Patients were randomly assigned to drink one cup of Hibiscus or black tea two times per day for one month. Each infusion contained one tea sachet weighing 2 gm, placed in a tea pot with 240 ml boiling water and steeped for 20-30 minutes and then added one cube of sugar.

The average systolic blood pressure (SBP) in the hibiscus group decreased from 134.4 +/- 11.8 mm Hg at the start of the study to 112.7 +/- 5.7 mm Hg after 1 month. The average SBP changed from 118.6 +/-14.9 to 127.3 +/- 8.7 mm Hg in the black tea group during the same time period. There were no statistically significant effects on the mean diastolic blood pressure in either group.

Commentary:

It’s always gratifying to see a simple, safe, inexpensive herb studied for such a common problem. Hibiscus has been used historically for high blood pressure and contains several important ingredients including alkaloids, anthocyanins and quercetin. It is thought that the antioxidant and diuretic effects are the most important mechanisms.

References

Mozaffari-Khosravi H, Jalali-Khanabadi B, Afkhami-Ardekani M, et al. The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes. J Human Hypertension 2009;23:48-54.

The average age was 50 and the average vitamin D levels was 58.1 nmol/L. Vitamin D levels were deficient (<50 nmol/L) in 192 women, insufficient (50 to 72 nmol/L) in 197 women and sufficient (> 72 nmol/L in 123 women. The average follow-up was 11.6 years with 116 women having distant recurrences and 106 women who died. Vitamin D levels were significantly lower in women with high grade tumors. Those women with vitamin D deficiency had an increased risk of distant recurrence and of dying, compared with those women who had sufficient serum vitamin D levels.

Commentary: This study is one more reason to test vitamin D levels- I would recommend it for all current or past breast cancer patients. In terms of using vitamin D levels to determine the initial risk for breast cancer, the evidence has been mixed, with some showing an association between latitude and risk of breast cancer, some showing an inverse relationship between vitamin D intake and breast density (a strong risk factor for breast cancer), but other studies showing vitamin D intake or blood levels of vitamin D inconsistently related to risk/incidence.

There have been some other attempts to use vitamin D levels as a prognostic indicator for breast cancer and mortality. Low vitamin D levels have been associated with increased breast cancer mortality and have also been shown to be significantly lower in women with locally advanced or metastatic disease compared with those women who have early breast cancers. Taking a vitamin D supplement to increase blood levels of vitamin D is one of the least expensive, safe strategies to reduce the risk of recurrence of breast cancer, as stated in this current study. For the rest of us… the research is full of good news about vitamin D and our health with studies demonstrating that higher blood levels of vitamin D is associated with lower rates of heart disease, ovarian cancer, multiple sclerosis, osteoarthritis and rheumatoid arthritis, bacterial vaginosis, and as mentioned, breast cancer.

It should be noted that the current studies, and in fact many studies, report vitamin D levels in the units of nmol/L. Other studies report ng/ml. This is a very important difference. It is important to compare one’s lab unit results for vitamin D levels with the proper target number and unit used. For reference, 75 nmol/L is equal to 30 ng/mL. In the current study, those women who had a vitamin D deficiency and reported as < 50 nmol/L would be equivalent to < 20 ng/ml.

References

Goodwin P, Ennis M, Pritchard K, et al. Prognostic effects of 25hydroxyvitamin D levels in early breast cancer. J Clinical Oncology 2009;27(23): 3757-3763

Peer-reviewed research studies were located in various data-bases searching for studies investigating vitamin D and depression, seasonal affective disorder, PMS, postpartum depression, perinatal depression, depressive disorder or mood disorder in women. Eleven studies were initially identified, but five were eliminated because they did not meet the inclusion criteria. Of these six studies, four reported significant results showing an association between low serum 25 (OH) D levels and symptoms of a mood disorder, SAD, major depressive disorder, or PMS. One study of major depression and one on SAD did not report an association. Only one of the four positive studies was a randomized controlled trial.

