Herbal / Medical Blogs

This is interesting - a week to get from SJW induction of 3A4 to return to steady state pre-induction levels of a 3A4 substrate. It suggests that week-on / week-off pulsing is a good bet for “tricking” the hepatic mixed oxidase system into maintaining steady levels of a 3A4 substrate in the setting of induction - for example artemsinin which induces its own clearance.

The recovery time-course of CYP3A after induction by St John’s wort administration.

Br J Clin Pharmacol. 2008 May;65(5):701-7

Authors: Imai H, Kotegawa T, Tsutsumi K, Morimoto T, Eshima N, Nakano S, Ohashi K

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: St John’s wort causes the induction of CYP3A. Little is known about how long the effect remains after cessation of St John’s wort. WHAT THIS STUDY ADDS: The in vivo CYP3A activity returns progressively to the basal level approximately 1 week after cessation of St John’s wort administration AIMS: To examine the recovery time course of CYP3A after enzyme induction by St John’s wort administration. METHODS: The subjects were 12 healthy men, aged 20-33 years. On the first day, they received an oral dose of midazolam 5 mg without St John’s wort (day -14). From the next day, they took St John’s wort for 14 days. On the last day of St John’s wort treatment (day 0) and 3 and 7 days after completion of St John’s wort treatment (days 3 and 7), they received the same dose of midazolam. On each day, blood samples were obtained until 8 h after midazolam administration. Plasma concentrations of midazolam were measured by HPLC. Pharmacokinetic parameters of midazolam were determined using noncompartmental analysis. RESULTS: Apparent oral clearance of midazolam was significantly increased after St John’s wort administration from 65.3 +/- 8.4 l h(-1) (day -14) to 86.8 +/- 17.3 l h(-1) (day 0). It returned to the control level 7 days after the completion of St John’s wort (day 7, 59.7 +/- 3.8 l h(-1)). No significant difference in the elimination half-life between the four periods of the study was observed. The changes in apparent oral clearance after St John’s wort discontinuation indicated that CYP3A activity recovers from enzyme induction with an estimated half-life of 46.2 h. CONCLUSIONS: CYP3A activity induced by St John’s wort administration progressively returns to the basal level after approximately 1 week. This finding may provide useful information to avoid clinically significant interactions of St John’s wort with CYP3A substrates.

PMID: 18294328 [PubMed - indexed for MEDLINE]

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The same flavonoid reported in the last post, this time extracted from Smilax, inhibiting cervical cancer cell line HeLa.

Kaempferol-7-O-beta-D-glucoside (KG) isolated from Smilax china L. rhizome induces G2/M phase arrest and apoptosis on HeLa cells in a p53-independent manner.:

Cancer Lett. 2008 Jun 18;264(2):229-40

Authors: Xu W, Liu J, Li C, Wu HZ, Liu YW

Kaempferol-7-O-beta-D-glucoside (KG), a flavonoid glycoside, isolated from Smilax china L. rhizome, displayed marked anticancer activity on a panel of established cancer cells, of which, HeLa human cervix carcinoma cells were the most sensitive. Meanwhile, the cytotoxic effects of KG on normal human cells (HEK293 embryonic kidney cells and L-02 embryonic liver cells) were much smaller than on cancer cells. This work studied the molecular mechanisms underlying KG induced growth inhibition in HeLa cells. The results showed that KG induced G2/M phase growth arrest correlated with Cyclin B1 and Cdk1 decrease in a p53-independent manner, and also caused an increase in apoptosis, which was confirmed by characteristic morphological changes, evident DNA fragmentation, increased apoptotic sub-G1 population. Furthermore, inhibition of NF-kappaB nuclear translocation, up-regulation of Bax and down-regulation of Bcl-2, were observed in HeLa cells treated with KG, which indicated that the mitochondrial pathway was involved in the apoptosis signal pathway. In summary, KG displayed a significant anti-tumor effect through cell cycle arrest and apoptotic induction in HeLa cells, which suggested that KG might have therapeutic potential against cervix carcinoma.

PMID: 18343026 [PubMed - indexed for MEDLINE]

Another study demonstrating the the anticancer properties of ginkgo and its constituents - now with pancreatic cancer.

Ginkgo biloba extract kaempferol inhibits cell proliferation and induces apoptosis in pancreatic cancer cells.

