we pay attention to the signals our body is giving us we can listen, learn, and heal. There is a strong like between autoimmune diseases and food sensitivities because of the interaction between the immune system and the digestive system.

 

Food Allergies

The inflammatory immune response is triggered by food sensitivities to gluten, corn, eggs, soy, and other foods. These food sensitivities may be genetic or acquired.

Herbalist Paul Bergner published tips for evaluating the digestive system function in order to identify and eliminate food allergens and heal the digestive tract. It is necessary to use a Food/Mood Diary (Appendix B) to identify foods eaten, moods, and symptoms. Some symptoms occur immediately, others over a period of days. While reviewing the Food/Mood Diary it is important to look for a Triangle pattern including 1) digestive symptoms, 2) predominant mood or energy symptoms, plus 3) complaints of musculoskeletal aches to autoimmune tissue disorders including inflammation. Symptoms such as upper gastrointestinal pain or abdominal bloating, without obvious causes, are the first indicator of digestive dis-ease. Steroidal drugs like prednisone can exacerbate the symptoms and damage to the gastro-intestinal tract. If the symptom triangle is present, it is necessary to test the body’s response to food elimination. If digestion, mood and autoimmune symptoms all improve after elimination of a food, it signals that the individual is constitutionally intolerant of the food.

To complicate the allergies further, Berger states that the food often causing the symptoms is consumed everyday and at most meals. These seem to be foods we cannot do without. Seemingly, we are addicted to them. Bergner links this to a possible sympathetic adrenal response to the presence of the irritant in the gut. Eating the food at regular intervals becomes woven into the systemic response to stress. Our bodies feel a surge of norepinephrine and adrenaline associated with the immune response these proteins trigger (Traditions in Western herbalism Conference materials). Do you have any known intolerances? Do you consume those foods anyway?

The only conclusive way to identify food allergies is to do a full elimination and provocation diet. Liz Lipski’s Elimination/Provocation Diet provides a healthy outline to follow (Appendix C). This should include up to 40 days of elimination, eating only foods commonly known to be ‘hypo-allergenic’, with a gradual reintroduction of foods, one-at-a-time to identify allergy triggers. Take detailed notes using the Food/Mood Diary and review your findings to eliminate from your diet the foods, which give you a high allergic response. After a period of elimination and healing, it can be possible to introduce the trigger foods back into your diet.

Probiotics
Sean Donahue, herbalists, recommends including a probiotic supplements with a minimum of 15-20 billion live organisms to re-establish healthy gut flora. This is supported by a study on Probiotics and Immune Health by Yan F, Polk DB., that found probiotics ‘regulate the functions of systemic and mucosal immune cells and intestinal epithelial cells’. This supports the therapeutic use of probiotics in treating immune response-related diseases, such as allergy, eczema, and viral infection.

Bitter Herbs
The use of bitter herbs for toning and strengthening the digestive system is well documents in traditional medicine of both Europe and China. Bitter herbs also have a toning and strengthening effect on the whole nervous system and vitality of the human body. This can help us deal with stress and maintain our overall health. I have found that taking bitter herbs 15 minutes before meal, can stimulate the digestion and ease assimilation in those suffering from eczema.

In his book, Foundations of Health, Healing with Herbs & Foods, Christopher Hobbs, Herbalist and Botanist explains that bitters work in three major ways. Bitter Herbs will 1) activate the gastric secretion of hydrochloric acid (HCL), 2) increase the tone and strength of the autonomic nervous system, and 3) activate the immune system. First, bitter herbs stimulate secretion of HCL in the stomach, and production of digestive enzymes such as bile from the gall bladder. Taken before meals, these bitters will stimulate digestive function preparing the body to digest the food that is coming. Effectively, bitters are improving blood circulation, nutrient absorption and elimination of waste.

Additionally, bitters work to strengthen the autonomic nervous system, which controls digestive organ function. By supporting the function of the digestive organs, they become stronger and more capable of doing their job without the use of bitters. In supporting our nervous system function, we may also feel lowered anxiety and stress.

Mr. Hobbs, writes that bitter herbs like gentian, can modulate the gut-associated immune system, thus activating or modulating the immune system. In Europe, bitter herbs are given to people recovering from infectious diseases including chronic fatigue syndrome. As stated by Mr. Hobbs, clinical tests in Europe have shown a decrease in sIgA antibodies and a reduction or elimination of symptoms associated with inflammatory bowel disease in patients using bitter herbs.  It is important to note the difference between immune stimulating herbs and immune modulating herbs. In conditions such as eczema it may be contraindicated to use immune stimulating herbs. Instead, immune modulating herbs that work to balance the already active immune system are better suited for this constitution (David Hoffman, Medical Herbalism, p. 446).

 

“Classic Bitters” Formula, Hobbs, Pg. 121
Artichoke leaf (1 part)
Gentian (1/4 part)
Orange or tangerine peel (1 Part)
Cardamom seed (1/4 Part)
Ginger root (1/4 Part)
Powder the above hers and add either vodka, wine or brandy Let soak for 2 weeks, shaking every day or so. Filter the liquid out and store in glass containers. Alternatively, simmer herbs for 30 minutes at 1 part herb mixture into 20 parts water. Refrigerate unused portion and consume within 3 days.

 

Other bitter herbs include:
Agrimonia eupatoria L. (Agrimony), Artemesia vulgaris L. (Mugwort), Hydrastis canadensis (Goldenseal), Foeniculum vulgare (Fennel), Taraxicum officinale (Dandelion Root), Sassafras albidum (Sassafras), Matricaria recutita (Chamomile), Salvia officinale (Sage), Thymus vulgaris (Thyme).

 

David Hoffman, Western Herbalist, includes a prescription for Eczema in his bookF17 :

Eczema Prescription

Galium aparine (cleavers)      1 part

Urtica dioica                           1 part

Trifolium pratense                  1 part

Dosage: Tincture up to 5ml, three times a day

With Tea infusion of fresh Urtica dioica or Galium aparine two to three times a day.

If the eczema is persistent and resistant to the use of mild alteratives listed above, continue with the Galium aparine, but substitute Arctium lappa (burdock root) and Scrophularia nodosa in equal parts. The dosage of this is recommended at up to 2.5ml of tincture three times a day building up to 5ml a day. If flare ups on the skin occur cut down the amount of Scrophularia nodosa and try again.

 

Other Digestive Healing Actions and Herbs
Demulcent (soothe mucus membranes) – Althea officinalis (Marshmallow)  or Ulmus fulva (Slippery Elm)
Vulnerary (heal wounds) – Calendula officinalis (Calendula), Plantago Spp. (Plaintain), Achillea millefolium L. (Yarrow)
Astringents – Juglans Nigra (leaf or hull) or Rubus idaeus (Raspberry Leaf)
Anti-Inflammatory – Evening Primrose Oil, Chamomile, Curcuma longa (Turmeric)
Hepatic Alteratives – Arctium lappa (burdock), Hydrastis canadensis (goldenseal), Mahonia aquifolium (oregon grape root), Berberis vulgaris (Barberry), Iris Versicolor (Blue Flag) *USE IN LOW DOSES
Diuretic and Lymphatic – Trifolium pratense (Red clover), Fumaria officinalis (fumitory), Viola Tricolor (heartsease)
Angelica archangelica (Angelica) – Astringent, tonic, diuretic, vulnerary, cholagogue, anti-inflammatory
Artemisia vulgaris (Mugwort)- bitter tonic, stimulant, nervine tonic

 

Respiratory
Our nose is can be the ‘canary in the coal mine’ of our respiratory system. If there is an environmental allergen around, the nose is sure to know. If environmental toxins complicate your eczema, asthma or seasonal allergies it is important to know how to support, tone and strengthen respiratory function. Use of non-steroidal anti-inflammatories (NSAID’s) like Ibuprofen and aspirin can disrupt the immune function in the respiratory tract.

 

Herbs that tone the upper respiratory tract include:

Euphrasia spp. (Eyebright) – Astringent

Ephedra sinica (Mormon tea) – Antispasmodic

Hydrastis canadensis (Goldenseal) – anticatarrhal, anti-inflammatory, antimicrobial, bitter

Hyssopus officinalis (Hyssop) – Anti-spasmodic, anti-inflammatory, nervine, expectorant.

Sambucs Nigra (Elder Berries) – work specifically in the respiratory tract to normalize inflammatory cytokine response. It seemingly strengthens cell membrantes preventing virus penetration.

Slidago virganurea (Goldenrod) – Anti-Inflammatory, anticatarrhal

Urtica dioica (Nettle) – Anti-inflammatory, anti-histamine

Cretageous (Hawthorn) – recommended for acute asthma attacks and toning to heart.

Inula Helenium (Elecampane) – Expectorant, antitussive, diaphoretic, hepatic, antimicrobial.

Lobelia – instantaneously stops spasms and opens airway, calming anxiety. *LOW DOSE ONLY, high dose can induce vomiting.
Immunomodulating, Adrenal supporting, and Adaptogenic herbs
Herbs in this category need more study but have shown promise in treating the overall system by modulating immune function, or supporting the adrenals and/or nervous system. Richo Cech, writes in his book Making Plant Medicine, that herbs containing medicinally active polysaccharides are typically immune enhancing and nutritive. These herbs can also help us deal with stress, which can contribute to the symptoms of eczema. Cech includes Astragalus, Boneset, Burdock, Codonopsis and Echinacea. Echinacea has been well accepted as an immune stimulating herb, however, studies are showing some of its immunemodulating abilities with allergen response F19.

Other Herbs to support these functions include:

EleuthroF20 – immunostimulating, immunomodulating, adaptogenic, nervine, stimulating
Ganoderma lucidumF21– immunomodulatory, anti-angiogenic, and cytotoxic effects. Constituents of Ganoderma lucidum affect immune cells and immune-related cells including B lymphocytes, T lymphocytes, dendritic cells, macrophages, and natural killer cells. In addition, studies suggest this mushroom also inhibits tumor growth through direct cytotoxic effect and anti-angiogenic actions.

Cordyceps – studies show and possible affinity for the intestinal immune systemF22,
Schizandra – helps restore and regulate the adrenals especially when depleted from steroid medications.
Glycyrrhiza glabra (Licorice Root) – emollient, demulcent, anti-inflammatory, antihepatotoxic, antispasmodic, expectorant, mild laxative, and nutritive.

 

 

Additional Supplements
Essential Fatty Acids – keep skin lubricated and balanced. Sources of EFAs include hemp seed, fish oil, and flaxseed.
Zinc – supports immune function and healing.
Vitamins C, D and E inhibit inflammation of the skin and itching.

 

 

 

HEALING ECZEMA

Our bodies want to heal. Our bodies know how to heal. Using the food we eat, the sleep we get, the environment we are in, and our mental and physical experiences, we perform a balancing act. Sometimes our body is out of balance and has to divert resources from one system to send them to another. If we first look at our personal symptoms and analyze our experiences, we can develop a healing plan. The longer the body is out of balance the more likely we are to develop ‘chronic’ dis-eases. It takes time for the body to get out of balance, and it takes time to get the body back into balance. There is no quick fix to healing eczema.

hEA
What is most important is being aware of your body and your specific symptoms. An easy way to determine if there is a correlation between a specific allergen (food or environmental is to keep a Food/Mood log. If we think about the foods we eat, the activities of our day, and the moods we experience, we can recognize patterns. We drink coffee to give us pep. We drink chamomile tea to relax us before bed. How do I feel when I eat a lot of pasta? What happens to my digestion or my mood when I eat a lot of ice cream or beans? How do I really feel? Have I been ignoring obvious symptoms?

 

Once we recognize patterns we can evaluate them and decide if they are healthy for us and contribute positively to our health and well-being. David Hoffman, FNIMH, AHG, in his book Medical Herbalism, states that human immunity is ‘ecology in action’, representing the relationship between us and the world. To treat and heal our immune system we must address four aspects of human life including body health and wholeness, emotional well-being, mental vision and perspective, and spiritual openness and vitality. So if eczema is caused by my immune system attacking itself….what does that mean spiritually and emotionally?

