Tribulus Terrestris: Herbal Aphrodisiac?

In Ayurvedic medicine, plants and extracts are used as herbal remedies for a multitude of health problems, including sexual disorders. For this, Tribulus Terrestris is one of the preferred herbal aphrodisiacs. The use of Tribulus Terrestris is not limited to India, as the therapeutic plant has been a staple of traditional and folk medicine in Turkey, China, and other countries. Used to enhance energy, stamina, and sexual function, Tribulus is believed to stimulate the libido and support normal testosterone levels.

How Does Tribulus Terrestris Work?

Tribulus contains a compound called protodioscin. Protodioscin is a precursor to testosterone production and is also thought to dilate blood vessels. Dilated blood vessels allow for greater blood flow. When more blood is able to reach the penis, more healthy and full erections may result. Many animal studies involving Tribulus Terrestris have repeatedly demonstrated its ability to normalize testosterone levels and reduce the occurrence of impotence.

The Effects of Tribulus Terrestris in Animal Models

When the National University of Singapore evaluated the effect of Tribulus Terrestris on rabbits, it was reported that testosterone and DHT levels increased. Some have interpreted this as evidence for its usefulness in mild to moderate cases of erectile dysfunction.

Researchers at the All India Institute of Medical Sciences administered an extract of Tribulus Terrestris to sexually sluggish male rats and observed increases in the frequency of erection. After conducting a similar experiment, improvements in sexual activity and erectile function were also reported by Korea’s Sungkyunkwan University.

Additionally, Tribulus Terrestris may work in tandem with other herbal aphrodisiacs and energizers. A study performed by the Department of Urology at Gyeongsang National University School of Medicine in Korea found that a combination of Tribulus Terrestris and Calendula officinalis helped improve erectile function in animals.

Tribulus Terrestris: The Final Word?

As is the case with most herbal remedies, the formal medical community has been slow to form a consensus on whether or not Tribulus can increase human testosterone levels above normal ranges. However, regardless of the uncertainty, researchers in the Department of Urology at Italy’s University Federico II of Naples evaluated a natural compound containing Tribulus Terrestris. The study, which involved a hundred human males who took the supplement daily, reported that after two months, patients reported improved sexual function and quality of life.

Reduced libido is one of the most prominent symptoms of andropause and affects many middle-aged men. Addressing the problem using natural plant extracts is of interest to many men who wish to avoid pharmaceutical drugs and their associated side effects.

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The Top 8 Herbs for Andropause

Andropause, or male menopause, is a condition associated with a drop in sexual activity, testosterone levels, and a diminished frequency of normal erections. It’s an age-related problem and many men are in full swing by middle age. Thankfully, there are natural solutions for combatting the demoralizing effects of andropause. Herbs that have been used for centuries have demonstrated their potent abilities and received validation from modern science. Here are the top 8 herbs for promoting vitality during andropause.

1. Tribulus Terrestris

A natural aphrodisiac, Tribulus Terrestris has been used in various countries for centuries to stimulate libido and promote normal testosterone levels. The plant’s active compound, protodioscin, is a precursor to testosterone. As a blood vessel dilator, protodioscin may allow more blood to reach the penis, resulting in a normal, full erection. In animal models, impotent male rats given Tribulus Terrestris showed an increased erection frequency.

2. Suma

The suma root comes from the suma ground vine, typically found in the rainforests of South America. It’s been widely used as a herbal tonic for hormone activity and some evidence suggests it’s effective for improving libido and sexual response. Ecdysterone, a bioactive compound in suma, may help promote normal hormone levels in men, particularly the sex hormone testosterone, which stimulates male sexual performance. Men suffering from andropause or general sexual dysfunction are among the most popular consumers of suma root.

3. Ashwagandha

Also known as “Indian ginseng,” Ashwagandha has been used for over 3000 years to remedy various sexual issues. There is some research to suggest that Ashwagandha, especially when combined with Tribulus Terrestris, may promote fertility in men. Researchers believe that Ashwagandha helps alleviate stress, which is essential for promoting sperm quality. The herb may also be helpful for encouraging normal energy levels, a common issue that plagues many infertile, impotent, and sexually inactive men.

4. Maca

Native to Peru, maca (also known as Peruvian ginseng) has been a favorite aphrodisiac and sexual endurance enhancer for thousands of years. Research has consistently shown maca to produce a significant erectile response. Positive effects on ejaculation rates have also been reported in animal models, and human studies confirm that maca may boost sperm quality.

5. Avena sativa

Avena sativa is a potent tool and its benefits for testosterone production, energy enhancement, endurance, and prostate health have been studied in the lab. Compounds in Avena sativa may stimulate luteinizing hormone, the hormone responsible for activating the production of testosterone. Examinations into the use of Avena sativa have found that it offers help for promoting a healthy sexual response, libido, and orgasm frequency.

6. Tongkat Ali

Another herb with powerful aphrodisiac properties, Tongkat Ali has been shown to stimulate libido, semen quality, and muscle growth. These effects are attributed to Tongkat Ali’s positive effects on testosterone levels. Middle-aged males experiencing menopause may see changes in their sexual health while supplementing with this Malaysian herb!

7. Catuaba

Similar to Tribulus Terrestris, Catuaba bark promotes a strong and longer-lasting erection by increasing blood flow to the penis.  Catuaba may also increase the brain’s sensitivity to dopamine, a neurotransmitter that enhances the pleasurable effects experienced during sex.

8. Muira puama

Studies have shown that Muira puama, a herb native to Brazil, may promote blood flow to support the chances of having a normal erection. Men who are experiencing andropause often seek out Muira puama for this reason, and its ability to increase sexual desire and satisfaction.

A Final Thought

Whether it’s reducing stress or promoting blood flow or testosterone levels, there are plenty of natural aphrodisiacs for supporting sexual health. Getting enough exercise and sleep are also integral for battling the early onset of andropause symptoms.

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Amazing Benefits of Ashwagandha Root for Women

Ashwagandha, also known as Indian ginseng, is an Ayurvedic herb commonly used in traditional Indian medicine. Investigations into the herb’s powerful effects on the body have sparked an explosion of interest, and research has reported the exciting potential for human health, specifically its effects on mental, physical, and emotional health.

Benefits of Ashwagandha Root

Ashwagandha may enhance energy, support aging, and stimulate sex drive. Here are 7 benefits women may experience with ashwagandha.

1. Promotes Graceful Aging

Stress, both metabolic and emotional, dramatically affects aging. Cortisol, the body’s stress hormone, contributes to muscle loss and weakness, wrinkles, and cognitive impairment. Research has found that ashwagandha improves resistance to stress, possibly decreasing cortisol production. One study of 64 individuals observed a reduction in stress and a significant decrease in cortisol levels in individuals taking ashwagandha compared with placebo.

2. Menopausal Support

Ashwagandha acts on the endocrine system by encouraging hormone balance. A study involving 51 menopausal women supplementing with ashwagandha noted a significant reduction in symptoms such as hot flashes, anxiety, and mood.

3. Sexual Potency

The Kama Sutra, one of the oldest surviving texts on human sexuality, mentions ashwagandha in its literature as a potent sexual stimulant. Research indicates that the herb supports sexual health and vitality by increasing blood flow and reducing bodily tension. Women taking ashwagandha typically experience an increase in sexual desire and satisfaction.