J Surg Res. 2008 Jul;148(1):17-23

Authors: Zhang Y, Chen AY, Li M, Chen C, Yao Q

BACKGROUND: Kaempferol is one of the most important constituents in ginkgo flavonoids. Recent studies indicate kaempferol may have antitumor activities. The objective of this study was to determine the effect and mechanisms of kaempferol on pancreatic cancer cell proliferation and apoptosis. MATERIALS AND METHODS: Pancreatic cancer cell lines MIA PaCa-2 and Panc-1 were treated with kaempferol, and the inhibitory effects of kaempferol on pancreatic cancer cell proliferation were examined by direct cell counting, 3H-thymidine incorporation, and MTS assay. Lactate dehydrogenase release from cells was determined as an index of cytotoxicity. Apoptosis was analyzed by terminal deoxynucleotidyl transferase mediated dUTP nick end labeling assay. RESULTS: Upon the treatment with 70 microm kaempferol for 4 days, MIA PaCa-2 cell proliferation was significantly inhibited by 79% and 45.7% as determined by direct cell counting and MTS assay, respectively, compared with control cells (P < 0.05). Similarly, the treatment with kaempferol significantly inhibited Panc-1 cell proliferation. Kaempferol treatment also significantly reduced 3H-thymidine incorporation in both MIA PaCa-2 and Panc-1 cells. Combination treatment of low concentrations of kaempferol and 5-fluorouracil showed an additive effect on the inhibition of MIA PaCa-2 cell proliferation. Furthermore, kaempferol had significantly less cytotoxicity than 5-fluorouracil in normal human pancreatic ductal epithelial cells (P = 0.029). In both MIA PaCa-2 and Panc-1 cells, apoptotic cell population was increased when treated with kaempferol in a concentration-dependent manner. CONCLUSIONS: Ginkgo biloba extract kaempferol effectively inhibits pancreatic cancer cell proliferation and induces cancer cell apoptosis, which may sensitize pancreatic tumor cells to chemotherapy. Kaempferol may have clinical applications as adjuvant therapy in the treatment of pancreatic cancer.

PMID: 18570926 [PubMed - indexed for MEDLINE]

The Weber-headed study by Bastyr, using NCCAM money and featuring Harvard Pharma pimp Biederman used an ineffective product to treat a so-called condition for which no practitioner in their right mind would ever use the herb, based on a completely hokey survey by some pharmacists in Texas that found 5 kids had been prescribed SJW for depression or ADHD.

One of the phenomena of the mainstream misinformation machine regarding herbal medicine is that any study, especially one published in JAMA, is apparently endowed with an aura of truth as if it were directly received from above on tablets of stone. This completely worthless and near fraudulent study of course failed to detect anything of consequence. But as a result the PR machine of mainstream news generation went straight into action, internet and press headlines proclaiming that St John’s Wort does not work for ADHD.

Mike Adams, an investigative reporter for Natural News Magazine in his expose of the Bastyr/ADHD/Hypericum study compiled a list of such headlines.

St. John’s wort fails to help kids with ADHD
The Associated Press

St. John’s Wort Doesn’t Work for ADHD
Washington Post

St. John’s Wort No Help in ADHD
ABC News

St. John’s wort no better than placebo for ADHD, Bastyr study finds
Seattle Times

St. John’s Wort No Help for ADHD
TIME Magazine

Herb does not ease ADHD
ZDNet

St. John’s wort doesn’t help ADHD, study finds
Reuters

None of which should surprise regular readers of HERBLOG, and none of which should surprise Bastyr. Hopefully the Bastyr Board will look at this pile of stinking stuff and ask Weber at al some hard questions. Promoting an understanding of how to use of herbal medicine in the modern world requires a little more than brown-nosing Big Pharma, validating DSM IV, and collaborating with corrupt truth twisters with an agenda to promote chemical control of kids behavior. This study does all of this and more.

HERBLOG awards this appalling study the title of jackass trial of the year. Let us hope that the good people at Bastyr wake up and do some genuine soul-searching.
This kind of thing does them no good at all.

Time to move on.

Biederman’s career highlights include a series of clinical trials to “prove” the efficacy of the ADHD drug atomoxetine (Strattera). Unlike Ritalin, this is not a direct stimulant, but appears to function as a norepinephrine reuptake inhibitor. (indirect stimulant for FWIW) The drug is made by Ely Lilly, one of Biederman’s major undisclosed sponsors (see earlier HERBLOG post about his failure to truthfully disclose conflict of interest payments.)