 

Footnotes

 

F1 Federation of American Societies for Experimental Biology (2009, May 4). Cellular On And Off Switch For Allergies And Asthma Discovered. ScienceDaily. Retrieved October 10, 2011, from http://www.sciencedaily.com­/releases/2009/04/090430101451.htm

 

F1a Atopic Dermatitis and Vaccinia Network. Did you Know? http://www.nationaljewish.org/advn/did-you-know/

 

F2 NIH, National Institute of Environmental Health Sciences (2007, October 1). Asthma Linked To Allergies, NIH Study. ScienceDaily. Retrieved October 8, 2011, from http://www.sciencedaily.com­ /releases/2007/09/070927143302.htm

 

F2a ScienceDaily in early 2010, and funded by the NIH/National Institute of Allergy and Infectious Diseases http://www.foodallergytest.com/eczema.html

 

F2b Baker, B. S. (2006), The role of microorganisms in atopic dermatitis. Clinical & Experimental Immunology, 144: 1–9. doi: 10.1111/j.1365-2249.2005.02980.x

 

F3  Rush University Medical Center (2008, January 31). Allergic Disease Linked To Irritable Bowel Syndrome. ScienceDaily. Retrieved October 8, 2011, from http://www.sciencedaily.com­ /releases/2008/01/080130170325.htm

 

F4 http://www.netdoctor.co.uk/skin_hair/skin_immune_system_003741.htm
F5 Guo-Ping Shi, DSc. Mast cells and atherosclerosis. Published online by Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115.as found at http://www.abcam.com/index.html?pageconfig=resource&rid=12011&pid=10694

 

F6 Wagner, Dr. Bettina. IgE and IgG(T) Antibocies in Allergy of the Horse as found at http://www.vet.cornell.edu/Zweig/projects/Wagner07.cfm

 

F7 Dermatology Online Journal, V12N3 Volume 12 Number 3 Atopic dermatitis and systemic autoimmune diseases: A descriptive cross-sectional study. Vida Feizy, Arefeh Ghobadi Dermatology Online Journal 12 (3): 3  Department of dermatology, Tehran university of medical sciences (TUMS). v.feizy@doctor.com

 

F8 National Institute of Alergy and Infectious Diseases. Atopic Dermatitis (Eczema) as found at http://www.niaid.nih.gov/TOPICS/ALLERGICDISEASES/Pages/eczema.aspx)

 

F9 DustMitesPedia, All About Dust Mites http://dustmitespedia.com/articles/allergy-skin-test-picture-skin-prick-allergy-test-pictures/

 

F11 NetDoctor. Topical Corticosteroids. Reviewed by Dr Victoria Lewis, consultant dermatologist. As found at http://www.netdoctor.co.uk/skin_hair/eczema_corticosteroids_003762.htm

 

F12. Omitted by Author.

 

F13  Author: Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine.com, Inc.WebMD. Understanding Allergy and Hay Fever Medications.  As found at http://www.webmd.com/allergies/antihistamines

 

F14 WebMD Medical Reference. News release, Sanofi-aventis U.S. American Academy of Allergy, Asthma and Immunology. Reviewed by Jonathan L Gelfand, MD on February 05, 2009

http://www.webmd.com/allergies/guide/allergy-medications

 

F15 FDA Pediatric Advisory Committee Meeting, March 22, 2010. ELIDEL® (pimecrolimus) Cream 1% as presented by Judit Nyirady, MD, Executive Director, Dermatology.

 

F16 Eczema.Net. Natural Remedies for Eczema. www.eczema.net/natural-remedies-for-eczema/

 

F17 Hoffman, David, Medical Herbalism : The science and practice of herbal medicine. (Healing Arts Press, 2003), 433 -434

 

F18  Paul Bergner “Gastrointestinal – Food sensitivities and disease”,  Medical Herbalism: Clinical Articles and Case Studies (2001) 11(1):7-13. As found at http://medherb.com/Therapeutics/Gastrointestinal_-_Food_Sensitivities_and_Disease.htm

 

F19 Joseph A. Rininger, Shirley Kickner, Padmasree Chigurupati, Anne McLean and Zsofia Franck

Paracelsian, Incorporated, Ithaca, New York. http://www.jleukbio.org/content/68/4/503.full

 

F20 Stargrove, Mitchell Bebel, Jonathan Treasure, Dwight L. McKee. Herb, nutrient, and drug interactions: clinical implications and therapeutic … http://books.google.com/books?id=49kLK–eumEC&pg=PA40&lpg=PA40&dq=Eleuthero+immunomodulating&source=bl&ots=gkfetqyyam&sig=jHmkTjZwO5FjdJzuYXGmkDzn9Wo&hl=en&ei=cb-TTp6_DZSNigLks_SVBQ&sa=X&oi=book_result&ct=result&resnum=4&ved=0CDYQ6AEwAw#v=onepage&q=Eleuthero%20immunomodulating&f=false

 

F21 Xu Z, Chen X, Zhong Z, Chen L, Wang Y. Ganoderma lucidum polysaccharides: immunomodulation and potential anti-tumor activities. Institute of Chinese Medical Sciences, University of Macau, Macau, P. R. China. Am J Chin Med. 2011;39(1):15-27.

 

F22 Jong-Ho KOH, Kwang-Won YU, Hyung-Joo SUH, Yang-Moon CHOI and Tae-Seok AHN, “Activation of Macrophages and the Intestinal Immune System by an Orally Administered Decoction from Cultured Mycelia of Cordyceps sinensis”, Biosci. Biotechnol. Biochem., Vol. 66, 407-411 (2002) .

 

 

 

 

Other Sources and Resources

 

Cech, Richo, Making Plant Medicine [Paperback]

http://www.mayoclinic.com/
http://www.medicinenet.com/atopic_dermatitis/page2.htm
http://www.nationaleczema.org/
http://www.eczemasite.com/causes-eczema.php
http://www.prohealth.com/library/showarticle.cfm?libid=10403 Dr. David Katz on Fighting Autoimmune Disease, Improving Immune Function – Fibromyalgia & Chronic Fatigue Syndrome News

Sage Medical Labratory http://www.foodallergytest.com/eczema.html

 

 

 

Appendices Attached

 

Appendix A – Side Effects of Corticosteroids

 

Appendix B – Food/Mood Diary

 

Appendix C – Liz Lipski’s Elimination Diet

Herbal Care During Pregnancy

Herbal Care During Pregnancy

Kerry Hughes

June 2011

Pregnancy Overview

Pregnancy is the carrying of one or more offspring, with normal gestation being 37-42 weeks after the last normal menstrual period, or 40 weeks in a woman who normally has a cycle length of 4 weeks.   The duration of pregnancy is usually termed in “Trimesters”, with the first trimester occurring until the end of week 12, the second trimester ending at the week 29, and the third trimester occurring until childbirth, or around 40 weeks.

 

During the first trimester, most women feel the worse, as nausea and other symptoms may be more prevalent for them during this time. This is because the pregnancy hormones, which begin to soar right away in pregnancy, are mostly manufactured by the woman’s pituitary gland.  Around week 10, the placenta largely  begins to takes over the manufacture of these pregnancy hormones and the pregnant woman often begins feeling much better at this point.  During the first trimester is when the risk of miscarriage is the highest as well, and the chances of miscarriage begin to drastically drop off around week 10.

 

Also, during the last trimester of pregnancy there are a number of other symptoms/discomforts that are common, as the body gets heavier and circulation is more difficult in the body. One of these discomforts is the swelling of the feet and ankles due to more taxed circulation.

 

Pregnancy complaints/symptoms usually vary by the time in pregnancy, so too, herbal care during pregnancy should take account to when during pregnancy the discomfort is experienced and why.  Below is an overview of some of the most common complaints or symptoms of pregnancy for which herbal care may be appropriate.

 

 

Table 1. Pregnancy Progression

 

 

Source: Wikipedia: http://en.wikipedia.org/wiki/File:Prenatal_development_table.svg

 

 

Basic Herbal Approach

Herbs should be employed carefully and consciously during pregnancy to make sure the benefit outweighs the risk, just as the use of any pharmaceutical or medical intervention in relation to a non-pregnant person. In this respect, it is best to avoid the use of herbs as therapeutic agents (or other medications) during pregnancy unless needed, especially during the first trimester.   However, there are several “herbs” that are safe enough to be considered foods, and others that have a well-established (through use by midwives and pregnant women) nutritive function during pregnancy, and these can be used safely.

 

 

A Note about Herbal Research in Pregnancy

One of the most misleading aspects of choosing herbal care during pregnancy is the fact that most herbal reference texts and herbal products commonly skirt the issue of safety during pregnancy by simply stating a person should ‘consult their healthcare professional before using during pregnancy’ or they say that due to a ‘lack of research’ on a particular herb, that it is not recommended for pregnancy.  This is misleading, and rather annoying, as it does not give the mother-to-be any information about why it may not be recommended, it is simply passing the responsibility on to either the healthcare professional or disregarding what could be a useful and safe alternative for herbal care during pregnancy because they have not done their homework and have no basis on which to form an opinion or educate.

 

That being said, there is very little research on the use of most herbs in pregnancy, and so it is important for a woman or doctor to decide if they will not use herbs just because of the lack of safety studies in pregnancy—some practitioners and women will take this viewpoint, and it is a ‘conservative’ approach, as it goes along with western medical thought. However, it may not be ‘conservative’ when viewed at what might be the alternatives that are taken by women for relief of common pregnancy discomforts.  The next place people look for information on the use of herbs during pregnancy is from herbal tradition and midwives. There are a number of herbs that are commonly used during pregnancy, such as raspberry leaf tea and nettles that have very little research associated with them, but a long tradition of use by pregnant women themselves.  Therefore, it is important for a woman to make up her own mind about how much assurance they want before using an herb.

 

 

Herbal Nutrition

Herbs have a nutritive function in pregnancy beyond their use in soothing common discomforts. Women have many needs from their nutrition when they are growing a baby, and it is well-accepted that women should take a prenatal vitamin and mineral supplement before and during pregnancy. Also very important for women is to supplement with omega-3 fatty acids, such as DHA, as there is plenty of research that links DHA with better outcomes for both baby and mother.  There are herbal sources of omega-3 fatty acids, such as flax seeds that are safe to consume during pregnancy, and may be ground up and included in food.

 

Herbs for Iron

Iron during pregnancy is important because approximately 20% of women become deficient while pregnant. During pregnancy the body produces about 50% more blood than usual, so it is easy to understand why iron demands are so high.

 

Despite what many think, herbs and vegetables can be good sources of iron, it is not necessary to be eating large amounts of meat to obtain iron.  Good sources for iron during pregnancy include raspberry leaf tea, nettle leaf tea, peppermint, dandelion, fennel, ginger, prunes, rosehip, and blackstrap molasses. A wonderful brand-name product that has been on the market for a long time and used by pregnant women is Floradix -Iron + Herbs. In order to increase absorption of iron, it is also important to consume enough vitamin C.

 

A nice herbal iron formula would be to combine the following herbs and make a nutritive vinegar with equal parts: yellow dock, nettles, dandelion root + leaf, and apricots (unsulfured).

 

Herbs for Vitamin C

Vitamin C is important for several essential functions for you and your baby, including tissue repair, wound healing, bone growth and repair, healthy skin,  and helping the body to fight infection. There are several good herbal sources of vitamin C, including rose hips, camu camu, acerola, alfalfa, peppermint, horsetail and raspberry leaf.  It is easy to obtain the vitamin C you need in foods and herbs, so it is not necessary to supplement separately with it.

 

Red Raspberry Leaf

Some call red raspberry leaf tea the supreme herb for pregnancy. It is thought to strengthen the uterine wall, relax smooth muscle, and help to make delivery easier and speedier by helping the uterus contract more efficiently.  Red raspberry leaf tea also contains a number of nutrients that are helpful for pregnancy, including calcium, iron and B vitamins.

