Archives for October 2012

Chasteberry, Vitex agnus-castus

An Herb for the Gynecologist’s Toolbox

Chastetree, vitus-agnus-castus
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Chastetree (Vitex agnus-castus) has been used since ancient Greece and is thought to have many gynecologic uses due to some of the plants compounds similar to human sex hormones.  In medieval Europe, it was thought to reduce sexual libido and was used by clergymen, hence it’s other name of “monk’s pepper”.  The plant found it’s way to Germany and in the 1940-50’s; research took place supporting its use in menstrual disorders, without affecting sexual libido.

Irregular periods, premenstrual syndrome (PMS), and cyclic breast pain encompass a majority of the common gynecologic complaints in my daily practice.  Really, the only conventional pharmaceuticals available are hormones, in the form of birth control pills to regulate cycles or anti-depressants for the psychological symptoms.  For women who don’t need a contraceptive method, I find most want to avoid taking hormones.  Others with the emotional premenstrual symptoms fear the side effects of anti-depressants.

In an attempt to offer alternatives that are supported by current evidence and potentially with fewer side effects, I came across chastetree.  This plant sounded like a good alternative and I wanted to see if there was actual research to support its use for some of these common gynecologic issues.

At it’s mechanistic level it appears the main way chastetree works is by its effects on prolactin and progesterone.  By binding dopamine receptors in the brain it inhibits prolactin, which has been shown to reduce breast pain.  Additionally, it also seems to increase progesterone secretion, and that can help regulate the second half of the menstrual cycle (Du Mee 1993).

Compared to some of the side effects of the normal hormonal methods or anti-depressants that I often prescribe, the side effects described are mild.  These include gastrointestinal complaints, dizziness, headache, tiredness and dry mouth (Roemheld-Hamm 2005).

In other countries, herbal medicine seems to be much more accepted and many physicians in Germany prescribe chastetree formulations to their patients, so why can’t we?  Specifically, in the case of chastetree, the German Commission E, a group evaluating the use of herbs, has approved it for irregular cycles, PMS and breast pain (Blumenthal 2000).  Maybe it’s time that the United States researches and, if evidence suggests, embrace alternative methods for the health benefit of its citizens.  The bulk of research in the United States is conducted by pharmaceuticals and they have little to gain from herbal remedies (but that’s for another blog entry) so the little research that is out there comes from other countries or in some cases, from academic institutions.

So, what is out there in terms of research?  Very little randomized studies, but a couple that supports its use.

In one randomized study, after 3 months more than half of 170 women experienced a 50% or greater reduction in premenstrual symptoms (Schellenberg 2001). Another showed improvement in self-reported severity of PMS symptoms, with global improvement and overall benefit versus risk (p=0.001; NNT=4). In another trial, chastetree reduced symptoms of edema, constipation, irritability, depressed mood, anger, headache, and breast pain (Roemheld-Hamm 205).  Cyclic breast pain was the focus in another study that demonstrated a decrease compared to placebo after 3 menstrual cycles (Wuttke et al 1997).

Other vitamins may be as effective in helping with menstrual symptoms.  For instance, another study found that Vitamin B6 and Chasteberry both decreased symptoms by nearly 50%, but the sample size was small (Lauritzen et al 1997).

Another issue is that the studies use varying doses and formulations. Fruit extract dose is 20-40mg daily but I also came across doses of 240-500mg daily and higher doses (up to 1800mg daily) being used.  Extracts (40 drops daily) and tincture (35-45 drops three times a day) are also available.  In the United States there is a marketed product called Femaprin (325mg), which also contains Vitamin B (100mg) by Nature’s Way, which would likely be safest to recommend to patients.

Based on these findings and the fact that physicians in other countries recommend chastetree, I feel comfortable now making the recommendation for irregular periods, premenstrual symptoms, and cyclic breast pain.

Finally, another tool in my gynecology toolbox that can potentially benefit my patients!

 

REFERENCES:

1. Blumenthal M (2000).  German Federal Institute for Drugs and Medical Devices.  Commission E.  Herbal Medicine:  Expanded Commission E monographs.  1st ed, Newton, Mass:  Integrative Medicine Communications.

2. Du Mee C (1993).  Vitex agnus castus.  Aust J Med Herbalism; 5:63-65.

3. Lauritzen C, Reuter HD, Repges R, Bohnert KJ, Schmidt U.  Treatment of premenstrual tension syndrome with Vitex agnus castus.  Controlled double-blind study versus pyridoxine.  Phytomedicine 1997;4:183-9.

4. Roemheld-Hamm B (2005).  Chasteberry.  Am Fam Physician; 72,5:821-824.

5. Schellenberg R (2001).  Treatment for the premenstrual syndrome with agnus castus fruit extract: Prospective, randomized, placebo controlled study.  BMJ 322:134-7.

