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.

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Herbs For A Healthy Heart

Cholesterol, poor circulation, and high blood pressure can prevent the heart from running smoothly. Thankfully, nature provides herbal remedies to support this vital life source and keep it running optimally.

When we talk about vitality in body, mind, and spirit, no organ takes center stage with more panache than the heart. Its rhythmic beating helps push blood through approximately 100,000 miles of blood vessels that weave through the body, delivering essential oxygen, nutrients, and compounds to cells, while picking up waste for the kidneys, liver, and lungs to filter and eliminate. It also functions as a center of emotion. When we snuggle up to a loved one, good vibes emanate from the chest, and when we suffer from extreme stress or loss, we often feel it in the heart. Simply put, the heart symbolizes the essence of life.

While life-or-death cardiovascular events require immediate medical attention, we can do a lot with herbs to improve the heart’s performance, manage chronic conditions, help heal from heart trauma {both physical and emotional}, and reduce the risk of cardiovascular disease.

Heart Tonics

A few key categories of plant compounds benefit the heart, including anthocyanin and anthocyanidin – pigments that give berries, pomegranates, purple grapes, and red wine, hibiscus, and other foods and herbs their famous deep blue/purple/ red color and healing properties. These compounds have profound antioxidant and anti-inflammatory properties that protect the cardiovascular system from oxidative damage while also limiting the ability of fats in the blood to oxidize. They also improve the integrity of blood vessel {endothelial} lining. Oligomeric proanthocyanidins {OPC’s or PCO’s}, precursors to these pigments, are found in Hawthorn, grape seeds, and skin, pine bark, and Pycnogenol {a supplement derived from pine bark {Pinus pinaster} and other plants, including peanuts, grape seed, and witch hazel}.

Flavanols, another related class of antioxidant compounds, help keep the endothelial lining smooth and flexible. One of the reasons why cacao and dark chocolate are associated with cardiovascular health is the abundance of these flavanols. {Alas, chocolate candy companies funded the more “promising” cacao research, while less vested researchers have not had quite as impressive results.}

Meanwhile, sulfur-based compounds in pungent vegetables like garlic and onions help lower cholesterol and blood pressure while also providing an antioxidant effect. Heart tonics may not dramatically lower cholesterol or blood pressure, but they offer benefit modestly over time while also providing a multitude of other beneficial effects throughout the cardiovascular system. These tonics are best taken regularly and long-term, including as functional foods in the diet.

Hawthorn {Crataegus spp.} shines as the most heart-focused herb for a reason. It seems as if it benefits every single aspect of cardiovascular well-being. The berries, flowers, and leaves {some herbalists also include the thorny spring twigs} are rich in antioxidant compounds, including OPC’s.

hawthorn btanical artHawthorn improves circulation and blood vessel lining and helps to normalize blood pressure by dilating vessels and acting as a natural angiotensin-converting-enzyme {ACE} inhibitor. {ACE inhibitors help relax blood vessels.} The herb strengthens the heart muscle, improving its ability to pump blood efficiently, with strong research supporting its use in congestive heart failure. It may promote healing after a heart attack and relieve angina and mild arrhythmias.

It’s also a classic herb for the emotional aspects of the heart: healing heartbreak, quelling anxiety felt in the heart and opening the heart to love.

Hawthorn is not drug-like in its actions, though, and can take several months of regular use for its benefits to show, which may not prove fast enough in acute conditions. I prefer to take hawthorn as a concentrated, tasty solid extract, but standard methods also work; teas, capsules, and tinctures. It’s extremely safe and food-like, but it may interact with some medications by acting in synergy to increase their effects, including some blood pressure medications and possibly digoxin. If you’re working with a skilled doctor, they may be able to monitor and reduce your drug dose accordingly, but don’t change your medications without your doctor’s approval.

garlic botanical artGarlic {Allium sativum} contains potent sulfur compounds, including allicin, that help improve circulation by thinning the blood and breaking down clots and inflammation-related fibrin, thereby reducing cholesterol and lipid peroxidation {undesirable oxidation of blood fats that leads to atherosclerosis and increased risk for heart attack}. It also modestly reduces blood pressure. I think of garlic as a remedy that cleans the blood and blood vessel linings so that everything flows more smoothly.