 

Some medical professionals make reference to a possibility of red raspberry leaf bringing on miscarriage. This is due to a study back in the 1950’s where fractions of the raspberry leaf were isolated and tested in vitro to the uterine tissues of guinea pigs and frogs.  Spasmolytic and uterine contractions were caused by separate fractions. However, this is common for studies on purified fractions of herbs to find contraindications that may not be a problem in the whole plant. A newer study (from 2010) found that the ability of red raspberry leaf preparations to augment uterine contraction was variable and dependant on the type of herbal preparation used, and they concluded that their results do not support the hypothesis that red raspberry leaf augments labor by a direct effect on uterine contractility.  Some women prone to miscarriage and due to this research (the first more cited study) choose not to consume red raspberry leaf until later in the pregnancy or after the first trimester. [1] [2]

 

Nettle Leaf  Tea

Nettle contains vitamins A, K and C, as well as calcium, iron and potassium. It is best used in dried form and made into a nutritive tea for use during pregnancy. Nettle is another one of the herbs for which there is confusion or misinformation passed around about whether or not it might have a uterine contracting effect during pregnancy, so many doctors will not recommend it do this. However, it should be clarified that it seems to be the dried nettle that is used in pregnancy for its nutritive effect, not the fresh plant, as the fresh plant may have concerns on stimulating uterine contractions (but yet this is also not certain). The American Pregnancy Association explains that many herbalists and midwives use and recommend stinging nettle tea for its vitamins and minerals, yet the Natural Medicines Database gives it a rating as possibly unsafe.

 

 

Common Discomforts/Conditions of Pregnancy & Herbs

 

Nausea/vomiting

Nausea is the most common (experienced by up to 90% of women) during the first trimester as the pregnant woman’s body is getting used to the hormones produced in the body, and while the pituitary gland is producing the hormones. It is thought that nausea is more commonly experienced by some women especially while they are low in blood sugar, or after a period of fasting, such as in the morning (after sleeping all night and not eating).   Therefore, one of the common suggestions for nausea is for women to eat something, especially something that will not upset their stomach, first thing in the morning (like a saltine cracker), perhaps before even getting out of bed.

One of the most famous herbs for nausea in general is ginger. This is one of the herbs that is safe and could be classified as food, as well, and can be useful during pregnancy. Another wonderful thing about ginger is that it comes in so many useful forms. It may be used as a warming herbal tea (just decocting ginger in water), it may be eaten as a food (eg. Candied ginger is great for this), and it may also be used in essential oil form.  When using as an essential oil, a woman may only need to sniff the ginger scent to help her to hold back her nausea. In some stores, ginger is available in an herbal nasal inhaler form, which can be a very portable and safe way for a woman to have it ready for use at any time. [3] If ginger seems not to do the trick, peppermint or peachleaf tea can be tried.

 

Ankle/Hand Swelling

Swelling in the extremities—especially in the feet and ankles—is a very common symptom of pregnancy, which usually is experienced and gets worse during the third trimester.  Minor swelling during pregnancy is considered normal. Most of the first actions to take while combating prenatal swelling are physical: avoid standing for long periods of time; avoid going out during hot climate conditions; don’t wear too tight pants or socks (esp. socks with bands), as these inhibit circulation; change positions while sleeping frequently; go out and get some exercise, as circulation is improved with exercise.  If the hands or face swell, or if swelling is more on one side of the body than the other, it is recommended to notify the health care professional, as it could be a sign of preeclampsia or another condition.

 

A couple Ayurvedic recipes involve the use of safe kitchen spices: 1- a few tablespoons of coriander in two cups water (boiled to one cup, and taken throughout the day, if desired with sugar and milk); 2- tea of fennel and palm sugar (2 cups water, 1 tsp palm sugar, 2 tsp fennel seeds; boiled until one cup remains) taken throughout the day.

 

Although there is not much research on the use of Poria mushroom for use in pregnancy, it is a common herb used in Traditional Chinese Medicine (TCM) for reducing edema, and is often used in pregnancy.

 

Other suggestions involve eating bitters, such as dandelion greens, which help the body metabolize fluids, eating extra garlic and onions, as it is known to promote good circulation, and eating foods that are natural gentle diuretics, such as celery, artichokes, parsley, and grapes.

 

Heartburn

Heartburn is another common discomfort during late pregnancy, as the internal organs, including the stomach, have less space due to the large developing fetus, and because the pregnancy hormones slow down digestion.  It can be experienced earlier in pregnancy, but as the hormone levels rise and pressure on the stomach increases, usually so does the incidence of heartburn.  Heartburn is just another term for indigestion, usually experienced as a burning sensation that starts in stomach and rises to the throat.

 

Common sense treatments include eating smaller meals throughout the day instead of three large meals; eating slowly, not lying down directly after eating; avoiding eating fried, spicy or rich foods, and avoiding mixing fatty and sweet foods together during meals.   Conventional treatments include antacid heartburn relievers, such as Tums, Maalox, Titralac, Mylanta, Riopan, and Gaviscon.

 

A tea of chamomile or peppermint is useful in decreasing acid and soothing the digestive system, and is commonly thought to be safe during pregnancy.   Prune juice (a small cup morning and night) is a safe and effective way to get the digestive system functioning, and can help heartburn if intestinal motility is a factor in the mother-to-be’s heartburn symptoms. Other dietary approaches for heartburn include eating carrots, apples, and lemon juice, which contain vegetable acids that can help to neutralize stomach acid.

 

 

Sensitive Teeth + bleeding gums

Another common symptom during pregnancy is sensitive teeth and the bleeding of the gums.  It is important that if there is excessive gum bleeding that the mother-to-be visits the dentist or doctor about this problem, as it could affect the health of the baby and delivery.  However, it is normal that as circulation and the supply of certain hormones increase in the body that there may be tenderness, swelling and bleeding of the gums.

 

The use of a soft toothbrush and toothpaste for sensitive teeth are often first measures to take with sensitive teeth.   It is also good to eat foods high in vitamin C, such as lemons, oranges, limes, kiwis, and mangos. Camu camu is a ‘super fruit’ from the Amazonian regions that is one of the highest sources of vitamin C.  Camu camu can be taken in supplement form, or as a food, such as a beverage.

 

 

Fatigue/Anemia

Fatigue is another common symptom of pregnancy that often hits women starting in the first trimester, and can endure throughout the pregnancy.   A certain amount of fatigue is normal and to be expected during pregnancy, as growing a baby takes extra energy and may make the mother-to-be feel tired!  As getting enough rest and sleep is important at any time for our health, it becomes mandatory for a good pregnancy and to care for the growing baby.  Regular exercise is also important during pregnancy, as it can help reduce the risk of developing discomforts and problems during the pregnancy.

 

When fatigue becomes severe, it is important to visit a doctor to find out if anemia is present.  Normally, prenatal care includes a normal program of testing the blood for presence of anemia (low iron in the blood). If anemia is not present in the beginning of the pregnancy, this does not mean that it will not become a problem later, and normally if it does show up during the pregnancy it usually happens by around the end of the second trimester.   If anemia is present, or simply to prevent fatigue, it is possible to increase the intake of foods and herbs that are high in iron (see nutritive recommendations above).

 

 

Difficulty Sleeping/ Insomnia

Finding a comfortable sleeping position may become difficult in later pregnancy.  It is generally not recommended that women lie on their backs during mid-late pregnancy, as this can result in decreased circulation to the mother and baby.  Sleeping on the left side of the body, supported by pillows,  is thought to be the optimal sleeping position.

 

It is not recommended for mothers-to-be to take sleep medication.  A little warm milk may be all that is needed before bedtime to help induce sleepiness. Teas of chamomile, lemon balm, oat straw and marjoram may have a relaxing effect on the mother, and are safe during pregnancy.   Essential oils may also aid in relaxation and sleep, such as lavender placed on an herbal pillow.

 

 

Constipation

Hormones as well as taking certain vitamin supplements, such as iron, may cause constipation.  Pressure on the rectum by the uterus may also cause constipation.  Another factor is that some women who are regular consumers of coffee or caffeine-containing beverages may find that they have become somewhat dependent on their caffeine-consuming rituals for regular bowel function, and may result in constipation if this ‘ritual’ is stopped or altered, as most feel it is important to cut back on caffeine consumption during pregnancy.

 

Doctors generally now are saying a low level of caffeine intake during pregnancy is ok (like one cup daily), so if a disruption of caffeine consumption is causing constipation, then perhaps continuing with decaf coffee or a small amount in the morning could be enough to get the bowels moving. Preferably, it is best to decrease or eliminate caffeine and to adopt other strategies for helping digestive motility, such as: adding more fiber to the diet, drinking plenty of fluids, and drinking warm liquids in the morning, exercising daily.  A safe natural laxative is a small cup of prune juice in the morning and evening, and this could be enough to make the system regular.   Psyllium fiber is also thought to be safe during pregnancy.

 

Hemorrhoids

Hemorrhoids are swollen veins that are like painful lumps on the anus. They are a frequent symptom of pregnancy due to increased circulation and pressure on the rectum and vagina due to the growing baby.  One of the fist things that should be avoided when hemorrhoids are a concern is constipation, as constipation can cause hemorrhoids and also make them more painful.  Other things to avoid is sitting or standing for long periods of time, straining during bowel movements.  Ice packs can be used on the area to help with the pain, or a warm bath may also provide relieve. It is also recommended to avoid wearing tight-fitting underwear, pants or pantyhose.

 

Herbal treatments like above may help with relieving constipation and therefore hemorrhoids.  Longer term use of other herbs, such as those high in bioflavonoids (like bilberry) and other antioxidants, can help increase general vein health and therefore prevent conditions such as hemorrhoids and varicose veins.  For relief of the pain and swelling of hemorrhoids during pregnancy, aloe gel applied topically can sooth the sore rectum, as well as the use of homeopathic calendula ointment, or a calendula salve.

 

 

Leg Cramps

Leg cramps during pregnancy are another common complaint and can occur due to both the increasing pressure of the growing uterus, as well as imbalances or deficiencies of certain minerals like calcium and potassium.

 

There are some physical measures that can be taken to reduce the potential for leg cramps: wear comfortable shoes, elevate the legs when possible, exercise daily, stretch the legs before going to bed, avoid lying on the back, massage on the legs and feet, foot and leg warm baths or hot water bottles. Secondly, it is important to consume foods rich in calcium, such as milk, broccoli or cheese.

 

Red raspberry leaf is a long-used herb in pregnancy as a nutritive and tonic for the female system.  It also is a good source of calcium—even when consumed as a tea.  A tea made of any of the following herbs is reported to contain 250-300 mg of calcium per cup (1 ounce of dried herbs steep in 1 quart of water for 4 hours): Raspberry leaf (Rubus idaeus), nettle (Urtica dioica), oatstraw (Avena sativa) and chickweed (Stellaria media).

 

 

Stretch Marks

Pregnancy definitely makes the skin of the body stretch to proportions that it is not normally used to, and the result for some women is stretch marks. They are a type of scar tissue that forms when the skin’s normal elasticity is not enough for the stretching that is required of the skin—they can normally appear on the abdomen, breasts, buttocks or thighs, and although they normally will not disappear completely, they will fade after delivery.  According the conventional theories, they occur to the surface under the skin and so they are usually not preventable. However, there are a number of herbs and oils that can help to deeply moisturize the skin, such as aloe vera gel, shea butter, and cocoa butter. Additionally, including in the diet vitamins and minerals that nourish the skin can be important, such as vitamin A, vitamin C and vitamin E.  Herbs such as nettle and horsetail are known to be nutritive to the skin and can be taken in tea form or supplements.

Stretch marks are a type of scar tissue that forms when the skin’s normal elasticity is not enough for the stretching required during pregnancy. They usually appear on the abdomen and can also appear on the breasts, buttocks or thighs. While they won’t disappear completely, stretch marks will fade after delivery. Stretch marks affect the surface under the skin and are usually not preventable.

