Frequent questions posed by males relate to arthritis, backache, energy, exercise and physical fitness, infertility, male menopause, mental alertness, and prostatitis. Most are questions pertinent for females, too, except for the so-called male menopause and prostatitis. If male menopause is real, I missed it or sailed right though it without knowing it. Kathi Keville (1996), a West Coast herbalist I admire, lists the herbs most likely to get a male through his menopause - eleuthero, ginseng, licorice, and schizandra - the same herbs suggested to increase male stamina. Under our discussion of prostate problems, Steven Holt (1996) speaks of the male "andropause" (a term not in my sexist Dorland's 25th Medical Dictionary, 1974) as the male equivalent of the female menopause, there defined as "cessation of menstruation in the human female, occurring usually between the age of 48 and 50." I'm more inclined to believe in a male period; a period of the month during which the male is more depressed, edgy and upset. But I'm even agnostic on that, too.
Many males and females ask me about stamina (including libido), strength, and stress, but I'll only dwell on stamina in this issue. As to strength, the so-called anabolic and ergogenic herbs are frequently recommended. Conversely, for stress the herbal tranquilizers, like chamomile, kava kava, lavender, melissa, passionflower, valerian, are often suggested, for male and female alike.
BENIGN PROSTATE HYPERPLASIA OR HYPERTROPHY (BPH or Old Man's Prostate)
Alphabetically first, but probably behind impotence as question numero uno in the minds of aging baby boomers, herbal remedies for BPH are the most talked about male topics, within my experience. And I've been following the prostate story since I attained 60, an age at which 60% of American males are experiencing prostate problems. In October of 1997, my HMO physician congratulated me on my prostate health. I think I'll recount the long story to put things in historical (not hysterical) perspective.
Oct. 11, 1989, I was called by a physicist here in the greater Washington DC area. He had been amazed at the effects saw palmetto extract was having on him and some friends who were also trying it. He had called to asked what I knew about it. (I always have to be suspicious of such calls; too often they are promoters pretending they aren't promoters). As we chatted, he mentioned that coincidentally, he had learned of a new drug being tried at Johns Hopkins for BPH, which was working effectively by preventing the conversion of T in the prostate to DHT, the latter probably causing the excess cell proliferation. Then he saw an abstract suggesting that saw palmetto blocked the conversion of T in the prostate to DHT. This so excited him that he wanted somehow to get in the business. I referred him to a Florida grower, one of the major exporters to Europe. In Europe the saw palmetto berries are extracted, and in turn the extracts are shipped back to the US and other markets. This rather parallels what happens with evening primrose, of which we once grew more than 1,000 acres in the US, mostly exporting the seed to Europe where the oil is extracted, encapsulated, and shipped back to the US. If the FDA doesn't interfere, it would seem logical to extract here in the US (saw palmetto is native to Florida). My physicist friend was using a mail-order herbal combo with a name like "PROST-AID". Merck's Proscar (finasteride) may be a billion-dollar annual baby (Graedons, 1991) blocking that testosterone conversion. If my mission in life is fulfilled, the drug company would have to compare its new synthetic prostate drug, in this case Proscar, not only with placebo, but also with the better herbal alternative(s)--saw palmetto and pumpkin seed or a mixture of the two. If the herbs proved reasonable, the pharmaceutical firm could get some marketing privileges for the processed herb as well as its new synthetic, if it too, proves helpful. But the poorer people of the US and the world at large would know that there was an effective, cheap natural alternative to Proscar and surgery, neither of which are without risk. According to Consumer Reports on Health (Oct. 1992), a year's supply of finasteride would cost about $600. Just after Halloween, an enterprising BPH patient could obtain a year's supply of delicious pumpkin seeds free or dirt cheap.
My anecdote and my mission statement above was written before Proscar was approved, and before I even heard of Hytrin, mentioned below. That adds irony to the quote that follows: "The American Urological Association has joined the government agency in a pilot study to compare Hytrin, TURP (transurethral incision of the prostate), balloon dilatation and watchful waiting. Plans to expand the study (perhaps to include Proscar and other new treatments) depend on funding, however, and results are not expected for several years" (Carlson, 1992). All these (except watchful waiting) are megabuck options, not necessarily better or safer than a proposed "Prosnut Butter", a combination of foods made like peanut butter. I bet my prostate that the Prosnut Butter would show positive results in BPH, and would prove as safe or safer than finasteride. In response to my sending him a one-page Trick or Treat: Prostatitis or Palmetto/Pumpkin, one editor of Consumer Reports (personal communication 23 Oct.1992) said: "Apropos your comment on Proscar and pumpkin seeds, we recently received a letter from a reader in his 70's (or perhaps 80's?) who wanted us to know that a handful of pumpkin seeds a week has kept his prostate healthy and his lady friends happy." Meanwhile, I was anxiously waiting for data from Europe showing that palmetto does inhibit conversion of T to DHT--the prostate bet was hinging on that. The data reached me finally on the 13th of April, 1993. Here's what it said: "The hexane extract of the fruit of the American dwarf palm tree Serenoa repens has been shown to have antiandrogenic properties through a direct action at the level of the androgen receptor and the inhibition of the enzyme testosterone-5-alpha-reductase." (Champault et al., 1984).
A 1994 postscript to the anecdote: Duke had now, for three years, publicly bet his prostate that saw palmetto and pumpkin seed will do as well as finasteride, when Whitaker came out in print and said that saw palmetto was three times better than finasteride. Murray (1994) puts it this way: "Although Proscar has received much attention. . . it is much less effective than the extract of Serenoa repens . . . Less than 50% of patients on Proscar will experience clinical improvement after taking the drug for one year, and it must be taken for at least six months before any improvement can be expected . . . Decreased libido, ejaculatory disorders, and impotence are the most common side effects reported . . . Proscar costs about seventy-five dollars a month. . ." Saw palmetto is a free Seminole food if you live in the Everglades. It seems to be effective about 90% of the time. Consequently, I'll be taking Serenoa to Peru with me next trip, not to self-medicate but to help Peru have a natural phytochemical answer to BPH.
Normally when someone called me at my old USDA office, asking what I would recommend for a given ailment, I answered that I have to assume that each caller is an FDA agent trying to entrap me. It is illegal for me, a botanist, to prescribe, not even to some unknown caller on the phone. This gentleman who called (not to be confused with the call noted above) had been through the usual circuitry trying to find my phone after he saw an article about me in Health (Mar/Apr. 1995. p. 58). In this article author Peter Jaret says: "At a recent conference of the nation's leading food scientists, the distinguished Department of Agriculture botanist made a startling wager. Like all men over 50, Duke stands about a thirty percent chance of developing prostate cancer (and a 65% chance for BPH). A new drug is proving remarkably effective in treating the disease, but Duke bet his fellow scientists that he'll never need it--thanks to a mixture of seeds and weeds he's concocted . . . And get this: Most of the experts figure he's right . . .Take Jim Duke's concoction. Two of its ingredients, licorice root and saw palmetto seeds, prevent the formation of a byproduct of testosterone that seems to encourage healthy prostate cells to become malignant."