4. Memory Support

Recent research has shown that ashwagandha reduces memory impairment in animal models. The herb may also protect the brain from the oxidative stress that leads to neurodegeneration. Relaxation, a benefit derived from the herb’s stress-fighting effects, also improves long-term visual memory.

5. Revitalization

Another benefit many women report after taking this herb is in regards to energy levels. This anecdotal evidence is supported by scientific investigation; a recent study reported ashwagandha’s benefits for improving energy while reducing stress-related disorders.

6. Mood Booster

Ashwagandha is a known mood-boosting herb, and research suggests that the therapeutic plant may play a potential role in fighting mood imbalance. Women battling mood swings may benefit from supplementing with ashwagandha.

7. Fertility

Stress, illness, hormone imbalance, and nutrient deficiencies — all of these issues threaten the female reproductive health and make it difficult for a woman to conceive. Research shows that ashwagandha supports thyroid function, an organ responsible for regulating hormones. Also, by decreasing stress, ashwagandha may encourage a situation that is optimal for fertility. More research is needed to clarify whether or not ashwagandha is effective for helping infertile females struggling to conceive.

Using Ashwagandha Root

Ashwagandha can be found in liquid and capsule form, sometimes with other herbs designed to promote female health. Always look for an organic supplement that comes from a trusted, high-quality source. I recommend Female Fuzion®, a blend of Ashwagandha root and other herbs, designed to help regulate the proper hormone balance to support normal energy levels, superior vitality, and a balanced mood.

Health Benefits of Ashwagandha

Withania somnifera, better known as ashwagandha or “Indian ginseng,” has been a staple of Ayurvedic medicine for over 3000 years. The herb has a wide range of activity that promotes physical and mental health, body rejuvenation, and longevity. It is known to inhibit anxiety and improve energy. In certain cases, ashwagandha may also promote healthy fertility.

Ashwagandha for Energy

Long distance cycling is an endurance sport that requires aerobic fitness and energy. Many products have been developed to provide energy in a quick, easy form: gel packets, energy chews, sports drinks, and more. Generally, these products just provide extra calories, which are necessary if you’re expending energy but don’t actually support physical ability.

In 2012, the Faculty of Sports Medicine and Physiotherapy at India’s Guru Nanak Dev University conducted an eight-week study in which forty elite cyclists supplemented with ashwagandha. By the study’s conclusion, significant enhancements in both cardiovascular and respiratory endurance were reported.

Perhaps even more importantly, research out of Malaysia found that when ashwagandha root extract was regularly administered to persons receiving chemotherapy, it had potential to relieve fatigue and improve their quality of life.

Cognitive Benefits of Ashwagandha

In Ayurvedic medicine, one of the primary uses of ashwagandha root extract is to enhance memory and improve brain function. One of the mechanisms responsible for this effect is ashwagandha’s antioxidant action. Since oxidative stress contributes to neurodegenerative disorders, lessening oxidative damage may offer neuroprotection.

Multiple studies have been performed to evaluate the neuroprotective properties of ashwagandha root extract on rats and found that it may prevent some instances of memory impairment and oxidative stress in the brain.

Ashwagandha to Relieve Stress

Stress affects both mind and body and can be a strain that leads to underperformance. Most people will also testify that stress affects their quality of life. Ashwagandha has been documented in Ayurvedic and Greek medicine for its stress-combating properties.

The Department of Neuropsychiatry and Geriatric Psychiatry at India’s Asha Hospital orchestrated a randomized, double-blind, placebo-controlled study involving sixty-four subjects with a history of chronic stress. After separating the participants into control and study groups, the study group began supplementing with high-concentration, full-spectrum ashwagandha root extract. After two months, the study group reported significant improvements in all stress measurements and quality of life; all without serious side effects.

Stress and Male Fertility

Additionally, stress is known to be a contributing factor for male infertility. Along with Tribulus Terrestris, Ashwagandha is prized for its stimulating effects on fertility.

The Department of Biochemistry at C.S.M. Medical University conducted a study involving sixty infertile men who, however, did have normal sperm production. Participants were given five grams of ashwagandha root powder every day for three months. At the study’s conclusion, stress reductions and improvements in semen quality were observed and 14% of the participants’ partners ended up becoming pregnant.

Supplementing with Ashwagandha

Ginseng Fuzion™ is our formula for boosting energy and promoting a positive response to stress. It offers a blend of the six best herbal adaptogens, including ashwagandha, and the feedback has been overwhelmingly positive. Be aware that ashwagandha may cause drowsiness; if you’re taking any medications that could interact with that effect, it’s best to consult your healthcare provider before starting any new nutritional supplement programs—which, unfortunately, many conventional practitioners disregard. Will we see the day when the medical establishment accepts and promotes ashwagandha root? Time will tell.

Benefits of Shilajit for Men and Women

Men who live and work in the mountains are known for their strength and endurance, and it appears there’s more to it than simply the mountain air. Shilajit, pronounced shil-ah-jeet, is an organic tar-like substance that naturally occurs in mountains around the globe, from the Himalayas to the Andes. It may not sound tasty, but as you’ll see in a moment, it works. Ayurvedic doctors began using it hundreds of years ago for its potent health-supportive properties.

6 Benefits of Shilajit for Men’s Health

Shilajit contains several potent substances including antioxidants and humic and fulvic acid. The plant contains over 80 minerals that support the body, and many have an incredible effect on a man’s health. If you’re a man, no matter where you live, you’ll want to look into shilajit. Here are 6 health benefits of Shilajit for men that will hopefully convince you:

1. Supports Fertility

A study gave 60 men suffering from infertility shilajit twice daily for 90 days. At the end of the trial period, sperm counts in the men increased by more than 60%, and sperm activity improved by 12% or more. This supports what Ayurvedic doctors have known for centuries. Any man dealing with infertility should consider this safe, natural alternative to address his condition.

2. Promotes Testosterone Levels Naturally

It does more than increase the number and health of a man’s ‘swimmers.’ Men who take shilajit enjoy a boost to their testosterone levels, and a man needs higher testosterone levels to protect muscle tissue, keep fat off, and maintain a better overall mood and thinking.

3. Enhances Performance

Tradition holds men who take shilajit have more energy and feel generally better. It could be the mountain air, or it could be the nutrient density of shilajit. Researchers have determined shilajit acts at the cellular level to improve energy production at its source, the mitochondria. When your cells are nourished like this, you feel like more awake, you recover faster, and you have what it takes to go that extra mile.

4. Protects the Heart

A recent study using animal models tested how well shilajit protects the heart. The animals who received the herb showed less cardiovascular damage, with researchers concluding the effect must come from more than simply its antioxidant activity.

5. Supports Memory

Increased testosterone levels play an important role in how well you think. But researchers have identified a special effect created by small molecules called dibezno-alpha-pyrones. These molecules prevent the breakdown of the brain chemicals needed for memory. Other studies report the fulvic acid in shilajit supports normal brain health.

6. Encourages Healthy Aging

Studies report shilajit’s antioxidant activity protects against cellular damage, and it’s this cellular damage that speeds the aging process in your heart, lungs, liver, and skin. The fulvic acid in shilajit delivers antioxidants and minerals directly to cells where they’re needed. This keeps them safe from free radical damage and accelerated aging.