 

 

Delivery

Just as there are 3 phases of pregnancy—the three trimesters—and there are also 3 stages of labor: the first stage is when the cervix is ripening, the second stage is from full dilation through the pushing and delivery of the baby, and the third stage of labor is the delivery of the placenta.

 

Leading up to the delivery, a formula can be taken to help ready the woman’s body for a smooth childbirth. This formula is called a “parchuriant formula” and the below example should be taken in the amount of ½ tsp, 3 times a day starting at about 36 weeks of pregnancy.

3 parts- Michella (Partridge berry)

2 parts- Viburnum prunifolium

1 part- Cimicifuga

 

In early labor a formula may be taken to help tonify the women’s uterus and act as nerviness as well: 1 part raspberry leaf, 1 part Mitchella, 2 parts chamomile,  and 3 parts passionflower.

 

After the delivery of the baby to help expel the placenta, goldenseal may be taken, or some midwives recommend a simple glass of red wine.   After the delivery a soothing and astringent herbal sitz bath with rose petals can help the mother to heal.

 

Another formula may be taken after the birth to help normalize the hormones, protect against postpartum depression, stabilize the pituitary gland and ease transitions, which is 1 part Vitex, 1 part Melissa, 2 parts Crataegus, and ¼ part fennel.

 

 

 

Concluding thoughts

Herbal care during pregnancy is a broad topic, yet there are many simple and gentle herbal approaches that can ease the common discomforts of pregnancy and help nourish the body and growing baby.

 

 

 

 

 


[1] Holst L, Haavik S, Nordeng H. Raspberry leaf–should it be recommended to pregnant women? Complement Ther Clin Pract. 2009 Nov;15(4):204-8. Epub 2009 Jun 13. Review.

[2] Jing Zheng, Pistilli MJ, Holloway AC, Crankshaw DJ. The effects of commercial preparations of red raspberry leaf on the contractility of the rat’s uterus in vitro. Reprod Sci. 2010 May;17(5):494-501. Epub 2010 Mar 10.

[3] Ebrahimi N, Maltepe C, Einarson A.Optimal management of nausea and vomiting of pregnancy. Int J Womens Health. 2010 Aug 4;2:241-8.

Holistic Support for Asthma

Herbal Therapeutics Paper 

Cole Lea

October 2011

Introduction

There are increasing rates of asthma in America. More and more people are looking to holistic treatments to help minimize asthma symptoms and to mitigate the unwanted effects of pharmaceuticals prescribed for the condition. Herbs, nutritional support, lifestyle changes and flower essences can help treat, control and even reverse asthma symptoms. These therapies are most effective when used as preventative tonics and for symptom control in the early stages of asthma attacks. Herbal therapy does not replace allopathic support, like rescue inhalers, for severe asthma attacks.

Are asthmatics canaries in the coal-mine? I wondered this after being diagnosed with asthma myself in my teenage years and reading about and noticing the higher than normal rates of asthma in the area I was raised. A common way that doctors and medical texts describe asthma is to say people have bronchial passages that are more sensitive than normal to allergens, irritation, and pollution. Perhaps more and more people are developing asthma because there is more and more pollution and chemicals in our environment.

 

According to the Centers for Disease control and Prevention (CDC) 24.6 million Americans are diagnosed with asthma. That is roughly 8 percent. Between 2001 and 2009 there has been a 12 percent hike in asthma in America. This increase hit black children especially hard with an almost 50 percent hike in that eight year period and as of 2009 a full 17 percent of black children suffered from asthma, the largest amount of any group.

 

Asthma is often well controlled by allopathic medications. Unfortunately the per-person cost for treating asthma averages about $3,300 per year and many people are forced to go with out care because of economic reasons.

Insurance coverage also has a huge impact: 2 in every 5 uninsured people with asthma are unable to afford medication to treat their condition, compared to 1 in every 9 people with insurance. Lack of insurance and access to asthma medications is a huge factor in asthma hospitalizations and deaths. Since 1980 the death rate for asthma has increased 50 percent with the childhood death rate increasing 80 percent!

 

Every day in America:

 

  • 40,000 people miss school or work due to asthma.
  • 30,000 people have an asthma attack.
  • 5,000 people visit the emergency room due to asthma.
  • 1,000 people are admitted to the hospital due to asthma.
  • 11 people die from asthma.

 

Mortality Rates:

 

  • There are more than 4,000 deaths due to asthma each year, many of which are avoidable with proper treatment and care. In addition, asthma is indicated as “contributing factor” for nearly 7,000 other deaths each year.
  • More females die of asthma than males, and women account for nearly 65% of asthma deaths overall.
  • African Americans are three times more likely to die from asthma.
  • African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women.

 

Asthma Triggers and Symptoms

 

Many people with asthma can reduce the occurrence of asthma symptoms by avoiding triggers. Unfortunately there are sometimes triggers that are more difficult to avoid which is one reason children with asthma, people living in polluted areas, and people who do work with chemicals are more likely to have fatal asthma attacks.

Asthma is a chronic inflammatory condition. It is a lung disorder in which the airways are more sensitive than typical, and can become seriously inflamed making breathing very difficult. There is often inflammation in the bronchial tubes, constriction of muscles surrounding the bronchial tubes, and the production of mucus or sputum. The sensitivity of the airways leads to inflammation deep in the lungs. In response to the inflammation there is a production of mucus and a tightening of the muscles surrounding the bronchial tubes. All of these things together cause narrower tighter airways and the symptoms of asthma.

 

 

Asthma is characterized by the following symptoms:

 

  • Wheezing on expiration, a tickle in the airway
  • Tightness of chest, sometimes painful
  • Coughing, usually dry coughing
  • Production of mucous clogging the airway
  • Shortness of breath, often described as not being able to get a deep enough breath or a feeling of breathing through a straw
  • Broncho-constriction and swelling of the bronchial tubes

 

Asthma Triggers

 

There are many, many different triggers for asthma attacks. An asthma attack can be described as the symptoms of asthma responding to a trigger. Many asthma triggers are very different for different people. For example weather changes can cause an extreme flare up of asthma symptoms in one person with asthma and have absolutely no effect on someone else.

 

Since it is so different for everyone one of the most important things in helping someone with asthma can be figuring out what triggers they have and in what ways asthma symptoms manifest for them. Another thing that can be particularly helpful aside from avoiding triggers is identifying and listening to warning signs. Often times there is a tickle in your throat or a slight tightness in the chest that, if caught early and treated, can be prevented from developing into a full blown asthma attack. Some of the treatments, allopathic or herbal, will not work for everyone with asthma. Some treatments will work depending on the symptom or the trigger. All of these things are important to keep in mind when developing a treatment plan.

 

Allergies are one of the main triggers for asthma. In childhood asthma it is estimated 75% is related to allergies. Below are some seemingly unrelated symptoms people have that can be a signal of allergic asthma.

 

Allergic symptoms that can indicate allergic symptoms:

 

Migraines

Hay fever

Eczema

Hives

 

Other triggers of asthma symptoms:

  • Ingested allergens such as food, drugs, food additives, yeasts or molds. Some common food triggers are dairy, eggs, soy, wheat, red wine, dried fruit, shellfish, and food additive monosodium glutamate (msg).
  • Airborne pollutants like dust, wood smoke, mold, chemicals, perfume.
  • Heartburn. As much as 30 percent of all asthma may be caused by gastric reflux.
  • Exercise and Weather Changes. Cold and dry is more irritating to asthma than warm and moist.
  • Emotional or Physical Stress.
  • Colds and Respiratory Infections.

 

Once a person is exposed to one of their triggers, the airways can become more and more sensitive to other triggers. They can even become sensitive to things that didn’t bother them before.

 

Allopathic Treatment of Asthma

The two most common types of pharmaceuticals prescribed for asthma are steroidal anti-inflammatory drugs and bronchodilators. Bronchodilators are drugs used for short-term emergency situations and anti-inflammatory drugs are prescribed for both short and long-term management of symptoms and to prevent asthma attacks in the future. Not every person that has asthma takes a long-term anti-inflammatory drug but if they are using their inhaler more often than their doctor likes they will be prescribed one.

 

Bronchodilators are usually what you think of when you imagine an asthma inhaler. They are also called rescue inhalers and they relieve the symptoms of asthma by relaxing the muscles that tighten around the airways. This will let more and more air come in the lungs and helps clear mucus from the lungs by opening the airways. Bronchodilators are what people use when they are having an asthma attack. Common types of bronchodilators are Proventil (albuterol) and Xopenex (levabuterol).

 

Anti-inflammatory drugs are given in serious acute situations orally. Oral corticosteroids like Deltasone and Metacorten (prednisone) are prescribed for 2 or 3 day periods. Inhaled anti-inflammatory corticosteroids drugs are prescribed to take daily and sometimes they are packaged in a typical inhaler like Flovent (fluticasone), sometimes they are packaged in a diskus with inhaled powder like Advair (fluticasone and salmeterol). These inhaled corticosteroids prevent asthma attacks from happening in the first place by reducing inflammation and sensitivity in the airways on an ongoing basis. They cannot be used in asthma attacks and they are not rescue inhalers. Finally many people who have allergy related asthma are prescribed allergy medication in addition to their long-term corticosteroid. Long-term asthma symptom prevention and allergy control are two areas where holistic treatments really shine!

 

Common Unwanted Effects of Pharmaceuticals

 

Proventil, Accuneb (Albuterol)

 

  • nervousness
  • dizziness
  • headache
  • nausea
  • sinus inflammation
  • sore or dry throat
  • tremor
  • trouble sleeping
  • vomiting.
  • sinus inflammation
  • unusual taste in mouth

 

 

Xopenex (levabuterol)

 

  • dizziness
  • tremor or nervousness
  • anxiety
  • headache
  • cough or runny nose
  • upset stomach
  • leg cramps

 

Deltasone or Metacorten (prednisone)

 

  • difficulty sleeping
  • nervousness
  • feeling of a whirling motion
  • increased appetite
  • increased sweating
  • indigestion
  • mood changes

 

 

Flovent (fluticasone)

 

  • dry mouth
  • flu
  • headache
  • hoarseness
  • nasal discharge
  • runny nose
  • sinus swelling
  • sore throat
  • stuffy nose
  • upper respiratory tract infection.

 

Advair (fluticasone and salmetrol)

 

  • upper respiratory tract infections
  • headaches
  • sore throat
  • bronchitis
  • coughing
  • nausea and vomiting
  • sinus infections
  • hoarseness or voice changes
  • muscle pain or bone pain
  • fever
  • menstrual problems
  • thrush
  • abdominal pain
  • diarrhea
  • dizziness
  • bloody nose

 

Many of the drugs prescribed for asthma are steroids or corticosteroids and they have similar unwanted effects like nervousness, anxiety, insomnia, and respiratory infections. These unwanted effects are often minimized with the use of calming nervines and long term use of adaptogens. It is a good idea to make sure the person you are working with is not allergic to plants in the Asteraceae family as these plants could potentially trigger asthma symptoms.

 

Holistic Treatments for Asthma

 

Lifestyle changes for people dealing with asthma symptoms are the obvious first step and they can often cause dramatic improvement. Once asthma triggers have been identified they can be eliminated as much as possible. Pet dander, cigarette smoke, dust, mold, and food allergies; all of these things can be controlled and avoided to a certain extent. If someone is unsure about what is causing the allergy an elimination diet can be used. In an elimination diet a person stops eating sugar, dairy, gluten, eggs, soy, food and beverages with sulphates, alcohol, chocolate, and then reintroduces the foods one at a time being careful to notice any sensitivity or asthma symptoms. This can also be used for products like soap, cleansers, and laundry detergent. People are commonly very reactive to the dyes and fragrances used in commercial cleaning products and personal care products, so eliminating their use for several weeks and only using water diluted castille soap is similar to the elimination diet. Then you watch for reactions when reintroducing the products. Many with asthma symptoms are so sensitive to chemical fragrances they will choose to make their own cleaning and personal care products and this is a great idea!

 

Stress reduction is another important factor that can make a huge difference. The benefits of herbal adaptogens and nervines are invaluable here. I like to think of adaptogens with an affinity for the respiratory system like Reishi (Ganoderma lucidum), or Holy Basil/Tulsi (Ocimum tenuiflorum) .