(What I said is licorice contains a compound which prevents the conversion of T to DHT, and that's also what finasteride does). The caller identified himself as an FDA toxicologist with a personal interest in protecting his prostate. Aware of health problems associated with licorice and its glycyrrhizin, he was surprised to learn that I had added licorice to my prosnut butter, since he had seen other publications of mine in which the licorice was not mentioned. I had to confess that I had not been taking prosnut butter, that I had bet my prostate gland in front of at least 14 FDA scientists that prosnut butter would prevent or reduce the conversion of T to DHT. Well, this FDA toxicologist had a saw palmetto product and was asking me for dosage information. Should he, less than 50 years old, take it? How much should he take? These are the types of answers that the FDA has prevented the herb industry from offering to the public. In answer to his question, I told him "I have to assume you are an FDA agent trying to entrap me. I cannot prescribe. However, if I were below 50, I would not necessarily take saw palmetto or finasteride unless my doctor or my family history suggested that I might be headed for prostate problems."
Before the phones had stopped ringing I had four calls from government officials, I feared to chastise me for betting my prostate gland that saw palmetto would work. But no, these were senior officials, and they were asking about how they should take it.
I've added a few things to almost all of the major disease recommendations since I submitted the draft of my Green Pharmacy book. There I favored pumpkinseed, saw palmetto and licorice, followed by pygeum and stinging nettle. Since then, there has been so much study on lycopene that I have come up with a "Lycopade" to chase my prostate power pills. I recently tried my first batch of lycopade, a mixture of good sources of lycopene. A lot of watermelon, a ruby red grapefruit and a little sweet tomato, makes a good beverage. A guava would improve it, but I don't have any. Grind it up, with some of the seeds since lycopene is better absorbed when accompanied by fats or oils. I don't know how much sitosterol is in watermelon or guava seed, but 60 mg sitosterol per day has been shown to alleviate BPH.
These are my suggestions. But let's hear what Steven Holt (1996) has to say. Although the exact causes of benign or malignant prostatic disease remain unknown, many accounts blame hormonal factors. Development of prostatic BPH may involve prostatic buildup of DHT, which promotes prostate growth. Many prostatic therapies focus on the reduction of DHT levels, primarily by interfering with 5-alpha-reductase. The hormonal mechanisms that affect 5-alpha-reductase activity are quite complex.
Some studies suggest that DHT builds up in the prostate of individuals with BPH, although blood levels of T and DHT usually decrease with age. Other researchers suggest that T deficiency, rather than excess, may be more important in BPH and other prostatic diseases. This hypothesis is linked to the concept of the male andropause, a condition which parallels female menopause, except that the hallmark of this postulated male climacteric includes reduced blood testosterone levels and increased levels of estrogens, follicle-stimulating hormone, luteinizing hormone, and sex hormone-binding globulins. This latter concept of male andropause is not widely accepted. Holt lists the herbal alternatives in the same descending order of probable effectiveness that I would assign them, saw palmetto, pygeum, stinging nettle.
Of Prunus africana (Pygeum africanum) Holt (1996) recounts a double-blind placebo controlled study with 263 subjects given 100 mg per day pygeum for 60 days. 66% of those receiving pygeum improved vs. 31% receiving placebo. Further studies in Italy showed that 100 mg per day pygeum standardized extract induced significant improvement in urinary frequency, urgency, dysuria, and urine flow as compared to placebo. The pygeum bark is known to contain anti-inflammatory compounds and probably all plants contain sitosterol. We are having trouble locating Prunus africana plants for the Herbal Village Garden. I saw plants in Nairobi and perhaps Tanzania, but lacked the necessary permits for export.
The third issue of Fitoterapia in 1997 had two leadoff articles on BPH. Marandola et al. (1997) and Bombardelli and Morazzoni (1997) both had good things to say about pygeum bark. The extracts contain active phytosterols in free and glycosylated forms, pericyclic triterpenes, ferulic esters of long chain fatty alcohols and esters of fatty acids.
Combinations of pygeum with stinging nettle root were superior to pygeum alone in improving urinary volume. Unpublished data (and Holt's published account thereof) suggest that nettle may work also by inhibiting 5-alpha-reductase. It does inhibit aromatase compounds involved in the conversion of testosterone to estrogenic compounds. "U. dioica may modulate the hormonal imbalance that is believed to account for the pathogenesis of BPH" (Holt, 1996). Marandola et al. (1997) suggest that polysaccharides and a lectin are largely responsible for the antiprostatic activity of the hydroalcoholic extract of stinging nettle root (Maybe I should add some nettle root to my gin & tonic and make that hydroalcoholic tincture). All of the foregoing contain sitosterol, 30-60 mg per day of which has been shown useful to alleviate the symptoms of BPH.
Saw palmetto is a good example of an herbal product now considered a medicine in some European countries, but a nutritional supplement here. At a recent scientific meeting, Dr. Leigh Broadhurst met with leading UK urologist, Dr. A. Colin Buck. Dr. Buck is a specialist on kidney stones, a very painful condition which most often affects men over 40. He told Leigh that kidney stones are a very new health problem. They were virtually unknown 100 years ago, and he attributes this in large part to our modern diet. Dr. Buck is actively searching for herbs that can consistently help alleviate inflammation of the small tubules in the kidney. He also encourages men to drink more water, and eat less meat, refined foods, and saturated fat, and more fruits, vegetables, and n-3 polyunsaturated fatty acids. These recommendations sound familiar, no? Heart disease is also a relatively "new" disease whose increasing incidence can be clearly related to dietary changes.
Dr. Buck is also very interested in phytotherapeutic approaches for prostate problems. He said that unlike Germany and Italy, the UK has not embraced alternative treatments for prostate health, but he was trying to change that. Dr. Buck commented that like saw palmetto, gamma linolenic acid, found in evening primrose, borage, and black currant seed oils, is a direct inhibitor of 5-alpha reductase (Buck, 1996). In Dr. Buck's opinion, combined treatment with saw palmetto, evening primrose oil, and various herbs had great potential for helping men with very little cost and no appreciable side effects.
ACNE
I remember back in grade school when the bumps started breaking out on my face, childhood acne. I scrubbed and massaged much too vigorously with rubbing alcohol. Acne was my major concern then, ten years before impotence and infertility became shadowy fears and forty years before BPH raised its ugly head. Yes, we have different fears in the different stages of life. Acne is a bit more male than female. In my Green Pharmacy draft, I suggested that acne, the " most common of dermatoses, prevails in pubertal individuals, especially males." Today I might use calendula, chamomile, and coneflower instead of rubbing alcohol, or perhaps alcohol extracts of these three C's. Other good herbs suggested for acne include aloe, eucalyptus, flax, garlic, goldenseal, lemonbalm, nettle, sage, tea tree and witchhazel, all containing some anti-acne antiseptic compounds.
ALOPECIA (BALDNESS)
Even male-pattern baldness is not exclusively a male problem, and frankly, baldness seems more unattractive in females than in males. Maybe you've already heard me bet my hair (and prostate gland) that rosemary would be as useful for Alzheimer's and saw palmetto as useful for prostate problems as the first FDA approved drugs, tacrine and finasteride respectively. Ironically, I believe some people might save their hair with saw palmetto, sage, rosemary and thyme.