A Final Thought

When it comes to taking shilajit, make sure you get the real stuff. If it’s solid at room temperature, you’ve got a hold of something that is of questionable quality. Shilajit should taste bitter, have a brownish-blackish color and melt in your hand.

Benefits of Shilajit for Women’s Health

Formed over hundreds of years from decayed plant material, Shilajit is a tar-like substance found in the Himalayas, Caucasus, and Andes. Pronounced “shil-ah-jeet,” it offers quite a few compounds that support human health. This substance has been part of Ayurvedic medicine for centuries and is especially beneficial for women, providing energy enhancement, mood support, and antioxidant protection.

3 Benefits of Shilajit for Women’s Health

Here are a few of the health benefits of Shilajit and how it relates to female health:

1. Supports Healthy Aging

In some villages in the Himalayas, Shilajit is a regular part of the diet. Residents of these villages consider it an important component for promoting good health. One research study found that Shilajit when combined with Indian ginseng, may be helpful for reducing the risk of age-related cognitive decline.

2. Energy Enhancer

The data doesn’t lie. Human and animal studies suggest that Shilajit helps you fight fatigue and feel energized. Traditional medicine credits it as a revitalizer to enhance physical performance. Why? Because Shilajit supports ATP production, helping to enhance energy at the cellular level.

When researchers decided to test its impact on the physical challenges associated with high altitudes, such as physical stress, lethargy, and general tiredness, they determined that its fulvic acid content acts at a deep tissue level to overcome these common issues.

3. Antioxidant Protection

Shilajit is loaded with fulvic acid, which has remarkably high antioxidant values. Recent research indicates that it supports brain health and its antioxidant compounds may be the main route through which Shilajit protects the brain. Women seeking to support cognitive function may want to consider Shilajit. Other studies have noted positive effects on memory, anxiety, cognitive function, mood support, and stimulating brain activity.

One Final Thought

Real Shilajit will have a brownish-blackish color, melt in your hand, and have a bitter taste. Always find a high-quality source, as many suppliers sell inferior or old products that have lost potency.

What is Shilajit?

From deep within the Caucasus and Himalayan mountains, Shilajit (pronounced shi-lah-jeet) is a naturally occurring substance that’s rich in beneficial nutrients. Although it’s somewhat unknown today, it is still prominent in many natural health practices, including Ayurveda. This blackish, smooth substance can be found in high concentrations in the Altai Mountains. One of the main constituents of the material is fulvic acid, which has shown some promise in heavy metal protection and brain support.

What is Shilajit?

Shilajit is a sticky resin that oozes from rocks in the mountains in response to heat from the sun. It is often referred to as “rock sweat” and “stone oil” for its tar and sap-like texture. Shilajit is most often a black color, but can range in hue depending on location. The substance is rich in nutrients, like humic acid, A, B, and C vitamins, and trace minerals, and it may be useful for supporting men’s health. While shilajit research is by no means large, there is evidence that its compounds offer many health benefits.

What are the Benefits of Shilajit?

Shilajit may support healthy aging, increase the body’s ability to rejuvenate tissue, increase metabolism, boost the immune system, promote digestive health, and even help strengthen bones. Its effects on brain health should also be noted. Research shows that compounds in shilajit may be helpful against Alzheimer’s disease risk. According to some spiritual traditions, shilajit is excellent for cleansing the chakras, or energy centers at various points of the body.

Shilajit contains at least 85 substances and minerals that are essential for the human body, including vitamins A, B, and C, and essential minerals like iron, zinc, and magnesium. Due to its mineral content, some research suggests it may be helpful in cases of anemia. It’s incredible as an antioxidant and helps neutralize harmful free-radicals. Its status as a potent antioxidant may explain why shilajit is so beneficial for brain health. Review of the literature on shilajit also shows the substance to be a powerful adaptogen. Perhaps its best feature though is its rich concentration of fulvic acid.

What is Fulvic Acid?

Fulvic acid–also known as humic acid–is like an octane booster for your body. It is a mixture of a number of different acids and is composed of degraded organic matter. Fulvic acid helps makes nutrients more absorbable, supports brain health, and makes it easier for your body to cleanse itself of chemicals, toxic metals, and harmful compounds that negatively affect your health.

Supplementing With Shilajit

Shilajit can be taken as a standalone supplement, and it’s also sometimes added to herbal formulations to supercharge their effect. In fact, that’s why we’ve added it to several of our products, including Zeotrex, our solution for chemical and toxic metal cleansing.

 

Shilajit: 10 Health Benefits and It’s Use

Shilajit, also called mineral pitch, is the result of a long process of breaking down plant matter and minerals. It is a sticky, black, tar-like substance that comes from rocks in high mountain ranges.

Shilajit was traditionally sourced in India and Tibet, though it is now found in many other countries.

Shilajit has been used in traditional Indian Ayurvedic medicine for centuries, and the compounds in it appear to be beneficial for many conditions.

Ten potential benefits of Shilajit

When it is used correctly, shilajit may have several benefits for the body. This may be due in part to the high concentration of fulvic and humic acids, as well as many minerals.

1. Brain function

man holding a red pill and a glass of water

Shilajit is formed from the slow decomposition of plant matter and is available as a supplement or powder.

The numerous compounds found in shilajit may be helpful for brain function, and may even aid Alzheimer’s therapy.

A study in the International Journal of Alzheimer’s Disease noted that shilajit is traditionally used for longevity and to slow aging. The compounds in it may help control cognitive disorders, such as Alzheimer’s.

Researchers expect shilajit to have an impact in preventing cognitive disorders, but more research is needed to explore these possibilities.

2. Aging

One study noted that fulvic acid, one of the key compounds in shilajit, acts as an antioxidant and anti-inflammatory compound. As such, it may help reduce free radicals and cellular damage in the body, which are two key factors in aging.

Daily supplementation of shilajit may contribute to the overall vitality and a slower aging process in some people.

3. Anemia

Anemia develops when the blood does not have enough healthy cells or hemoglobin. There are many causes of anemia, including iron deficiency.

Iron deficiency anemia can cause numerous symptoms in the body, including:

  • irregular heartbeat
  • fatigue and weakness
  • cold hands and feet
  • headache

Shilajit contains high levels of humic acid and iron, which may be helpful in treating iron deficiency anemia. It is important to explore this option with a doctor before taking supplements, however.

4. Antiviral

The wide range of minerals and compounds found in shilajit may also help fight off viruses. A research study noted that shilajit could fight off and kill many different viruses in isolated environments, including some herpes viruses.

Researchers commented that while it does appear to be effective, more studies carried out with live subjects are needed to back up these claims.

5. Chronic fatigue

A 2012 study published in the Journal of Ethnopharmacology found that shilajit helped reduce symptoms of chronic fatigue syndrome in test subjects.

Researchers noted that shilajit might help improve cell functions in the body, which means it may reduce fatigue at the source of the problem and increase energy levels naturally.

6. Altitude sickness

One of the claims made by traditional practitioners is that shilajit can help alleviate altitude sickness. The changes in pressure at high altitudes can greatly affect some people. Symptoms of altitude sickness range from body pain and fatigue to lung congestion and low oxygen in the brain.

