Of course, swine flu is not the first epidemic that has burst on the scene suddenly and frighteningly.  Legionnaire’s Disease erupted just as suddenly two decades ago, and was deadly until an antibiotic cure was discovered.  The media have blown up stories of “flesh-eating bacteria” and “mad cow disease” and then got bored of them (so-called flesh-eating bacteria are actually particularly deadly variants of common bacteria, and mad cow disease is caused by a slow-growing virus that is worrisome, and seems to have Europe’s and now Canada’s cattle stock.)  We’ve had bird flu, and SARS.   And of course, the scourge of AIDS and its virus, HIV, has had a numbingly profound effect on the world’s population and will, unfortunately, continue to do so in our lifetimes. 

Many centuries have had the imprint of a fearsome disease on them.  The bubonic plague dominated the Middle Ages, and rearranged the world’s population.  Chicken pox and other common viruses wiped out scores of Native Americans, tuberculosis ravaged the 1700s and 1800s and diseases like polio and diphtheria played a role in 20^th century history.

So, will swine flu grow in danger to the magnitude of one of these powerful killers? Will it become attenuated (less strong) as it spreads, much as streptococcus, which used to cause the deadly rheumatic fever but now is mostly the cause of a nuisance sore throat?  Will a cure or vaccine be developed? Or will it disappear again, as mysteriously as it appeared? 

The answers to these questions will, of course, take time.  But in the meantime we can do several things to allay our fears. 

One way to quell fear is through understanding.  So what is swine flu? Swine flu is caused by a type of virus called Influenza Type A H1N1, which is not usually that dangerous.  This strain, however, causes an illness that starts with a fever (over 100.5 degrees) a sore throat and a cough, frequently with other symptoms like muscle aching, headache, and malaise.  In other words, it behaves very much like a flu in the early stages.  The deaths from swine flu have been due to the progressive breathing problems or dehydration..

Are you at any real risk of getting swine flu?  Currently there are very few U.S. cases, and it’s too early to tell whether this virus will continue to spread rapidly or not. The Center for Disease Control (CDC) does not recommend wearing masks in public, avoiding public places, or changing behavior significantly.  It does recommend awareness of possible risk if traveling in other parts of the world, and vigilance when coming into contact with those with possible flu risk, particularly health care workers.

In fact, it’s helpful to understand the numbers of this illness that has dominated the news lately.  As of this writing in on May 1, there have been about 257 documented cases of swine flu worldwide.  Of those, 97 have been in Mexico, including 7 deaths.  The U.S. has had 109 confirmed cases of swine flu, with ONE DEATH.  So, keep worrying about drunken drivers on our roads, about mercury in our food supply, our mouths and our brain tissue, about second-hand smoke and about our children getting heavier and more sedentary.  All of these problems are real, and threaten us on a daily basis.  Swine flu, thankfully, does not, at least at this point.  We can only hope that this will remain the case.

Meanwhile, this talk about viruses gives us an opportunity to think about ways of strengthening our immune systems generally.  First, we recommend lessening the strain on our immune system by paying attention to food allergies, and taking measures to identify and remove heavy metals from our systems (for more information, see our website, http://www.wholehealthne.com).  Other burdens on our immune systems come from persistent stress (including worrying too much!), lack of sleep, and from too much alcohol, cigarettes and other toxins. 

Second, we can practice simple public health behaviors that can prevent the spread of illnesses, and teach them to our children.  Washing our hands frequently, covering our mouths when we cough or sneeze, making sure public food supplies are maintained in a clean way can have marked effects on the spread of common illnesses.

At The Rothfeld Center we use a combination of homeopathics, herbs and nutrients to support the immune system and ward off flu and viruses.

We use homeopathic Occilococcinum, a time-honored immune booster that is used at the first sign of the flu.  For those who want to be preventative, we recommend using one vial of Occilococcinum per week.  We also utilize the same homeopathic antiviral shot (intramuscular) that we use during flu season.

We also recommend Transfer Factors.  These remarkable substances are extracted from colostrum, produced by a nursing mother before the milk comes in, to boost the newborn’s immune system.  This remarkable natural medication has anticancer properties, antiviral effects, helps with allergies and has been shown in hundreds of studies to boost immune function.  We give TransFactor MultiImmune, a particularly powerful form of transfer factors.  As a preventive, we suggest taking 2 capsules daily, and increasing the dose to 2 capsules three times a day at the first sign of illness.  Incidentally, we highly recommend transfer factors to prevent getting ill during air flight or other crowded conditions.

Nature has provided us with a multitude of natural substances that have immune boosting activity.  For every-day use to prevent illness, I recommend vitamin C at least 1000 mg twice daily.  Vitamin C has a generally positive effect on immune cells, and is specifically anti-viral.  Vitamin C will shorten the duration of a cold, although it has not been shown to prevent one from developing.  Interestingly, vitamin C has profound antiviral effects when given intravenously, and is part of a natural treatment for hepatitis, mono and other viruses that is given in offices that practice natural medicine.  We recommend that our patients receive an intravenous Vitamin C antiviral drip at the first sign of the flu.

The critical role of Vitamin D in maintaining a healthy immune system is becoming more and more evident.  It is now clear that preventing epidemic influenza, among other illnesses, requires adequate vitamin D levels.  We give a minimum of 2000 iu of Vitamin D3 daily to support the immune system.