Saw Palmetto (Serenoa repens): Hexane, ethanol, or supercritical carbon dioxide extracts of saw palmetto have all been shown to inhibit the enzyme 5-alpha-reductase in vitro and in vivo. This enzyme converts testosterone (T) to dihydrotestosterone (DHT). Saw palmetto's synthetic competitor, finasteride, brags of propecic (hair-growing) properties. If the hair-restoring attributes of finasteride are due to inhibiting the conversion of T to DHT, and if saw palmetto also prevents this conversion, then it follows that it should have propecic properties. I ran into a fascinating radio announcer in Los Angeles when I was promoting The Green Pharmacy (Rodale Press). He was wearing a cap to cover his recent baldness, caused by an overdose of a hormone. But he said, thanks to saw palmetto, his hair was coming back. That's just an anecdote, but many Los Angeles radio listeners will have heard this story on the radio.
Ginkgo (Ginkgo biloba): Japanese scientists (Kobayashi et al., 1993) reported that a 70% ethanolic extract of ginkgo, also useful for Alzheimer's, promoted hair regrowth in shaved mice. However, we heard little about this propecic side effect from those thousands of Europeans taking ginkgo. Medscape produced no recent references to ginkgo and alopecia, while it produced 5 abstracts for ginkgo and Alzheimer's in 1996/7 alone.
Horsechestnut (Aesculus hippocastanum): Bombardelli et al. (1996) say that horsechestnut's esculin, along with ximenynic acid and lauric acid, significantly reduced hair loss in androgenic and symptomatic alopecia (a formulation containing 1% esculin, 0.5% ximenynic acid and 0.2% lauric acid was applied to the scalp of male and female subjects). The formulation induced favorable effects on the scalp microcirculation and on seborrhea; moreover, the shift in the trichogram percentages demonstrated an improved hair vitality. They predicted long term use of esculin for alopecia areolata, in which a deficiency in microcirculation perfusion of the galea capitis and hair bulbs is deemed causative.
Lavender, LICORICE, rosemary, sage and thyme are among aromatic suggestions for baldness. I emphasize the licorice because it contains one compound that prevents the conversion of T to DHT. I like the Scarborough Shampoo approach, since parsley, sage, rosemary, and thyme all have a folk reputation in baldness. I would add licorice. According to the Lawrence Review of Natural Products, a 10% glycyrrhizin shampoo can prevent sebum secretion for 1 week compared to a citric acid shampoo which can delay oil accumulation by 1 day (LRNP, Jun 1989). Stinging nettle also shows up in many anti-baldness shampoos.
PROSTATE CANCER
I was invited to a major soybean conference at the National Cancer Institute in 1991. Scientists were convening to speculate about what compounds in soybeans might be contributing to its anticancer activity, especially against breast and prostate cancer. Some contended the cancer preventive activity was due to estrogenic isoflavones, like genistein. Others applauded the protease-inhibiting Bowman-Birk inhibitors, others applauded phytic acid, others phytosterols like sitosterol, and still others saponins. I raised the beautiful spectre of synergy, suggesting that the mixture of isoflavones might be better than an equivalent amount of one isoflavone, that all of these chemicals might work better in concert than isolated, that the whole bean was better than the sum of its parts. I truly believe that generous indulgence in mixed 17-bean salads and a mixed 13-bean soups can help prevent prostate cancer. But even I, a frequent soup chef, find it easier to pop a standardized clover, kudzu, licorice and/or soy capsule or tincture than to mix up a delicious bean soup (which is also good for preventing other cancers, cardiovascular disease, and diabetes).
Following that fascinating soybean conference, I wrote a letter to several soy scientists predicting that an American bean (I had lima bean in mind, having seen data suggesting that it contains several genistein-like compounds) might prove richer in genistein than the cherished soybean. They soon tired of my sniping and quit writing to me, even though one owed me 60 analyses. Six years after I started sending out legume seeds for analysis, University of Michigan Botanist, Dr. Peter Kaufman, Ph. D. (Plant Physiology), produced some exciting results (Kaufman et al, 1997). Lima bean, as predicted, did prove richer in genistein. But not as predicted, Asian Indian Psoralea corylifolia (and possibly Amerindian Psoralea esculenta) proved more than 60 times richer than soy. Maybe that's why the soy scientists failed to respond to my letters. Soybean was by no means highest, as the soy scientists had loudly claimed in hundreds of popular publications; in Kaufman's genistein analyses, soybean was about average. Soybean, being America's number one legume crop is much more widely grown than the other genistein-rich legumes. Most of the research has been done on soybean as well, just because it has more research dollars behind it. Soybean products in many forms are widely available. And they seem to contain many compounds useful in preventing hormone-dependent cancers like breast and prostate cancer.
Let me now predict that soy scientists will cease saying that soy is the unique source of genistein. I predict, that in the face of this data, they will verge on synergy speculation, asying that (excluding the anomalous Psoralea corylifolia, whose seeds are occasionally eaten, and the kudzu root, rarely eaten), soy is richer than all those legumes named above in total daidzein+genistein. Let me add that some legume sprouts increase their genistein (and perhaps total estrogenic isoflavones) one hundred fold if attacked by fungus--and many, if not most, sprouts are infected with fungi. I'd venture to guess, that on average, bean sprouts would be better endowed with estrogenic isoflavones than unsprouted beans. And I'm suggesting that the same would be true of unsprouted and sprouted soybeans as well (stay tuned for a sprouting sequel to Dr. Kaufman's research).
Holt et al. (1996) suggest that 90% of men 90 years old will develop prostate cancer. After mentioning the low rate of prostate cancer in Asians, they also say that (quoted with intentional eliason) "genistein and daidzein . . . directly affect testosterone metabolism and reduce the toxic metabolites of testosterone." Prostate cancer claimed more than 38,000 lives in 1994 (Albertsen et al, 1995). In an annual review of what's new in modern medicine, Dr. Peter C. Albertsen, MD, MS, University of Connecticut Health Center, notes that cases of prostate cancer and prostate cancer deaths in the US exceeded 200,000 and 40,000 respectively for the first time in 1995. This clearly raises questions about the 40% increase in diagnoses between 1990 and 1992. Still, the Office of Technology Assessment concluded that current evidence does not justify annual digital and serum prostate-specific antigen (PSA) testing in men older than 50 years. They are "likely to cause more harm than good among men older than 70 years. . . A Medicare benefit for a screening program based on serum PSA might cost more than $2 billion during the first year alone" (Albertsen, 1996). "As 1996 draws to a close we read that 300,000 men in the US will be diagnosed with prostate cancer this year, though it remains relatively rare in Asia, Africa and South America" (Travis, 1996). Now the number has more than tripled, from 100,000 diagnosed cases in 1990, to 350,000 in 1997 (CRH Feb. 1997).
Several other items can contribute to the prevention of prostate cancer. According to J. Raloff, the free radical theory of prostate cancer may explain recent dietary observations and changes in what is being recommended for prevention of prostate cancer, which often, but not always, follows BPH.
1. Vitamin E - Supplements reduce incidence--tocopherol is well represented in purslane; tcotrienols are best represented in some oil palms.
