Disclosures: Herbs Commonly Used by Females

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1 Disclosures: Herbs Commonly Used by Females No financial I will be discussing non-fda approved supplements and integrative treatments (the FDA oversees safety but does not approve efficacy for these) Molly Heublein, MD Assistant Professor UCSF Division of Internal Medicine Women s Health Primary Care Goals of today s talk: How should we think about herbal medicine? Molly Heublein, MD Assistant Professor UCSF Division of Internal Medicine Women s Health Primary Care Get a brief introduction to Ayurveda and Traditional Chinese Medicine (TCM) Think about prescribing herbs and if/how that fits in a western medical system of thought Discuss my 5 favorite supplements 1

2 Western Biomedical Systems of Thought Ayurveda and TCM Western Medicine is Incredibly New - Seeks an isolatable disease separate from the patient - Cause and effect - Pathology focused - Evidence based medicine - Sees a pattern of disharmony as a description of the patient s whole experience - Balance and relationships (no single part can be understood outside the whole) - Symptom focused - Ancient wisdom Basics of Ayurveda Health defined as: a state of equilibrium of the Tridosha (fundamental physiological governing principles of the body), Agni (metabolic and digestive processes), and Dhatu (principles that uphold the formation of body tissues). Waste products are excreted well. The sense organs, mind and the soul are in a state of bliss Tridosha Dosha Vata Pitta Kapha Element Ether + Air Fire + Water Earth + Water Qualities Dry Light Cold Movement Hot Light Oily Sharp Heavy Slow Liquid Cold Basisht. Ayu Oct-Dec; 35 (4):

3 Doshas Diagnosis In Balance Vata Pitta Kapha Movement in the body Creativity Flexibility Imaginative Digestion Absorption of nutrients Body temperature Understanding Intelligence Shine of hair/eyes Cohesion of tissues Joint lubrication skin moisture Immunity Love Calmness Digestion is highly important Listening to patient s voice Pulse taking Tongue inspection Out of Balance/ove ractive Fear Anxiety Abnormal movement Delicate health Infertility Malabsorption Gas/bloating Constipation Rashes/acne Sour stomach Redness Anger Jealousy Inflammation Slowness Weight gain Congestion Water retention Greed Body habitus Picture from: Ayurvedic Treatment Basics of Chinese Medicine - Balance is the goal; disease is a situation of imbalance - Qi - Yin-Yang Photos from Flikr Creative commons yoga by Paolo Reno; sleepy man with clock Vic Lawrence; Spice Magic by Atul T Photo from Flickr Creative Commons yin yang grunge symbol Nicolas Raymond 3

4 Evaluation 4 Examinations: 1. Looking: Appearance, facial color, tongue. 2. Listening/smelling: Voice, respiration, cough, body odors 3. Asking: Questions- heat/cold, perspiration, pain 4. Touching: Pulse Chart from Traditional Chinese Medicine World Foundation. Diagnosis TCM- treatments Photo from: 4

5 Chinese herbs Three 30 year old women present c/o dysmenorrhea - Over 5000 herbs described in a recent pharmacopeia - Start with a traditional formulation of 3-15 herbs with modifications made for individual patient - TCM providers aware of narrow therapeutic window for some herbs Photo from Flickr Creative commons **El-Len** At the Market Safety? Evidence? Talking to our patients about supplements Check natural medicine database for safety, efficacy: Memorial Sloan Kettering Cancer Center About Herbs: The FDA regulates under the Dietary Supplement Health and Education Act of 1994 May not make unproven treatment claims May not be adulterated with other substances 5

6 Supplements I recommend the most. Boric acid Red yeast rice Cannabis Biotin St Johns Wort B7 or Vitamin H 2.5mg daily studied in several studies for nail strength and thickness No benefit in alopecia (not studied) FDA warning: Can interfere with lab tests (ie TSH) Biotin Treatment of vulvovaginal candidiasis with boric acid powder. Van Slyke KK, Michel VP, Rein MF. Am J Obstet Gynecol Sep 15;141(2): Photo from: Red Yeast Rice Rice fermented by the yeast monascus purpureus natural statin An analysis of RCTs reported LDL-c lowered by 27-32%, triglycerides lowered by 27-38%, and HDL-c raised by 15-22% (Liu 2006) Boric Acid For vaginal candidiasis, and possible benefit in BV and trichomaniasis Multiple studies, including 2 RTCs show equivalent outcomes w nystatin or azoles Dose: 600mg gelatin capsule given vaginally X1-2 weeks Photo from: Photo from: 6

7 - don t be afraid! St John s Wort - More effective than placebo, likely equally effective as SSRIs and TCAs for mild to moderate depression (data less strong for severe depression) - Drug interactions ocps, warfarin, etc Limited but growing research Cannabis proven benefit in neuropathic pain Nausea May be opioid sparing - 450mg BID or 300mg TID Photo from: Photo from: Resources to learn more: Weil Integrative Medicine Library, Oxford University Press Kaptchuk, Ted. The Web that Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill, Natural Medicines database: Memorial Sloan Kettering Cancer Center About Herbs: References Burns, Beverly. Traditional Chinese Medicine UCSF Osher Center. Online Video. YouTube, 25 Mar Accessed 9/2018. Basisht. Exploring insights towards definition and laws of health in Ayurveda: Global health perspective. Ayu Oct-Dec; 35 (4): Devries, Stephen et al. Integrative Cardiology. New York: Oxford University Press, FDA Warning: The FDA Warns that Biotin May Interfere with Lab Tests: FDA Safety Communication Date Issued: November 28, Accessed 9/2018. Gokani T. Ayurveda--the science of healing. Headache Jun;54(6): doi: /head Epub 2014 Apr 25. Review. Kaptchuk, Ted. The Web that Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill,

8 Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD DOI: / CD pubΩ Lipner SR. Rethinking biotin therapy for hair, nail, and skin disorders. J Am Acad Dermatol Jun;78(6): doi: /j.jaad Epub 2018 Feb 10. Lipner SR, Scher RK. Biotin for the treatment of nail disease: what is the evidence? J Dermatolog Treat Jun;29(4): doi: / Epub 2017 Nov 9. Review. Lysine, Professional Monograph Natural Medicines Website. 4 Oct Accessed 9/2018. Maizses, Victoria and Low Dog, Tieraona. Integrative Women s Health, Second Edition. Oxford University Press, New York Sharma H, Chandola HM, Singh G, Basisht G. Utilization of Ayurveda in health care: an approach for prevention, health promotion, and treatment of disease. Part 1--Ayurveda, the science of life. J Altern Complement Med Nov;13(9): Review. Soleymani T, Lo Sicco K, Shapiro J. The Infatuation With Biotin Supplementation: Is There Truth Behind Its Rising Popularity? A Comparative Analysis of Clinical Efficacy versus Social Popularity. J Drugs Dermatol May 1;16(5): Review. St Johns Wort, Professional Monograph Natural Medicines Website. 31 July Accessed 9/