Vitamin D receptors are involved in the regulation of glucocorticoid signaling and dysfunctional glucocorticoid signaling and increased glucocorticoids have been implicated in major depressive disorder. Other biochemical mechanisms may also exist, associating vitamin D with mood disorders.

I look forward to more research on specific mood disorders in women and vitamin D levels.

References:

Murphy P, Wagner C. Vitamin D and mood disorders among women: an integrative review. J Midwifery Women’s Health 2008;53:440-446.

This study was a single-blind controlled randomized clinical trial in women up to 20 weeks of pregnancy in Iran. 32 women received ginger and 35 received placebo. One ginger (250 mg) or placebo capsule four times per day was given over the course of four days. A four page questionnaire was used for each woman, one page per day for the four days. Women were also asked to record nausea intensity twice a day. At the end of four days, a researcher completed the questionnaire based on the woman’s responses.

Nausea intensity improved in 84% of those who used the ginger and in 56% of the women in the control group. The incidence of vomiting in the control group was 9% decreased and 50% decreased in the ginger group.

Commentary: At least four previous published studies have shown success in the use of ginger for nausea and vomiting of pregnancy. Doses of 1,000 mg – 1,500 mg per day have been used previously. The current study showed not only a positive effect, but women were satisfied with that effect and no complications were observed during the treatment period.

References

Ozgoli G, Goli M, Simbar M. Effects of ginger capsules on pregnancy, nausea and vomiting. J Alternative and Complementary Medicine 2009;15(3):243-246

After the treatment period, there was a significant decrease in the overall severity of symptoms and physical and psychological symptoms in both the Ginkgo group (23.68%) and the placebo group (8.74%). The average decrease in the severity of symptoms was significantly more in the Ginkgo group compared to the placebo group.

Comments: The results of this study demonstrated that ginkgo was more effective than placebo in reducing the severity of symptoms and the severity of physical and psychological symptoms in young women in Iran, with PMS. A previous study also found benefits with ginkgo and PMS, especially with breast tenderness and fluid retention. They also saw significant improvements in irritability and aggression, compared with placebo. The current study confirms the benefits of a standardized extract of ginkgo for the treatment of PMS. Based on the published -research to date, standardized extracts of – Vitex agnus castus (chaste tree berry), Hypericum perforatum (St. Johns wort) and Ginkgo biloba (ginkgo), appear to be the most effective botanical treatments for PMS. I would encourage women and their practitioners to seek PMS formulas that have at minimum, these three botanicals in the formulation.

References

Ozgoli G, Selselei E, Mojab F, Majd H. A randomized, placebo-controlled trial of ginkgo biloba in the treatment of premenstrual syndrome.

Commentary: We know that elevated homocysteine levels are associated with the risk for AMD and B vitamins lower homocysteine levels. The current study suggests that supplementation with these three B vitamins can lower the risk for AMD, although it is not clear if this result is indeed related to homocysteine lowering or some other mechanism.

References

Christen W,et al. Folic acid, pyridoxine, and cyanocobalamin combination treatment and age-related macular degeneration in women: The women’s antioxidant and folic acid cardiovascular study. Arch Intern Med 2009. Feb 23;169:335

The mean total Premenstrual Syndrome Diary (PMSD) score decreased from 29.23 at baseline to 6.41 at the end of the third cycle for the Vitex group and from 28.14 at baseline to 12.64 at the end of the third cycle for the placebo group. The difference in the PMSD score from baseline to the third cycle was significantly lower in the treatment group than in the placebo group. The Premenstrual Tension Syndrome Self-Rating Scale (PMTS) decreased from 26.17 at baseline to 9.92 for the treatment group and from 27.10 to 14.59 for the placebo group; similar positive results to the PMSD scores.

Comments: I’ve long used Vitex for the treatment of PMS and in my opinion, it is the single most important plant for the treatment of PMS. The effect of Vitex is on the hypothalamus-hypophysis axis and results in an increased secretion of luteinizing hormone which then favors a progesterone effect. Several other placebo controlled studies have found that Vitex reduced a variety of PMS symptoms. The current study adds to the clinical relevance of this plant in the treatment of moderate to severe symptoms of PMS.