2. Lycopene (and tomatoes) appear to reduce incidence--watermelon, tomatoes, pink grapefruit, guava, and pot marigold. All are good sources of lycopene.
3. 200 micrograms selenium. (That's what you'll find in 3 average brazilnuts).
4. Genistein - blocks much of estrogen's activity and inhibits the growth of prostate cancer cells. (Many beans, even including the soybean contain genistein.)
5. Sitosterol, 60 mg per day. (Hawthorn, black cumin, evening primrose, and sage were the better food grade sources of sitosterol in my database, last time I checked).
6. Limonene (caraway, celeryseed, citrus, and cardamon are good sources).
There's some evidence to support the role of citrus pectin in preventing metastasis of prostate cancer. Most prostate cancers do not metastasize. Those prostate cancers that do metastasize are problematic, often incurable. According to Raloff (1995) "Rats drinking pectin-supplemented water developed prostate metastases to the lung at about half the rate of rats drinking plain water." When metastases did appear in high pectin rats (whose water contained 1% modified pectin), there were only about 10% as many nascent tumors as in other metastatic rats. Pectin fragments thwart metastasis by preventing tumor cells from adhering to the walls of blood vessels. Keep up your pectin uptake. Keep a little of the white part of the citrus peel in your juices.
Substituting avocado (Persea americana) for animal fat in your diet might help prevent several types of cancer, including prostate cancer. According to Willet (1997), monounsaturated fatty acids (MUFA) and olive oil in particular, may reduce risk of breast cancer when substituted for other types of fat. There's an international correlation between fat consumption and national breast cancer mortality. "Persons interested in reducing their risk of cancer could be advised, as a prudent measure, to minimize their intake of foods high in animal fat, particularly red meat, because this is likely to decrease the risk of prostate and colon cancers" (Willet, 1997). If my database and its sources are correct, avocado fruits can contain up to 69% MUFA or oleic-acid, macadamia nuts up to 59%, hazelnuts 57%, the much maligned oil palm fruit 43%, marula nuts 42%, pistachio 34%, olives 33%, cashews 30%, peanuts 26%, brazilnuts 24%, chocolate 22%; coriander seed 17%, pumpkin 15%, fennel seed and butternut 11%.
ERGOGENIC
Back in those days when acne troubled me, I was one of those ninety pound weaklings very much concerned about my not-too-muscular physique. So much so, that, intrigued by the Popeye/spinach/iron propaganda, and not liking spinach, I naively, even stupidly, took the silver bullet approach. I actually ingested some of the iron from my chemistry set. Now I realize that had I been hemachromatotic, that could have even killed me. But I lucked out, still a 90-pound weakling with no iron deficiency.
What luck? Just as I was drafting this, the mailman brought the May 1997 supplemental issue of the Journal of Nutrition reporting several symposia, including one on sports medicine. But it was entitled "Symposium: Nutrition and Physical Performance: A Century of Progress and Tribute to the Modern Olympic Movement" (Applegate et al., 1997). In the symposium, Charles M. Tipton, writes "An ergogenic or performance aid is defined as any substance or method used to enhance athletic performance . . . The substance could be hormonal (epinephrine), medicative (antibiotic), nutritional (glucose), pharmaceutical (amphetamine) or therapeutic (aspirin)." Applegate and Grivetti (1997) even present a "partial list of presumed ergogenic aids and supplements used by athletes: (parentheses mine)" acetylcholine (in stinging nettle), amino acids (in all plants), bee pollen (all taken from plants), beta-sitosterol (in all plants), boron (probably in all plants; high in stinging nettle), branched chain amino acids, caffeine (chocolate, coffee, cola, guarana, guayusa, mate or tea), chromium picolinate, citrulline (watermelon, cantaloupe, cucumber), coenzyme Q10, creatine, desiccated liver, eicosanoids, ferulic acid (beet pectin, chia, water chestnut, wheat bran), gamma-hydroxybutyrate, gamma-oryzanol (rice), ginseng, glandulars, glucose polymers, inosine, medium-branched triglycerides, octacosanol, n-3-fatty acids, pangamic acid, RNA, royal jelly, smilax, sodium bicarbonate, spirulina, succinate, vitamins (in all plants) and wheat germ oil. Grunewald and Bailey (1993), surveying 624 commercially marketed supplements for bodybuilding athletes included some of these same supplements, listing amino acids, boron, carnitine, choline, chromium, dibencozide, ferulic acid, gamma oryzanol, medium chain triglycerides, weight gain powders, smilax compounds and yohimbine. These were the most frequently available supplements targeted towards bodybuilding athletes. Over 800 performance claims were made for these supplements. That's ergogenic substances viewed by nutritionists.
A recent issue of Herbs for Health, one of my favorite herbal periodicals, has quite a lot on ergogenics as well as sports medicine. Research chemist Leigh Broadhurst Ph. D., in her Herbs for Energy - Plants to Improve Athletic Performance, mentions herbal stimulants, including herbs like coca, ephedra, guarana, khat, kola, and licorice and herbal substances like caffeine, cocaine, ephedrine. She singles out licorice and its stimulant glycyrrhizin, which stimulates the adrenal cortex and prolongs the action of the adrenal hormones, which play a major role in regulating metabolism. For regaining energy levels (not chronic use) she recommends doses of 1 to 2 g licorice root with at least 4% glycyrrhizin thrice daily, for up to six weeks. Then she mentions the less dramatic adaptogens (herbs which "act in nonspecific ways to increase the body's resistance to physical stress" "Adaptogens, or tonics, help us handle any type of stress better".) She mentions aswangandha, oriental ginseng, and schizandra, citing scientific data to support their use. In that same issue, Steven Foster (1997) praises eleuthero ginseng: "Soviet cosmonauts and Olympic athletes have used it; the German government endorses it. It's said to improve stamina, performance, endurance, reflexes, and concentration. Siberian ginseng isn't really a ginseng, but it's a natural for boosting athletic performance, and it combats stress as well". Summing it up, Dr. Logan Chamberlain, editor of the magazine, says that like other sports enthusiasts, "I'm competitive and I like to win. . .I use fitness supplements, including a full megadose of vitamins, minerals and antioxidants. I take chromium picolinate to maintain muscle mass, Ginkgo biloba for improved circulation, and Siberian ginseng for endurance. I take DHEA because I don't produce high enough levels of this adrenal hormone at my age."
In my favorite kind of study (one that indicates synergy), Yoshida et al. (1995) studied the thermogenic (anti-obesity) effects of bofu-tsusho-san (TJ-62), an oriental herbal combination, in obese mice. They fed the obese mice the herbal mix, or a mix containing equivalent amounts of 1-ephedrine and d-pseudoephedrine. They fed a third group, in addition, a mixture of extracts of licorice root, Forsythia fruit, plus Schizonepeta spikes, that inhibited phosphodiesterase activity, for 8 weeks. One mg of TJ-62 was equivalent to 2.5 mg of caffeine in the inhibitory effect on phosphodiesterase activity. After feeding with TJ-62, body weight decreased in both obese mice and lean controls. Food intake was not changed by TJ-62. Feeding with 1-ephedrine and d-pseudoephedrine produced only 70% of the response induced by TJ-62. These responses were, furthermore, enhanced by the addition of the other three extracts to the levels that were similar to those produced by TJ-62. Bofu-tsusho-san works by activating BAT (brown-adipose-tissue) thermogenesis and inhibiting the phosphodiesterase activity in mice. My Translation: The chemicals ephedrine and pseudephedrine are thermogenic, but only 70% as thermogenic as the herbal mix TJ-62, which is made even more thermogenic by the addition of Forsythia, Glycyrhiza (licorice), and Schizonepeta. (Yoshida et al., 1995).
