July 22nd, 2016

Helping with Anxiety During Perimenopause and Menopause

Helping with Anxiety During Perimenopause and Menopause

Although hot flashes get a lot more attention, another common symptom during menopause is an increased feeling of anxiety.

In general, anxiety is twice as common in women than in men. During menopause as well as the time just prior (perimenopause), anxiety in women is especially common due to the hormonal changes taking place. Lower estrogen levels, in particular, are thought to trigger feelings of anxiety in many women.

Defining Anxiety

Anxiety refers to an unpleasant emotional state ranging from mild unease to intense fear. Anxiety differs from fear in that, while fear is a rational response to a real danger, anxiety usually lacks a clear or realistic cause. Though some anxiety is normal and even healthy, higher levels of anxiety are not only uncomfortable but can lead to significant problems.

Anxiety is often accompanied by a variety of symptoms. The most common symptoms relate to the chest, such as heart palpitations (awareness of a more forceful or faster heart beat), throbbing or stabbing pains, a feeling of tightness and inability to take in enough air, and a tendency to sigh or hyperventilate. Tension in the muscles of the back and neck often leads to headaches, back pains and muscle spasms. Other symptoms can include excessive sweating, dryness of the mouth, dizziness, digestive disturbances and the constant need to urinate or defecate. And, along with anxiety of course comes the inability to relax, which may lead to difficulty in getting to sleep and constant waking through the night.

Generalized anxiety disorder (GAD) is characterized by a persistent state of exaggerated worry and fear (at least six months), often when there is little or nothing to provoke it.

Severe anxiety will often produce what are known as “panic attacks”—intense feelings of fear. Panic attacks may occur independent from anxiety but are most often associated with generalized anxiety or agoraphobia. Agoraphobia is defined as an intense fear of being alone or being in public places. As a result, most people with agoraphobia become housebound.

Natural Approaches to Anxiety

As women in their 40s and 50s are going through menopause, declining estrogen levels often produce feelings of anxiety. This link is the result of the effect that lower estrogen levels have on brain’s regulation of moods and emotion. Changes in estrogen levels lead to alterations in important neurotransmitters (brain chemicals that transmit nerve impulses)—including serotonin, norepinephrine, dopamine and melatonin—that play a huge role in how we feel. About one in four women will experience more noticeable anxiety or depression during perimenopause and menopause.

Before offering some suggestions with specific natural products to address anxiety, there are important dietary recommendations that can help during this change of life. Perhaps the most important is simply to increase the consumption of plant foods, especially those high in phytoestrogens, while reducing the consumption of animal foods. Phytoestrogens are plant-derived substances that are able to weakly bind to the estrogen receptors in mammals and have a very weak, estrogen-like effect in some tissues and a weak anti-estrogen effect in other tissues.

Soy foods and flax seeds contain a high content of phytoestrogens and have received a lot of attention as phytoestrogen sources, but many other foods such as apples, carrots, fennel, celery, parsley and other legumes also contain phytoestrogens, though in smaller amounts.

A high dietary intake of phytoestrogens is thought to explain why hot flashes and other menopausal symptoms, including anxiety, appear to occur less frequently in cultures consuming a predominantly plant-based diet. In addition, such a diet is promising for disease prevention, with some research showing a lower incidence of breast cancer and heart disease in women consuming high-phytoestrogen diets.

Fish Oils

Fish oils concentrated for the omega-3 fatty acids EPA and DHA have been shown to have positive effects for patients with many different types of psychological disorders associated with stress, including anxiety, depression, bipolar disorder (manic depression), borderline personality disorder, and attention deficit disorder with hyperactivity (ADHD).

Results from trials in menopausal women showed particularly interesting results. For example, in a 2009 study conducted in Quebec, Canada, 120 women going through menopause were given either a fish oil supplement providing 1,200 mg of EPA+DHA or placebo for eight weeks. The baseline level of hot flashes was an average of 2.8 per day. After eight weeks, the hot flash frequency decreased by 55 percent in the EPA+DHA group, but only 25 percent decrease in the placebo group. Fish oil supplementation was also associated with an improvement in quality of life scores as well as mood.

Black Cohosh

In the last 30 years, black cohosh (Cimicifuga racemosa) has emerged as the most studied of the herbal alternatives to hormone replacement therapy for menopause symptoms. The collective findings in black cohosh studies and long-term clinical anecdotal evidence on black cohosh indicate that it is most effective for menopause symptoms of hot flashes day time or night time, mood swings, sleep disorders and body aches. It also appears to be helpful in reducing anxiety as well as symptoms of anxiety such as heart palpitations.