As discussed in the last HERBLOG post, the author’s justification for this clinical trial included the absurd claim that because 5 kids in Texas might have taken SJW for ADHD or depression, that Hypericum is the most prescribed herb for this “condition” of ADHD in the whole of the USA. On the same topic - ( ie Why the F***? ) there is yet another preposterous claim in the paper. In the introduction to the study, the authors state that …“since the NE uptake inhibitor atomoxetine has been approved by the FDA for ADHD and because Hypericum is believed to act as a norepinephrine reuptake inhibitor, we hypothesized that it may be beneficial in the treatment of ADHD….”

This so-called hypothesis is unmitigated nonsense.

Hypericum is NOT a NE reuptake inhibitor. That term refers to the pharmacological action of a drug (such as atomoxetine). Hypericum is a mild herb. Mild herbs are not drugs. They do not display drug type magic bullet actions. Hallo - Bastyr…come in please…where are you???? Do we really have to go through the fact that SJW is not a NERI, not an MAOI, not an SSRI, not even all of the above….

But for Biederman and Ely Lilly to be able to say that the Hypericum or any herb for that matter, does not work for ADHD…is to say the least convenient, if somewhat marginal. Sounds like a bit of a set up? Sounds like Bastyr folk walked right into it too. Nothing like an Institution that teaches botanical medicine saying that a her b does not work..it really must mean it does not work. Maybe they did not see the headlines coming….what headlines?

What headlines?….See next post.

One of the original  questions posed about this whole fiasco of a study is why on earth would a progressive-thinking center of excellence in natural medicine even contemplate trialling any medicine for so called ADHD?  Labels such as ADHD are arguably fictive (or philosophically nominalist) descriptors that do not refer to a real entity at all.  The DSM manual which taxonomically lists these “psychiatric disorders” can be seen as an elaborate hoax to support Big Pharma and psychopharmaceutical behavior control. Let us not forget that this is the same “authority” that labelled homosexuality as a “psychiatric disease” only a few years back. The whole business of mass-medicating children with psychotropic drugs is objectionable, and If there is a genuine question around herbal/botanical  interventions for children expressing the kind of behavior labelled ADD/ADHD  then the question comes up why SJW or Hypericum in the first place? There seems to be no rationale in traditional herbal prescribing for using SJW to influence this kind of behavior. SJW is a woundwort or healing herb, a liver herb, with a recent “biomedical” reputation for efficacy in certains forms of depression, although the trial data for this indicationis varying in quality and quantity. However, it is very improbable that any  trained practitioner, let alone licensed ND would propose taking SJW for ADHD. EVen the popular/consumer level  “natural” remedies given for so called ADHD generally include  either “stimulants” such as caffeine, and calming herbs such as Valerian, Kava and Scutellaria. SJW? not really.The rationale given in the Bastyr/JAMA paper for performing this clinical trial is that SJW is the most common herbal treatment for children with ADHD in the US. (along with Echinacea and Ginkgo). And where does this strange piece of information come from? The answer in the text is the citing of a reference to a questionnaire by three pharmacists  which surveyed a small number of caregivers  or parents of children attending community mental health centerers in urban, suburban and rural Texas. We have obtained the full text of this tedious little paper (see link below) . While the authors of the survey were probably well-intentioned, the document’s import is laughable when compared to the claims made for its significance by the Bastyr study authors. Firstly the children were diagnosed with EITHER depression or ADHD. Of 117 total patients, 5 (five) out of  n=117 who had either depression or ADHD had been given some SJW. A couple more were given Echinacea and or Ginkgo. From this entirely irrelevant and meaningless exercise we somehow get from 5 kids in Texas with depressive/ADHD diagnoses being given SJW on a one time basis  to the absurd and ludicrous claim that Hypericum is the most common herbal treatment for pediatric ADHD in the United States. This is extrapolation is bogus science masquerading as authoritative information - gone compeletely beserk. I was goingto make a cultural comment about the iPod being invented in Cupertino not Waco, but this stuff is not even remotely funny.Cala S, Crismon ML, Baumgartner J.Pharmacotherapy. 2003 Feb;23(2):222-30. A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression.This is not the end of the study’s flimsy self-justification however attempts; the next reason given for performing this study is based  on erroneous  statements about the psychopharmacology of Hypericum. Stay tuned. We have started so we will finish.