References

He Z, Chen R, Zhou Y, et al. Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. Maturitas 2009; 63:99-103

It has been known for a considerable amount of time, that folic acid when given to women planning for pregnancy and during pregnancy, can lower the risk for neural tube defects. Based on the research up to that time, the US Preventive Services Task Force (USPSTF) first published their recommendations in 1996. This has recently been updated and the USPSTF has issued a new statement in May, 2009. Based on the observational evidence and randomized controlled trials published since 1996, the USPSTF found convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid during the preconception period lowers the risk for neural tube defects.[1]

There now appears to be additional benefits for folic acid before conception and during pregnancy, possibly the prevention of cleft lip (BMJ 2007;334:464) and most recently, lowering the rates of severe congenital heart defects. In a Quebec study, investigators observed a drop in the prevalence of severe congenital heart defects after mandatory folic acid fortification of grains. The average prevalence of severe congenital heart defects at birth was 1.64 per 1000 births during the 9 years before the folic acid food fortification began and the rate fell by 6.2% yearly during the seven years studied, after the mandatory fortification.[2]

Following the recommendation that all women of child bearing age should take a daily supplement containing 0.4 mg to 0.8 mg per day of folic acid is good, safe medicine and perhaps even more beneficial than previously thought.

References

[1] Woffe T, Takacs-Witkop C, Miller T, Syed S. Folic acid supplementation for the prevention of neural tube defects: An update of the evidence for the U.S. Preventive Services Task Force. May 2009.150; (9): 632-639

[2] Ionescu-Ittu R, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: Time trend analysis in Quebec, Canada. BMJ 2009;338:b1673

St John’s wort was compared with a placebo in a double-blind, randomized clinical trial on symptoms and quality of life issues in perimenopausal women. Forty-seven 40 to 65 y.o. perimenopausal women who experienced three or more hot flashes per day were randomized to receive either 900 mg three times daily of a St. John’s wort extract or placebo for 3-months. Hot flash severity and frequency were evaluated and the Menopause-Specific Quality of Life questionnaire was used to evaluate menopause related quality of life.

After 12 weeks, only a small difference was seen favoring St. John’s wort in the frequency of hot flashes. A 30% improvement in 50% of the women was seen in the St. John’s wort group and only 23% in the placebo group. A significant reduction in sleep problems and depression was seen with St. John’s wort and the St. John’s wort group scored significantly better menopause related quality of life.

References

Al-Akoum M, Maunsell E, Verreault R, et al. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause 2009; 16(2):307-314

Folic acid updates for pregnant women

It has been known for a considerable amount of time, that folic acid when given to women planning for pregnancy and during pregnancy, can lower the risk for neural tube defects. Based on the research up to that time, the US Preventive Services Task Force (USPSTF) first published their recommendations in 1996. This has recently been updated and the USPSTF has issued a new statement in May, 2009. Based on the observational evidence and randomized controlled trials published since 1996, the USPSTF found convincing evidence that supplements containing 0.4 to 0.8 mg of folic acid during the preconception period lowers the risk for neural tube defects.[i]

There now appears to be additional benefits for folic acid before conception and during pregnancy, possibly the prevention of cleft lip (BMJ 2007;334:464) and most recently, lowering the rates of severe congenital heart defects. In a Quebec study, investigators observed a drop in the prevalence of severe congenital heart defects after mandatory folic acid fortification of grains. The average prevalence of severe congenital heart defects at birth was 1.64 per 1000 births during the 9 years before the folic acid food fortification began and the rate fell by 6.2% yearly during the seven years studied, after the mandatory fortification.[ii]

Following the recommendation that all women of child bearing age should take a daily supplement containing 0.4 mg to 0.8 mg per day of folic acid is good, safe medicine and perhaps even more beneficial than previously thought.

References

[i] (Woffe T, Takacs-Witkop C, Miller T, Syed S. Folic acid supplementation for the prevention of neural tube defects: An update of the evidence for the U.S. Preventive Services Task Force. May 2009.150; (9): 632-639)

[ii] (Ionescu-Ittu R, et al. Prevalence of severe congenital heart disease after folic acid fortification of grain products: Time trend analysis in Quebec, Canada. BMJ 2009;338:b1673.)

