What better way to introduce a "female issue" to Herbal Village readers than to introduce you to my friend and colleague, Dr. C. Leigh Broadhurst, Ph.D., author, lecturer, mother, nutritional consultant and planetary geochemist. Leigh and I have been friends for years now, puzzling and studying, and arguing over, the virtues and vices of herbal and nutritional medicine.
I seek, appreciate and value Leigh's counsel on many matters, especially clinical and phytochemical matters. Clearly, I really need her when it comes to discussing female issues. So I am pleased to include Leigh's insights in this issue, knowing she provides a skilled and reasoned analysis of the herbal and nutritional approaches to some problems more or less endemic to the female of the species.
I have consulted with many women over the past seven years or so, and I have encountered a reasonably good cross section of their health problems. Overall, most want to lose fat, and/or improve their diets so that they are not at risk for chronic disease. If they are older, they want to avoid or minimize medications of any sort, especially hormone replacement therapy for menopause, and chronic pain relievers for arthritis (discussed last issue). Many want to minimize the many problems they have with allergies and their menstrual cycle. A significant percentage have chronic systemic candidiasis, which can be described as a long term, debilitating whole-body yeast infection. Women with systemic candidiasis need a good deal of intensive help, and probably a newsletter issue all their own! A smaller percentage are not overweight but want to either (1) increase lean body mass by strength training and a performance diet, or (2) increase body weight due to illness or anorexia. The women I have talked with all have great concern for their families as well as themselves, and often a parent, husband, or child appears as a client some months later.
When these women decide for themselves that they want natural help, they are almost always really ready to listen. I typically get them on a long-term customized diet and supplement plan with individual detailed variation; sometimes including referrals for laboratory testing and/or medications. All this cannot be discussed in detail here. I also recommend appropriate herbal products to help them with their problems in the long or short term. In the following sections I have provided some case histories of women clients. They all have medically documented conditions, and were referred for or asked to investigate nutritional counseling. Their names have been changed, but the details have not. After a description of the problem and an outline of the solution, I have provided the rationale behind many of the herbal choices. In many cases the client's budget was an important factor in the solutions-unfortunately their natural products have to be purchased out of their own pocket. By no means do I consider my answers the "ultimate truth"-on the contrary it is a learning process for both of us. However, I hope that you can see yourself or someone you know in the following cases, and perhaps find some answers.
Elena is a lively, energetic Brazilian woman in her 50's. She is married, has several teenage children, and runs a family business with her husband, which requires unusual and long working hours. She is just hitting menopause, and wants to avoid hormone replacement therapy. She had a pre-cancerous lump in her breast in the past, which she claims went away after she adopted a juicing and herbal detoxifying program she read about. She believes that hormone replacement therapy might make it recur. After menopause began, she noticed weight creeping on, and she began to think about dieting. Like many Hispanics and full-blooded Native Americans, she has a tendency towards central obesity (while no obesity is a good situation, central obesity is associated with eatitis, and it explained why the flax oil had helped so fast.
Elena had switched from her Brazilian-American home cooking to a very austere diet literally overnight, and this had greatly reduced her bile flow, and strained her pancreas to quickly change its type and amount of enzyme production. Very low fat, high carbohydrate/fiber diets, especially when they are adopted "overnight" are widely known to cause gallstones, and gall bladder and pancreatic inflammation. Women over 40 are particularly prone to this. Polyunsaturated fats help thin the bile and promote bile production, thus reducing the strain, pain, and inflammation.
Elena could pick the right diet by adopting the Paleolithic diet of fruits, vegetables, lean meat, fish, and other protein and nuts. She has a lot of Native American ancestry, and as such it must be kept in mind that her ancestors were still hunting and gathering as little as 100 years ago. She was certain that dairy products bothered her, and had recently started on a popular soy powder beverage drink mix. She was drinking that everyday, but still didn't feel just right. I would encourage her to eat lean meats and fish, mix up the protein sources, and use the soy drink every other day or every third day. She should also continue taking flax seed meal and essential fatty acids (EFAs) in a 1 to 1 n-3 to n-6 ratio daily, and keep overall dietary fat at 20 to 25%, but not lower.
