Updated evidence on menopause hormone therapy

A recent panel has re-evaluated the scientific literature since  the 2001 publication of the Women’s Health Initiative in order to determine if hormone replacement therapy is safe long term and for chronic conditions such as bone loss, cardiovascular risk, and / or mood health. The results of this panel are from critical review of 51 published articles and will guide the standard of care for postmenopausal women. Frankly, we’ve learned a lot in the last 11 years and I think this panel did an excellent job of culling the data albeit falling short of offering reasonable and safe solutions to the challenge of increased risk of chronic disease beginning at menopause. But that's okay. It wasn't their goal. 

http://health.usnews.com/health-news/news/articles/2012/05/28/hrt-update-therapy-may-reduce-fractures-boost-some-risks

In full disclosure, I’m an advocate of natural products so my first inclination is the cheer the panel’s recommendation. It has been my read of the last decade of literature as well. However, it is oversimplified to come to the conclusion that HRT is good or HRT is bad. That binary way of thinking is ruinous. I strongly believe there is a definite place for Hormone Replacement Therapy. I also believe it cannot be used as the panacea it once was thought to be. In the case of bone health, we must be ever mindful of the complete physiology. Sure, estrogen inhibits osteoclastic activity and helps to maintain bone mineral density, but other hormones have a role in osteoblastic activity such as progesterone and testosterone. Growth hormone and cortisol have their own effects partially independent of sex hormones and partially dependent on their levels.  Furthermore, we now have evidence that bone morphogenetic proteins, progenitor cells for bone, have cross talk with estrogen and there may be other unknown interactions to other hormones and signals. Some authorities now place osteopenia and osteoporosis, especially precocious bone loss in the inflammatory disease marker, causing us to work through the contribution of cytokines and prostaglandins whose pathways are influenced by estrogen levels. And this is just bone health, not to mention cardiovascular health and other quality of life issues that are also influenced by hormone status. Why is this important to say? Because, we haven’t heard the last of HRT. We will likely come to understand a further undeclared subpopulation that has little to no risk of cancer and cardiovascular incident. However, we aren’t there yet and we have patients in front of us that need our help. This panel’s recommendation brings us one step closer to the truth. What is missing from the conversation and really outside the scope of this article is the reason for hormone imbalance and potential less risky recommendations that clinicians can make today to support not only the symptoms of menopause but also the long term consequences of hormone loss. Personally, I’ve been involved in understanding this exact mode of action. That is, improving the function of what has become known as the HPA or hypothalamus-pituitary-adrenal axis. In fact, there are several axes that we should be aware of that are influenced by an aging hypothalamus. These axes, but particularly the HPA, when supported can stimulate the body’s own production and balance of hormones. In essence, improving this system allows the feedback and control of hormone production to be self-regulating without the burden to liver biotransformation that exogenous hormones appear to have. When a post-menopausal woman can improve her ability to produce her own hormones with changes in menopausal symptoms, bone mineral density scores, and cardiovascular support, then we have something to write about. This approach can be used in conjunction with hormone therapy in order to be in line with the recommendation of smallest dose, shortest duration of time. This is the question that should be asked. “What can we do, today, for women to be on the smallest dose of hormone replacement for the shortest amount of time and still retain quality of life?” The question should not be “is HRT good?”. More research into patient selection criteria is warranted. However, what I’m afraid will happen, at the expense of quality patient care, is disregard for these recommendation with some clinicians refusing to prescribe and others continuing to over-prescribe. We want something with a broad therapeutic window with no history of safety concerns. Something that supports endogenous hormone production so that lowest dose, shortest duration can be honored. We want something that has clinical trials that support efficacy in a broad spectrum of conditions the way HRT does. What we want exists and is available on the market as a natural product. Femmenessence (Maca-GO®) is that commercially available natural product. The following is a technical/ White Paper on the evidence of Femmenessence (Maca-GO®) http://naturalhi.com/downloads/WhitePaper_MacaGO.pdf and links to the abstracts of the peer-reviewed journal articles referenced http://naturalhi.com/Post-Menopause.aspx

They make you fat…and they aren’t food!

What do new car smell, your favorite fragrance, and a plastic bottle have in common? Well, while it sounds like a bad joke, it is quite serious. Each of these and many other common products contain substances called obesogens. That’s right, chemicals that initiate or propagate obesity. Of course, diet and exercise are still real contributors to weight, but the body composition equation runs a coefficient of hormone balance and obesogens disrupt hormone balance….sometimes in a big way!  And don’t think that just because you maintain healthy body weight that this doesn’t apply to you. Obesogens are endocrine disruptors and are the same chemicals that contribute to hormone issues such polycystic ovarian syndrome, amenorrhea, low testosterone, infertility, increased perimenopausal and menopausal symptoms, and certain cancers regardless of what the scale says.