IMPOTENCE
If aphrodisia and impotence are all in the mind, and if you believe in any or all of the following, they will probably help. Many more have been mentioned optimistically in the literature. I've singled out the ones that seem to have the most credible evidence.
Ashwagandha (Withania somnifera): Many Ayurvedics and other folk regard this as their answer to ginseng for the libido (Keville, 1996). One old belief is that it strengthens the sperm. The root is an old traditional sexual tonic for male infertility and impotence. Even though we think of it as an Indian Ayurvedic herb, I found at least three informants in Kenya and Tanzania who also believed in the root as an aphrodisiac.
Carob (Ceratonia siliqua): How about an herbal him & him candy for BPH and impotence. Chocolate, carob and sunflower seeds or just carob-coated sunflower seeds are well known foods and relatively cheap. The rationale for carob in impotence is that carob is high in histidine. In a promotional article called "Ecstasy is Your Right", Cynthia Watson, MD (1996) discusses the role of histidine in bringing on orgasm. "Histidine is thought to be the key amino acid for bringing on orgasm. The value of histidine lies in its role in releasing histamine, a neurohormone and neurotransmitter. Histamines are released during orgasm. A person who releases histamines easily will have no trouble achieving orgasm." She cites successful studies by Pfeiffer (1975) with supplemental histidine in anorgasmic females, admitting them "into the world of sexual ecstasy". Caution: Too much histidine tends to have the opposite effect in men, causing premature ejaculation. The male with high histamine levels in the blood may ejaculate at the slightest stimulus . . . "The release of histamine from a huge concentration of mast cells in the penis head is the reflex that triggers orgasm. . .The man with low histamine has no trouble with erection, yet he does with ejaculation" (Watson, 1996). If Watson is correct, this could suggest munching on sunflowers,best source of histidine in my database (2%). In the CRC Handbook of Phytochemical Constituents, sunflower is the best source of histidine, followed by bean sprouts at 1.3%, carob and lupine at 1.2%, soy at 1.1%, jute, lablab, lentils and sprouts, lima beans, pigeon pea, winged bean at 0.9%, with butternut, peanut, taro leaves, watercress, white mustard, and yardlong bean at 0.8%, on a rounded and calculated Zero Moisture Basis (ZMB). Zello et al. (1995) estimate a requirement of 8-12 mg/kg/day histidine for adults, but they maintain that such estimates are too low.
Country Mallow (Sida cordifolia): Containing some 850 ppms ephedrine, a known antimyasthenic antisyncopic compound, the herb is being substituted for ephedra. The ephedrine may underlie its use in bronchitis, colds, coughs, impotence, and we can anticipate it will show up in weight loss capsules as well. According to unpublished reports by Sabinsa Corporation, Piscataway, NJ, the following are therapeutic indications: aphrodisiac, bronchospam, cough, and general tonic.
Evening Primrose (Oenothera biennis): A combination of diabetic neuropathy (described below) and angiopathy (damaged, blocked, and weakened blood vessels) is a causative factor for the very high incidence of impotence in diabetic men. It can affect men both physically and psychologically. These two diabetic complications can directly reduce blood circulation and nervous response in the groin and lower body in general. In some cases, diabetic neuropathy directly affects the genitourinary system nerves, causing impotence as well as urinary difficulties. In addition, the severe pain, burning, tingling, and/or numbness in the extremities caused by these conditions can cause emotional stress, which inhibits a normal sex life.
Although many diabetics are reasonably good at controlling their blood sugar, with diet, medications, herbs, exercise, insulin, etc., there is no substitute for the very tight metabolic control that a normal individual has. Over the long haul, the high and/or unstable glucose levels of a diabetic cause a number of severe and debilitating medical conditions called diabetic complications. One of the most intractable and irreversible complications is diabetic neuropathy. Diabetic neuropathy is progressive degeneration of nerve function. It commonly affects "peripheral nerves", that is sensory and motor nerves going to places such as the hands and feet. However, all types of nerves can be affected. As the nerves degenerate, diabetics may feel tingling, burning or pain (like "pins and needles" from sitting in one position too long), and may have muscle wasting as well since the nerves aren't stimulating the muscles correctly. Complete numbness or lack of sensation can occur, which is potentially very dangerous because there is nothing to warn you of injury, heat, or cold!
The good news is that research over the past 10 years has consistently found that gamma linolenic acid (GLA) supplementation can help slow the progression of, and in some cases even reverse, diabetic neuropathy. In both animal and human studies, GLA has been shown to significantly improve nerve conduction velocity (Horrobin, 1992; 1997). Abnormally slower than normal nerve conduction, velocity is characteristic of diabetic neuropathy and indicates that nerve impulses are not moving as fast or coherently as they should be. At a conference Dr. Leigh Broadhurst attended this July in Edinburgh, Dr. David Horrobin presented the combined results of two large multi-center clinical trials in which 202 diabetic patients were given 480 mg GLA per day for a year, and 202 other diabetic patients were given vegetable oil placebo. Twenty-five clinical parameters were measured. In the group that received evening primrose oil, 25 of 28 parameters improved significantly. In the placebo group, 27 of 28 parameters showed deterioration. In the second year of the study, all patients were given GLA, and the 202 that were previously in the placebo group showed improvement instead of deterioration in 23 parameters (Horrobin and Boulton, 1997).
Evening primrose oil was the source of GLA used in the study, and it requires 5-6 1,000 mg capsules per day to get the 480 mg dosage. Evening primrose was used not only because Dr. Horrobin's company manufactures Efamol, but also because evening primrose oil has been shown to be more effective at improving nerve conduction velocity than borage oil or black currant seed oil (Dines et al., 1996).
Studies in which evening primrose oil was given to diabetic research animals were also presented. In one study, I noticed that while nerve conduction velocity improved dramatically for the diabetic animals, it also improved modestly for the normal control animals. Leigh asked Dr. Horrobin if this was significant--in other words could GLA help improve nerve conduction velocity in general? This would imply that it would be helpful for other types of neuropathy, accidental nerve damage, aging, etc. Dr. Horrobin replied, "Yes, the improvement in the normal animals is real, and if the number of animals in the study had been greater, you would certainly see statistically significant results. I do believe that evening primrose oil has potential for a broader range of neurological conditions." So stay tuned--various evening primrose oil preparations are already prescription pharmaceuticals in a dozen countries, but remain nutritional supplements in the US.