As an herbal supplement to this diet, I would recommend that she take artichoke to increase bile output. For menopausal symptoms, I would select for daily supplementation vitamin C with polyflavonoids, and a phytoestrogen supplement containing soy germ isoflavones, dong quai, Korean ginseng, kudzu, and Mexican yam. I would also recommend that she take black cohosh and/or licorice several days per week (alternating if she wished) and more Korean ginseng daily if she could afford it. She had been taking some pycnogenol, but the C with polyflavonoids should take care of this. I would also add bilberry once or twice per day to further protect her from bruising, varicose veins, and hot flashes.
The herbs in the phytoestrogen supplement as well as Korean Ginseng, licorice, and black cohosh have isoflavones, ginsenosides, and related phytochemicals that bind weakly to estrogen receptors, or act somewhat similar to estrogen and other female hormones. These are known as "phytoestrogens". Mexican yam contains diosgenin, a steroid saponin that is the laboratory, but not human biochemical, precursor to progesterone. In the case of menopause, where estrogen levels are dropping overall, but fluctuating on a short term basis, the phytoestrogens appear to stabilize the female hormone system and prevent or lessen many menopausal side effects. Soy and flax meal (which is nature's richest source of lignans) also protect against breast and other reproductive cancers. Elena has no problems with hypertension or cardiovascular disease, and was very concerned with her pancreas and breast lumps, so licorice and Korean ginseng were choices that can provide demonstrable benefits beyond the phytoestrogenic effects. Licorice is known to be a powerful detoxifier and has been shown to inhibit the growth of liver and reproductive cancers both alone and in combination with other herbs (Huang 1993; Yano et al. 1994; Oka et al. 1995). Korean ginseng is adaptogenic, helps lower blood sugar, and improves stamina (Huang 1993; Sotaniemi et al. 1995). Further, an epidemiological study with 1,987 matched pairs with and without cancer showed that the longer a subject used ginseng, the lower the incidence of cancer. Those using ginseng over 500 times had 72% less cancer than those not using ginseng. Ginseng seemed most protective against stomach, esophageal, laryngeal, pancreatic, and ovarian cancer, and showed no significant effect on breast, cervical, bladder, and thyroid cancer (Yun and Choi, 1995).
Artichoke is a member of the thistle family, several members of which have long been considered beneficial for the liver and gall bladder, and are used to improve digestion and increase bile flow. A recent double blind cross-over study with 20 male subjects showed that a solution containing 320 mg of artichoke extract increased bile secretion by 127.3% after 30 minutes, 151.5% after 90 minutes, and 94.3% after 150 minutes (Kirchoff et al. 1994).
Although the phenomenon of hot flashes is not completely understood, we do know that they are related to dilation and increases in the permeability of capillaries. This causes flushing-you can imagine the same feeling if you think about taking a good swig of brandy on the ski slope. Your face flushes and reddens, and you feel warm, but it is a dangerous false warmth, because the dilated, permeable capillaries actually dump heat faster. Vitamin C and bioflavonoids work synergistically to strengthen capillaries and reduce their permeability. Bilberry contains anthocyanoside bioflavonoids, which are particularly effective in this regard, and together these herbs also help problems with bruising and varicose veins.
Huang, KC (1993). The Pharmacology of Chinese Herbs. CRC Press, Boca Raton FL.
Yano H, Mizoguchi A, Fukuda K et al. (1994). The herbal medicine Sho-saiko-to inhibits proliferation of cancer cell lines by inducing apoptosis and arrest at the G0/G1 phase. Cancer Res 54: 448-454. Note: this study and two related studies from Planta Med 1993 are discussed in Herbal Gram 1994; 32, 13.
Oka, H., Yamamoto, S., Kuroki, T. et al. (1995). Prospective study of chemoprevention of hepatocellular carcinoma with Sho-saiko-To. Cancer 76: 743-749.
Sotaniemi EA, Haapakoski E, Rautio A. Ginseng therapy in non-insulin-dependent diabetic patients. Diabetes Care 1995;18:1373-1375.