Plasticizers leach from carpets and newly installed car interiors, thus providing that ever so pungent new car smell. In fact, when working with a hormone imbalance patient, I ask questions about exposure to new carpets and cars and after the weird looks, I get the story and excitement of a new “thing”, and then another weird look. Although, more often than not symptoms started or got worse after the new purchase.

If you’re thinking this is just another made up term to scare us or another excuse to rationalize dietary indiscretion, you would be misinformed. Obesogen is a term first coined in 2002 and since then has been cited in 19 peer-reviewed articles, with 6 of those published in 2011 and 4 already in 2012. It is gaining understanding and isn’t going away.

Much like we are learning that certain phytonutrients speak directly to our own genetic material, the hypothalamus, our master gland, and may either potentiate or interfere with enzymes, so too do these environmental chemicals.

The following are four truths as found in the Journal of Andrology:

• “Obesogens are chemicals that directly or indirectly lead to increased fat accumulation and obesity. 
• Obesogens have the potential to disrupt multiple metabolic signaling pathways in the developing organism that can result in permanent changes in adult physiology.
• Prenatal or perinatal exposure to obesogenic endocrine disrupting chemicals has been shown to predispose an organism to store more fat from the beginning of its life.
• This suggests that humans, who have been exposed to obesogenic chemicals during sensitive windows of development, might be pre-programmed to store increased amounts of fat, resulting in a lifelong struggle to maintain a healthy weight and exacerbating the deleterious effects of poor diet and inadequate exercise.”[1]

So it really may be true that some people are literally programmed to be fatter. However, that doesn’t mean that it is inevitable or uncontrollable. We are all dealt a different deck. Not all of us have the genetic material to be Olympic athletes and some that do, do not participate in the required training to compete, thus illustrating the contributions of both how we were made and what we’re exposed to. Where this becomes vitally important is during the reproductive years. Preconception programs often address helping moms-to-be and dads-to-be engage in healthy behaviors, optimizing hormone levels, improving detoxification, and reducing exposures to toxins. This is one such sensitive windows where obesogens can wreak havoc on metabolism…prior to conception!

The list of obesogens include phthalates also known as plasticizers are also found in personal care products such as shaving creams, colognes, and lotions, Bisphenol A (BPA) is found in plastic bottles and polyvinylchlorides found in shower curtains.

Recent changes at Whole Foods Market address possible concerns with obesogens. Dr. J. Renae Norton describes these changes in a two part series (Part I and Part II).

However, you can drive yourself crazy thinking about avoiding these chemicals. Most of them are released for absorption through your skin or ingested when plastics are heated. Avoiding hot plastics is a good step in the right direction but total avoidance is likely not possible with these nearly ubiquitous chemicals. Additionally, though, you can support the excretion of these chemicals through supporting liver, kidney, and bowel function on a daily basis.  Glutathione levels are perhaps most important if we zoom in single markers of the body. Glutathione acts as a free radical scavenger and also supports liver function. Without the bowel and kidneys functioning at their best, these chemicals cannot be eliminated. Supporting kidney function can be done with Sole therapy using Original Himalayan Crystal Salt and pH Quintessence on a daily basis. The pH Quintessence product also supports liver function, glutathione levels and bowel motility, making it a versatile and easy to use product. While obesogens may have programmed you to gain weight faster than normal and caused hormone imbalance, supporting the hypothalamus, the master gland, can help send the right signals to the right glands that need help the most while your body restores homeostasis. The hypothalamus talks to the pituitary gland and these two partners then communicate to the thyroid gland, pancreas, adrenal glands, ovaries, and testes. Natural Health International has introduced products for men well as different stages of life for women (Premenopausal, Perimenopausal, and Postmenopausal) to support comprehensive endocrine balance without introducing hormones from outside the body but rather supporting hypothalamus and pituitary function and all their downstream metabolic effects.

Obesogens are a serious chemical insult, but with some awareness of their effects, can be minimized and our bodies fully supported.

---

[1] Janesick A, Blumberg B. Obesogens, stem cells and the developmental programming of obesity. Int J Androl. 2012 Feb 28. doi: 10.1111/j.1365-2605.2012.01247.x.