According to the full text The Bastyr Hypericum/ADHD trial used a SJW product supplied by Vital Nutrients Inc that is “marketed as standardized to 0.3% hypericin”. The text further relates this material was “independently” verified prior to the trial, and also suggests that the extract was not a high hyperforin ( 3-5%) type of product. This is part of the end discussion in the paper that suggested the effects being tested were a result of hypericin not hyperforin.

An interesting point emerges here: Vital Nutrients Inc is a reputable company run by Bastyr alum Dr Rik Liva. Liva has established a solid reputation in the natural products industry as a vigorous proponent of GMPs, quality assurance and the need for testing to ensure quality in dietary supplements. He has often gone on public record as saying that adherence to QA/GMPs is absolutely necessary to prevent the public from being duped. But when his owncompany’s extract was tested it was found to be 0.13% hypericin not 0.3% as labelled. This is a huge discrepancy. Perhaps the “independent” testing of the initial material was simply a wholesale suppliers “C of A (Certificate of Assurance) about the quality? A further puzzle is that Vital Nutrients do not actually market a “low hyperforin” SJW product. Their web site lists only a 3-5% hyperforin SJW item

SO it could be said that Liva’s Vital Inc producthad the potential for duping the consumer, it duped the triallists at any rate. The abstract could easily have read something like “egg on face as clinical trial fails to measure anything due to clusterfuck confusion over product administered to verum group” but then that would not have made the study authors or their Bastyr alum’s company look too clever.

Since Liva is pretty adept at publicity, perhaps we will be hearing from him about the apparent problems with the product used in the trial. Perhaps the “independent verification” of the supplied material could be revealed? The Bastyr paper itself suggests that the product probably became oxidized during the 8 week trial due to its being dispensed in 2- part capsules. One would hope for a longer than 8 week shelf life for most products….Perhaps Liva will shortly be reoutfitting the Vital Nutrients SJW in a “onezie” suit.

To be continued..

As Dr Yarnell rightly points out - one really cannot criticize a study without reading the full text. So now we have the study, and the story continues to unravel. Here is one little issue…..

The material used in the study contained, when tested at the end of the 8 week trial period, 0.13% hypericin. The abstract states that the material was 0.3% standardized. So the material was less than half the strength stated in the abstract. An explanation was given that hyperforin is unstable and may have oxidised. However, the hypericin was the critical ingredient here, not hyperforin. In fact the Vital Nutrients Inc material was not a high hyperforin extract in the first place. The plot thickens.

So the question is why does the abstract say one thing and the full text another? BS science as usual… Dr Yarnell is indeed correct.

Hypericum perforatum (St John’s Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Randomized Controlled Trial.

Dr Joseph Biederman is a nasty piece of work. He is a pediatric psychiatrist and a major advocate of medicating young children with psychiatric medications for DSM conditions such as ADHD and pediatric bipolar disorder. The diagnosis of peeds bipolar cases rose 4000% in the decade from 1994-2003, and sales of pharma drugs to “treat” or chemically control the so-called condition doubled from 2003 to 2006 according to Natural News Reporter Mike Adams who recently covered Senator Charles Grassey’s expose of Biederman’s funding lies following the revelations made by NYT reporters Harris and Carey last month.

As the NYT reported, Biederman failed to disclose at least $1.6 million consultancy fees from Big Pharma until investigated by Senator Grassley. Biederman and his colleagues Wilens and Spencer, all notorious advocates of child drugging, have “uprated” their conflict of interest estimated income following enquiries by Grassley. To protect research integrity, the NIH who funded Mass General Hospital to the tune of $287 million in 2005 for research requires researchers to report consultancy fees, and at that time HArvard forbade researchers from conducting clinical trials if they received more than $10,000 pa in such fees. The NYT gives a typical example - Biederman suggested that Johnson and Johnson paid him $3,500 in 2001, ie less than $10,000, but the company admitted the figure was in fact$58,000.

Failing to report income by researcher is a possible violation of Federal and University rules. Mass General theoretically could lose NIH funding as a result of this scandal, but it seems pretty unlikely - at this time, Biederman’s case has been referred to a Harvard “University Committee” for review.