You can eat one or more raw cloves of garlic per day, best crushed and allowed to sit for 10 to 15 minutes before consumption. This allows allicin to transform into its more potent form. You may still get some benefits from cooked garlic. Garlic tinctures, capsules, and other remedies provide another option. Some companies even make low-odor or odor-free pills if you’d rather not ward off vampires and coworkers with the metallic scent of garlic pouring from your breath and skin.

Note that therapeutic doses of garlic may increase bleeding, interact with blood thinners, and should not be taken before surgery or if you have a bleeding disorder. Some sensitive people get skin irritation, stomach upset, and gas from garlic.

Hypertension Support

Many things can cause high blood pressure, including serious conditions like kidney disease and preeclampsia that require medical attention. Even everyday hypertension can create wear and tear on the kidneys and increase the risk of stroke. Herbal and natural therapies tend to work best in mild to moderate cases of hypertension, and some people simply do not respond well enough to the herbs and need medication. Nonetheless, there are some promising antihypertension herbs to consider.

Minerals, including potassium, calcium, and magnesium, play an important role in maintaining blood pressure, and you may find that taking a multi-mineral supplement and eating more mineral-rich herbs {nettle, dandelion, burdock, parsley} and foods {vegetables, especially green leafies} keep your blood pressure in check. Limiting sodium, especially sodium-based additives in processed and restaurant food, and eating five to 10 servings of fruits and vegetables daily can also prove extremely helpful for controlling high blood pressure.

Hibiscus_lilieflorus-rosa-sinensis

Hibiscus {Hibiscus sabdariffa} is a specific species of hibiscus with an anthocyanin-rich flower calyx that you can steep to make a blood-red, tart tea. Hibiscus has long been a popular ingredient in teas – sweetened and sipped as “Rosa de Jamaica” tea in the Caribbean and in North America as a key ingredient in commercial berry “zinger” and fruit-flavored teas. Recent research has found it’s one of our more impressive antihypertensive herbs, boasting a strong safety record. In several human studies, hibiscus has performed as well as popular hypertension drugs, including lisinopril, captopril, and the diuretic hydrochlorothiazide. The herb also seems to reduce cholesterol, triglycerides, urinary tract infections, and blood sugar, and may even modestly aid weight loss.

You do need to drink relatively large amounts of the herb to lower blood pressure: steep 10-30 grams {up to 1-ounce} of the dried flowers in one liter {approximately one quart} of water for 30 minutes or longer and sip in divided doses throughout the day. While generally safe, it’s a tad corrosive to tooth enamel due to the fruits acids {not unlike lemon water} and may have very mild anti-fertility effects.

The herb rooibos has also been shown to benefit hypertension and heart health and can be blended into the tea as well.

Herbal Diuretics: We’ve long used diuretics medications safely to lower blood pressure, and we can also turn to diuretic herbs for similar but much milder effects. Eating four ribs of organic celery per day, fresh or juiced, offers diuretic and blood vessel dilating effects. Dandelion leaf and root have sodium-leaching diuretic properties that work fabulously for some people – but not at all for others. Interestingly, my mentor, herbalist Michael Moore, noted that dandelion is more effective for people of Latin America decent, and I’ve also found this to be true. The related chicory and burdock roots seem to act similarly, and you can combine all three roots into a tasty coffee-like tea.

Parsley, a relative of celery, is both mineral rich and diuretic. While parsley and celery seeds are more potent, they can also irritate the kidneys more so than the stalks and greens.

Cholesterol Support

When your cholesterol and triglyceride levels soar, first start by scrutinizing sugar and carbohydrate intake, overall excess calorie consumption, and lack of exercise. Excess sugars in the bloodstream are packaged up with fat to make triglycerides, which ultimately increases your LDL and other “bad” cholesterol, including very low-density lipoprotein {VLDL} formation.

Limit simple sugars and refined carbohydrates, as well as bad fats from factory-farmed animal products and fried foods. Eat more vegetables; protein {especially plant protein}; and “slow burn” low-to-moderate glycemic high-fiber foods {which include oats and whole grains. beans, apples, and pears for their pectin, and nopales, a tasty Mexican prickly pear cactus}.

An increase in exercise also helps by burning sugar for fuel and improving insulin sensitivity of the cells. Also look to bitter-tasting and blood-sugar balancing herbs. Besides the two herbs mentioned below, also consider cinnamon.