The other immune booster that most people know about is Echinacea.  Sometimes, we use it in a measured combination with other herbs (thuja and baptisia), a combination called Esberitox that has had several positive studies of its effects.  I don’t recommend Echinacea as an ongoing herb, and I prefer to use it when there is an illness.  Echinacea should be used with caution in someone with an autoimmune illness.

For everyday use, I recommend some beta carotene and some vitamin A both (usually 10,000 units of each), and I increase this for a few days when an illness is developing.  Garlic, ginkgo biloba, olive leaf and astragalus are good herbs to consider on a daily basis, to keep the immune system healthy.  Other nutrients critical to the immune system are zinc, vitamin E, selenium and coenzyme-Q-10.  L-lysine, an essential amino acid, is an immune booster and is used by many to prevent and to treat persistent herpes infections.  And finally, mushrooms are truly magic when considering the immune system.  Any combination of ganoderma, shiitake, maitake and lentigo are potent immune protectors with much research supporting them.

Dr. Rothfeld’s Flu-Fighting Program

All supplements reccomended can be purchased through The Natural Apothecary.

Primary / Preventative

• Occilococcinum: one vial weekly, one vial daily at first sign of symptoms
• Immune-boosting homeopathic injection (intramuscular, may repeat in 8 weeks)
• TransFactor Multi Immune: 1 capsule twice daily as preventative, 2 capsules three times daily when traveling or at first sign of symptoms
• Vitamin C (as Ester-C or Buffered C):  1000-2000 mg twice daily
• Vitamin D Balance 1 capsule daily (2000 iu)

Secondary / Treatment

• Esberitox: chew 3 tablets three times daily at first sign of symptoms
• L-lysine 500 mg three times daily at first sign of symptoms
• Vitamin A 25,0000 iu daily for 3-5 days at first sign of symptoms
• Zinc lozenges at first sign of symptoms
• Olive leaf extract 2 capsules twice daily at first sign of symptoms
• Consider Intravenous Vitamin C infusion at first sign of symptoms

Severe sunburns, particularly in childhood and the teenage years, have been linked to the development of potentially serious skin cancers (including malignant melanoma) later in life. Fair-haired redheads have three times the melanoma risk compared with the general population.

Repeated sunburns, even if they’re not particularly severe, have an incremental effect and also increase a person’s cancer risk. Experts estimate that in the United States alone more than one million new cases of skin cancer are diagnosed every year.

Key Symptoms

• Pink or reddish skin that feels hot and tender to the touch (mild sunburn).
• Red skin with small fluid-filled blisters that may itch and eventually break (moderate sunburn).
• Deep red to purplish skin–with or without blisters–accompanied by chills, fever, headache, nausea, dizziness, or dehydration (severe sunburn).

What Causes Sunburn?
The amount of sun exposure needed to produce a sunburn depends on a number of factors. Most important is a person’s skin pigmentation, signifying the amount of melanin present in the skin. Melanin is a pigment that absorbs UV rays. Dark-skinned people have a high concentration of melanin, and so are less likely to become sunburned than are people with fair skin, who have less melanin.

Other factors that affect sunburn risk include:

• Geographical location. The farther you are from the equator, the weaker and less direct are the sun’s rays and the less likely you are to develop a sunburn. Altitude is a factor as well: The higher up you are, the closer you are to the sun’s damaging rays. A 1999 study reported that residents of Vail, Colorado, located 8,500 feet up in the Rocky Mountains, were at 115% greater risk for skin cancer than were people living at the same latitude but closer to sea level.
• Season of the year and the time of day. As these shift, the angle of the sun (and thus the intensity of the sun’s damaging rays) alters as well. Many newspapers and radio and television stations provide the daily UV Index; check it out and protect yourself accordingly.
• Weather conditions. Even though cloud cover would seem to reduce the risk of sunburn, in fact 80% of the sun’s ultraviolet rays pass right through clouds. Some of the worst burns can be acquired on cool, cloudy days because the skin never “feels” hot.
• Amount of time spent in the sun. The longer you’re exposed, the more time the ultraviolet light has to penetrate the skin’s outer layers and do its damage.
• Use of certain drugs. Some antibiotics and corticosteroids, for instance, can make your skin more sensitive to sun exposure, as can the herb St. John’s wort. It’s always wise to check with your doctor or pharmacist about the medications you take to see if any causes an increased sensitivity to the sun.

Conventional Treatments
Most mild sunburns heal on their own in a matter of days as the skin renews itself. The redness will fade, and the skin may peel. Cool baths and simple moisturizers can provide some relief.

A severe burn can take as long as a week or more to heal. In some cases, severe sunburns with blistering are considered medical emergencies, particularly when the burn covers a large area of skin and also causes headache, fever, or chills.

Conventional treatment of this kind of injury includes keeping the area free of infection as it heals, and making sure that the person stays well-hydrated with fluids.

Finally, periodic checkups with a primary-care doctor or a skin doctor (dermatologist) is useful to check for signs of long-term sun damage.

Medications
A number of over-the-counter medications can help relieve the pain and, in cases of severe sunburn, accompanying inflammation.