Some recent studies have used black cohosh extract in combination with other botanical extracts, such St. John’s wort, red clover, soy and chaste berry. Of these, St. John’s wort deserves some additional attention.

St. John’s Wort

As most people even superficially familiar with herbal medicine know, St. John’s wort extract (SJWE) research has focused in the area of mild to moderate depression. Yet, there are several studies that have also been conducted with SJWE to evaluate its effects on menopausal symptoms. These studies have not only shown SJWE to improve mood, but also reduce hot flashes (most significantly after two months of use).

In regard to improving mood, the effects were also most obvious after two months of treatment (at 900 mg per day). Women in the St. John’s wort group reported improvements in psychological symptoms linked to menopause, significantly better quality of life scores, fewer sleep problems, as well as a feeling of sexual well-being.

Maca

Another botanical medicine that can be of great benefit in relieving anxiety during menopause is maca (Lepidium meyenii)—an historic herbal remedy from Peru often used to enhance male sexuality, but which also has some very interesting effects on women. Research on menopausal women using a maca indicates that unlike hormone replacement therapy (HRT) and phytoestrogenic botanicals, maca can increase the body’s production of estrogen—versus simply adding estrogen replacement to the body—and lower levels of cortisol.

What makes this especially interesting is that, from other research conducted on the composition of various powdered preparations of maca root, it appears that the herb does not contain plant estrogen or hormones. It has been suggested that maca’s therapeutic actions rely on plant sterols stimulating the hypothalamus, pituitary, adrenal and ovarian glands, and therefore also affecting the thyroid and pineal glands, thus improving sleep, mood, fertility, energy and hot flashes. As such, maca tends to treat menopausal symptoms as a whole; it doesn’t treat any one specific symptom of menopause (such as hot flashes) alone.

In one double-blind four-month study of early postmenopausal women, patients were given either placebo or two 500 mg capsules of maca twice daily for a total of 2 g/day. After two months, maca stimulated estrogen production and suppressed cortisol. It also had a small effect on increasing bone density and alleviated numerous menopausal symptoms including hot flashes, insomnia, depression, nervousness and diminished concentration.

In regard to these herbal approaches to menopausal symptoms, here is a little clarity:

• Choose one of the following for general symptom relief:
o Black cohosh extract: The dosage of the extract used in the majority of clinical studies has been 2 mg of 27-deoxyacteine twice daily.
o Maca: Gelatinized maca extract 1,000 mg twice daily or dosage equivalent to 3,500 dried, powdered maca root daily.

• If symptoms of anxiety or depression are significant (can be used with either of the two approaches above):
o St. John’s wort extract standardized to 0.3 percent hypericin 900 to 1,800 mg daily

Final Comments

Increased lactic acid levels may be an underlying factor in many cases of anxiety. There are at least six nutritional factors that may be responsible for elevated lactic acid levels in people with anxiety:

1. Alcohol
2. Caffeine
3. Sugar
4. Deficiency of the B vitamins niacin, pyridoxine, and thiamin
5. Deficiency of calcium or magnesium
6. Food allergens
By avoiding alcohol, caffeine, sugar and food allergens, people with anxiety can go a long way toward relieving their symptoms. In fact, something as simple as eliminating coffee can result in complete relief from symptoms of anxiety. This recommendation may seem too simple to be valid, but substantial clinical evidence indicates that in many cases it is all that is necessary!

Dr. Michael Murray
7/22/2016

July 18th, 2016

Dealing with Depression: A Natural Perspective

dealing with depression

Approximately 30 million Americans take antidepressant drugs. That is a mind-blowing statistic. The obvious question is: Why are so many people depressed? There are a lot of theories, but the way a person feels at any point in time is determined by the interplay between two primary factors:

1. Internal focus and attitude:
• Images held up before the mind’s eye
• Self-talk, habitual questions and explanatory style (optimist vs. pessimist)

2. Physiology:
• Breathing pattern, posture, muscular tension and other physical factors (e.g., pain)
• Hormonal, nutritional and chemical factors

Obviously, to truly impact the way a person feels, a comprehensive approach is required that takes into consideration both of these areas and all that they entail. That said, many people are a bit “stuck” and natural products can provide the necessary boost in mood to help make important changes in diet and lifestyle easier to accomplish.