 

If there are triggers we cannot exactly eliminate completely like pollution, weather or seasonal allergies, we can herbally support the client in a way tailored to that trigger. For example Stinging Nettle (Urtica doica) is an excellent treatment for allergy related asthma. Folks who have indoor allergies sometimes are able to minimize symptoms by purchasing and air filter. I have found it helpful to wear a scarf to breathe through if I am unwittingly exposed to diesel emissions or perfume. People with weather sensitive or pollution sensitive asthma that are living in a climate that gets extremely hot or dry in summers often need an air conditioner. When it gets cold and that is an asthma trigger breathing through a scarf and drinking warm liquids can be helpful.

 

 

Actions Indicated in Herbal Treatment of Asthma:

 

Anti-inflammatory herbs to bring down the swelling of the airways like Licorice (Glychirriza glabra) or Turmeric (Curcuma longa).

 

Herbs with bronchodilating and antispasmodic effects including; Ma Huang (Ephedra sinica), Sundew (Drosera rotundifolia), Wild Cherry (Prunus serotina), and Gumweed (Grindelia camporum)

 

Expectorants to help prevent mucus buildup in the lungs. Note that many herbalists advise against using stimulant expectorants as they can irritate things further but I think it depends on the client and the trigger. I have personally had great results using stimulating expectorants. Some examples of relaxing expectorants are Lobelia (Lobelia inflata), Licorice (Glycyrrhiza glabra), and Gumweed (Grindelia camporum). Two plants that could be classified as stimulating expectorants that I find to be indispensible are Mullein (Verbascum thapus) and Elecampagne (Inula helenium).

 

Demulcents to support the expectoration and soothe irritation. Great herbs for this are Licorice (Glychirriza glabra), and Mullein (Verbascum thapus) as they have an affinity for the respiratory system. However Marshmallow (Althea officinalis) or any other Mallow (Althea spp.) would also work.

 

Cardiotonics to support strain and lung congestion. My favorites are Hawthorne (Cratageus spp.) and Motherwort (Leonurus cardiaca). Both of these are great choices because they are also relaxing nervines.

 

Antimicrobials are really important if there is a respiratory infection or the possibility of a respiratory infection. Aniseed (Pimpinella anisum) and Hyssop (Hyssopus officinalis) are specific to the respiratory tract.

 

Relaxing nervines and adaptogen herbs are great as a preventative if symptoms are triggered by stress. If stress is not a symptom trigger, asthma symptoms and medications can cause stress, insomnia, and anxiety as well. An asthma specific nervine like Lobelia (Lobelia inflata) will work, however since Lobelia is a low-dosage herb I prefer to mix it with other nervines like Skullcap (Scuttelaria latiflora), Chamomile (Matricaria recuita), Motherwort (Leonurus cardiaca), Catnip (Nepeta cataria), or Passionflower (Passiflora incarnata). Several adaptogens particularly useful here are Holy Basil/Tulsi (Ocimum tenuiflorum) , Licorice (Glychirizza glabra) and Reishi (Ganoderma lucidum) because they are specific to the respiratory system. Others that can be helpful to include are Ashwaganda (Withania somniferum) for its nervine qualities helpful to those with insomnia, or Turmeric (Curcuma longa) which is an anti-inflammatory.

 

Alteratives are always good herbal allies. They will support our bodies in processing pharmaceutical drugs and are specially helpful for folks who have allergy or pollution related asthma. Alteratives can help open up the routes of elimination in the body and often help our bodies process waste and toxins. Most also have the added benefit of vitamins and minerals as well. Red Clover (Trifolium pretense) is my number one alterative choice because it has a respiratory affinity. It can help clear mucus from the lungs and you will breathe deeper. Stinging Nettles (Urtica doica) is a respiratory strengthener. Beloved to those of us with allergic asthma, nettle is perfect for bringing up respiratory congestion without irritating inflamed mucosa. Nettle can be juiced, made into a tea, or tinctured for use as a restorative tonic. Nettles is combined with Eyebright (Euphrasia), and Mullein (Verbascum thapus) for a tea used to combat hayfever triggered asthma. If corticosteroids are making you anxious, nervous, jittery, or spacey, Burdock (Articum lappa) or Dandelion (Taraxacum officinale) can help ground you as well as support the elimination of toxins.

 

Tinctures for Asthma Symptoms

 

Tinctures are great because they are portable and they keep forever. They are also a economical use of herbs that are scarce. They can help us use herbs on a regular basis that we don’t have access to year round. They can be used daily as a preventative or when symptoms present themselves. Keep in mind not every herb will work for every asthmatic or every symptom so it is good to try several. These can be used individually (also called “simple”) or in combination.

 

  • Mullein (Verbascum thapus)
  • Elecampagne (Inula helenium)
  • Gumweed (Grindelia camphorum)
  • Nettle (Urtica doica)
  • Lobelia (Lobelia inflata)
  • Red Clover (Trifolium pretense)
  • Wild Cherry Bark (Prunella serotina)
  • Holy Basil/ Tulsi (Ocimum tenuiflorum)

 

Combination Tincture Formula

 

1pt. Mullein

1pt. Nettle

1pt. Holy Basil/Tulsi

3/4pt. Motherwort

1/4pt. Lobelia

 

This combination tincture can be taken in a 30ml dose 2-3 X daily.

 

 

Herbal Tea Blends for Asthma Symptom Prevention

 

These tea blends are great for long-term maintenance as well as coping with mild asthma symptoms. They can be used before resorting to a rescue inhaler, or in conjunction with a rescue inhaler. To make a tea from these blends you take one tablespoon of tea blend per cup of boiling water and steep covered for 10-15 minutes. Honey is a soothing addition. Another way to take these herbs for long-term support is by infusion. An infusion is made by putting a handful (or roughly one ounce) of dried herb in a glass quart jar and filling it up with boiling water. Cover the jar and leave it to sit 4-8 hours. Overnight is perfect. You may want to include a wooden spoon in jar to prevent the glass from cracking. This has never happened to me but I have heard stories! If you do not have a quart jar you can leave the boiling water in the pot with the herbs to steep. Cover the pot. You will need four cups of water to equal a quart. Infusions are strong tasting medicinal strength teas. They can be taken with honey, hot or cold. You can also make the rock stars of these blends into simple infusions. A simple is when you use just one herb. Nettle, Mullein, Red Clover and Holy Basil make delicious simples for asthma maintenance.

 

Allergy and Asthma Free Tea

 

1pt. Eyebright (Euphrasia)

2pt. Mullien (Verbascum thapus)

3pt. Nettle (Urtica doica)

 

Breathe Calm and Deep

 

3 pt. Holy Basil/Tulsi (Ocimum tenuiflorum)

3 pt. Red Clover (Trifolium pretense)

1 pt. Hyssop (Hyssopus officinalis)

1pt. Catnip (Nepeta cataria)

1pt. Burdock (Articum lappa)

 

Tasty Lung Strengthening Tea

 

3pt. Mullein (Verbascum thapus)

2pt. Nettle (Urtica doica)

1pt. Holy Basil/Tulsi (Ocimum tenuiflorum)

½ pt. Peppermint (Mentha piperata)

 

Essential oils and Aromatherapy for Asthma

 

Essential oils can be very soothing and helpful for people with asthma symptoms. I encourage folks to experiment with the scents and actions essential oils have on them BEFORE they are having an asthma attack. Since having an asthma attack can make one much more sensitive to strong smells this is no time to experiment with new scents in my opinion. Two of the most effective ways to use essential oils for asthma symptoms are as rubs (in oil or salve, think vaporub!) or inhaled from the bottle or a piece of cloth. One can also put a few drops in the shower while bathing or in a diffuser if you have one. Essential oils to use will be ones that help you breathe deeply, and essential oils that are calming/relaxing to the nervous system.

 

Essential Oils to Use for Deep Breathing

 

  • Peppermint
  • Holy Basil
  • Aniseed
  • Hyssop
  • Thyme (specifically effective for kids is Thymus vulgarus linololiferum)
  • Rosemary
  • Tea Tree ( be conservative and test beforehand as tea tree can irritate some people)
  • Eucalyptus

 

Essential Oils to Calm and Relax

 

  • Roman Chamomile
  • Lavender
  • Geranium

 

Inhalation Recipe (safe for children 5 and over)

 

8 drops of tea tree oil

7 drops of chamomile

OR

10 drops of lavender

10 drops of thyme

10 drops of peppermint

Mix into a combo blend and use 3 drops at a time in shower, diffuser or on a piece of cloth.

 

Oil/ Rub recipe

 

2 TBS of light neutral oil like grapeseed or almond oil

10 drops of lavender or geranium

10 drops of eucalyptus or tea tree oil

Rub on back. I like to add my favorite flower and gemstone essences to this.

 

Flower and Gemstone Essences for Asthma Symptoms

 

Flower essences are especially comforting during or immediately following the panic of an asthma attack. In particular Rescue Remedy (Bach’s Five Flower blend), and Star of Bethlehem are good for acute emergency situations. Comfrey and Wild Rose can be helpful if asthma attacks are stress or trauma related. Opal gemstone essence can help with over taxed adrenals and it is good to take after a course of prednisone. Lapis lazuli, Aquamarine, and Blue Tourmaline are all gemstone essences that are specific to the lungs and worth getting to know. These essences can be taken individually or added to tinctures, rubs and cups of tea.

 

The Value of Emotional Healing

 

Emotionally asthma has been associated with someone who has not been allowed to express their feelings and emotions. Someone who has a secret they were not allowed to tell. Someone who hasn’t been able to cry or yell or express their emotions in the way that they wanted or needed to. Talk therapy can really help someone who identifies with this description.

 

Conclusion

 

The value of holistic treatments for asthma symptoms cannot be overstated. Economically herbs are much cheaper and accessible to low income individuals and the millions of Americans without access to affordable health insurance. Many of these plants grow as weeds in our communities or are easily cultivated. The ability to manage symptoms and mitigate the effects of pharmaceuticals with herbs and other natural therapies improves the quality of life.

 

 

References

 

Asthma and Allergy Foundation of America. Website: www.aafa.org. Retrieved: June, 2011.

 

Balch, Phyllis A., CNC. Prescription for Herbal Healing. (192-194).

 

Centers for Disease Control and Prevention. Website: http://www.cdc.gov/VitalSigns/Asthma/.

Retrieved: June, 2001.

 

Hoffman, David, FNMH, AHG. Medical Herbalism – The Science and Practice of Herbal Medicine.

(330-334).

 

Potts, Billie. Witches Heal. (34, 40, 44-46).

 

Stein, Diane. Natural Remedy Book for Women. (108-113).

 

WebMD. Website: www.webmd.com/drugs. Retrieved: June, 2011.

 

Weed, Susun S.  Healing Wise. (174).

 

Worwood, Valerie Ann. The Complete Book of Essential Oils and Aromatherapy. (185).

Treating Infertility with Herbs and Nutrition

Riyana Rebecca Sang

Herbal Therapeutics June 27th, 2011

Treating Infertility with Herbs & Nutrition

Introduction

Infertility is a problem that effects about one in every six to ten couples in the United States, with the numbers steadily rising over the last couple of decades.  Medically, infertility is defined as a couple’s inability to conceive after stopping all forms of contraception for one year.  Studies differ on how often the issue is related to the man, the woman, or a combination of both: some say as high as 40% of problems with fertility are associated with the “male factor,” leaving the other 60% to be related to issues with the woman’s health and / or some combination of them both.  There are many factors that can affect a couple’s fertility, such as decreased sperm count, diet, pathological issues within the woman’s body such as endometrosis or a malpositioned uterus, emotional and psychological factors, stress and overwork, etc.  Although the many factors involved in a couple’s infertility may be complicated and difficult to diagnose and discern, herbal care and nutritional counseling can be very effective in assisting couples to conceive  — even when there is no specific “cause” for a couple’s infertility that can be easily identified as the culprit.