Artichoke leaf {Cynara scolymus} is one of the best-researched herbs in the category of “bitters” for high cholesterol and related issues, including blood sugar and obesity. Its strength lies in reducing LDL cholesterol and fasting blood glucose levels while also increasing good HDL cholesterol levels.

Because artichoke leaf is so intensely bitter, you don’t want to drink it as a tea. Take it as a tincture {tasting it increases the benefits} or capsule {still effective}. Excessive amounts may cause stomach upset and nausea, and it’s best taken with food to limit stomach upset and hypoglycemia.

fenugreek botanical art

Fenugreek {Trigonella foenumgraecum} is among our best-researched herbs for controlling blood sugar and diabetes, and these benefits translate to triglyceride management, as well. While most of the early research involved large quantities of the fiber-rich ground seeds –  two 25 gram doses per day {if poured into capsules, this would mean 50 pills a day} -other studies have found benefits with lesser quantities as well as with extracts. In one study of people with type 2 diabetes, those who consumed 10 grams per day of the powdered whole seeds had significantly better fasting blood glucose, hemoglobin A1c, insulin, total cholesterol, and triglycerides compared to those taking a placebo, even though LDL and HDL cholesterol did not change significantly. A similar study found that fenugreek reduced VLDL cholesterol and that it worked better when added to hot water rather than yogurt.

Fenugreek imparts a maple fragrance to the urine, but this is harmless. If you have type 1 diabetes or take insulin and other blood-sugar regulating medications, work with a healthcare practitioner to ensure that you safely introduce fenugreek without inducing hypoglycemia.

Circulation Support

Herbs like gotu kola, ginger, garlic, rosemary, and very small amounts of cayenne or prickly ash increase blood flow.  Think of ginger, cayenne, and prickly ash if you’re chronically cold with poor circulation to the hands and feet.

The others improve the quality of blood vessel lining, making them smoother and less prone to breakage. The pigments and precursors we discussed as heart tonics – blue berries, gotu kola, dark purple grapes, Japanese knotweed roots, and hibiscus – work well for this.

Other beneficial herbs include horse chestnut, yarrow, and again gotu kola, which are often used for vascular insufficiency, varicose veins, and hemorrhoids topically and internally and may also help prevent deep vein thrombosis {DVT}. Herbs that thin the blood and help break down clots and fibrin include ginger and garlic. Be very careful combining these herbs with medications, and work with a practitioner if you take pharmaceuticals, as serious herb-drug interactions could occur.

Gotu-Kola-ExtractGotu Kola {Centella asiatica} has many uses and is probably better known for its stress-relieving adaptogenic, nerve tonic, and brain-boosting effects, as well as its ability to improve the healing and integrity of various types of tissues in the body {gut lining, skin, collagen, blood vessels}.

In addition to these benefits, gotu kola has a gentle yet profound ability to improve circulation and the quality of blood vessel lining, decreasing the risk of breakage and sluggish blood. Studies show benefit in venous hypertension, ankle edema, foot swelling, chronic venous insufficiency, varicose veins, post-thrombotic syndrome following DVT, and in preventing circulation issues on long flights. Most of the studies have focused on a specific standardized extract od gotu kola called “total triterpenic fraction of Centella asiatica {TTF-CA},” with higher doses {120 to 180 mg} achieving better results, though this extract product does not appear to be commercially available. When buying gotu kola tincture or capsules, follow the label’s dosage recommendations.

You can consume crude gotu kola in relatively large quantities – fresh leaves are commonly eaten as food in the plant’s native lands – and long-term use is recommended. You may not see benefits for one or more months, but the long flight study of TTFCA did note improvements when taken just two days prior to flying.

Gotu kola is generally safe, though it may modestly inhibit fertility and interact with a few medications. Quality on the market varies, and because it favors sewage and sludge-like growing conditions, contamination with fecal bacteria poses a concern. Purchase organic gotu kola from reputable companies or grow your own.

Gladden the Heart

While it may seem “hippie-dippy,” people have used herbs to ‘gladden the heart” for centuries. It goes back to the concept of the heart as the emotional center of the body.