A Quick Look at Antidepressant Drugs

Since the introduction of Prozac in 1987, antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), are now among the world’s most widely prescribed medications, with sales in the U.S. alone of about $20 billion per year. These antidepressants also include brands like Zoloft, Paxil, Luvox, Celexa and Lexapro.

In recent years, the side effects of these drugs, from weight gain and sexual dysfunction to suicidal behavior, have been better defined. In addition, there is growing evidence that in most studies, there is really no difference in efficacy between the placebo and the drug in all but the most severe cases. The presence of unwanted side effects coupled with little real benefit makes these drugs less than an ideal approach.

Approximately 20 percent of patients experience nausea; 20 percent headaches; 15 percent anxiety and nervousness; 14 percent insomnia; 12 percent drowsiness; 12 percent diarrhea; 9.5 percent dry mouth; 9 percent loss of appetite; 8 percent sweating and tremor and 3 percent rash. SSRIs also definitely inhibit sexual function. In studies where sexual side effects were thoroughly evaluated, 43 percent of men and women taking SSRIs reported loss of libido or diminished sexual response.

A recent study published in the official journal of the European College of Neuropsychopharmacology raises a new issue with long-term antidepressant use, adding another reason for consumers to seek alternatives. The study, conducted by researchers at the University of Pisa, Italy, found that antidepressant drugs adversely affected feelings of commitment and attachment towards their partners in both men and women. In other words, the drugs made subjects alienated from their partners. This new study raises another question on the real value of antidepressant drugs on quality of life issues.

Boosting Serotonin Naturally

SSRI antidepressant drugs are thought to work by specifically inhibiting the re-uptake of serotonin at the nerve endings in the brain. As a result, more serotonin is likely to bind to receptor sites on brain cells and transmit the serotonin signal. Serotonin is a very important neurotransmitter derived from the amino acid tryptophan. It is the brain’s own natural antidepressant and tranquilizer. A decrease in serotonin function is thought to be a major cause of depression, anxiety and insomnia.

Serotonin is not only important in controlling your mood and behavior; it also acts as a kind of chemical traffic cop that regulates the activity of many other neurotransmitters. The level of serotonin present in your brain can have a tremendous impact on how you think, feel and behave.

Natural Mood Enhancers

Besides the beneficial effects noted in clinical studies with healthier dietary choices and key nutritional supplements, there are also several natural products that have been shown in double-blind studies to promote a happier state. The better-researched choices are St. John’s wort extract, SAMe, 5-HTP, and saffron extract.

St. John’s wort extract (SJWE) is the most thoroughly researched natural antidepressant. SJWE was once the brightest star in herbal medicine, but a dubious 2002 study funded by the drug company giant Pfizer led to a crushing 97 percent drop in its popularity that year and it has never recovered. Pfizer’s drug, Zoloft, was the number one selling antidepressant at the time. Many experts felt that the researchers stacked the deck against SJW especially since several double-blind studies afterwards showed that SJW is more effective and has fewer side effects than Zoloft and other antidepressant drugs.

A 2008 Cochrane Database Review concluded after reviewing the results from more than 30 double-blind studies with SJWE: “a) is superior to placebo in patients with major depression; b) is similarly effective as standard antidepressants and c) has fewer side effects than standard antidepressants.” Typical dosage levels for SJWE ranges from 900 to 1800 mg daily.

S-Adenosylmethionine (SAMe) is involved in the methylation of important brain chemicals, including neurotransmitters and phospholipids like phosphatidylcholine and phosphatidylserine. Normally, the brain manufactures all the SAMe it needs from the amino acid methionine. However, SAMe synthesis is impaired in depressed patients. Supplementing the diet with SAMe in depressed patients results in increased levels of neurotransmitters, as well as improved binding to receptor sites.

The results of a number of clinical studies suggest that SAMe is one of the most effective natural antidepressants. Overall in the double-blind studies comparing SAMe to antidepressant drugs, 76 percent of the SAMe group showed significant improvements in mood compared to only 61 percent in the drug group. Typical starting dosage is 200 mg twice daily.