Shilajit is a complex substance that contains more than 80 different minerals, as well as fulvic acid and humic acid. Because of this broad spectrum of beneficial components, shilajit is thought to help reduce many symptoms of altitude sickness.

It may help improve the brain’s cognitive processes, boost the immune system, and reduce inflammation, all of which could lessen altitude sickness.

7. Liver cancer

Shilajit also shows promise in fighting against certain types of cancer cells. One study found that shilajit helped force the destruction of cancerous cells in the liver.

It also stopped these cancer cells from multiplying. Researchers noted that their results show that shilajit has an anti-cancer effect, but more studies are needed.

8. Heart health

man having his blood pressure taken

As it may lower blood pressure, those with heart disease or hypotension should not take shilajit.

Shilajit may also protect the heart and improve heart health. A recent study using rats noted the protective effects shilajit has on the heart.

Animals who were treated with shilajit prior to cardiac injury had less damage to the heart than those who were not given shilajit.

It is important to note that shilajit may reduce blood pressure in some cases and should not be taken by anyone who has an active heart condition.

9. Obesity

Carrying extra weight can tire the muscles and put stress on the bones. A study in the Journal of Medicinal Food noted that people who were obese who took an oral supplement of purified shilajit responded better to exercise than those who did not.

Researchers noted that the shilajit seemed to activate genes in the body that helped the skeletal muscles quickly adapt to the new workout. This could mean less fatigue and more strength over time.

10. Male fertility and testosterone

Shilajit has also been studied to increase male fertility. One study gave 60 infertile men shilajit twice a day for 90 days.

After the test period, almost half of the men who completed the treatment showed an increase in total sperm count and sperm motility, or how many and how well the sperm move towards the egg, both of which are factors in male fertility,

Another study looked at the ability of shilajit to increase testosterone levels in healthy volunteers. Men between 45 and 55 years old were given shilajit for 90 days. At the end of this period, researchers noted significant increases in the levels of total testosterone.

Use

young woman holding a glass of milk in one hand and a glass of water in the other

Shilajit powder can be taken dissolved in water or milk.

Shilajit is available as a powder or as a supplement that can be dissolved in milk or water.

A person can dissolve a pea-sized portion of shilajit in liquid and drink it up to three times a day, depending on the instructions on the package.

The recommended dose of shilajit is 300 to 500 milligrams per day. However, it is important that a person speaks with a doctor before taking any natural supplements.

Potential side effects

Research suggests that shilajit is safe for long-term use as a dietary supplement. However, there are some potential side effects of using shilajit.

Shilajit may lower blood pressure, which can be dangerous for people on high blood pressure medications. People with an active heart disease or with a history of hypotension should avoid taking shilajit to prevent a drop in blood pressure.

The United States Food and Drug Administration (FDA) does not monitor natural supplements, so it is important to get the supplement from a reputable source. Low-quality shilajit may be tainted with heavy metals, free radicals, and even arsenic in some cases.

Also,

Shilajit has several health benefits and is a safe and effective supplement when used correctly. It is always best to speak to a doctor about the correct dosage in each case.

Working directly with a doctor can also help a person monitor any potential side effects.

Turmeric and Black Pepper: A Winning Combination

Turmeric (Curcuma longa) is a spice held in high regard for its bountiful health properties and its culinary uses. It’s a favorite herb of Ayurvedic and Chinese traditional medicine, and its therapeutic uses date back thousands of years. Numerous studies have found that turmeric root can have a significant positive effect on neurological, cardiovascular, metabolic, immune system, and cellular health. It may even help support your thyroid and promote longevity. Turmeric owes its many health-promoting qualities to curcumin, the natural compound that gives turmeric its rich golden color.

The Trouble With Turmeric

For all its miraculous health benefits, turmeric does have one weakness. The golden spice has very low bioavailability. This means that your body can only use a very small portion of the turmeric you consume. As the absorption levels of curcumin are very low, your body cannot harness the full healing properties of the spice. Fortunately, there is a simple way to enhance bioavailability. Just add black pepper to unlock the full potential of turmeric.

Black Pepper Can Boost Bioavailability by 2000%

Black pepper (Piper nigrum) is one of the most commonly consumed spices on the planet. In many parts of the world, you can find it on nearly every dinner table, right next to the salt. It’s usually just called “pepper,” but it also bears the nicknames “black gold” and “the king of spices.” It has a phenomenally long shelf life. Properly stored, black pepper can maintain its taste and aroma for many years.

Black pepper also has many health benefits of its own. It’s been used to relieve nausea, headaches, poor digestion, and sore throats. Much like how turmeric owes its healthy properties to curcumin, black pepper gets both its health benefits and its pungent flavor from a natural alkaloid compound called piperine.

Taking turmeric with black pepper may boost its bioavailability up to an astonishing 2000%. This is because piperine acts as an excellent bio-enhancer. Put simply, it can improve the bioavailability of other substances in the body.[1] The serving needed is quite small. You only need a pinch of pepper to enhance the absorption of turmeric.

The Powerful Potential of Piperine

When you consume a nutrient, your digestive system can only absorb a certain portion of it. The proportion of a nutrient that your body can digest, absorb, and utilize is its bioavailability. For example, the bioavailability of protein is very high. Most people use over 90% of the protein they consume. After it moves through your digestive system, your body eliminates the rest as waste.

For a nutrient to be absorbed into your body, it must pass through a membrane in your gut into your bloodstream. Large molecules have a more difficult time getting through this barrier. Piperine may help relax your intestinal membrane, allowing larger particles, like turmeric, to pass through.

The effect of piperine on the liver may play another factor. As part of your normal metabolism, your liver releases a substance called UDP-glucuronic acid. In a process called glucuronidation, this acid bonds with other substances to make them more water-soluble, and thus more easily excreted.

With turmeric, this glucuronidation may operate too quickly, eliminating the herb from your system before your body can make full use of it. Studies have found that piperine lowers the blood levels of UDP-glucuronic acid, inhibiting glucuronidation. In other words, it slows your liver metabolism of curcumin enough that your body can absorb the nutrient more effectively.

The Perks of Turmeric Plus Pepper

While turmeric and black pepper each have their own unique health properties, many of the properties are enhanced when you combine the two.

Possesses Antioxidant Properties

Turmeric contains many compounds with antioxidant properties. Curcumin, in particular, is a potent antioxidant. In fact, it’s ten times more powerful than resveratrol, the much-hyped antioxidant in red wine.

Piperine possesses its own antioxidant properties. Animal studies have found that piperine can reduce the oxidative stress brought on by a high-fat diet. By consuming pepper with turmeric regularly, you get double the antioxidant protection, helping you stay healthier, longer.

Resists Harmful Organisms

In vitro studies have found that turmeric resists harmful organisms, though more research is required to determine if this effect can be replicated in the human body. As a bioenhancer, black pepper not only boosts these abilities, it resists harmful organisms as well.

Protects Liver Health

In the liver, turmeric helps increase cholesterol elimination by boosting bile production. Curcumin also protects liver cells from damage caused by toxins such as peroxide, galactosamine, tobacco smoke, and household chemicals. Black pepper helps by boosting the bioavailability of glutathione, an important compound that protects the liver on a cellular level.

Eases Discomfort

Both turmeric and black pepper work to relieve temporary discomfort. Piperine desensitizes a pain receptor called TRPV1. Turmeric helps ease occasional joint discomfort. Put them together and you have surefire relief for stiffness and soreness. This is one of the reasons turmeric is so popular among athletes.