Yun T-K, Choi S-Y (1995). Preventive effect of ginseng intake against various human cancers: a case-control study on 1987 pairs. Canc Epidem Biomarkers Preven 4: 401-408.
Kirchoff R, Beckers CH, Kirchoff GM et al. (1994). Increase in choleresis by means of artichoke extract. Phytomed 1: 107-115.
Donna is an outgoing "take-charge" woman in her 30's and has two children in elementary school. Both she and her husband Sammy are overweight, and have been for years. They are beginning to feel "old before their time", fatigued, and irritable, and their physicians have asked them repeatedly to lose weight. They know they need to diet together. They are devoted to each other and need each other's support, and they both want to set an example for their children. They have been reading my columns for a year, and have realized that their son, who is showing signs of ADHD, may have food allergies, and also needs nutritional support. They refused to kowtow to school counselors who recommended out of hand that their son be medicated.
Donna's mother and sister are also overweight, and so are members of Sammy's family. Everyone has a tremendous sweet tooth, and they love candy, pastries, cookies, and ice cream. When they have meat, they like to cover it with sweetish BBQ sauce, catsup, honey mustard, etc. Sammy likes to drink Pepsi and snack on peanuts during the day while at work. He also likes to eat peanut butter right out of the jar. They have tried many diets and lowering their fat intake, but with little success, especially for Donna who continued to gain! Sammy has an arthritic condition in his elbow that he attributes to his job that requires a good deal of lifting. At the end of the day the pain is bad and makes him irritable and unlikely to exercise. He is afraid he may have to quit his job, and although he is not much of a drinker, he finds he is drinking more beer after work than he used to. Donna gets colds and other infections frequently, and is often on antibiotics, which cause yeast infections.
I would propose a diet and nutritional supplement program which is low to moderate in fat, but much lower in carbohydrates, especially sugar and wheat flour. I would give the couple tips on how to wean themselves off sugar, which should help them kick their sugar/carbohydrate addictions in a matter of weeks. I would also counsel them on the amount of "hidden fat" they had been consuming in their diet. Sammy has a family tendency towards gout, so I would take him off beer and peanuts, have him watch his meat intake, and counsel him to take a lot of vitamin C and other antioxidants. The change in diet and addition of supplements should help the couple regain a lot of their lost energy, and reduce their incidence of sickness. After changing their diet, the couple should be ready for serious dieting and exercise.
I would suggest that both of them start on a diet supplement that has Citrin, an extract from Garcinia cambogia, and chromium picolinate. In the case of cost concerns, the couple could rotate American, Siberian, and Korean ginsengs daily for general health and energy. I would also suggest the couple take bee pollen and fiber supplements between meals to help curb appetite, and to help ease them into eating more vegetables and fiber in general, which had been lacking in their diets. As a fiber supplement the couple could choose between a flax meal or psyllium seed capsules. Both should begin to lose weight steadily.
After some months I got a call from Donna who was very upset because she had gotten a urinary tract infection. She did not want to be on a long course of antibiotics, because of the past trouble with yeast infections, which she now realized caused terrible sugar cravings, PMS, bloating, and weight gain. However, she was in a great deal of pain. She was also upset because she had not been sick in so long. Cranberry juice has long been recommended for urinary tract infections, and can be of some benefit, but cranberry juice is about as tart as lemon juice, and therefore most of what is in commercial cranberry juice is sugar or corn syrup and water. I would recommend that Donna use cranberry herb capsules along with her antibiotic prescription.
The rinds of both Garcinia cambogia and G. indica are about 30% dry weight (-)-hydroxycitric acid (HCA). HCA has been shown to help prevent the deposition of body fat in both animals and humans. The mechanism is as follows: Acetyl coenzyme A is the source of all carbon atoms for the biosynthesis of fatty acids, and is normally formed from citrate derived from the metabolic oxidation of glucose. HCA is a very competitive inhibitor of the enzyme citrate lyase, with an affinity for citrate lyase more than 100 times greater than citrate. The result is that citrate is not converted into acetyl coenzyme A and oxaloacetate. Without acetyl coenzyme A, fatty acids cannot be synthesized.