St. John's Wort and Menopause

St. John’s wort products and extracts have been used for a wide range of medical conditions, the most common being depressive disorders. The most robust research is in the area of mild to moderate depression, with some additional research in anxiety, severe depression, seasonal affective disorder, premenstrual syndrome, and perimenopause/menopause. St. John’s wort is the most thoroughly researched natural antidepressant, but the majority of these studies have not been conducted on menopausal women.

A study of St John’s wort liquid extract showed a statistically decline in hot flashes severity, duration and frequency in the SJW group compared to placebo at week 8.[1]

Another double blind randomized clinical trial demonstrated that after 3 months of treatment, women in the St. John’s wort group reported significantly better quality of life scores, and significantly fewer sleep problems compared to placebo. [2]

About ten years ago, a non placebo controlled, drug monitoring study was conducted in women with menopause symptoms using 900 mg of St. Johns wort for 12 weeks. About three quarters of the women experienced improvement in both the self-rating scale and the physician rating, and significantly improved in psychological and psychosomatic symptoms as well as a feeling of sexual well-being.[3]

The first of three studies using St. John’s wort and black cohosh was published in 1999. This double-blind, randomized, placebo-controlled trial used St. John’s wort and black cohosh made by the makers of Remifemin.[4] The Kupperman index for the combination product decreased from 31.4 to 18.7 compared with a decrease in the placebo group from 30.3 to 22.3. Psychological symptoms also improved significantly in the black cohosh/St. John’s wort combination group.

A double-blind randomized placebo-controlled study was done using a combination trial of black cohosh and St. John’s wort. The mean Menopause Rating Scale score decreased 50% in the treatment group and 19.6% in the placebo group.[5] The Hamilton Depression Rating Scale score decreased 41.8% in the treatment group and 12.7% in the placebo group. In both testing measures the St. John’s wort + black cohosh group was significantly superior to the placebo group.

Another black cohosh/St. John’s wort trial was carried out in peri or postmenopausal Korean women, and was published in 2007.[6] Mean Kupperman index scores at 4 and 12 weeks were significantly lower in the treatment group (P < 0.002). At the end of the study, the average decrease in the Kupperman Index was 20 points in the treatment group and only 8.2 points in the placebo group (P < 0.001). Vaginal dryness and low libido were two symptoms that did not improve, but the average hot flash scores were significantly lower in the black cohosh/St. Johns wort group.

Finally, a study was done in which a combination of black cohosh with or without St. John’s wort was used in 6141 women at 1287 outpatient gynecologists in Germany in a prospective, controlled open-label observational study.[7] The greatest changes occurred with the combination therapy for nervousness/irritability and mood swings, but in the area of depression, there was a reduction in both treatment groups.

St. John’s wort is emerging as an important clinical tool in treating perimenopausal/menopausal women—for hot flashes and/or depression and/or mood swings, as a single agent, or in combination with other therapies.

For more blogs and information from Dr Hudson go to http://www.drtorihudson.com

References


--------------------------------------------------------------------------------

[1] Abdali K, Khajehei M, Tabatabaee R. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17(2): 326-331.

[2] Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin S. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009 Mar-Apr;16(2):307-14.

[3] Grube B, Walper A, Whatley D. St. John’s wort extract: Efficacy for menopasual symptoms of psychological origin. Adv Ther 1999;16:177.

[4] Boblitz N, Schrader E, Henneicke-Von Zepelin H, et al. Benefit of a fixed drug combination containing St. John’s wort and black cohosh for climacteric patients-results of a randomised clinical trial )poster presentation from 6th Annual Symposium on Complementary Health Care, Exeter, England, December 2-4 1999). Focus Alt Comp Ther 2000;5(1):85-86.

[5] Uebelhack R, Jens-Uwe Blohmer, et al. Black cohosh and St. john’s wort for climacteric complaints. Obstet Gynecol 2006;107:247-255.

[6] Chung D, Kim H, Park K, et al. Black cohosh and St. John’s wort (GYNO-Plus) for climacteric symptoms. Yonsei Med J 2007;48(2):289-294.

[7] Briese V, Stammwitz U, Friede M, et al. Black cohosh with or without St. John’s wort for symptom-specific climacteric treatment- Results of a large-scale, controlled, observational study. Maturitas 2007;57:405-414.

Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients by Dr Tori Hudson

A prospective observational study was carried out in 50 breast cancer patients on tamoxifen, an anti-estrogen therapy that can also induce or worsen menopausal symptoms. All 50 women were post surgery, 87% of them were post radiation treatment and approximately half of them had received chemotherapy as well. Each patient was treated with an isopropanolic extract of black cohosh (1-4 tablets, 2.5 mg) for 6 months. Symptoms were recorded before therapy and after 1, 3 and 6 months using the menopause rating scale (MRS II).