Aids Digestion

Ayurvedic medicine has relied on turmeric to support digestive health for thousands of years. Modern studies have found that it reduces spasms and flatulence. Both turmeric and black pepper have been found to enhance the activity of digestive enzymes in the gut, helping your system process food more quickly and easily.

The Best Ways to Get Black Pepper With Turmeric

Whole foods are always the best way to consume nutrients. When combining turmeric and black pepper, look to food sources such as curry. It may be a happy accident, or maybe the ancient peoples of India knew something we didn’t, but many recipes for curry happen to include turmeric and black pepper. You can also make a tasty tea from turmeric, black pepper, and other healing herbs like capsaicin. Simply mix these herbs into a high-fat liquid like almond milk and enjoy.

While undoubtedly delicious, making curry every day could prove inconvenient. In these cases, you should consider a turmeric and black pepper supplement. Read the label carefully as many turmeric extracts neglect to include black pepper. You could add your own, but top quality blends will already include both. Global Healing Center’s Turmeric extract combines these wonderful spices into one convenient, potent, and highly bioavailable blend.

Is Christmas Tree Syndrome A Real Thing?

As Christmas edges closer, the media is rife with seasonal health stories. But can our Christmas trees really make us sick?
Christmas tree allergy

What is Christmas tree syndrome?

Constantly on the lookout for interesting health stories, I stumbled across a collection of articles about Christmas tree syndrome recently, which piqued my interest.

According to a plethora of news outlets and articles spanning the past decade, Christmas trees are a ready source of mold, which can wreak havoc in our respiratory tract and potentially spoil our holiday fun.

This may be an issue for the roughly 13 percentof the population of the United States who are affected by mold allergy. But the studies cited are far from extensive, and mold allergy is not terribly well understood.

So, do you need to be throwing doubtful glances at your carefully decorated Christmas conifer, or is the whole thing a holiday hype?

Mold spores, allergy, and asthma

According to the Asthma and Allergy Foundation of America (AAFA), “[I]f, you have an allergy that occurs over several seasons, you may be allergic to the spores of molds or other fungi.”

Spores come in a variety of shapes and sizes, and they are ever-present in our environment — both indoors and outdoors. There may be in excess of 1 million fungal species that inhabit our planet, of which just over 100 families, or genera, can cause mold allergy.

The main culprits, however, are just four: AlternariaCladosporiumPenicillium, and Aspergillus.

Mold spores become dangerous when they reach critical levels. This is the case for individuals who have a mold allergy, as well as those with other allergies or asthma, where mold exposure can serve as a secondary trigger and make symptoms worse.

Our weather and light levels affect the composition and levels of individual spore species, which are in constant flux. Our knowledge of critical spore levels is far from extensive, but studies have suggested that for Alternaria, levels can be as low as 100 spores per cubic meter, while for Cladosporium, it is 3,000 spores per cubic meter.

But what does this have to do with our Christmas trees?

Are Christmas trees a health hazard?

It all started in 1970, when Dr. Derek M. Wyse published a paper titled “Christmas tree allergy: mold and pollen studies” in the Canadian Medical Association Journal.

He found that approximately 7 percent of allergic people saw a spike in symptoms when they had a Christmas tree in their home.

Yet, when he measured the variety of mold spores in 10 festive homes, he found his results largely inconclusive because the type of mold he found in the homes varied. Nonetheless, the term Christmas tree allergy was coined.

Fast forward to 2007, when Dr. Phillip Hemmers reported at the annual meeting of the American College of Allergy, Asthma & Immunology in Dallas, TX, that he had followed the fate of one particular Christmas tree.

He found that mold spores had gone up by more than fivefold during a 14-day period over the holidays, reaching 5,000 spores per cubic meter at the end of the festive period.

In 2011, Dr. Lawrence E. Kurlandsky — along with his colleagues from the State University of New York Upstate Medical University in Syracuse — published a more extensive study.

Having analyzed clippings from 28 Christmas trees belonging to their team and fellow staff, they found 53 mold species, of which 70 percent were potentially harmful.

Christmas trees — yay or nay?

Winter sees an annual peak in colds, flu outbreaks, and asthma attacks. The exact reasons aren’t known. But whether your Christmas tree or a combination of other factors is really to blame is difficult to say.

However, if you do have allergies or asthma, it’s worth taking the potential spike in tree-related spore levels seriously. Dr. Kurlandsky recommends washing your tree before bringing it inside, keeping it only for the minimum time possible, and using an air purifier to keep spore levels in check.

The AAFA recommend keeping your living spaces clear of other sources of mold and reducing damp by lowering humidity levels.

For those not affected by allergies, however, the alarm bells are off. “If you and your children don’t have any obvious allergies, then it is probably not going to bother you,” Dr. Kurlandsky says.

For now, our office Christmas tree is safe after all.

Clinical Efficacy of Hibiscus in Improving Iron Status in Patients with Anemia

Anemia, defined as a hemoglobin (Hb) serum concentration of <11.0 g/dL at sea level, is usually caused by low intake and absorption of dietary iron. Anemia currently affects roughly 67.6% of the population in Africa, many of whom are concurrently exposed to malaria. In Tanzania, hibiscus (Hibiscus sabdariffa, Malvaceae) flower and calyx infusions or juices are among several natural products used for anemia. Hibiscus contains several minerals, including iron, and ascorbic acid, which is known to increase iron absorption. In vivo, an aqueous extract of hibiscus significantly increased hematocrit (Hct) and Hb levels. Clinical trials have evaluated its use in lowering cholesterol, reducing hypertension, and controlling type 2 diabetes; however, none have examined its effect on iron deficiency. Therefore, these authors conducted a randomized clinical trial to measure the effect of hibiscus extract on iron status in patients with anemia.

Hibiscus calyxes were collected from local farms in March 2014, with a voucher specimen deposited in the herbarium of the Botany Department, University of Dar es Salaam, Tanzania. An aqueous extract optimized for both ascorbic acid and iron extraction was prepared to contain 0.831 mg/g L-ascorbic acid and 0.078 mg/g iron. The extract was issued to patients in 10-day dose packs with instructions.

Of the 202 individuals screened, 130 who were eligible (aged 18-50 years, Hb between 8.0-12.9 g/dL for men and 8.0-11.9 g/dL for women [anemic], no use of vitamin or mineral supplements for 30 days before enrollment, no organ impairment, no chronic illness, no blood given or received in prior 6 months, not pregnant or nursing, residents of study area, no history of serious medical conditions, and no participation in any investigational trial for 90 days before the study) were randomly assigned into 4 groups with similar proportions of key characteristics (e.g., gender, age, and Hb levels) in each.

Patients in group D1 (n=35) drank 1 L of the product daily; those in D2 (n=34), 1500 mL; and those in D3(n=32), 2 L. Patients in D4 (control; n=29) took 200 mg ferrous sulphate yielding 65 mg ferrous iron daily. The primary endpoint was changed in iron status indicators (Hb level, serum ferritin [Fer], and Hct parameters [mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), and red cell distribution width (RDW)]) between baseline and end of follow-up. Vital signs, laboratory tests, and questionnaires were used at baseline and at clinic visits every 10th day. Tests included complete blood count, renal and liver function tests, and hematology. Adverse events were assessed and classified as mild, medium, or severe. Compliance was monitored through home visits by village health workers in addition to clinic visits.