Despite this action, the inhibition of citrate lyase is mostly of academic concern with respect to normal human metabolism, because the amount of fat which humans actually synthesize (de novo lipogenesis) is very small (Flatt, 1995). Most fat we carry around comes from dietary fat which is not utilized for energy, and is thus stored. Therefore, an effective fat loss aid must also increase the utilization of fat for energy and/or help restrict intake. The blocking of citrate lyase also lowers the amount of malonyl coenzyme A that is produced. Lower levels of malonyl coenzyme A activate the metabolism of fat in the liver and fat cell (adipose tissue) stores. This increase in fat metabolism can help prevent the storage of dietary fat. Research has also shown that HCA actively suppresses appetite, at least for 4 to 6 weeks (Majeed et al. 1994).
Several human studies have been conducted with Citrin, a standardized HCA extract. In an 8 week double blind study with 54 subjects, 22 who received a supplement with 500 mg Citrin and 100 mcg chromium three times per day lost 11.1 lbs. vs. 4.2 lbs. in the 17-subject control group. All subjects were in a medically supervised weight loss program. Two open field studies were conducted with a supplement containing 250 mg Citrin and 100 mcg chromium picolinate given three times per day. Twenty-nine and 52 subjects completed the studies, with average weight losses of 11.4 and 10.8 pounds per person, respectively (Majeed et al. 1994; Conte, 1995).
In an 8 week randomized placebo controlled double blind clinical trial, Thom (1996) gave 60 obese subjects (44 female, 16 male) HCA three times per day 30 minutes before each meal. The total daily dose was 1320 mg of Citrisan, another brand name for Citrin. All subjects were on a 1200 calories/day diet and instructed to exercise 3 times per week. Subjects receiving the HCA lost an average of 14.11 lbs., with 83% of that being fat. Subjects receiving placebo lost 8.37 lbs., 80% of which was fat. Subjective appetite scores were significantly reduced in the HCA group but not the placebo group.
Cranberry juice has been known medically to help prevent and control urinary tract infections for over 100 years. Cranberries not only acidify the urine, but also have a chemical polymer that interferes with the ability of bacteria to adhere to the lining of the bladder. The result is that bacteria are flushed out in the urine before they can multiply significantly and cause infection. In a 6 month double blind, placebo controlled study with 153 elderly female subjects, 300 ml cranberry juice per day reduced urinary bacteria by a factor of 1.9 (Avorn et al., 1994). Commercial cranberry juice was used vs. sweetened cranberry flavored water with vitamin C added. I expect that results would have been better (in both groups!) without the sugar, which can directly or indirectly contribute to urinary infections.
Flatt, J.P. Use and storage of carbohydrate and fat. Am J Clin Nutr 1995; 61:952S-959S.
Majeed M., Rosen, R., McCarty, M., Conte A, Patil, D., Butrym, E. (1994). Citrin¨: A Revolutionary Herbal Approach to Weight Management. Burligame CA: New Editions Publishing.
Conte, A.A. (1995). Effective natural weight loss techniques. Alt. Comp. Therapies 1: 212-215.
Thom, E. (1996). Hydroxycitrate (HCA) in the treatment of obesity. Int J. Obesity 20: 75.
Avorn, J., Monane, M., Gurwitz, J. et al. (1994). Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA 271: 751-754.
Tracy is tall and large but very lean and muscular. She is an exercise enthusiast, engaging in aerobic or weight training on a daily basis. She has had long stretches in the past where her menstrual period stopped, but this has not been a problem since she got married. She had a child with no trouble, and nursed him for 8 months. However, over 6 months after weaning she still had not had a menstrual period. While pregnant and nursing, Tracy had consumed a ratio of n-3 to n-6 EFAs at or greater than 1, mostly by using flax seed oil and fish oil. She did take two capsules of evening primrose oil (n-6) also, but overall ate a low fat diet. Before pregnancy she had been quite a fan of low fat granola with flax seed added, but found it repulsed her as soon as she became pregnant. After having her son, she went back to her flax seed and meal enthusiastically, and skipped the evening primrose oil because she fed it to her son directly. During this time Tracy had left a secure job and switched careers, and was now juggling her own business with raising her child. Tracy had higher than normal levels of the hormone prolactin, which were suppressing menstruation. High levels of prolactin are not unusual, and can be caused by stress, certain medications, nutrition, and imbalances in other hormones. In rare cases very high levels of prolactin indicate serious brain disorders such as tumors.