Ginkgo (Ginkgo biloba): In reviewing a study (Sohn & Sikora, 1991), Naturopath D. Brown suggests that ginkgo (80 mg 3 times per day) should be the phytomedical treatment of choice for erectile dysfunction. Sohn and Sikora had gotten very good results with 78% of patients given 240 mg ginkgo orally for 9 months. All had been on intravenous drug applications before, some successfully, others unsuccessfully. No side effects were noted. Sikora et al. (1989) reported on 60 patients getting 60 mg ginkgo for arterial erectile dysfunction that had not responded to papaverine injections. After 6 months, 50% regained potency and in 20%, new trials with papaverine were successful. In the others, 25% showed improved arterial flow but no change in erection and 5% exhibited no change. (Brown, 1995). Michael Castleman tells us (Listen Your Health, Oct. 8, 1991) of ginkgo prescribed to men with erection loss. In all cases, the ginkgo worked within three weeks. In some studies, men took 50 mg ginkgo per day for 12 to 18 months. At 20 cents a capsule that would be only about 75 to 100 dollars a man. "Half regained their erections. . .Ginkgo appears to be very effective in the treatment of arterial erectile dysfunction."
Ginseng (Panax spp.): Ginseng is probably more familiar to most Americans than another more potent (and risky) aphrodisiac, yohimbine, thanks in part to intensive advertising. Michael Tierra (1988) suggests American ginseng (with red deer antlers, look out Bambi), celeryseed, and saw palmetto for both frigidity and impotence. American ginseng (Panax quinquefolius) is probably North America's most famous unproven aphrodisiac. Ginseng-sponsored studies have indicated an increase in the mounting and ejaculation rates of mice fed ginseng, (Duke, 1989). I question the significance of these studies in my book. Still I grow both American (Panax quinquefolius), Eleuthero (Eleutherococcus senticosus) and Oriental Ginseng (Panax ginseng), just in case the Chinese are correct, that ginseng will make an old man young again. America exports $75-100 million dollars worth every year, mostly to Asians, who have great faith in American ginseng, regarded by some as the herbal "fountain-of-youth".
Going in to the summer of 1997, I have fewer ginseng plants surviving than ever before, probably no more than 50 plants. The deer have persistently eaten those that weren't overgrown with briars and poison ivy, leaving none for old Jim Duke.
Horny Goatweed (Epimedium spp.): Until I got a call from one of my favorite herbalists asking what the horny goat weed was, I had just called it epimedium. But she, like me, had read that eating the goatweed made goats horny. I could not find the name horny goatweed in any of my handy Chinese books, but found the equally interesting name, yinyanhuo. Confessing that I still maintain a healthy agnosticism about many of the aphrodisiac claims about eleutherococcus, ginseng and ginkgo, I share with you the suggestions of my good friends, Albert Leung, Ph. D., Pharmacognistic Consultant, and Steven Foster, Herbalist Par Excellence, who have teamed up to update the already excellent Encyclopedia of Common Natural Ingredients. They say that this tonic epimedium has been shown to have numerous pharmacological effects in experimental animals and humans, including stimulation or improvement of male sexual function in experimental animals, with cured, but not raw, epimedium (I presume the horny goat was eating uncured herb). Michael Tierra mentions Epimedium grandiflorum, noting that "research in China has demonstrated the effectiveness of this herb in stimulating sexual activity and sperm production. It also stimulates the sensory nerves. While it has not been shown to have any estrogen properties, it does have a moderate androgen-like effect on the testes, prostate and levator ani. . .It is contraindicated when there is a tendency towards hypersexuality and wet dreams." Maybe I'd best buy some to replace the ginseng.
Oats (Avena sativa): Even the director of one fine botanical garden in the West has bought into the wild oats story, that oats are a male aphrodisiac. Kathi Keville includes it in what I'll term her "impotentea", with 1/2 oz each of damiana leaves, ginkgo leaves, ginseng root, wild oats and yohimbe bark. I'd include some saw palmetto as well. Kathi says that animal experiences suggests that wild oats can keep men healthy and fertile, like racehorses, especially when the wild oats seeds are at the milky stage, with a milky "endosperm" (Keville, 1996). Quakers would quake at what some journals are saying about oats (Weissman, 1995). Never have I seen such promotion for this lowly cereal. Quoting or misquoting Dr. J. L Summers, M.D., Urologist, they says its sexual enhancing properties are so recognized in animals and man that the term oats has the double meaning sexual energy and activity. Then Summers is said to have said the stinging nettle, too, has been tested and found to ensure higher levels of free testosterone in male subjects and provide significant relief for sufferers of BPH. Talk about seminal wild oats, based on a seminal study of the oat. Weissman quotes that it was significantly more effective (in firmness of erection) than placebo for men and less effective than placebo for women. Then these journals quote the good Dr. Watson, M.D., I think correctly: "It is the androgen, testosterone, that largely fuels libido in both sexes." The star anecdotal character, in his early sixties, and unable to attain erection for over 6 years, doubled his testosterone in two weeks, again doubling by the end of the month. His coital activity left the zero and he went to 1-to 3 times weekly. On one occasion he ejaculated twice in one evening. Caveat emptor!
Quebracho (Aspidosperma quebracho-blanco): South of the border, in South America, some of the more famous aphrodisiacs are quebracho (Aspidosperma quebracho-blanco), catuaba (Erythroxylum spp.), muira puama (Ptychopetalum spp.), and para palo (Rhynchosia spp.) Perhaps the first of these is the more promising, as it contains the proven aphrodisiac alkaloid yohimbine. Better yet, it is generally recognized as safe (GRAS), according to Leung's Encyclopedia of Common Natural Ingredients. The quebracho is also reported to contain beta-sitosterol, a rather ubiquitous compound. In her interesting paper on herb teas, "Is There a Safer Tea", Julia Morton hints that this ubiquitous compound might be aphrodisiac. Leung, and Foster (1995) remind us that alkaloids of the food quebracho (especially akuammidine, aspidosamine, aspidospermine, quebrachamine, and yohimbine) have many biological activities among them aphrodisiac, anesthetic, diuretic, arterial hypertensive, hypotensive, respiratory stimulant, spasmolytic, uterosedative, and peripheral vasoconstrictor.
Yohimbe (Pausinystalia yohimbe): Last and most aphrodisiac, according to many scientists, is yohimbine. Research under the direction of Dr. Virgil Wooten, M.D., Asst. Prof. Internal Medicine, Eastern Virginia Medical School, shows that yohimbine can help more than narcoleptics. One man being treated for sexual dysfunction reported to his physician that something was correcting his narcolepsy. Suspecting the yohimbine, 8 narcoleptics were given yohimbine, and 7 of the 8 improved dramatically. Each was then able to stay awake for a full 8-hour workday, even after they had been on yohimbine for several days. Dr. Wooten suggests that yohimbine is worth asking your doctor about if you are a diagnosed narcoleptic. (Prevention, Oct. p. 40 1995). Tyler (1994) notes that while yohimbine is neither approved by Commission E in Germany or by our FDA as an OTC aphrodisiac, "recent clinical studies have confirmed the value of yohimbine in treating impotence in human males". Some 46% of patients with psychogenic impotence reported positive responses; 43% of patients with organically caused impotence improved erectile function. Werbach and Murray (1993) stress that yohimbine was the only FDA-approved drug for erectile dysfuntion (but as a prescription drug). Used alone it was effective in 34-43% of cases, either organic (physical) or psychogenic (psychological).