If you’ve not already been alarmed by the push for statins as primary heart disease prevention you will want to know that in 2006, 1.3 million coronary angioplasty procedures were done in the U.S., at a cost of $48,399.00 and 448,000 coronary bypass operations at a cost of $99,743.00. That’s a total of over 104 billion dollars. For those two procedures alone, we spent more than 100 billion dollars in 2006. If these procedures accomplished as much as they cost, that would be one thing, but even the New England Journal of Medicine reported in 2007 that angioplasties and stents do not prolong life or prevent heart attacks in stable patients; stable patients are 95% of those who undergo those procedures. And…. coronary bypass surgery sadly prolongs life in less than 3% of patients. We have good scientific evidence that diet and lifestyle changes can prevent at least 90% of all heart disease. 90%!!!!!! In yet another recent study proving this point, an intervention diet of either low-fat or Mediterranean diet significantly improved cardiovascular event free survival in those who had a previous heart attack.[1]

The well known Lyon Diet Heart Study also demonstrated a survival advantage with the Mediterranean diet.[2]

For both primary and secondary heart disease prevention, we have to step up our game in helping our patients “get religion” about rigorously changing their eating habits, losing weight, exercising a minimum of 30 minutes every day (and for overweight 40 and over women, likely 60 + minutes daily), and of course stopping smoking.

In addition to using nutritional and botanical supplementation to address any lipid or hypertension issues, a diverse approach attending to arterial health and inflammation deserves our attention as well. While questioning statins, we might also want to question our own use of nutraceuticals in treating hyperlipidemia with items such as soluble fibers, soy, red yeast rice, niacin, phytosterols, pantethine, tocotrienols, resveratrol, policosanol, gugulipids or garlic. I have as of yet not abandoned this thinking of improving lipid profiles, but a broader perspective is in order. While of course attending to normalizing blood pressure, (magnesium, potassium, bonito protein, marine omega 3 fatty acids, vitamin D, lycopene, pycnogenol, hawthorne, L-arginine, carnitine, NAC and more) I have also expanded my attention to arterial health with attention to dilatation, anti-inflammation, reduction of LDL oxidation, platelet function and reducing vascular calcification.

I look more to combination ingredients and product formulations that approach cardiovascular health from the multi-mechanism perspective. While not an exhaustive list, items to consider beyond lipid therapies:

Dilatation: L-arginine, quercitin/flavonoids, vitamin C and E, magnesium, co-enzyme Q-10, taurine, garlic, soy

Anti-inflammation: marine omega 3 fatty acids, flax oil, isoquercitin, quercitin/rutin/ flavonoids, resveratrol

Reduce LDL oxidation: niacin, green tea, garlic, pantethine, resveratrol, policosanol, Co-enzyme Q-10

Anti-thrombotic: marine omega 3 fatty acids, garlic, pomegranate, nattokinase, ginger, resveratrol

Reduce vascular calcification: Vitamin K2, marine omega 3 fatty acids

More than 500,000 women die of cardiovascular-related causes annually in the U.S., with approximately 100,000 prematurely, before the age of 65. Starting at age 50, more women die of cardiovascular diseases than of any other condition and women younger than 55 who have a heart attack have a worse prognosis and higher incidence of heart attack-related death than do men of the same age who have a heart attack, as well as a greater chance of having another heart attack. Disability due to cardiovascular disease is also a major concern, especially in older women. And for African-American women, the risk of heart-related death is even greater- it is twice as high as for Caucasian women.

To be successful with our mission of preventing and treating heart disease, and helping women with the difficult challenges of weight loss and lifestyle changes, we must enhance patient education, expand strategies for motivation, improve and broaden plant/nutrient based supplementation prescribing, and continue wise and considered selective/judicious use of pharmaceutical/conventional interventions.

References

[2] De Lorgeril M, Salen P, Martin J, et al. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999;99:779-785.