If you suspect you were overexposed to sunlight but symptoms have yet to develop, try taking one or two aspirin; this may help to minimize the coming inflammation and pain of the burn. Conventional nonsteroidal anti-inflammatory medications (NSAIDs such as ibuprofen) may help the pain as well.

Benzocaine and other “-caine” products (including Solarcaine) are standard over-the-counter remedies for sunburn pain, which are available in sprays and other easy-to-apply forms. Be sure to stop using the product, however, if it seems to cause increased skin sensitivity.

In cases of extensive sunburn damage, doctors may prescribe oral corticosteroids (for up to 10 days) to lessen inflammation and reduce the risk of scarring.

Treatment and Prevention
Unless a sunburn is quite severe, the skin will heal on its own, and a number of home remedies (see Self-Care Remedies, below) can help to soothe your discomfort as you wait for the skin to renew itself.

Prevention: Without a doubt, prevention is the easiest and most effective way to contend with sunburns and prevent the long-term risks (from premature wrinkles to skin cancer) associated with sun exposure. The best prevention strategy includes not staying in the sun for long periods, choosing a good sunscreen, and using it properly.

To avoid the sun’s damaging rays, remember:

• Timing is key. The sun is strongest (and most likely to burn the skin) between 10 A.M. and 4 P.M., even on overcast days.
• Beware of reflective surfaces. Water or sand can bounce as much as 17% of the sun’s ultraviolet rays back at you. Snow can play the same trick, reflecting up to 80% of the sun’s ultraviolet rays.
• Cover exposed skin. Wear tightly woven dark-colored garments (they give more protection), high-quality sunglasses (look for ones designed to block ultraviolet radiation), and a wide-brimmed hat (a 4-inch brim is sufficient).
• Protect children. Be sure youngsters are protected, especially babies, because their skin burns more easily than adults’.
• Forgo the tanning parlor. Tanning machines developed over the past decade emit both UVA and UVB radiation that mimic true sun exposure. These are just as capable of damaging your skin, and as likely to cause sunburn, as a day at the beach.

To choose the right sunscreen, remember:

• Comparison shop. It’s worth your time to find the product that’s best for you. Sunscreens chemically absorb damaging ultraviolet rays. Sunblocks actually deflect ultraviolet radiation.
• Pick the right SPF. The Sun Protection Factor (SPF) ratings range from 2 to 60. The numbers indicate a product’s ability to shield you from UVB rays. If you normally burn in 30 minutes, an SPF 15 is designed to protect you for about 450 minutes (15 X 30 = 450 minutes), or more than 7 hours. Most people should start with an SPF of 15 or higher, though more susceptible individuals and children may need an SPF of 30 for better protection.
• Buy a “broad-spectrum” sunscreen. This is one that protects you from both UVA and UVB rays. Check the label for such compounds as benzophenones, oxybenzone, sulisobenzone, titanium dioxide, zinc oxide, or Parsol 1789 (butyl methoydibenzoylmethane, also called avobenzone).

To apply the cream correctly, remember:

• Be generous. Many sunburns develop because too little suncreen is used. Coat the skin liberally, all over. For an average-sized, bathing suit-clad person, aim for an ounce (enough to fill a shot glass) to cover all the exposed skin. Protect your lips with a balm rated SPF 15 or higher.
• Let it sink in. Apply your suncreen 20 to 30 minutes before going outside. This gives the protective chemicals time to sink in. By letting the sunscreen dry fully, it’s also more likely to stay on your skin and not get wiped off.
• Reapply often. If you’ve been very active in the sun or water, reapply sunscreen every two hours, even if the product claims to be “waterproof.” There’s evidence, for instance, that people who regularly use sunscreen (SPF 15) develop more sunburns than people who rarely apply sunscreen–perhaps because the sunscreen users think that they’re protected for the whole day when they’re not.
• Use it year-round. Apply an SPF 15 sunscreen daily, regardless of your skin type. Over a lifetime, most sun exposure–80% by some estimates–comes unexpectedly, during day-to-day tasks. If you wear make-up, apply the sunscreen first or use a cosmetic product that contains SPF 15.

How Supplements Can Help
Supplements are used to enhance the body’s ability to control inflammation (thus preventing some sun damage) or to speed recovery following overexposure to the sun.

Just a reminder: If you have a serious medical condition or are taking medication, it always a good idea to check with your doctor before beginning a supplement program.

For mild burns (with pain but no broken skin or blistering), try one of the following remedies:

• Chamomile oil and lavender oil (10 drops each) can be added to a cool bath; soak for at least 30 minutes.
• A lukewarm bath containing 1 cup of dissolved baking soda is another alternative; soak for at least 10 minutes.
• Fresh aloe vera gel, calendula cream, chamomile cream or chamomile oil, and lavender oil can be topically applied to sunburned skin to soothe irritation and speed up healing.

For moderate burns (small areas of blistering that make infection a concern), try one of the following remedies:

• Rub commercially available (and sterile) calendula cream into a gently cleaned area to lessen inflammation and help prevent infection through the broken skin.
• Mix a few drops of chamomile oil or lavender oil (or both) with half an ounce of almond oil (or another neutral oil). Apply the mixture gently to the affected areas twice a day.
• A topical vitamin E cream will help promote healing and prevent scarring. You can make your own by breaking open a capsule and mixing the oil with 1 tablespoon of moisturizing cream (see Self-Care Remedies, below).
• Apply flaxseed oil topically, which will reduce inflammation, and take it orally to promote overall skin health and texture.
  For severe burns (deep burn with systemic symptoms such as fever, confusion, and dehydration), don’t attempt self-treatment for an extensive sunburn with severe symptoms. Go to an emergency room or an immediate-care center, or call your family doctor. For all degrees of sunburn, two antioxidants–vitamin C and vitamin E–should be taken long-term because sun exposure releases free- radical molecules within the body that can damage the skin.