Results: The total MRS II score for women while on black cohosh treatment reduced from 17.6 to 13.6, a statistically significant reduction. Symptoms of hot flashes, sweating, sleep problems, and anxiety improved, but vaginal dryness and body aches/pains did not change. Twenty two patients reported adverse events, but none were linked with the black cohosh; 90% of the women reported the tolerability of the black cohosh extract as very good or good.

Commentary: This is one more positive study using black cohosh extract for menopausal symptoms and even more meaningful, women on tamoxifen can have more problematic menopause symptoms and so a significant benefit of black cohosh is especially needed. Readers will also want to be reminded that we do have safety data on black cohosh in breast cancer patients—there is no estrogen in black cohosh, no phytoestrogens in black cohosh, no ability to stimulate breast cancer cells and laboratory data showed that black cohosh inhibited proliferation of estrogen receptor positive breast cancer cells and augmented the anti-estrogen effect when using black cohosh with tamoxifen. Black cohosh is clearly the first choice herb for menopause symptoms in breast cancer patients, and in breast cancer patients on tamoxifen.

Reference:

Rostock M, Fischer J, Mumm A, et al. Black cohosh (Cimicifuga racemosa) in tamoxifen-treated breast cancer patients with climacteric complaints – a prospective observational study. Gynecol Endocrinol. 2011 Jan 13;

For more information about Dr Hudson go to http://www.torihudson.com

St. John's Wort and Menopause by Dr Tori Hudson

Several studies of St. John’s wort alone and St. John’s wort with black cohosh have been able to demonstrate that these products are good options for perimenopausal and menopausal women with hot flashes, mood issues, sleep problems and quality of life.

In the newest of the St. John’s wort studies in perimenopausal/menopausal women, a total of 100 Iranian women with an average age of 50 participated in a randomized, double-blind, placebo-controlled clinical trial comparing St. John’s wort with placebo in the treatment of hot flashes.[1] 50 women received 20 drops three times daily of St. John’s wort extract (Hypericin) that contained hypericin 0.2 mg/mL and 50 women received a placebo of distilled water. The study duration was two months. Clinical exams and interviews were performed at baseline, 4 weeks and 8 weeks. Treatment effectiveness was measured evaluating frequency, duration and severity of hot flashes as the main objective of the study.

In women taking St. John’s wort, the frequency began to decline during the 1st and 2nd months, but showed more improvement during the 2nd month. There was no statistical change in hot flash frequency during the first month of placebo but did improve during the second month. Women who used St. John’s wort showed more improvement in hot flash frequency than placebo. The decline in duration of hot flashes was statistically significant at week 8 and the decline was much more evident in the St. John’s wort group. The severity of hot flashes was relieved in the St. John’s wort group during the 2 months of treatment and was more significant in the second month. Women in the placebo group did not show any significant decrease in severity of hot flashes during the 1st month, but they did have some improvement during the 2nd month, but not as great as those women in the St. John’s wort group.

Comments
St. John’s wort has emerged as an important clinical tool in treating perimenopausal/menopausal women—for hot flashes and/or depression and/or mood swings, and/or sleep problems either as an encapsulated standardized extract from 300 mg twice per day to three times per day, or a tincture/liquid extract ½ tsp 2-3 times per day, or in combination with other menopause therapies such as black cohosh, maca extract, kava or others.

Reference
[1] Abdali K, Khajehei M, Tabatabaee R. Effect of St. John’s wort on severity, frequency, and duration of hot flashes in premenopausal, perimenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Menopause 2010;17(2): 326-331.

Maca - as posted on the forum What Nobody Tells You About Maca Root Powder – Dangers And Side Effects

Firstly thank you for your input Nan and Tim. Also I want to make a disclaimer that I am the CEO of Natural Health International www.naturalhi.com and we produce Maca-GO which is the ingredient in Femmenessence our women’s product and Maca-OG the ingredient in Revolution Macalibrium our men’s product. FYI these are NOT normal maca products they are concentrated, pre gelatinized and specific phenotype combinations of maca.

I think this blog is very interesting as it taps into all the good, bad and ugly in our industry in one. The below is not meant to be an advertisement for NHI but instead giving you some real insights into our industry and what we do, to try and do everything right. Our products only cover certain areas of health so I am a consumer just like you and I pick companies apart before I buy their products because I know what they can do if they chose to and are willing to go the extra mile. I am also going to post this on our blog http://naturalhealthint.blogspot.com so please feel free to ask me additional questions there.