 

Part 2: Some Possible Causes of Infertility

 

If a couple has problems conceiving a child after a year of attempting to do so, many natural practitioners and most allopathic medical doctors will recommend testing to look into whether or not there are pathological reasons for conception to be blocked.  Western medical science, with its ability to do blood tests for hormone levels and allergy tests, etc., can be very helpful in this regard, but it is not the only avenue for investigation.  Having the woman chart her basal body temperature, cervical mucus, cervix position, and other fertility signs a la Toni Weschler’s book Taking Charge of Your Fertility can also lead to some very insightful information as to what is happening within the woman’s body that is inhibiting conception.   Charting fertility signs can help a woman understand if she is having annovulatory cycles (not ovulating), conceiving and then naturally aborting the child, or none of these things.   This information can be very helpful to the herbal practitioner in creating individualized formulas and recommendations for the couple (more on that later).

However, UK Herbalist Carol Rogers says that “ A greater proportion of infertility occurs in women whose reproductive function is otherwise normal than as a result of any of these abnormalities.”[i] Many couples who have difficulty becoming pregnant suffer from a combination of sub-clinical conditions. These conditions can’t cause infertility on their own but — in combination — they can substantially reduce a couple’s probability of conceiving.  For example, a gluten intolerance alone may not cause infertility, but the the resulting inflammation in the gut can minimize your nutrient absorption and lead to deficiencies in nutrients you need for optimal sperm, egg and hormone production and a healthy pregnancy.  Brooklyn acupuncturist and herbalist Karen Vaughan notes that there are a diverse range of causes for infertility, some of which may be ‘caught’ by medical testing and some which may be more mysterious.  “Missing minerals, insulin resistance, lack of essential fats, lack of protein, strong fears of motherhood or pregnancy, low quality menstrual cycles, silent infections like chlamydia or gonorrhea, blocked fallopian tubes, PCOS, aging eggs and sperm, and many other factors affect fertility and the remedies are all different.”[ii]

Some of the most common factors affecting fertility in women are:

 

e    Retroverted or “Tilted” Uterus: In most women, the uterus is tipped forward, towards the bladder.  However 1-in-5 women has a retroverted or tipped backwards towards the spine.  Most fertility doctors no longer consider this a factor in infertility, although some natural practitioners may suggest bodywork such as Mayan Abdominal Massage (rhibozo massage) to ensure optimum fertility and increase the chances that once conception occurs, the woman will not miscarry.

e    Prolapse & Fibroids: Fibroids are common benign tumors in the uterus, generally associated with hormonal imbalance and an excess of estrogen.  A recent study found that Fibroids in general, regardless of location, were associated with a 15% reduction in pregnancy rates, a 30% reduction in live birth rates, and a 67% increase in miscarriage rates when compared with controls without fibroids.[iii]

e    Cervical problems: The cervix can also be affected adversely and cause sterility. Infection or excess mucus from inflammation can expel the sperm, or polyps may prevent the sperm from entering the uterus.

e    Fallopian Tube problems: Fallopian tube blockages may obstruct the egg from passing down into the vagina.  This can be caused by genetic predisposition or because of infection, such as salpingitis (inflammation of the fallopian tubes), endometriosis, and TB.  These infections can cause the thickening of the tubes which either narrow or completely block the passages, or they can cause the tubes, uterus and ovaries to become matted together by adhesions, or in the case of endometriosis, by growths of tissue from the uterus.

e    Vaginal mucus: if too viscous can impair fertility

e    Polycystic Ovarian Syndrome (PCOS): PCOS is a very common condition affecting women of reproductive age, affecting 5-10% of premenopausal women.  It has a variety of symptoms, including weight gain, annovulatory cycles, irregular menstruation, hyperandrogenism (overproduction of androgens), hirsutism (increased body hair), ovarian cysts, and insulin resistance.  A woman may have some but not all of these symptoms – she may be diagnosed with PCOS even if a pelvic exam does not indicate the presence of cysts.

e    Endometoriosis: Another very common reproductive condition that may affect fertility; effects approximately 5-10% of all women.  Endometriosis involves tissue that forms the lining of the uterus growing in other parts of the pelvis and sometimes even outside the pelvis entirely.  Interestingly, Christiana Northrup calls Endometriosis, “the illness of competition.”  She traces it to when “a woman’s emotional needs are competing with her functioning in the outside world.  When a woman feels that her innermost emotional needs are in direct conflict with what the world is demanding of her, endometriosis is one of the ways that her body tries to draw her attention to the problem.”[iv]

e    Emotional problems: Where emotional problems cause tension and anxiety, or when just wanting to conceive is producing psychological blockages to conception, herbal remedies may well be helpful. Susan Weed highly recommends Motherwort (Leonorus) when emotional issues seem to be blocking conception, especially when nervousness or ambivalence about the transition into motherhood is a main factor.

e    Debility: David Hoffman cites lowered energy and general fatigue as a common issue with fertility.  “Where illness, malnourishment, fatigue, and conditions such as anaemia, anorexia and kidney problems have lowered vitality and produced a state of debility which has affected fertility, there are many herbs which can help to build up the strength of the generative organs. Bitters, tonics and adaptogens are actions to consider. The specifics will depend upon the individual concerned, but application of the model for remedy selection will usually clarify this.  True Unicorn Root (Aletris farinosa) is considered beneficial for habitual miscarriage due to chronic weakness. It can be used safely throughout pregnancy. It acts to stimulate the uterus and ovaries and is commonly used for infertility and impotence.”[v]

e    Immune health: Imbalances in the immune system can inhibit conception. Treating low-grade infection in the genito-urinary system and addressing any autoimmune factors can be an important factor in fertility health.  Sometimes a woman’s system builds up antibodies against her partner’s sperm, or the fetus itself.  Also, some STD’s – often asymptomatic – can affect fertility.  One such STD is a Chlamydia infection. In men, a Chlamydia infection can lead to sperm abnormalities including sperm antibodies. In women, it can lead to scarring, blocked tubes and miscarriage.  One study found 60% of asymptomatic male partners of infected females attending a fertility clinic were found to be infected with Chlamydia.

e    Endocrine System Health: Disorders within the endocrine system that affect fertility can include hyper or hypo thyroidism, pituitary dysfunction, and signs of adrenal weakness. The endocrine system plays a huge part in hormonal balance.

e    Body weight: Being underweight or overweight in women can lead to issues with hormones and the ability to conceive.  Further, the effects of fad dieting and the resulting labile weight levels disrupts the delicate balance of hormones. Nutritional deficiency, common in many fad diets, may result in amenorrhea and anovulation. For optimal reproductive health, a woman should ideally have no less than 25% body fat. This becomes especially important after menopause when the fat tissue becomes a major source of estrogen, preventing bone loss and ensuring the skin and mucus membranes stay healthy.  On the other hand, obesity can also lead to hormonal imbalances, and obese women more likely to suffer from the effects of excess androgens (PCOS).

e    Adrenal Fatigue: Herbalist Rosalee De La Foret cites adrenal fatigue as a common issue for couples struggling with conception.  In my practice I often see adrenal fatigue or, in TCM terms, kidney yang deficiency, as an underlying cause of infertility. Kidney yang deficiency is a whole other topic in itself but it is addressed with herbs, lifestyle, and nutritional changes that can help restore balance to these depleted individuals. Adaptogen herbs, nutrient dense foods, healthy sleep habits, regular exercise, and stress management tools are commonly suggested.”[vi]

e    Environmental Health: The health of the environment plays a large role in fertility health. Pesticides, heavy metals, xenoestrogens, and radiation have all been implicated in infertility and with miscarriage.  Some researchers speculate that the rate of infertility may be increasing, especially in comparison to rates previously experienced in pre-industrialized society. Much of this concern is attributed to exposure from man-made, industrial chemicals that contaminate the environment, including solvents (e.g. benzene), polyhalogentated aromatic hydrocarbons (PHAHs, e.g. benzo[a]pyrene, PCBs, dioxins), herbicides (e.g. 2,4-D) insecticides (e.g. dibromochloropropane), fungicides (e.g. vinclozolin), metals (e.g. lead, cadmium), and plasticizers (e.g. bisphenol-A). In large part the concern relates to chemicals called xenoestrogens that have an estrogen-like activity, but these chemicals can have other effects as well, such as increasing or decreasing the secretion of estrogen and androgens, inhibiting hormonal activities generally, or causing direct damage to reproductive tissues.  “Humans cannot pollute this planet and their own bodies without consequenes, and infertility is one of them.  Conditions on the Earth may not favor fertility the way they used to.  It’s as thought the collective species brain were generating a great deal of energy toward making many women and men infertile, due to the stresses of today’s families, social environments, and personal addictions, and to the stress of the planet itself.”[vii]

Stress: In both men and women, stress can negatively affect sexual performance and fertility. With stress the activity of the hypothalamus is decreased, resulting in diminished GnRH, FSH and LH secretion, and decreased levels of the gonadotropins such as estrogen, progesterone, and testosterone. Statistics suggest that about 5-10 % of infertility is stress related. This problem obviously becomes compounded if drugs and alcohol are used as a coping mechanism.[viii]

Age: Although age does have an impact on fertility in women, Susan Weed and Carol Northrup both caution us not to focus on this aspect of infertility too much, as it is perhaps over-emphasized by infertility doctors and the medical establishment.  “Contrary to current opinion, having children in your forties is ordinary and common worldwide,” Weed notes. “What is unusual and unique to our time is having a first child in one’s forties. Our mothers, mothers, mothers were having their fifth or eighth or tenth child when they were in their forties, not their first.  If people tell you it just isn’t done, close your eyes and call upon the spirit of your great, great, great, great grandmother, then smile and tell them it seems utterly ordinary to you.”

e    Sexual Activty / Libido: A healthy sex life is essential to conception.  Many studies have shown that it isn’t simply the act of sex itself but also orgasm that is a factor in conception.  “Orgasm on the part of the male is necessary for fertilization. The woman’s orgasm does increase the possibility of conception. Women who experience orgasm after their partner (up to 40 minutes after his ejaculation) have the very best chance of becoming pregnant.”[ix]

 

While many of the factors above may affect men as well (such as environmental toxicity, debility, and endocrine health / hormonal balance) some factors that specifically affect male fertility are:

e    Sperm count: The commonest cause in men is no sperm or a low sperm count. This may be caused by numerous factors including an infection after puberty which was accompanied by a high fever, unrepaired undescended testicles, taking certain drugs, trauma to the testicles, or exposure to large amounts of X-ray. For the most part however, a low sperm count tends to be related to more easily reversible conditions. A long illness or a chronic infection may lower general health, as could poor diet, strenuous physical exercise, lack of exercise, too much smoking and drinking, over-weight, overwork, tension and fatigue. A common reason for a low sperm count is abnormal temperature regulation in the testicles, which function at a temperature slightly lower than the rest of the body.[x]

e    Low sperm motility:  This makes them unable to travel from the vagina, through the fallopian tubes to fertilize the ovum. This tends to be related to some of the above factors, and may also be due to enlargement of the prostate gland, as well as an imbalance of male hormones in the body. The vessels along which the sperm travel in men could be blocked by an inflammatory or infectious process or by varicosity in the area.[xi]

 

Part 3: Diet, Nutrition and Fertility

 

Many of the causes of infertility are related to diet (PCOS, adrenal fatigue, general toxicity).  Luckily, many of the things that couples can do to increase their likelihood of conception are also related to diet and nutrition.  In general, conceiving a child is similar to cultivating a garden; feeding ourselves healthy, whole foods high in nutrition and low in sugars and toxins is like feeding the soil that the seeds will be nestled in before emerging into the sunlight.