For prevention: In addition, there are new research developments concerning vitamins (and even foods) that may prevent or delay the damaging effects of overexposure to the sun. Vitamin A supplements have shown some promise in this regard, although this work is still in experimental stages.

One recent study, for instance, found that a five-year regimen of oral vitamin A supplementation had a dramatic effect in reducing certain types of skin cancer cells in nearly 2,300 study participants. All were at increased risk for full-blown skin cancer because of a history of precancerous skin changes.

Because high doses of vitamin A have the potential to damage the liver as well as causing other problems, this type of treatment should only be done only under a doctor’s supervision. Research is now underway to determine safe dosage ranges.

Self-Care Remedies
Sunburns certainly are not a new problem for humans, and so traditional remedies for soothing the pain of burned skin are still relevant today.

Try cold compresses.To relieve sunburn pain, make a cold compress by soaking a piece of cotton-flannel or a large gauze pad in cold tap water; place the compress gently on the affected areas. You can also apply cooled, used tea bags to the sunburn–the tannins in tea have an anti-inflammatory effect. Occasionally, cold compresses cause more discomfort; in such cases, try soaking in a lukewarm tub with baking soda added to the bath water.

Soak in a colloidal oatmeal bath. If a large section of your body (say your back and legs) is sunburned, try soaking in a cool bath containing colloidal oatmeal, a product easily found in pharmacies. (You can make your own by grinding 1 cup of dry instant oatmeal in a blender; make sure it’s very fine.) The oatmeal will help moisturize and soften your skin, which can get very dry and irritated following a sunburn. It may also relieve the itch that often accompanies healing skin.

Avoid greasy creams or lotions. Don’t use baby oil or petroleum jelly on a sunburn, since they only trap heat and could eventually cause increased discomfort.

Sprinkle talcum powder between the sheets.This minimizes chafing while you sleep.

Take extra care when in the car. While it’s rare to get sunburned through the closed windows of a car–UVB radiation is blocked by clear glass–you can get cumulative skin damage through windows that aren’t treated to shield UVA radiation. Although most cars made since 1990 have front windshields partially treated against UVA, the back and side windows usually aren’t. So it’s always a good idea to apply sunblock before car trips–especially to children’s sensitive skin.

Alternative Therapies
If your burn is serous enough to require medical attention, certain acupuncture techniques may be useful as a complement to standard medical care. An acupuncture surface treatment activates the “tendinomuscular” or “sinews” acupuncture points for the injured area, and can speed recovery if the treatment is given in the first 10 to 12 days after the sunburn.

Check that your acupuncturist knows how to do this treatment, as some practitioner training programs may not emphasize specialized injury treatments.

When to Call a Doctor

• If you experience fever, chills, headache, nausea, or dizziness.
• If large blisters form over an area larger than the size of your hand; such areas of exposed raw skin can become infected.
• If pain or itching is unusually severe. This could be the sign of a more serious burn.
• If your symptoms get worse after applying a topical home remedy. Burned tissue can become sensitized to otherwise helpful healing agents.

Even the best of natural and preventive health programs can do only so much, and it is sometimes necessary to use surgery as a treatment. But, while “going under the knife” may be scary, it does not have to include a total surrendering of the principles of self-care and good healing. In fact, preparing and going through surgery are good times to demonstrate a true complementary medicine approach.

Good nutrition is as important before and after surgery as it is at any other time. Years ago, Dr. George Blackburn at N.E. Deaconness Hospital demonstrated the improvement in post-operative healing that accompanied better attention to what the patient ate. While opinions on good diets continue to evolve (my preference for limiting grain-based and sugar-based carbohydrates has been stated in this column before) it is clear that good weight management, attention to an adequate amount of protein (necessary for wound healing) and fresh, nutrient-rich produce are good starts. Sugar and alcohol are well known to suppress wound healing, and should be eliminated. Caffeine withdrawal is bad enough at any time, but worse when compounding a post- operative experience. And, (if it must be stated in a health periodical), cigarette smoking drastically increases the risk of anesthesia and post-op complications.

Several vitamins and minerals help to speed the rate of healing, and to limit the formation of scar tissue. Vitamin C is known to increase wound healing, as are the minerals zinc and copper. If possible, it’s helpful to begin taking these nutrients several weeks before the surgery, and to continue for a month after. Vitamin C can be taken up to 3000 mg per day without much risk of diarrhea, but the dose can be lowered if there are digestive problems. A good dose of zinc for wound healing is 30 mg per day, balanced by 2 mg copper. The vitamin C can be accompanied by bioflavinoids, usually 500 mg for each 1000 mg of vitamin C. The bioflavinoids (and other flavinoids such as pycnogenol and grape pips) help scars to heal. Vitamin E 400 iu is also helpful, and vitamin E oil (from capsules) can be rubbed on a healing wound once it is safe to do so. Any stress increases the need for B vitamins and for magnesium. Finally, common herbs for surgery preparation include Siberian ginseng or eleuthrococcus (which aids in withstanding stress), gingko biloba (which helps circulation) and gotu kola (which is demonstrated clinically to speed wound healing).