The first point I would like to address is that statistically in medicine they estimate that no matter what product you use around 5-10% of the population will either have no reaction or an adverse reaction. So straight away even the best product on the planet 1 out of 20 people or even slightly higher it wont work. What we see with many products is even lower - say for example looking at women’s health – Black Cohosh (60% success rate), Red Clover and Soy (45%-55%) and many others which are even lower. Also these success rates fail to point out that while they may be 60% effective (ie 6 out of 10 women they work for) but they may only reduce symptoms statistically significantly eg 50%-60% instead of highly significantly. As an aside Hormone Replacement therapy has a 90% success rate and 80%-100% reduction in symptoms which is why so many women use it. Obviously it has lots of risks but when you see those statistics and understand how people can play with them it gives you an idea of the huge variance between natural products and pharmaceutical products. In relation to Femmenessence (Maca-GO) we had an 84% success rate and highly significant reductions over 80%. The other aspect that isn’t pointed out is which symptoms? Black Cohosh, Red Colver and Soy we see reduce hot flashes and night sweats but in Bio identical and Femmenessence we see changes in mood, vaginal dryness, mood and many other areas of health which relate to hormones.

Secondly who’s research. Let me assure you 99% of ALL research is paid for either directly or indirectly by a company. The question is who conducted the research? Was it a doctor in a clinic who works for the company or was it done by a third party who does not have a financial interest in the success of the product and has their own credibility to consider like a University. How many people was it done on? Did they do pharmacology and toxicology? Was there an ethics commit and credible board determining the methodology? What was the methodology of the trial and was it not just subjective like many herbal clinical trials are – by that I mean was there actually something tangible that we could measure like cholesterol, hormones, bone density instead of just how do you feel? Also was the research actually done on that exact product or someone else’s and they used it. And most importantly where was this research published? Was it in a peer reviewed credible medical journal or just written up by the company. Which third party doctors have then reviewed the research and given positive comments or even use the product with patients? What you will find with maca is nearly all the research was done on someone else’s product and companies are piggy backing off that research. The credible research you will see has been done by Dr Gonzales in Peru primarily on men and Dr Meissner on women. This research has been published in international medical journals. As an aside we had an ethics commit of over 12 experts in Europe, our trial was conducted by the Institute of Medicinal Herbs in Europe and our double blind placebo controlled clinical trial was conducted on hundreds of women measuring every hormone from estrodiol, progesterone, LH, FSH, thyroid etc to lipid, cholesterol, bone density and all menopausal symptoms. It was conducted at three geographically displaced hospitals with different socio economic groups. The research has been published in Menopause (which is published by the North American Menopause Society and group funded by mainstream and pharmaceutical companies which as you can imagine would be very discerning of natural products like ours) also Pharmacology and Toxicology and the International Journal of Biomedical Science. Taking it even further some of the most influential doctors in women’s health in the world have reviewed it and written about it such as Dr Christiane Northrup (Oprah’s Women’s Health expert), Dr Tori Hudson regarded as the top Naturopathic Doctor in the US for women’s health, Dr Toru Tabei in Japan, Dr Maryon Stewart in the UK and Jan Roberts best selling author, practitioner and expert in fertility in Australia.

Thirdly as Tim has emphasized where do the companies get their products? Most of the companies in our industry are marketing companies. They don’t do their own research, don’t have their own manufacturing and don’t grow their own herbs. Know who you are getting products from and where they get their products. Also are they organically certified, kosher, GMP, fair trade etc. depending on your beliefs and what is important to you. Natural Health International is vertically integrated in that we have our own fields, manufacturing and control the whole process. We are USDA, European Union and Japanese Organically certified as well as GMP, Kosher and Halal. We have joint ventures and mutually beneficial relationships in every country where we co own with the local people all operations. We value add in each country instead of exporting simple raw materials which increases the revenue into those countries and creates industries not just trade.