 

Alcohol, caffeine, tobacco and other intoxicants:

Pregnant women have long been told that alcohol can effect the fetus, but Todd Coldecott says that alcohol in general is unhealthy for anything to with reproduction. “Even moderate consumption, or 1-2 glasses of wine per week can increase prolactin levels and suppress ovulation.  The elevation of prolactin also occurs with the usage of antidepressants, analgesics, hallucinogens, and marijuana. Tobacco too poses problems for women, and although no one knows exact link, female smokers generally have decreased estrogen levels, poor cervical mucus, a higher risk of pelvic infection, and an increased incidence of ectopic pregnancy and miscarriage.  Additionally, nicotine appears to toxic to sperm, and thus smoking can interfere with fertility. Coffee is another vice, and women who consume one cup of brewed coffee a day are half as likely to conceive. Caffeine is also implicated in cyclic breast pain and fibrocystic breast disease.”[xii]

Coldecott says that men can tolerate more alcohol without effect on fertility, but excessive alcohol conception (which he defines as 2-3 pints of beer per day) can lead to poor sperm motility and depressed libido. In addition, “the ensuing damage to liver function liver also causes estrogen levels to rise and antagonize the activity testosterone. Tobacco also poses certain risks, and about two-thirds of impotent men are smokers. Nicotine inhibits blood flow to the penis, and only 1-2 cigarettes will cause an immediate impairment of circulation.”[xiii] Men who smoke marijuana frequently typically demonstrate lower testosterone levels than average, as well as poor sperm motility. Other drugs, such as cocaine and amphetamine inhibit parasympathetic activity and can result in premature ejaculation.

 

Gluten, Soy & Wheat

The incidence of gluten intolerance or celiac disease is higher in women experiencing unexplained infertility than among the general population.[xiv] Gluten intolerance is not only related to unexplained infertility, but also to recurrent miscarriage, and intolerance to gluten, often undiagnosed, contributes to nutrient malabsorption as those suffering from the intolerance do not readily absorb micronutrients like iron, zinc and folic acid which are critical to reproduction.  Strict adherence to a gluten-free diet usually resolves symptoms including unexplained infertility and recurrent miscarriage.  Gluten is a protein found in various grains including wheat, spelt, barley and rye.

Another common allergen that is damaging to reproductive health is soy.  Soy is a potent source of xenoestrogens.  Soy isoflavones can create potent, adverse effects on both the male and female reproductive systems – particularly in their early development.[xv] It’s important that women trying to conceive avoid foods that list soy, soy lecithin, soy protein, soy flour, texturized vegetable protein (TVP) – taking special care to avoid soy milks and soy-based meat substitutes.

 

Refined Sugars & Insulin Intolerence

Vaughan argues that there is a strong connection between insulin resistance and infertility, even when there is no PCOS. Too much insulin in the blood promotes insulin growth factor, which causes cysts and fibroids to grow, and elevated insulin levels can also contribute to abnormalities in the HPA axis, which affects hormone levels.  Insulin resistance is caused by eating too many sugars and carbohydrates and not getting enough healthy nutrition – especially Omega 3 fats – to balance it out.

Vaughan recommends that women with reproductive health issues follow a low-glycemic diet that limits consumption of refined sugars, which she says “may improve fertility and pregnancy outcome.  Sugar and refined carbohydrate consumption plays a particularly devastating role in polycystic ovarian syndrome.  Women with polycystic ovarian syndrome may see improvements in their fertility by increasing protein and restricting or eliminating simple, refined sugars.”[xvi]

 

Dietary Supplements

In addition to a rising diet rife with sugars that lead to insulin issues, Vaughan also notes that the reduced mineral nutrition in our foods can be detrimental to fertility.  “Between the mid 1970s and mid 1990?s the USDA tested the nutritional content of food and found most minerals declined by a third due to soil depletion.  Magnesium is one of the most important, but zinc, boron and a number of trace minerals are also significant.  I suggest at least 500mg of magnesium plus a multi-mineral or trace concentrate supplement.”[xvii] In addition to magnesium supplementation, Vaughan recommends that couples working with fertility and conception should also consider taking fish sufficient to provide 1000mg of DHA, Vitamin D (5000-10,000 iu per day), and a prenatal vitamin with folic acid in it.   Vitamin D has been shown to reduce pregnancy complications such as premature deliver and preeclampsia, and may also reduce the risk of Autism and Type 1 Diabetes in newborns.

Susan Weed also notes the importance of Vitamin E in addressing infertility issues, especially when working with women over 40.  “Vitamin E is an especially critical nutrient for fertility after forty and freedom from birth defects. Freshly-ground wheat flour, cold-pressed oils, and nut butters are all good sources of vitamin E, as are stinging nettle infusion and most cooked seaweed, such as kelp. The man’s vitamin E level has as much, if not more, bearing on freedom from birth defects as does the woman’s vitamin E level.?”  She also recommends boosting nutrition overall by drinking herbal infusions infused overnight.  “Women who drink 2-4 cups of stinging nettle infusion daily and eat cooked leafy greens as well as lettuce salads are getting the abundant folic acid, calcium, magnesium, and other minerals needed to create a healthy baby. (Tinctures, pills, and teas contain little or none of these important nutrients.)”[xviii]

 

The Pre-Conception Diet

Many herbalists, naturopaths, and other health practitioners recommend that couples working with fertility issues also consider going on a pre-conception diet for 6 months to a year before attempting to conceive, especially if the couple has miscarried in the past or if there are specific pathological reasons interfering with establishing a pregnancy (such endometriosis, fibroids, annovulatory cycles, etc).

Most pre-conception diets have similar tenants to the Traditional Nutrition regime created by Weston Price in the 1900s.  Some common attributes include:

e    Raw, grassfed dairy foods (milk, cheese, yogurt, kefir, butter, ghee, etc.) and/OR seafood (fish and shellfish).  Fat, including butterfat, is an important source of fat soluble vitamins – the very nutrients that are vital to the reproductive process.   Skim and part-skim dairy products lack butterfat and the life-giving nutrients it contains.   A recent study of over 18,000 women found that skim and low-fat dairy products may actually increase the risk of anovulatory infertility, while full-fat dairy products actually decrease the risk of infertility.  Women who eat at least one portion of high-fat dairy food per day have more productive ovulation, by 27% than women who eat low-fat dairy. Women who eat 2 servings or more of low fat dairy have 85% more ovulation-related infertility.  It’s important that all dairy comes from organic, pasture-raised cows.  In addition to reducing a woman’s exposure to excess chemicals and hormones, “the fat from pasture-raised cows contain has as much as five times the CLA (a fatty acid which is a potent anti-cancer agent, muscle builder, and immunity booster) as fat from grain-fed cows.  The Omega 3 essential fatty acids are found in similar proportions to deep sea fish.  Grass-fed milk contains rumenic acid (a CLA), DHA, vaccenic acid,branched chain fatty acids, butyric acid, lecithin, cysteine-rich wheyproteins, calcium, iodine and vitamin D all of which have value from reducing cancer to increasing fertility.”[xix]

e    Healthy Fats: One of the best things a woman can do with her diet to help her increase her ability to conceive is make sure she is getting enough healthy fats. “Fat is the substance of  the phospholipid bilayer that surrounds cells, including eggs, and lets nutrients and sperm through the membrane.  Fat in the form of cholesterol makes up the building blocks of hormones needed to trigger ovulation and implantation.”[xx] Good healthy fats are butter, lard, coconut oil, olive oil, the fat in nuts and seeds (and nut butters), and other animal fats.  Avocados are another good food to get good fats. Avocados and nuts provide a lot of Vitamin E, which is vital to conception.

e    It’s important to avoid transfats, however, which impair fertility. Scientists from the Harvard University School of Public Health advise women wanting to get pregnant to avoid all trans fats, as they may increase the risk of infertility by up to 70%.

e    Organ meats: from organic, grassfed animals one or two times a week (liver, liver pates, heart, kidney, etc).  Couples can try mixing ground organ meats into ground beef for spaghetti, etc., if they aren’t used to them.

e    Animal protein: It’s important that this includes both the meat and the fats. Fish and shellfish are also good (oysters, calms, crab, lobster) as they supply idodine – an idodine deficiency can cause infertility.  Eggs, especially egg yolks, can also be very helpful.

e    Vegetables & Leafy Greens: fresh or lightly cooked vegetables (serve with plenty of butter, homemade dips, or olive oil and vinegar dressings over your salads) are a good source of nutrition, vitamins, minerals, anti-oxidants, and healthy carbohydrates.  Leafy greens provide folate (also in chicken, fish, fruit, nuts, and lentils) – which helps prevent birth defects.

e    Fermented foods: sauerkraut, pickles, kimchi, and kombucha, anything lacto-fermented.

e    Bone broths: Bone broths bring lots and lots of minerals to the diet, and also cleanse the body and help digestion.

 

Part 4: Treating Infertility with Herbs & Nutrition

 

When working with a couple affected by infertility, one of the most important (and perhaps counter-intuitive) suggestions that we can offer as herbalists is to stop trying to conceive, at least, for a certain period of time.  Couples should spend 4-6 months trying to tonify the body and avoid conception.  During this time, the woman should monitor her  ovulatory cycle in this time a la the fertility awareness method.  Both partners should also take up the pre-conception diet and test and supplement for nutritional deficiencies, especially magnesium, vitamin D, vitamin C, vitamin E, Selenium, Zinc, B vitamins – especially for vegetarian women.

Rogers recommends a three-step process of treating infertility with herbs:

  1. Use hormonal normalizers prescribed until cycle is regular: chaste berry, wild yam, false unicorn root.
  2. Next, nourishing herbal tinctures or teas are taken for several months: alfalfa, nettles, red clover, raspberry leaf, peony root, rehmannia, schizandra, dong quai.   Red clover and red raspberry are high in calcium and magnesium, two minerals especially good for conception.
  3. Finally use uterine tonics for 2 months or until conception.: false unicorn root, squaw vine, true unicorn, blue cohosh, golden seal.
  4. For men: reduce use of toxic pollutants, decrease stress.  Increase Vitamin A, E, Zinc, and Manganese (up to 50 mg of zinc daily, found in large amounts in sperm, testicles and prostate). Herbal tonics of panax ginseng, schizandra, he shou wu, saw palmetto and some of the nourishing herbs for women work as well.[xxi]

 

De Foret recommends that couples see the failure to conceive as “a symptom of an underlying cause.  Couples seeking holistic treatment need ot understand that while the end-result may be conception followed by birth, the big picture goal is to create a healthy balance in the entire body.”  Her model utilizes bi-phasic formulation that matches different herbs to coincide with where the woman is in her cycle and what support is most helpful at that time. The idea is that in the first two weeks of the menstrual cycle (follicular phase) a woman is building estrogen hormones in her body. The last two weeks progesterone is building (luteal phase).  “Using a bi-phasic formulation you can then support the woman’s natural cycle. One formula is created for the follicular phase of the cycle and one formula is given for the luteal phase of the cycle. Other considerations may also be present in this formula including liver health, immune support, adrenal support, etc.”[xxii]

Vaughan takes herbal formulation by stages one step further, advising that herbalists use the information from charting to develop the herbal recommendations and formulation for the woman.  She advises to check and see if the follicular phase is too short (leading to shorter cycles overall), if the luteal phases is too long, or if the spike in temperature that indicates ovulation is not high enough to actually release an egg, etc, and use these assessments to choose herbs that target that part of the cycle to support.  As an acupuncturist trained in TCM, she advises using “yin tonifying herbs for the follicular phase and yang tonifying herbs for the luteal phase, with certain herbs specific to ovulation used at that time.”

 

…A woman goes through more than two different hormonal processes during her menstrual cycle. In the first phase she ripens the egg and builds the endometrium in her womb, which depends upon  Kidney Yin and Blood.  In the second , Liver Q and Blood movement govern ovulation.  In the third phase  Kidney Yang and Spleen Qi regulate the luteal stage or hold the pregnancy if it occurs.  In Phase 4, when PMS is most prevalent, Liver Qi helps the premenstrual transformation.  And Phase 5 is menstruation, covered by Blood and a little Qi to keep it moving.