I would have Tracy start on Vitex (chasteberry) at three capsules per day. I would also have her increase n-6 EFAs in her diet by decreasing flax seed oil and increasing nuts and nut butters rich in linoleic acid, and resuming evening primrose supplements. I would have her omit flax seed and shift her to a high protein diet, omitting all grains. Since she had already cut out all caffeinated beverages while pregnant/nursing except for 2 cups normal strength coffee per day, I would make no further changes there. After following the program for several months Tracey should ovulate and have a normal period. The supplementation can have the side effect of increasing the length of menstrual periods, and a reduction in premenstrual symptoms. While in lean women this is a benign side effect, for heavy or obese women with frequent periods (shortened luteal phases), this effect is not a side effect, but the desired effect.
Vitex (chaste tree) is an herb for which a long tradition of folk use has been unquestionably confirmed. It has many effects on the female reproductive system, one of which is to normalize the secretion of prolactin. Standardized extracts of Vitex are recommended in Commission E, and are widely prescribed in German gynecological practices. Numerous studies and clinical reports have concluded that Vitex is effective in resolving abnormal menstrual cycles in the majority of patients. The typical dose in Germany is 40 drops once per day of a proprietary standardized extract and treatment requires several months duration or more. Like many herbal preparations, Vitex acts to slowly balance the hormone system, however, patience is rewarded by efficacy without side effects or significantly increasing chances for multiple births. Vitex is contraindicated during pregnancy, but may be used immediately following childbirth (Brown, 1994).
Vitex stimulates the pituitary and hypothalamus, increasing the release of lutenizing hormone and decreasing the production of follicle stimulating hormone. The result is an increase in the progesterone to estrogen ratio. This ratio shift is also seen in normal Corpus Luteum functioning, thus Vitex has a Corpus Luteum hormone-like effect . After ovulation, the follicle converts to the Corpus Lutem and produces progesterone in order to prepare the uterus for implantation of a fertilized egg. If fertilization does not occur, the Corpus Lutem recedes, and menstruation occurs. Corpus Lutem insufficiency is responsible for a number of menstrual abnormalities, including abnormally heavy or frequent periods, irregular cycles, excessive bleeding, uterine fibroids, anovulatory cycles, infertility, and amenorrhea. In rats, Vitex was shown to inhibit prolactin release by the pituitary, particularly when rats were under stress. Vitex is thought to bind directly to dopamine receptors in the pituitary, thus inhibiting prolactin release. In a double blind placebo controlled study of 52 women with hyperprolactinema; those subjects receiving Vitex showed significantly lower prolactin release, and progesterone levels were higher. The dosage was 20 mg per day for 3 months. Shortened luteal phases were normalized, no side effects were noted, and two women became pregnant (Milewicz et al. 1993). In another study, 13 out of 13 patients with hyperprolactinemia and cyclic menstrual disorder regained normal menstrual cycles when treated with Vitex for three months. In all patients prolactin levels were significantly reduced, and in some patients they became normal. (Roeder, 1994).
In two other studies mentioned by Brown (1994), treatment over 3 months produced significant or complete relief of PMS symptoms in over 90% of patients, with almost no side effects reported. Shortened luteal phases were normalized. This effect can cause an increase in length of menstrual periods, and a near total lack of premenstrual symptoms.
Like our hormones, Vitex has a balancing, adaptogenic effect, because it can paradoxically increase prolactin levels if they are too low. High prolactin levels are not always bad-they are necessary to maintain the supply of breast milk. Animal studies have shown an increase in lactation and growth of mammary glands following Vitex administration. In a controlled study of nursing women, Vitex increased milk production in mothers with poor milk production. The herb sometimes took a few ed ginger is effective for nausea and vomiting caused by factors from seasickness to post-operative nausea. A randomized double-blind clinical trial of 30 women with severe pregnancy nausea confirmed the effectiveness of ginger (Fischer-Rasmussen et al. 1990). Take ginger capsules with water or ginger tea in small sips to ease morning sickness.