Patients, from 8 villages in Mkuranga District, Tanzania, had a mean age of 37 ± 11.8 years; 79 (60.8%) were women. About 20% had been ill in the 12 months before baseline, with urinary tract infections most common (41.7%). About 34% were using antibiotics at baseline; 32.7%, analgesics. “A significant proportion” of patients with no reported illness was taking medicine. There were no significant differences among groups in red blood cell characteristics, nutrition, or inflammatory markers at baseline (P>0.05 for all). After 4 weeks, 82 patients remained in the study—18 in group D1, 24 in D2, 21 in D3, and 19 in D4. A total of 37 were lost to follow-up for unknown reasons; others, for medical reasons or by moving away. Malaria (58 cases) did not cause any cited dropouts. Baseline data on malaria status are not provided.

In this study, the hibiscus treatment was not effective in treating anemia, but showed potential for improving hematological parameters. Fer levels rose significantly in D4 (control; P=0.0014) compared to baseline; in other groups, nonsignificantly (P>0.05). RDW fell, although nonsignificantly, in all groups compared to baseline, most noticeably in D3 (P=0.2754). There was a significant decrease in MCH in D1, D2, and D4 compared to baseline (P<0.05 for all); in D3, there was a nonsignificant decrease in MCH (P=0.0571). In D1 and D4, significant declines in Hb were seen compared to baseline (P=0.0123 and P=0.0219, respectively). [Note: In the article text, the value for D1 is given as P=0.123.]

The authors call for studies with larger populations. Findings differ from a study of hibiscus and pineapple (Ananas comosus, Bromeliaceae) juice, with an average increase in Hb after 9 days that exceeded conventional anemia treatment (+2 g/dL in 3 weeks). Additional studies are also needed to examine the complex comorbidities of anemia and malaria. A recent study in Tanzania found that “iron deficiency appears to protect against both malaria infection and mortality.”1,2

References

1Richards S. Iron deficiency protective against malaria. The Scientist website. Available at: http://www.the-scientist.com/?articles.view/articleNo/31974/title/Iron-Deficiency-Protective-Against-Malaria/. Published April 13, 2012. Accessed October 4, 2017.

2Gwamaka M, Kurtis JD, Sorensen BE, et al. Iron deficiency protects against severe Plasmodium falciparum malaria and death in young children. Clin Infect Dis. April 15, 2012;54(8):1137-1144.

Peter EL, Rumisha SF, Mashoto KO, Minzi OMS, Mfinanga S. Efficacy of standardized extract of Hibiscus sabdariffa L. (Malvaceae) in improving the iron status of adults in malaria endemic area: a randomized controlled trial. J Ethnopharmacol. September 14, 2017;209:288-293.

What Do You Know About Rose Water?

Rose water is a liquid made from water and rose petals. It is used as a perfume due to its sweet scent, but it has medicinal and culinary values, as well.

There is a long tradition of rose water being used in medicine, including in Iran and other parts of the Middle East, as far back as the 7th century.

There is also evidence of North American Indian tribes using it to treat ailments.

Fast facts on rose water:

  • Rose water can usually be used without any side effects.
  • Rose water contains numerous, powerful antioxidants.
  • Recent research has found that it can help relax the central nervous system.

What are the benefits?

Below, we look at some of the benefits of rose water and their uses in medicine.

Skin

Rose water in small glass bottle, next to rose flower.

Rose water is often used as a perfume, though it also has many medicinal benefits.

The skin is the largest organ in the body and acts as a barrier against UV radiation, chemicals, and other physical pollutants.

The antioxidants in rose water protect the cells in the skin against damage.

Rose water also has anti-inflammatory properties, which means it can be put on the skin to soothe the irritation caused by conditions, such as eczema and rosacea.

Rose water acts as an inhibitor against elastase and collagenase, which are both harmful to the skin.

This, in turn, can help soothe the skin and reduce redness, as well as act as an anti-aging product by reducing the appearance of lines and wrinkles.

Respiratory

Due to its soothing and anti-inflammatory effect, rose water can be taken to treat a sore throat. Furthermore, a study has shown that it can act as a relaxant on the muscles in the throat.

Eyes

In its liquid form rose water can be used as part of an eye drop and has been shown to have excellent benefits for people with eye problems.

Conditions it can help treat include:

  • conjunctivitis
  • conjunctival xerosis or dry eye
  • acute dacryocystitis
  • degenerative conditions, such as pterygium or pinguecula
  • cataracts

Wounds

Rose water has antiseptic and antibacterial properties, which mean it can help wounds heal faster, by keeping them clean and fighting injections.

The types of wounds rose water can be used on include:

  • burns
  • cuts
  • scars

Infections

Due to its antiseptic properties and the fact rose water can prompt the creation of histamines by the immune system, it has been shown to be useful for preventing and treating infections.

Brain

Rose water in a bowl with rose petals, for vapor therapy.

Rose water vapor therapy can improve mood and aid relaxation.

The inhalation of rose water vapors has been traditionally used as a way to improve a person’s mood. The liquid can also be taken orally.

Research has shown that rose water has antidepressant and anti-anxiety properties. It is believed to induce sleep and to have a hypnotic effect similar to that of the pharmaceutical drug diazepam.

It has been used to treat a number of mental health conditions, including:

  • depression
  • grief
  • stress
  • tension

In other medical cases, rose water is known to be beneficial in the treatment of conditions such as dementia and Alzheimer’s disease.

A specific protein fragment called an amyloid, which is created by the body, has been shown to be present in these conditions and to affect the brain function, kill cells, and hinder memory. Encouragingly, properties found in rose water are an inhibitor of this amyloid.

Headaches

Just as the fumes of rose water are inhaled to help improve mood, it is believed that the de-stressing effects can also help treat headaches and migraines.

Rose water has been used in aromatherapy for some time and can also be applied to a cloth and laid on the forehead for similar effects.

Digestion

The ingestion of rose water has also been shown to have beneficial effects on the digestive system. It works by increasing bile flow, which helps symptoms of common complaints, including bloating and upset stomach.

The consumption of rose water can also work as a laxative. It can increase both the amount of water in the feces and the frequency of going to the toilet, making it a good treatment for constipation.

What forms and types are there?

Rose water in spray diffuser bottle.

Rose water contains rose oil and tends to be more affordable than pure rose oil.

Rose water contains between 10 and 50 percent rose oil. It is often used in religious ceremonies, as well as in the food industry. However, the same product can come in different forms.

Rose oil

This is created by distilling the rose flower. The oil can be mass-produced in factories and is a pale, yellow color and semisolid.

Due to its high concentration, rose oil is known to be a fairly expensive product.

Dried flowers

Both the buds and the petals of the rose can be dried and are used for different reasons.

Often the petals are eaten, with yogurt, for example, and are used for the previously mentioned digestive benefits.

Other products

Other forms that rose products may come in can include:

  • Rose hips: The seedpods of the roses, which are used either fresh or dried, and as they are or processed in factories.
  • Hydrosol and absolute extract: This can be taken from the flower, petals, or hips and can be a cheaper alternative to rose oil.
  • Ethanolic, aqueous, and chloroform extracts: These can be taken from the flower, petals, or hips and are used for research purposes.