And finally what are the claims companies made based on? Which products, what research or what anecdotal evidence. In relation to maca anecdotally we have seen that if Peruvian’s with their genetics and gastro intestinal profile consume cooked, high quality maca, in food amounts (ie higher doses) for extended periods of time ie years - yes their hormones will be in balance (although there is no scientific evidence of this), they will experience improved fertility, energy and health. What we have seen with American’s is that generally they will see the same benefits (if they take it longer term as mentioned above) with the caveat that SOME will have gastro intestinal reactions, some will have other adverse reactions, some need much lower doses, many have other conditions which need to be addressed first. The important fact to point out is NO research on normal maca has been able to prove scientifically effects on hormones in peri and post menopausal women, increases in bone density, improvements in cholesterol and lipids except Maca-GO (Femmenessence). Why? We believe that to date the combinations of maca types used have been focused on men’s health, low concentrations and low bio availability. This doesn’t mean that we wont have research from other companies in the future like ours, it is just to date no one has been able to mirror our results which is why we have doctors, pharmacists and medical groups talking about and using Femmenessence and such mixed results with normal maca. But again as mentioned Femmenessence is only 84% effective which means 3 women out of 20 it doesn’t work for or have reactions.

I hope this information helped. I am definitely trying to get our information out there because I too believe this is an amazing herb and don’t want people to be disheartened if they get the wrong product for them. Personally I believe any women wanting to use maca for women’s health issues should use Femmenessence (there is one for younger, peri and post menopausal women). Any woman or man wanting to increased energy and a general super food for smoothies look to an organic, gelatinized maca powder specifically black maca as Tim pointed out. Any man with low hormone levels and cardiovascular health – Revolution macalibrium.

Regards,

James Frame
CEO
Natural Health International

Are you using the right type of Maca

By Peter Bablis D.C., N.D., LAc, Dip. Medical Herbalist, Homeopathy, Dip. Clinical Nutrition, PhD
As a college lecturer, integrative doctor, and medical herbalist, I have used as well as keenly followed the research into the herb Maca (Lepidium peruvianum) over the past five years. In my practice, and in keeping with the research of the late nineties, my focus has always been Maca’s use for men in relation to fertility and energy. I used a standard Maca powder for this application with fair success but had never really seen strong or consistent results in women except for improved general energy and wellbeing. However over the last five years, the focus of my lectures and use of particular products has shifted as I have become aware that not all Maca is the same.

About Maca

Maca is an adaptogenic herb cultivated exclusively in the central Peruvian Andes at 12-14,000 feet under harsh natural growing and weather conditions. Adaptogens are an extremely rare class of herb that modulates the body’s response by supporting it in dealing with physiological, biochemical, and psychological stressors1. So rare in fact that Russian researchers studying the mode of action of over 4000 plants found only 12 true adaptogens amongst them. Other common adaptogenic plants include Ginseng, Ashwagandha, Eleuthero, Holy Basil, Licorice, Rhodiola and Schisandra.

Maca has a wide range of active constituents including amino acids, glucosinolates, phytosterols, and alkaloids. But rather than trying to break down and standardize individual active constituents within Maca, it is more interesting to investigate the full spectrum of active constituents of specific phenotypes (Phenotype: the observable physical or biochemical characteristics of an organism, as determined by both genetic makeup and environmental influences) and the natural synergies of all the active constituents that exist in the individual
phenotype. Research has demonstrated that there are in fact 13 different phenotypes within the species Lepidium peruvianum (Maca) that exhibit different colors, have different analytical profiles and even in some cases elicit different physiological effects on the body2.The Importance of the Phenotypes of Maca Dr. Gustavo F. Gonzales from the Universidad Peruana Cayetano Heredia in Lima, Peru has published some very interesting research regarding different Maca phenotypes in relation to men’s health1. As an example, his research has demonstrated that while the red Maca phenotype will reduce the size of a prostate, other phenotypes won’t, or may even increase the size, while black Maca is considered the strongest in energy-promoting properties3. In addition, Dr. Henry Meissner (Director of Research and Development at Natural Health International San Francisco CA) has published some potentially ground breaking papers on specific, concentrated Maca phenotype combinations. Known as Maca-GO® (or commercially
as Femmenessence), these combinations specifically affect hormone levels in post menopausal women4,5. In the double blind, placebo crossover human trials conducted by Meissner, he found that specific phenotype combinations and concentrated levels of all the active ingredients are critical to ensuring actual, measurable physiological effects on hormones, lipids and bone density6,7. Meissner’s research has further evolved this concept of different phenotypes by introducing three concentrated phenotype combination products for women depending on their stage of life. The Femmenessence MacaPause phenotype combination is designed to improve a
post menopausal women’s hormone production. This combination has resulted in statistically significant increases in estradiol (P<0.001), increases in progesterone and reductions in FSH (P<0.05), with highly significant reductions in menopausal symptoms as well as increases
in HDL “good cholesterol”, reductions in LDL “bad cholesterol”, triglycerides and body weight as well as increases in bone density8. The Femmenessence MacaLife phenotype concentrated combination is designed to reduce menopausal symptoms and modulate mood associated with peri menopause and the fluctuation of hormones during this stage of life and Femmenessence MacaHarmony is for younger women to address hormone imbalance and PMS and improve fertility9,10,11,12.