Vitamin and mineral supplementation is of supreme importance if you are pregnant or even just thinking about it. We now know that nutrients provided through diet alone are simply not enough for many women, especially if they are overweight or have had multiple pregnancies. Folic acid is at the top of everyone's list now as the best example of how nutritional supplements can prevent the needless tragedy of neural tube birth defects. More recent research has shown that many women who have given birth to babies with neural tube defects have a defective enzyme (Mills et al. 1995). This enzyme requires folic acid to work, and since the enzyme doesn't function correctly, it needs more folic acid than usual to do its job. Furthermore, the incidence of neural tube birth defects is twice as great in obese women as compared to lean women (Prentice and Goldberg, 1996). One factor here is that obese women don't seem to respond to folic acid like lean women do-it loses some of its protective effect. A lack of response to zinc supplementation in pregnant obese women but not thin women has also been demonstrated (Goldenberg et al. 1995). There are likely to be more nutrients that behave as such-we just don't have the research done yet.
Overall, for thin women, there are 37 infants per 1000 who are stillborn or die shortly after birth, mostly due to pre-term births, severe birth defects, or respiratory failure (Prentice and Goldberg, 1996). For normal women there are 48; overweight women 60; and obese women 121! In general, the overweight and obese women eat more calories but fewer essential nutrients, which is a deadly combination for both mother and child. Research in the USDA laboratory where I work has shown that it takes 4 years or more for women to replace their body stores of chromium after pregnancy and nursing if they do not supplement (Anderson et al. 1993). Pregnancy complications such as carpal tunnel syndrome, edema, clumsiness, leg cramps, and gestational diabetes are indicative of magnesium, B6, other B vitamin, and chromium deficiencies. Vitamin C is of utmost importance. I found it astonishing that an exceedingly popular book on pregnancy I was "given" by my HMO in 1994 mentioned that bleeding gums are a symptom of pregnancy, and cautioned only to brush carefully. Bleeding gums during pregnancy are a warning that you're verging on scurvy! Daily consumption of 1,000 or more mg C with bioflavonoids will stop bleeding gums in their tracks; 50-75 mg coenzyme Q10 and 2-4 capsules bee propolis and baikal skullcap per day are also beneficial for the gums.
Fischer-Rasmussen, W., Kjaer, SK., Dahl C., Asping, U. (1990). Ginger treatment of hyperemesis gravidarum. Eur J Obstet Gynecol Reprod Biol 42: 163-164.
Mills, J., McPartin, J., Kirke, P. et al. (1995). Homocysteine metabolism in pregnancies complicated by neural tube birth defects. Lancet 345: 149-151.
Prentice, A., Goldberg, G. (1996). Maternal obesity increases congenital malformations. Nutr Rev 54: 146-152.
Goldenberg, RL., Tamura, T., Neggers, Y. et al. (1995). The effect of zinc supplementation on pregnancy outcome. JAMA 274: 463-468.
Anderson, R.A., Bryden, N.A., Patterson, K.Y. et al. (1993). Breast milk chromium and its association with chromium intake, chromium excretion, and serum chromium. Am J Clin Nutr 57: 519-523.
Dr. Leigh Broadhurst, Ph.D., is a physical and analytical geochemist and an expert in the design and operation of chemical research laboratories. Dr. Broadhurst is President of 22nd Century Nutrition, a corporate/personal nutrition and scientific consulting company. In addition, she is a Visiting Research Scientist, working for Dr. Richard Anderson, Ph.D. at the United States Department of Agriculture's Human Nutrition Research Center, Beltsville, MD, where she is researching chromium nutrition and antidiabetic botanical products. Dr. Broadhurst is also Senior Vice President of Herbal Vineyard, Inc., a corporation headed by Dr. James Duke. Herbal Vineyard maintains a comprehensive phytochemical database on the Internet and provides consulting and botanical research services.
Dr. Broadhurst serves as a scientific consultant to a number of national and international health and nutritional-related companies. She is a nationally popular speaker, writer and media consultant and is a member of and participates in several professional organizations.