These herbs uplift the spirits and boost the sensation of good vibes emanating from the heart. They’re useful when your heart feels heavy if you’re broken hearted, need to open your heart to others {or yourself}, or are overcome with grief. These herbs tend to be rich in essential oils, engaging the senses in a variety of aromatic and tasty ways to lift your spirits.

rose illustrationRose blossoms, particularly the rosy-scented heirloom and wild species, are one of my favorite herbs in this category. The aromatics of rose have cardiotonic properties and work best as a sprinkle of rose petals in a tea blend, a glycerite or honey extract, a cold water extract steeped for several hours, a flower essence, or simply a bouquet on the table. Also, consider them for the workaholic who needs to stop and smell the roses.

Linden blossoms have a delicate yet heady aroma of honey, and although very little research exists, we often turn to linden for stress-related hypertension and to gladden the heart. Europeans often sip tea made from this fragrant herb.

Holy basil is another favorite of mine. The leaves and flowers have diverse health benefits, including anti-inflammatory qualities as well as “calm energy” adaptogenic, nervine, and cognition-enhancing properties.

Motherwort’s aerial parts harvested in flower are less obviously aromatic, but they do target anxiety that manifests in the heart –  the kind of panic that makes you feel like you’re having a heart attack, palpitations, or tachycardia – though it also has mild mood-boosting properties.

Because it’s so terribly bitter, we usually take motherwort fresh in tincture form, but you can also make an extract in vinegar or glycerine if you want to avoid alcohol.

Lemon balm bridges the benefits of its relatives holy basil and motherwort and makes for a tasty and soothing tea to feed the heart.

 

 

 

 

Hibiscus Water Extract Demonstrates Significant Antioxidant Effects in Patients with Marfan Syndrome

Marfan syndrome (MFS) is an autosomal dominant genetic disorder manifesting in persistent oxidative stress and malfunction of connective tissue in the cardiovascular and skeletal systems. Previous studies of hibiscus (Hibiscus sabdariffa, Malvaceae) calyx drinks showed improvements in circulating antioxidant levels in healthy humans. Anthocyanins and organic acids like ascorbic acid are water-soluble antioxidants that are uncharacteristically rich in the hibiscus calyx, the ripened flowering body that is typically dark red in color. The goal of this prospective, observational, single-cohort study was to evaluate if a water infusion of hibiscus consumed daily could improve oxidative stress in patients with MFS.

The 3-month study took place at the National Institute of Cardiology Ignacio Chávez; Mexico City, Mexico. Seventeen patients with MFS and 10 healthy, control subjects were recruited through physical examination at the National Institute of Cardiology Ignacio Chávez. Additional echocardiography, computerized tomography, or magnetic resonance was done to ensure no aortic damage, and none of the enrolled patients were on anti-inflammatory medication.

Each patient consumed 1L daily for 3 months of a beverage made from boiling 20 g hibiscus calyces in a liter of boiling water (95-100°C) for 10 minutes, then left to cool. Hibiscus calyces were acquired in Chilapa de Álvarez (high zone from Guerrero, Mexico). Anthocyanins, flavonoids, and ascorbic acid (vitamin C) were estimated in the beverage by ultraviolet spectrometry, although composition data were not included in the study. Circulating levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione-S-transferase (GST), glutathione reductase (GSHR), glutathione (GSH), lipid peroxidation (LPO) index, total antioxidant capacity (TAC), and ascorbic acid were measured in plasma from patients with MFS.

Levels of all oxidative stress markers were significantly different in patients with MFS versus control subjects. After 3 months of treatment, significant improvements in SOD (P = 0.03), GPx (P = 0.02), GST (P = 0.01), GSHR (P = 0.03), GSH (P = 0.05), LPO index (P = 0.001), and TAC (P = 0.04) were observed in patients with MFS. [Note: The P values in the abstract do not match those found in the text and figures.]

This study adds to existing clinical research on the antioxidant effects of hibiscus calyx beverages in humans. More research should be done to determine whether high-elevation hibiscus could have a different composition than other varieties. Admitted limitations include the small sample size, which was in large part due to the rarity of MFS (occurring in 2 or 3 individuals per 10,000). The long-term effects of hibiscus on slowing the progression of chronic disease related to oxidative stress should be investigated further.

Resource:

Soto ME, Zuñiga-Muñoz A, Guarner Lans V, Duran-Hernández EJ, Pérez-Torres I. Infusion of Hibiscus sabdariffa L. modulates oxidative stress in patients with Marfan syndrome. Mediators Inflamm. 2016;2016:8625203. doi: 10.1155/2016/8625203.