CAUTIONARY NOTE: Side effects and dosage peculiarities make both yohimbe herb and the alkaloid yohimbine difficult to handle. De Smet and Smeets (1994) say that the normal dose of 5 mg yohimbine can create problems. In bipolar depression patients, 10 mg can induce manic symptoms. May also cause anxiety, elevated heart rate, elevations in blood pressure, flushing, hallucinations, headache etc. On Nov. 20, 1995, NBC nightly news gave yohimbine some well deserved press, noting that it not only improved impotent males but made potent males enjoy their love-making even more. Dr. Cynthia Mervis Watson was interviewed furthering the views she has expressed elsewhere. I have maintained for the last ten years, at least, that if there is a real aphrodisiac for males, yohimbe is it.
INFERTILITY
Infertility seems to be a problem with both sexes. According to Richard Podell MD, a specialist in internal medicine, Dept. of Family Medicine in New Jersey's UMDNJ-Robert Wood Johnson Medical School, male infertility causes 10-25% of fertility problems in the US and Europe (Podell, 1996). While about 15% of couples are infertile (unable to conceive after a year trying), only 1-2% are truly sterile. Of those infertile couples who seek help, perhaps half can eventually bear children, on their own or with medical help. In 40% of cases, men are the cause; 40% of the time women, and 20% both are at fault (Time-Life, 1996). Podell (1996) reports a multicenter open study of 100 males at 4 infertility centers, treated with 3 g per day L-carnitine. The study showed statistically significant increases in both the total number of sperm and the proportion of sperm that could move vigorously. Podell notes encouraging results for other supplements including vitamins B-12 & C, arginine, folic acid, and zinc.
The tales of impotence and infertility are intricately intertwined. Still I'd give the G-whizes below a try, if infertility seemed to be a problem. The aphrodisiac side effects might come in handy:
Garlic (Allium sativum): Careful readers may find a rationale for the reputed aphrodisiac activity of garlic in garlic's hypotensive activity. Aqueous and alcoholic extracts of garlic increase the production of nitric-oxide, which is associated with decreased hypertension. In vivo, 4 g oral fresh garlic can double the nitric oxide synthetase activity of blood platelets in 3 hours. (Koch and Lawson, 1996). Nitric oxide is said to be necessary to achieve and maintain an erection. Some people even resort to nitroglycerine patches that contain nitric acid to help achieve erections. According to some authors, the majority of cases of male erectile impotence are due to inadequate production of nitric oxide. Arginine is used by the cells that line the artery walls to manufacture nitric oxide, which facilitates blood flow to the penis. Without nitric oxide, erections are impossible. "Take arginine, choline, and B5 a half hour before sex, and it will give you a firmer erection" says Pearson. Arginine also increases sperm count in men, and for no known reason, fertility in women. Smile! Sunflower is the best source of arginine in our database: (http://www.ars-grin.gov/~ngrlsb/).
Ginger (Zingiber officinale): Paul Schulick, Vermont Herbalist, and author of Ginger - Common Spice and Wonder Drug (1994) tells us that Saudi Scientists, in testing the efficacy and safety of alleged aphrodisiacs, tested ginger for its effect on male rats. Devoid of sperm-poisoning properties, ginger significantly increased the sperm count and motility
Ginseng (Panax ginseng): While I disagree that ginseng is unique in this regard, I still quote my good herbal friend, Kathi Keville, who says "So far, ginseng is the only herb recognized by science to stimulate testosterone production. . .If any herb can maintain a man's fertility, ginseng seems the most likely candidate". She tells the story of two men who started taking ginseng, saw palmetto and schizandra to build up their physical stamina. After many infertile years, both men were extremely surprised when their wives announced that they were pregnant (Keville, 1996).
SNORING
Recently I have had a lot of questions about snoring, frequently, but not always from women whose spouses snore. Snoring is not a unisexual issue. Strangely, some of the CNS-stimulants in chocolate, coffee and tea, caffeine and theophylline, and a semi-synthetic drug, aminophylline, are useful for sleep apnea, if not snoring. According to Martindale, just 5 mg of aminophylline in a suppository (and remember that cocoa butter is one of the most frequently used suppository vehicles) is the dose for a child with apnea. While I still don't have the original document, I get the hint from the abstract of a Japanese patent, that citral and geraniol, both reportedly sedative, are aromatherapeutically effective against snoring. An antisnoring "serenitea" comes to mind, chocolate and/or tea, spiced up with basil, ginger, monarda (bee balm) and thyme. Ginger and basil are good herbal sources of citral, monarda and thyme of geraniol, and might be tried via herbal steams as well as in teas. I'd try this on female as well as male snorers. I'll pass for now on the suppository approach they suggest for children. I haven't tried all the combinations mentioned, but I think ginger added to tea, with a lot of lemon peel for its citral, makes a superior beverage, whether it prevents snoring or not.
Quick Herbal References
Acne: Aloe, Calendula, Chamomile, Coneflower, Eucalyptus, Flax, Garlic, Golden seal, Lemonbalm, Nettle, Sage, Tea tree, Witchhazel
Alopecia: (Baldness): Ginkgo, Horse Chestnut, Nettle, Rosemary, Sage, Saw Palmetto, Thyme
Arthritis: Boswellia, Capsicum, Celery seed, Ginger, Nettle, Turmeric, Willow
Backache: Capsicum, Peppermint, Thyme
BPH (Benign Prostatic Hypertrophy): Evening Primrose, Nettle, Pumpkin, Pygeum, Saw Palmetto
Ergogenics: (Energy; Fitness): Sarsaparilla, Ginseng
Impotence: Ginkgo, Ginger, Ginseng, Evening Primrose, Muira Puama, Nettle, Oats, Yohimbe
Infertility: Garlic, Ginger, Ginkgo, Ginseng, Licorice, Sunflower
Male Menopause: Eleuthero, Ginseng, Licorice, Schizandra
Mental alertness: Eleuthero, Ginseng
Stamina: Epimedium, Eleuthero, Ginseng
Strength: Sarsaparilla
Stress: Chamomile, St. John's Wort, Kava Kava, Lavender, Melissa, Passionflower,Valerian
REFERENCES
Albertsen, P. C. et al. 1995. Long Term Survival Among Men with Conservatively Treated Localized Prostate Cancer. JAMA 274(8): 626-631.
Applegate, EA, Grivetti, LE. 1997. Search for the Competitive Edge; A History of Dietary Fads and Supplements. J. Nutr. 127(5S): 869S-873S.
Applegate, EA, Clarkson, PM, Grandjean, AC, Grivetti, LE, McDonald, RB and Tipton, CM. 1997. Introduction: Symposium: Nutrition and Physical Performance: A Century. Of Progress and Tribute to the Modern Olympic Movement. J. Nutr. 127(5S): 857S-859S.
Bombardelli, E, Morazzoni, P. 1997. Prunus africana (Hook. f.) Kalkm. Fitoterapia Volume 68, No. 3, 1997, 205-218.
Bombardelli, E, Morazzoni, P, Griffini, A. Aesculus hippocastanum L. Fitoterapia 67(6):483-511. 1996.
Broadhurst, CL. 1997. Herbs for Energy - Plants to Improve Athletic Performance. Herbs for Health Jul/Aug pp. 22-28.