Ironically, another well known right wing psychiatrist, Fuller Torrey of the Stanley Research Institute, rounded on the Biederman fiasco in public saying “In the area of child psychiatry in particular..we desperately need research that is not influenced by industry money. The price we pay for these kind of revelations is credibility, and we just can’t afford to lose anymore in this field” reports the NYT.

So what’s new about such sordid conflict of interest revelations? Just that the same Dr Joseph Biederman is an author of the Bastyr study on ADHD and Hypericum that found the herb did not work. Better just take the drugs heh?

Bastyr’s defenders would probably say something like well we needed an acknowledged “expert” in the field in which we were going to run a trial…we would say, you can tell a lot about someone by the company they keep.

Here we go. Edzard is at it again. What a complete and utter craphead this guy is. If you read the fine print (= full text) of this profound exercise in masturbatory metastudy fantasia you will find that this study’s male authors decided (in their infinite [lack of] wisdom, and very finite lack of practical clinical experience as well as complete and utter incomprehension of the real world outside of their warped academic wankdom) to exclude studies that related to menopause induced by chemotherapy or surgery. So, as anyone with half an ounce of clinical experience knows, menopause induced by sudden surgical or cytotoxic chemotherapeutic trauma precipitates the most extreme symptoms that are profoundly distressing for those experiencing them. Black cohosh works for these folk. It works every time. All the time. It works so well that I have had patients kicking down the door to replenish their supplies of BC tincture when they even suspect they might have run out over the weekend. So you have to take enough. If you take enough…it works. The typical trial doses are less than 100 mg qd. How did they figure that out? Try an order of magnitude more. Its a herb. It won’t kill you. And it works. The contrast between the simple beauty and elegance of the real world effectiveness of this herb for menopausal symptoms and the pronouncements of the self-appointed high priests of evidence based medicine about the same herb is, I suppose, in the end, an expression of how profoundly screwed things really are today. Further rigorous trials are indeed warranted. Preferably the accused will be Ernst and his ilk.

Black cohosh (Cimicifuga racemosa) for menopausal symptoms: A systematic review of its efficacy.

Pharmacol Res. 2008 Jun 8;

Authors: Borrelli F, Ernst E

Since conventional hormone replacement therapy has fallen out of favour, alternatives are being sought by many women. These therapies include herbal preparations such as black cohosh (Cimicifuga racemosa). The purpose of this update of a previous systematic review is to evaluate the clinical evidence for or against the efficacy of black cohosh in alleviating menopausal symptoms. Five computerized databases (Medline, Embase, Amed, Phytobase and Cochrane Library) were searched to identify all clinical data that provided evidence on the efficacy of C. racemosa. Bibliographies of the articles thus located were scanned for further relevant publications. Only double blind, randomized, clinical trials (RCTs) were included in the evaluation of efficacy. No language restrictions were imposed. Trials were excluded if they did not focus on menopausal problems, they included women suffering medically induced menopause, they did not use black cohosh monopreparations, or they did not use placebo or a standard drug treatment for the control group. Six studies with a total of 1112 peri- and post-menopausal women met our inclusion criteria. The evidence from these RCTs does not consistently demonstrate an effect of black cohosh on menopausal symptoms; a beneficial effect of black cohosh on peri-menopausal women cannot be excluded. The efficacy of black cohosh as a treatment for menopausal symptoms is uncertain and further rigorous trials seem warranted.

PMID: 18585461 [PubMed - as supplied by publisher]

(Via Herbal Science Research aggregator.)

How much calcium you need depends on your age and gender. Men have it easy. According to the National Academy of Sciences, males ages 19 through 50 need 1,000 mg per day. After 51, needs rise to 1,200 mg per day. For women, it’s trickier. Prevention is everything. Although both sexes require adequate calcium during adolescence to preserve bone mass and prevent fractures later, by the time women are perimenopausal and early postmenopausal, calcium has minimal effect on bone mass and bone loss. As women age into their late 60’s, 70’s and beyond is when calcium again, is oh so important as that is the time of increased risks for fracture and increased bone loss.

The National Institutes of Health has one of the most well-accepted guidelines for women’s calcium intake:

Most people need to supplement to get enough calcium because we have reduced our dairy intake. Estimating dietary sources of calcium is an important first step, before deciding how much to augment in a pill. Not counting dairy or calcium-fortified foods, you get about 250 mg of calcium per day from our grains, seeds and vegetables. If you drink milk, calcium-fortified soy milk or OJ, you rack up an additional 300 mg per 1 cup serving. That’s 250 mg + 300 mg = 550 mg per day. Let’s say you’re 51, postmenopausal and not using estrogen. You’ll need an additional 950 mg to reach the goal of 1,500 mg per day. More is not better. Taking too much may not be good for your heart or other soft tissue and may inhibit mineral absorption.