5-Hydroxytryptophan (5-HTP) is the direct precursor to serotonin that is able to cross the blood brain barrier and raise brain serotonin levels. As a result, supplementing the diet with 5-HTP has been shown to produce significant benefits in conditions linked to low serotonin including depression, carbohydrate cravings, headaches and fibromyalgia. The typical dosage is 50 to 100 mg three-times per day. Be sure to point customers to use 5-HTP in enteric-coated capsules or tablets (pills prepared in a manner so that they will not dissolve in the stomach) significantly reduce the likelihood of nausea—a very common side effect with non-enteric coated 5-HTP.

Saffron (Crocus sativus) is the world’s most expensive spice because the stigma (the portion of the flower used for cooking) must be hand picked off the flower. To obtain one pound of saffron, a minimum of 50,000 flowers are needed. In Persian traditional medicine, saffron is used for depression. Modern clinical studies now show that saffron extracts are safe and effective for mild to moderate depression, including a study showing efficacy equal to Prozac. The typical dosage for saffron extract is 30 mg per day.

Final Comments

Individuals with depression often need to learn how to set goals, use positive self-talk and affirmations, identify self-empowering questions and find ways to inject humor and laughter into their lives. It is not an easy task, but it is much easier to accomplish when you eliminate the “noise” caused by unhealthy lifestyle and dietary choices, as well as insufficient levels of key nutrients.

In regard to weaning off prescription antidepressants, customers must be encouraged to work with their physician. In general, discontinuing any drug for these conditions has to be done gradually. Stopping an SSRI too quickly is associated with symptoms such as dizziness, loss of coordination, fatigue, tingling, burning, blurred vision, insomnia and vivid dreams. Less often, there may be nausea or diarrhea, flu-like symptoms, irritability, anxiety and crying spells.

To provide support when weaning off of SSRIs, SAMe can be used without concern. Patients are often advised to avoid 5-HTP and other natural products that may impact serotonin levels out of fear of producing what is referred to as the “serotonin syndrome,” characterized by confusion, fever, shivering, sweating, diarrhea and muscle spasms. Although it is theoretically possible that combining these natural products with standard antidepressant drugs could produce this syndrome, to my knowledge no one has actually experienced this syndrome with the simultaneous use of 5-HTP and an SSRI especially at the dosage levels recommended for 5-HTP (50 to 100 mg three times daily).

My general recommendations for helping wean patients off SSRIs is to reduce the dosage of the SSRI by 50 percent and take 50 mg of 5-HTP three times daily and/or 200 mg SAMe daily. After two weeks, reduce the dosage of the SSRI by half again or take the previous dosage every other day. Stay on this dosage for a month before finally discontinuing the SSRI. If needed the dosage of 5-HTP can be increased to 100 mg three times daily and the dosage of SAMe can be increased to 400 mg twice daily.

Dr. Michael Murray
7/19/2016

July 15th, 2016

Quercetin and its Modified Form for Allergies and More

Grapefruit_Schnitt_2008-3-3

Flavonoids are a group of plant pigments largely responsible for the colors of many fruits and flowers. Flavonoids are also responsible for the medicinal actions of foods, juices, herbs and bee pollen and are now known to be directly related to their flavonoid content.

As a class of compounds, flavonoids have been referred to as “nature’s biologic response modifiers” because of their ability to modify the body’s reaction to other compounds, such as allergens, viruses, and carcinogens, as evidenced by their anti-inflammatory, antiallergic, antiviral, and anticancer properties. In addition, flavonoids act as powerful antioxidants, providing remarkable protection against oxidative and free radical damage.

This brief review will focus on the use of quercetin and its more bioavailable modified form—enzymatically modified isoquercitrin (EMIQ).

Quercetin

Quercetin serves as the backbone structure for many other flavonoids, including the citrus flavonoids rutin, quercitrin, and hesperidin. These derivatives differ from quercetin in that they have sugar molecules attached to the quercetin backbone. Quercetin is consistently the most active of the flavonoids in experimental studies, and many medicinal plants owe much of their activity to their high quercetin content.

In preclinical studies, quercetin has demonstrated significant anti-inflammatory and antiallergic activity. It directly inhibits several of the initial steps of inflammation and allergy. For example, it inhibits both the manufacture and release of histamine and other allergic/inflammatory mediators. In addition it exerts potent antioxidant activity. Based on these test tube studies, quercetin is often recommended for use in virtually all sorts of inflammatory and allergic conditions, however there is a lack of clinical studies in these applications with regular quercetin. In a study using EMIQ, very good results were achieved in hay fever (discussed below).