While homeopathy is a system of medicine in itself with an intricate diagnostic and treatment plan, it adapts well to self-care. Arnica montana is a remedy which is frequently used to heal from trauma, and is readily available in strengths of 30X (more potent remedies are best given under a homeopath’s care). Arnica tablets (or remedy mixtures containing Arnica) are usually taken under the tongue every 2-4 hours post-surgically. Likewise, the flower remedy called Rescue Remedy has been used by many patients both before surgery (to calm down) and after (to make for a more relaxed healing). Homeopathic Arnica montana is available in a cream-base as well, for rubbing on a healing area.

Many systems of medicine can be useful to help with post-operative care and well-being. Acupuncture is a time-honored way of bringing a body into balance, and many acupuncture techniques, including the use of magnets pioneered by Japanese acupuncturists, can have a marked positive effect on scar tissue, as well as a measurable lessening of post-operative pain. Indeed, the latest introduction of acupuncture to the U.S. was largely due to a New York Times columnist, James Reston, reporting on his post-appendectomy acupuncture pain control in the pages of his prestigious newspaper in 1972. Massage therapy can encourage good blood flow into an area of healing, help to break down excessive scar tissue, and combat the stress of a scary procedure. Spinal alignment, and craniosacral rhythms, can be thrown off during surgery and therefore may be addressed by appropriate practitioners.

Hands-on healing goes by many names. Reiki is a technique which is fairly easily taught, and there is much anecdotal evidence of its help in healing. An emergency room physician and Reiki Master, Dr. Nancy Eos, described many cases in her book Reiki and Medicine. Dr. Mehmet Oz, a Columbia-Presbyterian cardiac surgeon, made the cover of the New York Times Magazine for his use of hands-on healers in the operating room during coronary bypass surgery. Therapeutic Touch, a similar technique taught mostly to nurses, has been shown in the laboratory to improve wound healing. In another study, Dr. Bernard Grad of McGill University measured a famous healer’s successful ability to influence healing rates in artificially induced surgical wounds in mice. And the Chinese system of QiGong can be used as a self-care tool, and a powerful energizer when performed by an experienced practitioner. Finally, the most ancient system of healing is still probably the most widely practiced in the waiting rooms and post-op units. Prayer has shown demonstrable results on healing, as well as on hope. Dr. Larry Dossey has spoken widely of the effects of prayer and the clinical studies supporting it (most recently in his book, Healing Words: The Power of Prayer and the Practice of Medicine).

Most complementary medicine programs to help deal with surgery rely on the well-known fact that stress and anxiety will slow the healing process. This is true whether physical measures are being studied (the increase in catecholamines and other stress neurotransmitters which interfere with the smooth healing process and with proper organ function), or emotional (a 1995 article in the medical journal Lancet showed that people who were major caregivers of sick relatives healed an experimental wound slower than a control group without such stresses). So, a number of techniques, including music, meditation, visualization and psychological preparation, have been and are being studied for their effects on the surgical process.

Much of this information is available in a remarkable book by a Cambridge, Mass, psychotherapist, Peggy Huddleston. Her book, Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques, is a recently-published compendium of stories, data, referral sources, guided imagery techniques, and solid wisdom for the patient faced with surgery as a likely option. Ms. Huddleston’s suggestions encourage an active patient who is a partner in his/her care, a critical stance for someone who is facing a terrifying and seemingly powerless experience. Her Five Steps to Prepare for Surgery (Relax to feel peaceful, Visualize your healing, Organize a support group, Use healing statements, and Meet your anesthesiologist) lead a reader to a more participatory place of healing. The book is well-referenced, and there is plenty of space allowed for one’s own ideas. And, included toward the back, are statements to give to the surgeon and the anesthesiologist to repeat (e.g. following the operation, repeat 5 times: “Your operation has gone very well”). The book probably should be on home shelves before an emergency necessitates a sudden hunt for it in bookstores.

Many in alternative medicine look at surgery as the enemy, to avoid at all costs and to submit to with fear and loathing. But in a true spectrum of healthcare taking the best of the conventional and complementary worlds, surgery can be (along with chemotherapy, drugs, and radiation) a powerful ally, one that is used sparingly and appropriately, in cooperation with the best ways of preparing the mind, body and spirit for a necessary trauma and for a safe and easy recovery.

As more women enter the time of menopause, the issues of hormone cessation and their possible replacement become important. The wisdom of estrogen replacement (ERT), with or without progestins, will be discussed in a later column. But many women are unable or unwilling to take hormone replacement. For them, two herbs are of critical importance.

In 1995, six million monthly doses of one herb used in menopause were sold in Germany and Australia alone. The product, called Remifemin, is a formulation of Black Cohosh (cimicifuga racemosa) which has been standardized to contain 1 mg of a group of substances known as triterpenes. It has been tested in double-blinded and placebo-controlled studies, and compared to estradiol (the common estrogen replacement in Premarin and other medicines). Triterpenes and other flavones (the components of herbs and flowers that give them flavor, color and, frequently, medically activity) in black cohosh seem to affect a number of areas in the pituitary, hypothalamus and vasomotor centers. They inhibit leutinizing hormone (LH), without affecting the other pituitary hormones as does estrogen. They have a proportional effect on the vaginal lining (increasing the protective cells of that tissue) as opposed to estradiol, which seems to affect the uterine lining more. And they have a positive action on hot flashes and on the depression and anxiety that can occur with menopause.