My Clinical Experience

In my clinic, I have seen first-hand the effect of using specific Maca phenotypes for specific populations. As opposed to just “feeling better”, my female patients have experienced actual physiological changes in hormone levels after using the different Femmenessence phenotype combinations. Addressing conditions ranging from amenorrhea, PMS and adrenal fatigue to menopausal symptoms and heart and bone health6. It is within this range of benefits, derived from combining individual phenotypes in specific ratios and concentrating the full spectrum of active constituents, that I have found surpasses normal adaptogenic Maca products, which are generally random combinations of the different phenotypes mixed together. Furthermore they are not concentrated, which may be beneficial for general wellbeing and energy but not for specific clinical uses. Alternatively, I have also used a different phenotype combination in men to reduce prostate size and another combination to counter adrenal fatigue2.

Quality Matters

Another factor in relation to Maca is the bioavailability and concentration of the active ingredients required to elicit physiological effects4,5,13. Quality of seed sources and soil content, as well as organic or biodynamic growing strategies and drying methods, all play a part in maximizing the quality of all active constituents. Interestingly, the higher elevation, region-specific quality soil (not necessarily from certain regions of the depleted Junin Plateau), and traditional sun-drying the crop at elevation over a period of three months (not in tobacco dryers in Lima), have all been shown to contribute to the highest quality raw material. In relation to manufacturing, Maca is a tuber and is naturally hard to digest raw. For that reason the native Peruvians traditionally cooked Maca the same way we would a potato. Scientifically this process of improving bioavailability has been addressed through gelatinization, with Meissner (Natural Health International) and La Molina University being the leaders in developing their own processes. Meissner has perfected the process to such a degree that Maca-GO® (Femmenessence) is 99.9% water soluble4.

As the natural products industry continues to evolve, it is critical that we combine the best of traditional knowledge, organic and biodynamic-type farming practices with the highest levels of science, manufacturing and quality control. All herbs are not created equal therefore it is important to investigate them in detail, support their use with pharmacology, toxicology and human placebo controlled clinical trials and use efficacious products with therapeutic levels that elicit real health benefits.

Reference:
1 Winston D, et al. Adaptogens. Herbs for Strength, Stamina, and Stress Relief. Healing Arts Press 2007
2 Gonzales GF, et al. Red Maca (Lepidium meyenii) reduced prostate size in rats. Reproductive Biology and Endocrinology 2005, 3(5) 14
3 Skyfield Tropical: Free Online Botanical Encyclopedia Maca (lepidium peruvianum): Botanical Characteristics
4 Meissner H.O., Mrozikiewicz P.M., Bobkiewicz-Kozlowska T. et al. Hormone-balancing effect of pre-gelatinised organic Maca (Lepidium peruvianum Chacon):
(I) Biochemical and pharmacodynamic study on Maca using clinical laboratory model on ovariectomised rats. I. J. B. S., 2006; 2: 260
5 Meissner H.O., Kapczy_ski W., M_cisz A. et al. Use of Gelatinised Maca (Lepidium peruvianum) in Early--Postmenopausal Women - a Pilot Study. I. J. B. S., 2005; 1: 33
6 Carter R. Clinical Effects of a Proprietary, Standardized, Concentrated, Organic Lepidium Peruvianum Formulation (Maca-GOÆ) as an Alternative to HRT 2007
7 Meissner HO, et al. Use of Gelatinized Maca (Lepidium peruvianum) in Early Postmenopausal Women—a Pilot Study. IJBS 2005, 1(1):33-45
8 Meissner HO, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (II) Physiological and Symptomatic Responses of Earlypostmenopausal
Women to Standardized Doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre Clinical Study. IJBS 2006, 2(4):360-374
9 Gonzales GF, Cordova A, Gonzales C, et al. Lepidium meyenii (Maca) improved semen parameters in adult men. Asian J Androl 2001, 3(4):301
10 Obregon LV. “Maca” Planta Medicinal y Nutritiva del Peru. 1 Edition Lima: Instituto de Fitoterapia Americano. 2001, 1-182
11 Chacon de Popovici, Gloria. Maca (Lepidium peruvianum Chacon), Millenarian Peruvian Food Plant, With Highly Nutritional and Medicinal Properties. 1st Edition.
Universidad Nacional Mayor de San Marcos. Lima, Peru. 2001, 1-337
12 Chacon G. Pytochemical study on Lepidium meyenii. PhD Thesis. Universidad Nacional Mayor de San Marcos. Lima, Peru. 1961, 1-46
13 Meissner H.O., Kedzia B., Mrozikiewicz P.M., et al. Short- and Long- Term Physiological responses of Male and Female Rats to Two Dietary Levels of Pre-Gelatinised Maca
Lepidium peruvianum Chacon). I.J.B.S., 2006; 2: 15