It is not necessary to come up with five formulas unless the cycle is seriously disturbed.   If only one part of the cycle is not functioning well, you can target it.  This is not only done by, say giving vitex which increases progesterone during the luteal phase.  Instead I might use magnesium and zinc throughout the cycle as these help the body form progesterone itself.  Or I might add a little warming cinnamon and maca to the Yin phase of the formula in order to give the yin enough oomph to transform to yang at ovulation.[xxiii]

 

Vaghan’s Herbs for the Follicular Stage (yin): goji berries, slippery elm, peony root, black sesame seeds, seaweeds, shatavari, Dong Quai.

Ovulation Herbs: goji berries, peony root, damiana, bluperum

Luteal Stage Herbs (yang): Cinnamon, ginger, vitex

Premenstrual Herbs: Cilantro, licorice, Xiao yao san

Menstruation Herbs: Topical frankincense, turmeric, San qi.

 

Vitex agnus castus (Chaste Tree Berry): Vitex is a progesterone agonist which can help to minimize the risk of miscarriage. In addition, it can also stimulate ovulation. It works specifically by enhancing pituitary function, thus improving ovarian function. Research carried out in the University of Gottingen in Sweden, found that although it does not contain the hormone progesterone, it affects the pituitary gland in such a way that it corrects and regulates the secretion of progesterone from the ovaries. Vitex also corrects any hormone deficiency of either estrogen or progesterone.

 

Chamaelirium luteum (False Unicorn Root) also has the effect of correcting hormonal imbalances. In Britain, the most frequent use of this remedy is for female infertility, as well as impotence on the part of the man. Herbalists have been known to warn people of the potency of this plant should they not want to conceive! It is an effective tonic to the uterus and ovaries, and is useful to redress almost any imbalance in either male or female reproductive systems. It helps to prevent miscarriage, uterine hemorrhage and over-relaxed conditions of the uterus, even to the extent of prolapse.

 

Angelica sinensis (Dong Quai):

 

Avena sativa (Milky Oats): moistening, nutritive tonic

 

Urtica dioica (Nettles): high mineral content, restores general health

 

Trifolium pratense (Red Clover):  A strong overnight infusion of red clover, or red clover mixed with nettles and oatstraw has pushed many women over the brink from infertility to fertility.  This seems to work best when a little extra nourishment is needed in an otherwise healthy woman.   “Red clover is the single best remedy for women over forty who want to conceive but can’t — even if there are medical reasons for not conceiving such blocked tubes, diabetes, ovarian cysts, internal scaring, endometriosis. There are many heart-warming success stories I could share about red clover! But suffice to say, drinking 2-4 cups of the infusion of the dried blossoms (neither tincture nor tea nor pills will work for this application) seems to do wonders for fertility, no matter what your age.”  — Susan Weed

 

Leonorus cardiaca (Motherwort): Calmative, especially for issues around motherhood.

 

Symphytum uplandica (Comfrey): Again from Susan Weed,  “the single most important herb for pregnant women over forty is comfrey. The leaves of the mature plant contain an abundance of constituents beneficial to mother and babe, including generous amounts of minerals, alantoin, proteins, and many vitamins. The minerals in comfrey help insure  healthy nervous system growth; the fetus’s developing brain uses the proteins. And the alantoin helps the mother’s tissues become stretchy and elastic. ??Aging can lead to increases stiffness and brittleness in bones and muscles, making pregnancy more arduous and painful, labor slower and more difficult, and injury more likely during birth. The hormones of pregnancy, which help soften and relax the pelvic tissues, may not be produced in adequate amounts. Comfrey comes to the rescue! Comfrey creates flexible and strong tissues throughout the body especially mucus surfaces (including intestines, uterus, bladder and vagina) the bones, the ligaments and tendons, and the skin.??Regular use of the leaf infusion, at least a quart a week, promotes a safe delivery by:strengthening uterine muscles and preparing them to work easily and well; strengthening perineal tissues so they become resistant to tearing; strengthening uterine ligaments so the uterus does not prolapse; strengthening the bladder and increasing resistance to bacterial infection; strengthening the vagina and helping to promote an environment hostile to infection; providing easily assimilated minerals to prevent eclampsia and other complications; helping the bones of the pelvis flex and open during birth; increasing iron in the blood and thus forestalling post-partum hemorrhage.

 

Adaptogens to assist the HPA-axis function:

Female: Cordyceps, licorice, rhodiola, shatavari

Male: American ginseng, ashwagandha, asian ginseng, cordyceps, he shou wu, lucium, rhodiola, rhaponticum, and shilajit.

Asian ginseng – promotes estrogen

Astragauls – sperm motility

He shou wu – sperm count and motility

Schisandra: increaseses pelvic circulation, tones repro

Ashwagandha – stablilizes HPA axis, reduces adrenaline & cortisol, helps with thyroid.

 

More helpful herbs from Carol Rogers: True Unicorn Root, Squaw Vine, Blue & Black Cohosh, Wild yam, Red Raspberry, Alfalfa

 


[i] Rogers, Carol.  The Women’s Guide to Herbal Medicine. 1997.  Retrieved from: http://www.womens-herbal-guide.com/publications.htm

[ii] Vaughan, Karen.  “Staging Herbal Formulas to Enhance Fertility.”  August 13th, 2010.  Retrieved from: http://www.acupuncturebrooklyn.com/alternative-health/staging-herbal-formulas-to-enhance-fertility

[iii] Kovak, Peter.  “Fibroids and Infertility: An Updated Systematic Review of the Evidence.”  2009.  Retrieved from: http://www.medscape.com/viewarticle/701937

[iv] Northrip, Christiane.  Women’s Bodies, Women’s Wisdom, p172. Bantam Books, New York, 2002.

[v] Hoffman, David. “Infertility.”  Retrieved from http://www.healthy.net

[vi] De La Foret, Rosalee.  “Holistic Herbal Perspectives for Challenges with Fertility,” 2010.  Retrieved from Methowvalleyherbs.blogspot.com

[vii] Northrup, p 413.

[viii] Caldecott, Todd.  “Fertility Inventory.”  Retrieved from http://www.toddcaldecott.com/

[ix] Weed, “Fertility Over Forty.”

[x] Hoffman, David.

[xi] Hoffman, David.

[xii] Coldecott, Todd.

[xiii] Codecott, Todd.

[xiv] Jenny, “Unexplained Infertility.”  Retrieved from www.nourishedkitchen.com

[xv] “Unexplained Infertility.”

[xvi] Vaughan, Karen, “Insulin Resistance and Infertility.”  2010.  Retrieved from: http://www.acupuncturebrooklyn.com/alternative-health/insulin-resistence-and-infertility

[xvii] Vaughan, “Staging Herbal Formulas to Help with Fertility.”

[xviii] Weed, Susan, “Fertility Over Forty.” 2000.  Retrieved from: http://www.susunweed.com/Article_Fertility_After_Forty.htm

[xix] Vaughan, “Full Fat Dairy Helps Ovulation in the Infertile.” 2010.  Retrieved from: http://www.acupuncturebrooklyn.com/alternative-health/full-fat-dairy-helps-ovulation-in-the-infertile.

[xx] Vaughan, “Full Fat Dairy Helps Ovulation in the Infertile.”

[xxi] Rogers, The Women’s Guide to Herbal Medicine.

[xxii] De Foret, “Holistic Herbal Perspectives for Challenges with Fertility.”

[xxiii] Vaghan, “Staging Herbal Formulas…”

Bipolarism: A More Holistic Approach

Bipolarism: A More Holistic Approach

Joolie Geldner

June 2010

Introduction

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

Attention­ Deficit Hyperactivity Disorder: Herbal and Natural Treatments

Attention­ Deficit Hyperactivity Disorder: Herbal and Natural Treatments

Daniel Burton

May 2008

Introduction

Attention­ Deficit Hyperactivity Disorder (ADHD), also known by its older name, Attention Deficit Disorder (ADD), is distinctly a phenomenon of the late 20th and early 21st 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 adaptogensnootropics, 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.

Holistic Health for Transgender and Gender Variant Folks

Holistic Health for Transgender & Gender Variant Folks

Dori Midnight

 

Introduction

This paper will cover basic herbal and nutritional support for transgender and gendervariant folks speci?cally 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 speci?c 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: de?nitions & 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 speci?cally with the intent of helping people servetransgender patients with respect and understanding, which means being aware of language andword choices. One de?nition 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 de?nitions 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 in?ammation, 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 ?ora after surgery, especially if taking antibiotics, may halt yeast infections and bowel irritability: acidophilus andbi?dus, 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 bon?re, 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 1st 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 ?ushing 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-in?ammatory 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 ?ush 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 re?ned (?our, 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 ?ght  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, 3rd week lower to 500 mg/3 x day. Best buffered or time released.QuerctinEvening Primrose Oil (and ?sh oil if not vegetarian): 1500 mg as needed forin?ammation.
  • Hot/Cold therapy: ice for 1st 24 hrs, then alternate hot and cold
  • Baths: Epsom or sea salt scrubs (to eliminate toxins)Add lavender , chamomile oils or ?owers 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 Speci?cs-St. John’s Wort and Ginkgo– are incompatible with most drugsincluding hormones and anaesthesia. The liver detoxi?es/breaks-down hormonesand drugs in the body through the production of enzymes. These herbs speci?cally 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) BruisesArnica 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-In?ammatoriesTurmeric/Curcuma longa, Bromelain plus Quercetin (supplement taken away from food ), Black Cohosh/Cimmicifuga racemosa, Lobelia in?ata (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 ?ring 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 in?amed 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 ?ow 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 ?ber- ?ax, 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 ?rst 3-5 days, such as Miso soup• Hydrotherapy- cold for ?rst 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 ?laments in brain (connects brain cells) andcreates neurotransmitters, supports sexual health, blood and arterial ?ow, skin health etc…

The classic de?nition 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, chie?y 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 ?ll 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 signi?cant 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 dif?cult if not impossible. So while testosterone is effective and very helpful for transmen, it alsorepresents a more signi?cant 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 (?broids, 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 of?cianalis), Sassafras(Sassafras albidum), Damiana (Turnera diffusa), Ashwagandha (Withania somnifera), Ginsengs (Panax), Oats (Avena sativa), He Shou Wu (Polygonum multi?orum), 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 ?ight or ?ghtstress 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 ?ower,  skullcap, valerian, vervain, wild lettuce. Adaptogens: reishi,  schizandra, ashwaganda, astragalus, aralia, ginseng, tulsi

Liver tonics/detoxi?ers/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 puri?er 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 multi?orum): “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 ?sh 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 in?ammation- 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 ?ltration 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% ?ber, 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 ?elds got their periods early and developed sexcharacteristics early…}
  • Soy: contains estrogens, often is really processed and genetically modi?ed.

 

?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, ?sh, 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 ?exible), dioxins (in bleach, tampons),bisphenol-A (in dental ?llings & tin cans), car exhaust. *Perhaps one approach would be to eat plants and take herbs that have morephyto- estrogens AND Androgens- helps ?ll 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 of?cinalis) , 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: (?broids & cysts, PCOS, Ovarian cancer) ?Uterine tonics and stimulants: Vitex agnus castus, ginger (Zingiber of?cinale), 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:

In?ammation (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-in?ammatories: 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 de?nite 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, Passion?ower (Passi?ora 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 in?ammation, reduces hormones that suppressimmunity function.

 

 

KIDNEY AND LIVER SUPPORT:

careful treating liver- don’t want to change metabolism of hormones ?Hepatics: Dandelion root (Taraxacum of?cianale), 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 ?ow, 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: ?ower essences are remedies that address emotional or spiritual crises or imbalances. There are thousands of remedies made from ?owers, 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, ?nding 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, ?lled 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, ?nding 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. ?nding your beauty

Sun?ower: self- radiance, shining your particular light, masculine energy- w/o in?ated 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

The Relationship Between the Menstrual Cycle and the Lower Gastrointestinal System

The relationship between the menstrual cycle and the lower gastrointestinal system

Lisa Beard

November 2008

Introduction

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.

The Thyroid Gland: Anatomy and Physiology

The Thyroid Gland: Anatomy & Physiology

Michelle Steinberg

Spring 2008

Introduction: 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.

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