Remifemin has been used in well over one million women world-wide, and side effects are known to be minimal, mostly some minor digestive disturbance if not taken with meals. It seems to take 1-2 months to see results of the therapy, which in most studies has been 2 pills twice daily (giving a total of 4 mg triterpenes, or more specifically a substance called 27-deoxyacteine). Other forms of black cohosh may be as effective, although they have not been studied as thoroughly as Remifemin. Cimicifuga racemosa has been used for centuries, both in Western herbology and in Oriental medicine, where it is known as an herb which tonifies and moves blood.

The fruit of the “chaste tree“, a small tree that grows in subtropical climates throughout the world, has been known for centuries as a medicinal herb of extraordinary usefulness. Even the name given by the Romans, “Vitex“, sounds like a Madison Avenue label for an all-purpose tonic. In fact, Vitex is a tonic (strengthener) of the hormonal system, particularly in women where it is the cornerstone of many herbal remedies.

The ancients clearly knew of vitex’ affect on female hormones. The name “chaste tree”, in fact, came from a popular belief that vitex “checks violent sexual desire” (in the words of Pliny the Greek historian). This belief carried through to the last century, where vitex was given to nuns in convents. Modern knowledge of vitex, however, began in this century with European scientific research on its hormonal uses.

Vitex seems to have its main effect on the anterior lobe of the pituitary, or master gland. It is here that the hormones that control the menstrual cycle, and therefore influence the production of the ovarian hormones estrogen and progesterone. One of the main uses of vitex in the West currently is in menopause. This herb appears to be a natural way of augmenting the body’s progesterone, and therefore modifying some of the hormone-withdrawal effects of menopause in those women choosing not to take estrogen replacement therapy (ERT), or even those who are on estrogens. For this indication, vitex is best used in conjunction with other “like-minded” herbs such as Dong Quai (angelica sinensis), Blue Cohosh and Wild Yam, all of which support the effects of the female hormones present at menopause.

As with much of herbal medicine, vitex is best used over a period of time, and the results may not be obvious for a few months. For this reason, the treatment course (other than in pregnancy- related situations and treatment of severe cramping) should be six months minimum. The fruit can be mixed with other herbs into a tea (the active ingredients are water-soluble) for a nice tonic beverage. It can be powdered and put into capsules. In most studies, it is used as a tincture, in a dropper form (usual dose is about 30-40 drops in water per day) or a standardized solid extract, 175 mg capsule. Side effects are minimal; however, it probably should not be used without supervision when progesterone is being given.

When used properly, this versatile herb can truly be a VITal EXample of herbal medicine.

1. Well, this is a perfect example of how a bit of information can be distorted. Here are the facts:
2. This study showed that St. John’s Wort wasn’t helpful for major depression. Major depression is NOT an indication for St. John’s Wort, it’s unreasonable to expect an herb to cure a situation that might require hospitalization and acute interventions.
3. The study was funded by Pfizer Pharmaceuticals, who produce Zoloft. Thirteen of the sixteen researchers had received grants from the company. Why would a pharmaceutical company fund a study of an herb that they have no possibility of patenting, except to show that it pales in comparison to their medication?
4. The British Medical Journal, a well-respected peer-reviewed periodical, published an article in 1998 that analyzed 29 studies on St. John’s Wort, of which 21 were considered good quality studies. That article concluded that studies support St. John’s Wort’s use in mild to moderate (not major) depression.
5. Doing herb studies is very tricky. St. John’s Wort, for instance, has at least 12 active ingredients. Which of these work in depression? No one knows yet, and so different studies concentrate on standardizing different ingredients.
6. There is currently no regulation of natural products. In fact, Consumer Labs, an independent organization that evaluates natural products on the market, has found wide variations in the amount of active ingredients in the 21 St. John’s Wort products they tested. (The Rothfeld Center, in an effort to maintain the quality control of our products, supports and subscribes to Consumer Labs.).

The public can get very confused when medical information is filtered through the “sound bite” media. Hopefully in this and future e-letters, we can help you to sort through some of this information.

Purchase St. John’s Wort online at the Natural Apothecary

A number of recent articles in prominent medical journals support the use of acidophilus and other probiotics in a number of digestive problems. Probiotics, as their name implies, are living organisms that promote the health of the digestive tract. In contrast, antibiotics are medications (usually synthetic) that destroy organisms.

Antibiotics, or course, have important uses in modern medicine, and they are necessary to kill the invading infections that cause many of our diseases. However, no antibiotic kills only the bad organisms. Instead, a broad-spectrum antibiotic will kill most of the organisms in the body, particularly in the digestive tract. In fact, there are millions of good organisms in the digestive tract, more organisms than there are cells in the body! These organisms are important for our proper digestion, absorption of critical nutrients, and proper elimination.