Brown, D. 1995. Ginkgo biloba extract (GBE) for erectile dysfunction. QRNM. Fall. p.185-186.
Buck, AC 1996. Phytotherapy for the prostate. British Journal of Urology 78, 325-336.
Carlson, S.E. 1992. Cancer of the prostate. JAMA. 268(22):3196.
Chamberlain, L. 1997. Notebook to our readers. Herbs for Health Jul/Aug pp. 6.
Champault, G., et al. 1984. Medical treatment of prostatic adenoma. Controlled trial: PA 109 vs. placebo in 110 patients. Ann Urol. 18:407-10.
De Smet, P. and Smeets, S.N.M. 1994. Potential risks of health food products containing yohimbine extracts. B. Med. J. 309:958.
Dines KC, Cotter MA, Cameron NE (1996). Effectiveness of natural oils as sources of gamma-linolenic acid to correct peripheral nerve conduction velocity abnormalities in diabetic rats: modulation by thromboxane A2 inhibition. Prostaglandins Leukot Essen Fatty Acids 55, 159-165.
Duke, J.A. 1985. CRC Handbook of Medicinal Herbs. 704 pp. CRC Press, Boca Raton, FL, .696 pp.
Duke, J.A. and E.S. Ayensu. 1985. Medicinal Plants of China. 2 vols. 705 pp. Reference Publications, Algonac, MI.
Duke, J.A. 1986. HERBALBUM (longplay LP record well recorded by studio bluegrass musicians in Nashville Studio; typical bluegrass instrumentation under the direction of Carl Vipperman and Bill Blackmon.)
Duke, J.A. 1986. Handbook of Northeastern Indian Medicinal Plants. 212 pp. Quarterman Press, Lincoln, MA.
Duke, J.A. 1989. Ginseng, a Concise Handbook. 273 pp. Reference Publications, Algonac, MI.
Foster, S. 1997. Roots of steel - increase stamina with siberian ginseng. Herbs for Health Jul/Aug pp. 31-35.
Foster, S. and Duke, J. A. 1990. Peterson's Field Guide to Medicinal Plants. Houghton Miflin, Boston, MA.
Graedon, J. and Graedon, T. 1991. Graedon's Best Medicine. New York: Bantam. pp. 332-333.
Grunewald KK; Bailey RS. 1993. Commercially marketed supplements for bodybuilding athletes. Sports Med 15(2): 90-103.
Holt, S. Prostatic health. Part 2, dietary supplements. Alternative & Complementary Therapies 2(6):395-398, 1996.
Holt, S., Likver, L. And Muntyan, I. 1996. The vegetarian way to a healthy urinary tract. Alt. & Compl. Med. 2(3):168-72.
Horrobin, DF (ed.) 1992. Treatment of Diabetic Neuropathy: A New Approach. Edinburgh, UK: Churchill Livingstone.
Horrobin DF 1997. Essential fatty acid (EFA) metabolism in patients with diabetic neuropathy. Prostaglandins Leukot Essent Fatty Acids 57, 256 (abstr.)
Horrobin DF, Boulton AJM 1997. Two multi-centre double blind trial of gammalinolenic acid in diabetic sensorimotor neuropathy. Essential Fatty Acids and Eicosanoids: Invited Papers from the Fourth International Conference July 1997, Champaign, IL: AOCS Press, in press. Also Prostaglandins Leukot Essent Fatty Acids 1997, 57, 201 (abstr.)
Kaufman, PB et al. 1997. A comparative survey of leguminous plants as sources of the isoflavones genistein and daidzein: implications for human nutrition and health. Journal of Alternative and Complementary Medicine. 3(1):7-12.
Keville, K. 1996. Herbs for Health and Healing. Rodale Press.
Kobayashi, N. et al. 1993. Effect of Leaves of Ginkgo biloba on Hair Regrowth in C3H Strain Mice. Yakugaku Zasshi 113: 718-24.
Koch, H. P. and Lawson, L.D. (Eds.). 1996. Garlic. The Science and Therapeutic Application of Allium sativum L. and Related Species. Williams & Wilkins, Baltimore, Md. 329 pp.
Leung, A. Y. And Foster, S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics, 2nd ed. John Wiley & Sons, New York, 649 pp., 1996.
Marandola, P, Jallous, H, Bombardelli, E, Morazzoni, P. 1997. Main phytoderivatives in the management of benign prostatic hyperplasia. Fitoterapia Volume 68, No. 3, 1997, pp. 195-204.
Murray, M.T. 1994. Natural Alternatives to Over-The-Counter and Prescription Drugs. William Morrow & Co., Inc. New York:New York. 383 pp.
Pearson and Shaw. 1982. Life Extension: A Practical Scientific Approach. 858 pp.
Pfeiffer, C. 1975. Mental and Elemental Nutrients: A Physician\rquote s Guide to Nutrition and Health Care. Keats. New Canaan:Connecticut.
Podell, R. N. 1996. L-Carnitine Improves the Quality of Sperm for Some Infertile Men. Nut. Sci. News 1(5): 16.
Raloff, J. 1997. Radical Prostates--Female hormones may play a pivotol role in a distinctly male epidemic. SN 151:126-7. Feb. 22.
Schulick, P. 1994. Ginger- Common Spice and Wonder Drug. Herbal Free Press, Brattleboro VT. 166 pp.
Shimada, H; Tyler, VE; McLaughlin, JL. 1997. Biologically active acylglycerides from the berries of saw-palmetto (Serenoa repens). J. Nat. Prod. 60(4): 417-418.
Sohn, M. and Sikora, R. 1991. Ginkgo biloba extract in the therapy of erectile dysfunction. J. Sex. Educ. Ther. 17:53-61.
Tierra, M. 1988. Planetary Herbology, Lotus Press, Santa Fe NM, 485 pp, 1988.
Time-Life, editors. 1996. The Medical Advisor. The Complete Guide to Alternative & Conventional Treatments. Time Life, Inc., Alexandria Va. 1152 pp. (Cited as TMA, 1996).
Tipton, CM. 1997. Sports Medicine: A Century of Progress. J. Nutr. 127(5S): 878S-885S.
Travis, J. 1996. Gene variations sway prostate cancer risk. Sci. News 150: p. 295.
Watson, C. M. 1993. Love Potions. Jeremy P. Tarcher/Perigee, Los Angeles. 272 pp.
Watson, C. 1996. Ecstasy is Your Right. J. Ong. Res. 2(3): 21-23.
Weissman, J. 1995. Sow Your Wild Oats. J. Long. Res. 1(5): 14-16.
Werbach, MR and Murray, MT. 1994. Botanical Influences on Illness. 344 pp.
Willet, W.C. 1997. Fat, energy and breast cancer. J. Nutr. 127(5S):921S-923S.
Winslow, R. 1996. Study finds Abbot's prostate drug is much more effective than Merck's. Wall Street Journal May 7, 1996.
Yoshida T; Sakane N; Wakabayashi Y; Umekawa T; Kondo M. 1995. Thermogenic, anti-obesity effects of bofu-tsusho-san in MSG-obese mice. Int J Obes Relat Metab Disord 19(10): 717-22.