St. John's Wort and Perimenopause by Dr Tori Hudson

This double-blind, randomized clinical trial, studied the effect of Hypericum perforatum extract (St. John’s wort extract) compared with placebo, on symptoms and quality of life of 47 symptomatic perimenopausal women aged 40 to 65 with three or more hot flashes per day. Women were randomly assigned to receive a St. John’s wort extract (900 mg three times per day) or placebo. The women used a daily diary to record hot flash severity and frequency during the week before the study group selection process and again for a week before the end of the three month follow-up. The Menopause-Specific Quality of Life questionnaire was also used.

RESULTS: After 12 weeks of treatment, a non-significant difference in favor of the St. John’s wort group was observed in the daily hot flash frequency and the hot flash score. However, after those three months of treatment, women in the St. John’s wort group reported significantly better quality of life scores, and significantly fewer sleep problems compared to placebo.

Commentary: St. Johns wort research is expanding into the realm of use for perimenopause and menopause symptoms. Other recent studies have reported improvement in psychological, well-being and quality of life in symptomatic perimenopausal and menopausal women. In the current study, while not especially helpful for hot flashes, there was an improvement in quality of life scores and sleep problems. I commonly use St. Johns wort with black cohosh for women with hot flashes and mood issues during perimenopause and menopause. The research on each and even two studies using the combination of the two reveal that these two plants in combination are a premium option for perimenopausal and menopausal women with some of the most common of symptoms.

For more information on St. John's Wort http://www.naturalhi.com/Products/StJohnsWort.aspx

For more blogs, information and events with Dr Hudson preseting please go to http://drtorihudson.com/

Reference
Al-Akoum M, Maunsell E, Verreault R, Provencher L, Otis H, Dodin S. Effects of Hypericum perforatum (St. John’s wort) on hot flashes and quality of life in perimenopausal women: a randomized pilot trial. Menopause. 2009 Mar-Apr;16(2):307-14

Your Health & the Healthcare Industry

The terms integrated and holistic health now include so many different therapies and health modalities that many consumers, patients and doctors alike are getting lost in the maze, or overwhelmed with choices. This Blog has been written to offer information, guidance and opinions on all therapies based on experience, research and inside knowledge. It will also offer advice and information on specific key health concerns such as fertility, cancer, menopause, osteoporosis, PMS, sleep disorders, heart disease, how to lose weight healthily, nutrition and the list goes on.

Let me start with the premise that I believe that your health should be founded on addressing four key areas: Diet & Nutrition, Exercise & Movement, Environment & Lifestyle and Empowerment (this includes emotional and spiritual health as well as attitude to your health and knowledge). This foundation should be aligned with treatment or wellness therapies that are in line your own person health time line, your own belief system and combined to form your own person health plan.

Your own personal health time line relates to your personal health situation at that time. For example if your liver has failed and you need a transplant, dialysis is only going to do so much and milk thistle isn’t an option. However if you aren’t at this critical stage on your own health time line there are a variety of therapies whether they are allopathic or complementary that offer you solutions. Your healthcare choices are very much a personal decision and this Blog will simply put forward options, information and advice based on knowledge and a vast amount of experience by our blogging team. This Blog will also comment on events and realities in the health and natural products industry which being on the “inside” gives us access to and that I think it is important to make known to the public.

The natural products industry we believe is no different to every other industry and is focused on making money. Making money isn’t a bad thing as books like Sacred Commerce discuss. If business creates a win/win/win result for the consumer, employee, company, community, environment and everyone involved. It is when companies, whether consciously or unconsciously, create a win/lose scenarios that business becomes a negative relationship. However fortunately there are a number of individuals and companies that do try to make a difference, have the best quality products and focus on win/win/win results.

One of my personal business philosophy’s is that if you put people before profit, profit will come.

Please leave me your comments and questions and our team will always get back to you.

Regards,

James