A healthy digestive tract has the ability to repair itself to some extent, but prolonged exposure to antibiotics overwhelms this ability to heal. This exposure can come from repeated antibiotic use such as with sinusitis, urinary or respiratory infection, or from a chronic course of antibiotic commonly used to treat acne or prostatitis. In fact, there’s no guarantee that avoiding antibiotic prescriptions will eliminate this problem. More antibiotics are used today in raising animals for food than are used to treat humans, and these antibiotics are carried into our bodies when we eat animal flesh.

Fortunately, the digestive tract acts as a fertile ground in which we can plant new, healthy organisms, and those organisms are called probiotics. Taking these valuable mixtures of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacteria longum, and other organisms can restore proper digestive function. Saccharomyces boulardii is a special organism that seems to have some use in treating Clostridium dificile, a dangerous digestive infection that results from overuse of antibiotics.

And what about yogurt? Yogurt and other cultured products like kefir and buttermilk deliver the proper organisms to the digestive tract, and can be used to prevent the side effects of antibiotics. But, it’s got to be pure unsweetened yogurt (adding fresh fruit and nuts is fine). The sugar-laden, chemically-altered yogurt products now on the market may taste good, but are useless in treating digestive problems.

Purchase probiotics (PB8) online at the Natural Apothecary.

For more information on Digestive Health, click here.

In the movie “Sleeper” by Woody Allen, the futuristic characters chuckle and say, “Remember when it was thought that cigarettes and fat were bad for you?” It certainly seems that ideas of health go back and forth like other trends. For instance, there is a growing body of evidence that a high carbohydrate diet, recommended by everyone from the American Heart Association to the strictest macrobiotic, may not be as healthy as we once thought (more on that in a later column). Now, some important studies have been done which emphasize the importance of that much- maligned substance, salt.

It is common practice to recommend a low salt diet (or more specifically, a low sodium diet, since we are talking here about sodium chloride, or table salt) in the general population, and particularly in hypertension. It is known that populations with lower salt intake have lower blood pressures generally. However, there is no good evidence that lowering a salt intake will lower blood pressure significantly, and certainly little evidence that it will modify the ill effects of high blood pressure, like heart attacks and strokes. Now comes a study from the medical journal Hypertension which shows that hypertensive people who lowered their salt intake most suffered the most heart attacks, almost four times the amount experienced by the group with the highest salt intake!

This result was not totally unsurprising. It is known that about half of hypertensives and a quarter of the population as a whole are “salt-sensitive“, that is, their system overreacts to salt by raising blood pressure. The rest of us don’t seem to react much to salt. However, in this “sensitive” population, increasing potassium, magnesium and calcium intake seems to control the sensitivity. So, taking adequate doses of these minerals (about 3500 mg potassium, 800-1000 mg for calcium, 1200-1500 mg calcium for post-menopausal women, and 500-800 mg magnesium) seem like a better idea, along with a moderate level of salt intake.

The kidney has a delicate mechanism (called the renin-angiotensin system) for maintaining pressure in the blood vessels. Artificially lowering one element of the system (sodium) causes an elevated renin level, and thus the kidney works harder to retain the salt that it has. In other words, the hypertension is a sign that a hormonal system is out of balance, and thinking we can starve it into submission may be naive. Sodium is necessary enough that a major adrenal steroid hormone, aldosterone, is devoted to its regulation and retention. Many studies show the necessity of dietary salt, from population studies showing a tendency toward shorter life span in people eating low-salt diets, to animal studies showing growth failure with sodium restriction. Multiple studies earlier this century showed fatigue and mental dulling to result from salt depletion diets.

Which brings me to the second exciting piece of medical information. Researchers at the Johns Hopkins University have published reports in Lancet and more recently, JAMA, suggesting that patients with Chronic Fatigue Syndrome can be helped by increasing salt in their bloodstream. More specifically, these patients (admittedly a small number so far) were found to have something called Neurally Mediated Postural Hypotension, which means that their blood pressure dropped down when they stood up, exercised, or with other activities that normally require the prompt reaction of the neurologic and adrenal systems to maintain blood pressure. When these patients were given higher amounts of sodium chloride and/or aldosterone (the adrenal hormone which keeps sodium in the body) they experienced less fatigue and brain fogginess (some patients were given other medications to increase blood pressure as well).

These studies are important for a number of reasons. Firstly, of course, is the possibility that this group of patients can finally be treated with a therapy that seems to have significantly positive effects. Chronic Fatigue Syndrome has only recently been accepted in the medical community as a diagnosis, and is still widely treated as a psychiatric disorder by physicians unaware of its prevalence and symptomatology.

Secondly is the support for the natural medicine concept of endocrine “exhaustion.” Much of the research on CFS has focused on hunting for “The Virus”, an infectious disease model more suitable to Pasteur and Ehrlich’s “Magic Bullets” and Jonas Salk’s search for a polio vaccine. However, many complementary medicine physicians, and other alternative providers, have treated CFS as a problem of coordination and depletion of the thyroid, adrenal, and other hormones, including neurotransmitters like seratonin. Thyroid support in the form of prescription or nutritional supplements like kelp and L-tyrosine have been helpful, as well as adrenal cortical extract, nutrients like vitamin C and pantothenic acid and herbs like ginseng and licorice which help the adrenal. Some physicians have given DHEA, an adrenal hormone (actually, the most prevalent hormone in the body) which is low in some CFS patients and is thought to relate to “reserves” of corticosteroid hormones. Some have suggest a topical preparation of wild yam, which contains natural forms of steroid hormones. Some have augmented the patient’s seratonin by using the newer SSRI drugs (mislabeled “anti-depressants”) like Prozac and Zoloft, [and herbs like St. John’s Wort and Valerian. ] Some patients have even been helped by low doses of natural hydrocortisone, to assist their body’s own production.