Before discussing the clinical results with quercetin, it is important to address its absorption and metabolism. In human absorption studies, quercetin has been shown to be poorly absorbed with a high degree of variability from one person to the next. Results appear most likely to occur at relatively high dosage levels (e.g., 1,000 mg per day) or by using EMIQ to overcome these shortcomings.

One of the first clinical studies with quercetin was a double-blind study in nonbacterial chronic prostatitis (inflammation of the prostate gland). This condition is characterized by chronic pelvic pain that is worse upon urination. In patients taking quercetin (500 mg twice daily), more than 67 percent had an improvement of symptoms of at least 25 percent. Combining quercetin with bromelain (discussed under in Available Forms) produced even better results (82 percent had at least a 25 percent improvement in symptom score).

By far the most popular application for quercetin is in beverages designed for athletic performance. The commercial success of this application led to significant scientific investigation of quercetin’s ability to improve physical performance. In a number of clinical trials, quercetin was shown to improve mental/physical performance and reduce infection risk.

In one study, of 40 trained male cyclists who received quercetin or placebo before, during, and for two weeks, after a three-day period in which subjects cycled for three hours/day at approximately 57 percent maximal workload, only one of 20 developed upper respiratory infection symptoms in the quercetin group compared with nine of 20 in the placebo group. In another study, reduction in upper respiratory tract infection total sick days and severity was noted in middle aged and older subjects ingesting 1000 mg/day quercetin for 12 weeks who rated themselves as physically fit.

EMIQ

EMIQ is manufactured through a natural enzymatic modification that attaches glucose chains (glycosides) to the quercetin molecule. The result of this modification greatly enhances quercetin bioavailability. In the digestive process the glycoside portion is cleaved liberating the quercetin and as a result EMIQ greatly increases quercetin levels in the blood compared to the ingestion of quercetin or its related compound rutin. Blood levels of quercetin are more than 40 times greater with EMIQ compared to an equal amount of quercetin. Hence, 50 mg of EMIQ would be equal to approximately 1,000 mg of quercetin. Most clinical studies have used a dosage of 200 mg daily of EMIQ. That level would be equal to a whopping 8,000 mg of quercetin.

In Japan, research has shown EMIQ is useful in helping reduce the major symptoms of hay fever. In these double- blind, placebo-controlled studies, subjects suffering from allergy to Japanese cedar pollen, took two capsules daily of 100 mg EMIQ or a placebo for eight weeks during the pollen season. Throughout the course of the study, EMIQ group experienced significantly less red, itchy eyes.

EMIQ also exerts significant effects in reducing body fat accumulation including abdominal (visceral or “belly fat”). The mechanism of action is the promotion of enzymes that promote the breakdown of fat within fat cells. In the first human double blind study, 200 overweight and obese subjects (102 men and 98 women) were randomly divided into two groups and ingested a beverage containing 0 mg or 275 mg of EMIQ for 12 weeks. Abdominal total fat area, visceral fat area, subcutaneous fat area and waist circumference reduced significantly in test group compared to placebo group. The overall reduction in body fat was over 20 percent. A second study by the same research group showed that a dosage of 110 mg per day produced similar benefits.

Available Forms

Quercetin is available alone in powder, tablet, and capsule form as well as in beverages. However, if quercetin is being used for its anti-inflammatory properties, products that combine with an equal amount of the pineapple enzyme bromelain may provide additional benefit. Bromelain exerts anti-allergy and anti-inflammatory activity on its own and may also enhance the absorption of quercetin. Combination preparations of proteindigesting enzymes, like bromelain, and flavonoids have been shown to potentiate each other’s anti-inflammatory activity.

EMIQ is also available in beverages as well as in capsules or tablets. It is absorbed very well on its own, so it is not necessary to combine it with bromelain.

Safety and Drug Interactions

Both quercetin and EMIQ are well tolerated in humans with no side effects noted in the clinical studies. Animal studies have also showed that quercetin and EMIQ have no apparent side effects, even when consumed in large quantities for long periods of time (up to two years). EMIQ has generally recognized as safe (GRAS) status in the United States.

Quercetin and EMIQ may enhance the uptake from the intestine of certain drugs, including vinblastine, cyclosporine, digoxin, fexofenadine, losartan, nifedipine, felodipine, verapamil, and terfenadine. Lower dosage of these drugs may be required to avoid toxicity.