Side effects

A person can apply rose products topically by putting a small amount — about the size of a dime — on their arm as an initial test. If there is no adverse or allergic reaction within 24 hours it can be safely applied elsewhere.

In some cases, a person can have a reaction to rose water due to a particular and often unknown sensitivity to the product.

This can include:

  • burning
  • stinging
  • redness
  • irritation

If someone experiences any of these effects after the use of rose water, they should tell a doctor immediately, as it may be a sign of an infection or allergic reaction.

Aloe Vera Cream Delays Development of Radiation-induced Dermatitis in Patients with Head and Neck Cancers

Treatments for head and neck cancers include surgery, chemotherapy, and radiotherapy, used either alone or in combination. Used to treat inoperable tumors, radiotherapy can cause radiation-induced dermatitis, which is treated with steroidal, nonsteroidal, and metallic topical medications. Researchers have studied the use of skin care products containing aloe vera (Aloe vera, Asphodelaceae) in patients undergoing radiotherapy. Aloe vera has been shown to have anti-inflammatory properties and researched for its use in treating a variety of skin ailments including eczema, psoriasis, burns, wounds, and ultraviolet (UV)-induced skin erythema. These authors conducted a single-center, investigator-blinded, randomized, clinical study to evaluate the efficacy of a topical aloe vera-based cream (AVC) in preventing radiation-induced dermatitis in patients undergoing therapeutic radiation for head and neck cancers.

The study was conducted between July 2012 and December 2012 in the Department of Radiation Oncology at Mangalore Institute of Oncology in Pumpwell, Mangalore, India. Eligible patients were those scheduled to receive radiotherapy or chemoradiotherapy 6 weeks following surgery and who had a Karnofsky Performance Status Scale score above 70, meaning that patients could care for themselves but could not carry on normal activity or do active work.

Sixty patients were randomly assigned, with 30 in each group, to either the Johnson’s® Baby Oil (JBO) (Johnson & Johnson; Mumbai, India) control group or the AVC Elovera® (Glenmark; Mumbai, India) group. Elovera consists primarily of 10% aloe vera extract and 0.5% vitamin E. At baseline, the mean age for the JBO group was 55.2 ± 9.66 years, and for the AVC group, 55.9 ± 8.99 years. Males represented 24 patients in the JBO group and 26 in the AVC group. During the second week of treatment, 1 patient in the JBO group died of cancer.

All patients received irradiation at a maximum energy level of 6 MV at a rate of 300 MU per minute. All fields were treated 5 days a week with no more than 1 fraction of 2 Gy daily. Patients scheduled for chemoradiotherapy received carboplatin infusions weekly 3 hours before the first weekly radiation treatment. Before starting the study, the patients and their caregivers were taught how to apply the JBO (5 mL) or AVC (5 g) 5 times daily as follows: 2 hours before, immediately after, and 2, 4, and 6 hours after radiotherapy. Use of JBO or AVC was discontinued if moist desquamation occurred, and 1% gentian violet paint was applied instead.

The patients were assessed for radiation-induced dermatitis weekly according to the criteria of the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer, which ranks skin condition as follows: grade 0 (no skin rending, ulceration, inflammation, or damage); grade 1 (faint erythema or dry desquamation); grade 2 (moderate to brisk erythema, patchy moist desquamation mostly confined to skin folds and creases, moderate edema); grade 3 (moist desquamation ≤1.5 cm in diameter in areas other than skin folds or creases, and bleeding induced by minor trauma or abrasion); and grade 4 (skin necrosis or ulceration of full-thickness dermis and spontaneous bleeding from the involved site).

After weeks 1 and 2, patients in both groups had normal skin, without any signs of radiation-induced dermatitis. Following week 2, dermatitis was observed in the 2 groups as follows:

  • Week 3: 41.4% in the JBO group and 16.7% in the AVC group
  • Week 4: 82.8% in the JBO group and 70% in the AVC group
  • Week 5: 93.1% in the JBO group and 90% in the AVC group
  • Weeks 6 and 7: 96.6% in the JBO group and 90% in the AVC group
  • Two weeks post-treatment: 86.2% in the JBO group and 73.3% in the AVC group

Dermatitis reported in both groups at week 3 was grade 1; the between-group difference in the incidence was significant (P=0.04). After week 4, grade 2 dermatitis was seen in both groups. The most severe dermatitis of grade 3 was reported by 34.48% in the JBO group and 40% in the AVC group at week 7 (P=0.07). No one developed grade 4 dermatitis. Two weeks post-treatment, the average grade of dermatitis was lower in the AVC group compared with the JBO group; specifically, the patients in the AVC group had a significantly lower incidence of grade 2 dermatitis compared with the JBO group (P<0.02).

Earlier studies reported that aloe vera gel, used with mild soap, relieved dermatitis in women undergoing radiation for breast cancer1; “[h]owever,” write the authors of the study reported here, “the observation that an Aloe vera-based cream delays the incidence of dermatitis (when evaluated from the initiation of the treatment) is novel and indicates the usefulness of Aloe vera in enhancing the healing of radiation dermatitis.” Other studies have shown that aloe vera enhances wound healing.2,3

The authors conclude that the prophylactic use of an AVC delays the development of radiation-induced dermatitis in patients being treated for head and neck cancers. Further studies with a larger sample size are needed to further validate the efficacy of aloe vera.

References

1Ryan JL. Ionizing radiation: the good, the bad, and the ugly. J Invest Dermatol. 2012;132(3 Pt 2):985-993.

2Atiba A, Nishimura M, Kakinuma S, et al. Aloe vera oral administration accelerates acute radiation-delayed wound healing by stimulating transforming growth factor-β and fibroblast growth factor production. Am J Surg. 2011;201(6):809-818.

3Visuthikosol V, Chowchuen B, Sukwanarat Y, Sriurairatana S, Boonpucknavig V. Effect of Aloe vera gel to healing of burn wound: a clinical and histologic study. J Med Assoc Thai. 1995;78(8):403-409. 

Rao S, Hegde SK, Baliga-Rao MP, Palatty PL, George T, Baliga MS. An Aloe vera-based cosmeceutical cream delays and mitigates ionizing radiation-induced dermatitis in head and neck cancer patients undergoing curative radiotherapy: a clinical study. Medicines (Basel). June 2017:4(3):44. doi: 10.3390/medicines4030044.

Meta-analysis of the Effects of Ginkgo Extract on Behavioral and Psychological Symptoms of Dementia

Behavioral and psychological symptoms of dementia (BPSD) are characterized by symptoms of aggression, agitation, and psychosis, which typically decrease the quality of life for the patient while increasing caregiver distress, the risk for nursing home admission, and financial burden on the healthcare system. BPSD is a treatment target for patients with dementia. In conventional medicine, pharmacological management of anti-dementia drugs (i.e., acetylcholinesterase inhibitors, memantine), antidepressants, and select antipsychotics has proven beneficial for this patient population. The agitation has been observed in patients with dementia who receive the selective serotonin reuptake inhibitor (commonly referred to as “SSRI”) citalopram. EGb 761® (Dr. Willmar Schwabe GmbH & Co. KG; Karlsruhe, Germany) is a ginkgo (Ginkgo biloba, Ginkgoaceae) leaf extract. The extract contains 22.0-27.0% ginkgo flavonoids calculated as ginkgo flavone glycosides and terpene lactones, consisting of 2.8-3.4% ginkgolides A, B, and C, 2.6-3.2% bilobalide, and less than 5 ppm of ginkgolic acids. Studies show that EGb 761 is an effective treatment for BPSD. The purpose of this meta-analysis was to evaluate the effects of EGb 761 on individual BPSD; namely, an overall reduction of symptoms, reduction of symptoms present at baseline, and the prevention of newly emerging symptoms. Also, symptoms of caregiver burden were evaluated.