But bone is not nourished by calcium alone. Vitamin D, is probably even more important than calcium. Other nutrients that can affect bone health include magnesium, manganese, boron, zinc, folic acid, vitamin B6 and vitamin K. These different nutrients are important in one or more of the following: bone density, bone architecture and/or bone strength.

In a double-blind study, Taiwanese peri-menopausal women, aged 45-55, were given either placebo or 100 mg of Pycnogenol twice daily for 6 months. One hundred fifty-five women received the Pycnogenol and seventy-five the placebo. The Women’s Health Questionnaire with 36-items was used to evaluate the climacteric symptoms at baseline, and at 1, 3 and 6 months.

Results - Blood pressure decreased similarly in both groups. HDL increased and LDL decreased significantly from baseline with Pycnogenol, but no significant differences were seen in HDL between the two groups, however, LDL was more significantly reduced in the Pycnogenol group. Perimenopause symptoms of depression, vasomotor symptoms, memory, anxiety, sexual function, and sleep all improved significantly (P

Yang H-M, Liao M-F, Zhu S-Y, Liao M-N, Rohdewald P. A randomised, double-blind, placebo-controlled trial on the effect of Pycnogenol on the climacteric syndrome in perimenopausal women. Acta Obstetricia et Gynecologica. 2007;86:978-985

Commentary:

I was surprised to see this study, as I have never thought to use Pycnogenol in the treatment of perimenopause/menopause symptoms. The most common symptoms of perimenopause/menopause that I see in my practice are hot flashes, sweating, heart palpitations, fatigue, depression, decreased sexual function, insomnia and cognitive impairment. It’s imperative to have as many non-hormonal natural medicine options as possible, and making clinical decisions based on evidence based therapies is extremely helpful, enhancing our ability to help more women, more of the time. I’m pleased to be able to add Pycnogenol to my list of choices and will look forward to hopefully positive results.

Our last HERBLOG post regarding the Bastyr ADHD study attracted email comment, controversy and criticism. All of which is good. With Word Press comments disabled you never know if anyone is bothering to read a blog.

Thanks to Paul Bergner of the North American Institute of Medical Herbalism and Editor of the journal Medical Herbalism pointed out that Dr John Bastyr was not a founder of Bastyr University. The four founders of Bastyr were Bill Mitchell, Joe Pizzorno, Les Griffith and Sheila Quinn. As Bill Mitchell wrote in his book Plant Medicine in Practice, Bastyr was a towering figure of American botanical medicine, the “best of the best”. Bergner reports that being in the presence of this master clinician was amazing, and Bill Mitchell’s book gives a flavor of the man to those of us who were not fortunate enough able to meet him or hear him teach.

Bastyr University teaches Botanical Medicine as part of its core curriculum for Naturopathic Physicians, and arguably has one of the best botanical departments in North America at this time, which also offers a Herbal Sciences undergraduate degree, oriented more towards those considering non-clinical careers in the herb industry.

Dr Eric Yarnell, a current core faculty member at Bastyr’s Botanical Medicine department, defends the ADHD study and criticizes my post statement that Bastyr is joining the chorus that Hypericum does not work as a wild exaggeration. Eric suggests that since HYpericum is in fact a popular remedy with self medicating public for ADHD, it is reasonable to see if it works or not. He also suggests I read the whole paper, which I did not. Fair comment. His points are worth looking at in detail, which we will do in the next post.

So JAMA publishes a trial run out of Bastyr University, the renowned Naturopathic college in Seattle, which resoundingly informs us that SJW does not work for ADHD? What a total waste of time and money. What herb have they been smoking up there in Seattle? Is there a herbally literate practitioner anywhere who would recommend SJW as a single agent for a behavioral pattern such as “ADHD”. The centres of excellence so called in natural medicine would be better occupied in dismantling the ADHD “label” - instead of regarding it as disease that might be cured by a single herb given as a druand en route adding to the “SJW does not work” chorus.One wonders what the founders of Bastyr - Dr John Bastyr and Dr Biill Mitchell would think of such an unsavoury scenario.