6. Wuttke W, Splitt G, Gorkow C, et al.  Treatment of cyclical mastalgia; Results of a randomized, placebo-conrolled, double-blind study [in German] Geburtshilfe Frauenheilkd 1997;57:569-74.

 

DISCLAIMER:  **Speak to your own gynecologist before starting any medication, as this product hasn’t been FDA approved.  Your personal physician should evaluate potential causes of your symptoms before recommending management.**

 

 

 

Environmental Laws – California 2012

COMPLETED!

Food & Water – For your protection!

I’m continuing the saga of learning about all the new environmentally oriented laws that were enacted for 2012, just about in time for those that will be enacted in 2013! Because I am obsessive I had to complete the project…and now I am finally DONE!  In the 745 new California laws taking effect or continuing this year, 9 are aimed at protecting your food and water supply.

Admittedly, it continues to take time to read through each of the actual bills and decipher what is being said, it really is taking me until the beginning of October to get through all of this!

If you want to refer to any of these bills in their entirety, anyone can access the PDF with links to the bills as they passed through Congress, including the amendments and the final enacted bill:

www.leginfo.ca.gov/pdf/BillsEnactedReport2011.pdf

FOOD & WATER –>

AB0054

Drinking Water: Insuring Safe Drinking Water

This bill is a long one with multiple components.  The current California Safe Drinking Water Act requires the State Department of Public Health to administer provisions relating to the regulation of drinking water to protect public health and laws already exist to provide funds.  Here comes the legalese of this bill.  It does a few different things.  First, it allows a public water system that is a lead applicant for a project to be funded by the Safe Drinking Water Revolving Fund and would make expenditures related to the project potentially reimbursable.  Second, it authorizes the commission to review and decide on consolidation of territory in the jurisdiction of a mutual water company.  Finally,  it authorizes the commission to include in the service review, whether the drinking water sources comply with safe drinking water standards.

AB0222 

Food and Agriculture: Biotechnology

There is already a bill in place that regulates the Food and Agriculture fund programs.  All this amendment does is eliminates the requirement of the Department of Food and Agriculture from being required to report issues to the Governor and the Legislature.  Not sure the new oversight committee of these funds and programs is any longer, self-regulation?

AB0337

Ocean Protection: Sustainable Seafood

Enacts a voluntary seafood promotion program to promote sustainable fishing industry practices, provide grants/loans for limited activities, and develop labeling standards for these sustainable fishing companies.

AB0983

Safe Drinking Water: State Revolving Fund

Makes minor amendments to the already enacted California Safe Drinking Water Act, basically just addressing actions pertaining to the fund.

AB1152

Groundwater: Groundwater Elevations

Establishes rules for the Department of Water Resources in terms of monitoring groundwater elevations within each basin or sub-basin and the well water management.  Prevents counties from being eligible for water grant/loans administered by the state if they decline to accept responsibility for monitoring groundwater elevations (from unmonitored private wells included).

AB1194

Drinking Water: Safety

The Calderon-Sher Safe Drinking Water Act of 1996 requires the State Department of Public health to adopt regulations regarding contaminants in water potentially ingested by people.  The new addition is that this law permits the department to issue citations if a public water system is in violation and defines the specifics.

AB1292

Safe Drinking Water Funds: Revenue Bonds

Already in place is a bill where money is appropriated into the State Department of Health budget to design and construct projects for public water systems to assist in providing safe drinking water.  This bill authorizes the bank to issue taxable or tax-exempt revenue bonds to provide funding.

SB0267

Water Safety: Pollutant Discharge

Under current law, the State Water Resources Control Board and California Regional Water Quality Control board define waste discharge requirements in accordance with the Clean Water Act and Porter-Cologne Water Quality Control Act.  The Porter-Cologne Water Quality Control Act is a state act requiring any proposal to discharge pollutants or fill material to file a report at least 180 days in advance of the date on which it is desiring to discharge the materials.  This bill only changes the date requirement by 5 days, to 185 days before.

SB0818

Food Labeling: Olive Oil

Since I am particularly fond of olives, I found this one interesting.  Currently, the State Department of Public Health enforces laws regarding manufacture, blending, production and sale of olive oil and any violation is a crime.  This law pertains solely to the edible oil obtained solely from the fruit of the olive tree.  The hierarchy from highest to lowest: extra-virgin olive oil, virgin olive oil, and virgin oil not fit for human consumption (lampante virgin olive oil), olive oil, and refined olive oil.  These are all described in detail in the bill.

In 2013, I think I will pick and choose.