The following databases were searched: PubMed/Medline (from inception through December 2013), EMBASE (from January 2006 through December 2013), and PASCAL (from inception through December 2013). The search was updated June 2016. The following search terms were used: (ginkg* OR gingk*) AND clinical trial(pt) for PubMed, ((ginkg* OR gingk*) NOT medline(sb)) AND (clinical* OR trial OR randomized) for PubMed excluding Medline, (GINKGO OR GINGKO), AND (HUMAN/CT OR HOMME/CTFR) for PASCAL, and (ginkgo or gingko) AND CT = (CLINICAL TRIAL; CLINICAL STUDY; DOUBLE BLIND PROCEDURE) AND py > 2005 for EMBASE. Reference sections were screened. The manufacturer of EGb 761 was contacted for any unpublished studies. Included studies met the following criteria: (1) randomized, placebo-controlled clinical trials of EGb 761; (2) duration of ≥ 20 weeks; and (3) included patients with dementia (probable Alzheimer’s disease [AD], probable vascular dementia [VaD], or possible AD with cerebrovascular disease) and clinically significant BPSD (Neuropsychiatric Inventory [NPI] total score ≥ 6). A meta-analysis was conducted. The primary outcome measure was single-item scores on the NPI (a 12-item inventory of the presence and severity of behavioral changes in patients with dementia).

Four studies met the inclusion criteria. The authors do not say how many articles were excluded. All four studies were similarly designed (i.e., multicentered, randomized, double-blind, placebo-controlled), included patients with mild to moderate dementia, and evaluated 240 mg/day EGb 761 or placebo for 22 weeks or 24 weeks. The manufacturer of EGb 761, Dr. Willmar Schwabe GmbH & Co KG, provided individual patient data from all studies for use in the meta-analysis. The 12-item inventory designed to assess the presence and severity of altered behavior associated with dementia upon which study patients were evaluated (NPI) assessed the following signs and symptoms: delusions, hallucinations, agitation/aggression, depression/dysphoria, anxiety, elation/euphoria, apathy/indifference, disinhibition, irritability/lability, aberrant motor behavior, sleep and nighttime behavior disorders, and appetite and eating disorders. All included patients scored 35 or less on the Test for the Early Detection of Dementia with the Differentiation from Depression; had scores ranging from 9-23 on the SKT short cognitive performance test; and had clinically significant BPSD, denoted by a composite score of ≥ 6 on the NPI with at least one item score (other than delusions or hallucinations) with a value ≥ 3.

While 1628 patients were randomly assigned in the four trials evaluated, the meta-analysis included data from 1598 patients (n = 796, EGb 761; n = 802, placebo). The mean age was 66 years ± 9 years, and ≥ 67% of each group were women. There were no significant differences between groups at baseline. At the study’s end, the EGb 761 group had significantly greater improvement from baseline compared with the placebo group on the NPI composite score and caregiver distress scores (P values not reported).

  • For net effects of individual NPI composite scores, the EGb 761 group had significant improvement from baseline compared with the placebo group in the incidence of apathy (P < 0.001) > disturbance in sleep/nighttime behavior (P < 0.001) > depression (P < 0.001) > anxiety (P < 0.001) > irritability/lability (P < 0.001).

o   There were minimal changes in the incidence of delusions, hallucinations, and elation/euphoria, as well as in those endpoints that were low at baseline (i.e., disinhibition, aberrant motor behavior, and appetite/eating).

  • For net effects of individual caregiver distress scale scores, the EGb 761 group had significant improvement in the incidence of symptoms from baseline compared with the placebo group for depression (P < 0.001) > disturbance in sleep/nighttime behavior (P < 0.001) > apathy (P < 0.001) > anxiety (P < 0.001) > irritability/liability (P < 0.001).
  • Similarly, for individual NPI composite scores, the EGb 761 group had significantly greater symptom improvement from baseline compared with the placebo group for aberrant motor behavior (P < 0.001) > apathy (P < 0.001) > depression (P < 0.001) > agitation (P < 0.001) > disturbance in sleep/nighttime behavior (P < 0.001) > anxiety (P < 0.001).
  • For individual caregiver distress scale scores, the EGb 761 group had significantly greater symptom improvement from baseline compared with the placebo group for agitation (P < 0.001) > depression (P < 0.001) aberrant motor behavior (P < 0.001) > disturbance in sleep/nighttime behavior (P < 0.001) > anxiety (P < 0.001) > apathy (P < 0.001).
  • For individual NPI composite scores for symptoms not originally present at baseline but emerging during the study period, the incidence at the study’s end was significantly lower in EGb 761 group compared with the placebo group for depression (P < 0.001) > apathy (P = 0.002) > disinhibition (P = 0.001) > disturbance in sleep/nighttime behavior (P = 0.258).
  • For individual caregiver distress scale scores for symptoms not originally present at baseline but emerging during the study period, the incidence at the study’s end was significantly lower in EGb 761 group compared with the placebo group for depression (P < 0.001) > apathy (P = 0.022) > disinhibition (P = 0.004) > disturbance in sleep/nighttime behavior (P = 0.004).
  • Overall, the symptoms that were most prevalent at baseline improved in 50-60% of the EGb 761 group and 30-40% of the placebo group.

The authors conclude that 22 or 24 weeks of treatment with EGb 761 provided significant benefit for nine out of 12 symptoms of individual NPI composite and caregiver distress scores compared with placebo. The mechanism of action of how EGb 761 improves each symptom has not been confirmed but may be related to modulation of neurotransmitter systems.

This study has several strengths that make it unique and of high scientific value. (1) The authors were able to obtain raw data from all studies to conduct the meta-analysis. (2) The four included studies were homogeneous. (3) The population size was relatively large. (4) All included studies evaluated the same dose and preparation of ginkgo.

This article also had some limitations. (1) The authors did not report how many articles were located in their original search. (2) The authors did not provide P values of the total NPI composite and caregiver distress scores. (3) The search was English-language only so some studies may have been missed. (4) Considering that the authors had access to raw data, it would have been beneficial if they had conducted a meta-analysis of safety. An analysis of risk/benefit is always of value and this study missed that opportunity.

Two of the authors (Mueller and Hoerr) are employees of Dr. Willmar Schwabe GmbH & Co. KG, and the others have received speakers’ honoraria.

Resource:

Savaskan E, Mueller H, Hoerr R, von Gunten A, Gauthier S. Treatment effects of Ginkgo biloba extract EGb 761® on the spectrum of behavioral and psychological symptoms of dementia: a meta-analysis of randomized controlled trials. Int Psychogeriatr. September 21, 2017:1-9. doi: 10.1017/S1041610217001892.