Hypericum perforatum (St John’s Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Randomized Controlled Trial.

JAMA. 2008 Jun 11;299(22):2633-41 Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J  

CONTEXT: Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St Johns wort) is 1 of the top 3 botanicals used. OBJECTIVE: To determine the efficacy and safety of H perforatum for the treatment of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview. INTERVENTION: After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial. MAIN OUTCOME MEASURES: Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events. RESULTS: One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score </=2) on the Clinical Global Impression Improvement Scale (H perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78). CONCLUSION: In this study, use of H perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms.

Trial Registration clinicaltrials.gov Identifier: NCT00100295.PMID: 18544723 [PubMed - in process]

(Via Herbal Science Research aggregator.)

Kevin Kelly, Executive editor of Wired magazine and has a wide ranging personal web site that includes a blog called Cool Tools devoted to gadgets that work. I am a fan of Kelly’s writing and if you are unfamiliar with it go check out his work at kk.org. His Cool Tool blog is here

Cool Tools today mentions The Blender Bottle - a brilliant non electrical device for blending smoothies - for camping, road trips, travel or just home convenience. The protein plus smoothie is a foundation of all patient protocols at our clinic, and the challenge of making these brews on the road is a recurrent complaint. The Blender Bottle is the best answer to date.

The Blender Bottle is a shaker bottle with a free-floating surgical stainless steel wire ball inside. Not unlike a kitchen whisk, the ball moves freely within your drink, breaking up clumps and further mixing the mix as you shake it for a smooth, totally grit- and clump-free serving..

Blender Bottle
$7
(20 oz.)
Available from Amazon

$8
(28 oz.)
Available from Amazon

Manufactured by Sundesa

This randomized, double-blind, placebo-controlled clinical trial with 96 menopausal women was conducted over 6 months. 66 women were given 135 mg of soy isoflavone and 30 women were given placebo. After one week, the women in the treatment group were tested and further divided into 2 subgroups, equol-producing (EP) and non equol-producing (non-EP), according to peak levels of equol in the urine. Women in both of these subgroups were then given 3 grams of soy germ extract powder twice a day, totaling 135 mg of isoflavones daily, for 6 months.Menopause symptoms were evaluated using a modified Kupperman Index, measuring 17 items (hot flashes, excessive sweating, coldness of extremities, shortness of breath, numbness of extremities, paresthesia of extremities, insomnia, easy awakening, excitability, nervousness, melancholia, vertigo, weakness, arthralgia or myalgia, headaches, palpitations and formication. and scoring them as none, mild, moderate or severe.

Compared with the placebo group, symptoms of hot flashes and excessive sweating significantly reduced after 3 months and weakness, palpitations, limb paresthesias and total symptoms significantly decreased after 6 months, (P

Jou H-J, Wu S-S, Change F-W, Ling P-Y, Chue K, Wu W-H. Effect of intestinal production of equol on menopausal symptoms in women treated with soy isoflavones. Intl J Gynecology and Obstetrics (2008), doi: 10.1016/j.ijgo. 2008.01.028

Commentary: The research on soy’s ability to relieve menopause symptoms has produced quite mixed results. Differences in study doses, different proportions of genistein and daidzein used in the study medication, and differences in the study population have been used to explain the discrepancies. Study populations who may have a higher percentage of women who are equol producers have been previously suspected to be the determining factor in the effectiveness of soy isoflvaones, but the current study seems to be the first to demonstrate more clearly that a woman’s ability to produce equol determines her response to soy isoflavone supplementation. Daidzein and genestien are the two most significant phytoestrogens in soy. Daidzein is converted to equol, a metabolite of daidzein, by bacterial flora in the gut. It may be appropriate to test for equol production prior to treatment of perimenopausal and menopausal women to achieve the most success, and/or improve gut flora so that the individuals can more easily transform soy isoflavones to equol. This can be done with improving one’s diet to whole foods nutrition, reducing sugar to a minimum, consuming mostly unsaturated fats, and possibly taking probiotics as a nutritional supplement or in quality yogurts.

Effects of rhubarb extract on radiation induced lung toxicity via decreasing transforming growth factor-beta-1 and interleukin-6 in lung cancer patients treated with radiotherapy. Yu HM, Liu YF, Cheng YF, Hu LK, Hou M, Lung Cancer. 2008 Feb;59(2):219-26

BACKGROUND: Radiation induced lung toxicity (RILT) is the main adverse effect in the radiation therapy of lung cancer. However, the optimal management of RILT has not been defined. In this paper, we investigated the effects of rhubarb extract on RILT, pulmonary function (PF), transforming growth factor-beta-1 (TGF-beta1), and interleukin-6 (IL-6) in lung cancer patients treated with radiotherapy. PATIENTS AND METHODS: We conducted a randomized, double-blind, placebo-controlled trial. Eighty consecutive patients were randomly enrolled into two groups: trial group and control group. The trial group received three-dimensional conformal radiation therapy (3D-CRT) plus rhubarb (at a dose of 20 mg kg(-1) once a day) for 6 weeks. The control group received 3D-CRT plus a placebo containing starch for 6 weeks. Plasma TGF-beta1 and serum IL-6 were measured in all patients before, every 2 weeks during, and at 6 weeks after the completion of the treatment. RILT and PF were evaluated at 6 weeks and 6 months after the end of the treatment, respectively. The differences of TGF-beta1, IL-6, RILT, and PF between the two groups were analysed. RESULTS: The incidence of RILT in the trial group was significantly lower than that in the control group at 6 weeks and 6 months after treatment (32.4% versus 56.7% at week 6, and 27.0% versus 52.8% at month 6, both P<0.05). The plasma TGF-beta1 levels in the trial group were significantly lower than that in the control group during and after the treatment (P<0.05 or 0.01, respectively). The serum IL-6 levels in the trial group were significantly lower than that in the control group during the treatment (all P<0.01). The forced vital capacity (FVC), forced expiratory volume at 1s (FEV1) at 6 weeks and the diffusion capacity for carbon monoxide (DLCO) at 6 months in the trial group were significantly improved compared to the control group (P<0.05 or 0.01, respectively). CONCLUSIONS: The rhubarb extract significantly attenuated RILT and improved PF, probably by decreasing the level of TGF-beta1 and IL-6. These results may be of value for the prophylaxis of RILT, but the exact mechanisms underlying these prophylactic effects remain to be further explored.

PMID: 17870203 [PubMed - indexed for MEDLINE]

(Via Herbal Science Research aggregator.)

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A study of 1,471 post menopausal women in New Zealand with a mean age of 74 were randomized to receive 1 gm of calcium citrate or placebo daily for 5 years. The occurrence of sudden death, heart attacks, stroke and transient ischemic attacks were reported by either the women or their family members. A twofold increase in MIs was seen among women in the calcium group compared with the placebo group. When accumulating the total of heart attacks, strokes or sudden deaths, the incidence was 1.47 times higher in the calcium group than in the placebo group as well. However, when the investigators incorporated national health database results for unreported cardiovascular events, the increase in the incidence in heart attacks was not statistically significant.

Bolland M, Barber P, Doughty R, et al. Vascular events in healthy older women receiving calcium supplementation: Randomised controlled trial. BMJ 2008;Feb 2; 336:262-266

[Click here to download fulltext PDF from BMJ]

Commentary: It is interesting and important to point out that the Women’s Health Initiative ( Circulation 2007;115:846) showed no statistically significant increase in cardiovascular events in postmenopausal women receiving calcium supplements and another study showed a non-significant but yet a trend in increased risk for ischemic heart disease. (Arch Intern Med 2006;166:869). These three studies all point to the fact that there is no definite statement or conclusion that can be made regarding calcium and cardiovascular events. That said, I am concerned that the importance of calcium supplementation in postmenopausal women, especially younger postmenopausal women, is very overplayed. And, most individuals do not estimate their dietary calcium sources, and then use a pill to supplement in addition to dietary sources to meet a total of 1,200mg-1,500 mg per day. Rather, they often take 1,000 mg to 1,500 mg per day, in addition to their dietary sources. A result of this misinterpretation of calcium guidelines might be excessive calcium and depletion of other nutrients such as copper, silicon and magnesium, all of which have cardioprotective benefits. In addition, these total daily calcium guidelines turn out to be most important to young girls and postmenopausal women 65 and older. These are the times in life when lack of bone architecture/density growth (young girls) and bone loss (elderly women) is most crucial in the prevention of osteoporosis and risk for fractures. For women in their 30’s, 40’s, 50’s and early 60’s, our bones seem to do just fine with average dietary intake.