The researchers themselves are approaching their findings cautiously, assuming they are looking at a genetic predisposition to this condition which somehow becomes a problem. However, it is tempting to consider that they may be looking at one aspect of a hormonal “stress response” system (called the General Adaptation Syndrome by Dr. Hans Selye) and that supporting all the hormones naturally will coax the body back into balance.

Several broader issues are suggested by these studies supporting the use of salt. One is to reiterate that moderation is the best policy when discussing nutrition. As one wag put it, if you don’t like the evidence for a dietary recommendation, wait until the research supports what you do like. Up until the this century tomatoes were widely thought to be inedible, even deadly. Those of us who remember nutritional medicine pioneer Adele Davis exhorting us to eat brewer’s yeast must be glad that the fine lady is not around to see the bad rap yeast is getting in today’s nutritional circles. And one must wonder if Carrie Nation would have lived longer if she’d had that nightly schnapps that researchers now tell us will protect against heart disease!

Another is the importance of looking at individual differences, what Dr. Roger Williams called “Biochemical Individuality.” A portion of the population needs to lower their salt, the rest of us do not. About a third of the population is sugar and carbohydrate sensitive, others are less so. If we just lump everyone and look at Bell Curves, as our current medical studies do, we will miss the variations that make us all unique. This is the true value of many of the natural systems of medicine, that they approach everyone individually. Thus, it’s not unusual for a practitioner of Chinese Medicine to prescribe salt for a patient who is fatigued, especially if that person has darkish color in their face, a groaning voice, and a certain pulse quality. This signifies a weakness of the Kidney energy, which has to do with reserves, with the ability to sustain an effort physically or mentally. The taste associated with the Kidney is salty. Likewise, a complementary medicine provider might look for other signs of adrenal exhaustion, like dizziness, sugar cravings in the afternoon, and tightness of the mid back muscles over the adrenal gland. The art of seeing patients as individuals is being lost in the modern world of technological medicine.

The last issue is a reminder of how much a part of nature we really are. We came from the salty brine, we are bathed in salt in the womb, and filled with it throughout our lives. Wars have been fought over it, economies supported, and drab meals made tasty.

The natural approach to prostate problems involves four steps. The first is to lessen “congestion” in the lower pelvis area, that is, to improve the blood and energy flow to the prostate region. Constipation, low back problems, scar tissue and injury all affect this flow, and can be improved by the appropriate dietary changes, massage and manipulation therapies, and acupuncture.

The second is to eat a diet aimed at improving the health of the prostate . Diets containing a high amount of soy products have been recommended as preventing prostate enlargement, since soy contains natural substances (isoflavones) which help detoxify the harmful DHT. This may explain why Japanese men, who eat a higher soy diet, have lower incidences of prostate problems. Diets which rely on red-orange fruits and vegetables (containing carotenes) are associated with decreased prostate cancer incidence, as are diets higher in polyunsaturated fish and vegetable oils. Adequate fiber in the diet helps, by decreasing the pressure in the lower bowel area. Finally, some foods like sunflower and pumpkin seeds seem to have a positive effect on prostate symptoms.

The third is to supplement the nutrients which seem to aid in prostate function. Zinc is required to utilize carotenes, and therefore may be cancer protective. Zinc also, in conjunction with vitamin B6, regulates the enzyme which converts testosterone to the harmful DHT. Essential fatty acids are converted in the body to the messenger hormone prostaglandins (so-called because they were first found in the prostate) which control inflammation, among other functions. Vitamin E helps preserve the fatty acids. Thus a nutritional supplementation program for prostate function would include zinc (usually chelated 50-75 mg, or picolinate 30-60 mg); Vitamin E 800 IU; flax seed oil 2 tbps of liquid (keep refrigerated) or 3 capsules (cod liver oil 1 tsp per day is also helpful); B complex 50 mg with B6 50 mg; and vitamin A / beta carotene (10-15,000 units of each). Selenium, Evening Primrose Oil, and the amino acids glutamine, alanine and lysine have also been helpful.

Fourth, several herbs have been studied and used extensively in prostate conditions. Saw palmetto berries (also called Serenoa repens, it is from a common tree grown in the southeastern U.S.) contain substances which actively inhibit the formation of DHT from testosterone (by inhibiting the enzyme, 5 alpha reductase, which converts it), prevent the DHT that is produced from acting on the prostate, and cools inflammation in the gland itself. Studies show this herb to be remarkably safe, and “metanalyses” comparing the saw palmetto extract to Proscar show higher effectiveness in improving prostate symptoms, with much less side effects. German studies of up to 2000 men with BPH, as well as studies in British, French and Italian medical journals have confirmed the value of saw palmetto extract, and there is currently a huge market in Europe for its use. The results frequently were less residual urine after voiding, less nighttime visits to the bathroom, and stronger stream. In order for saw palmetto to be effective, it must be in an extract form (usually capsules, though tinctures are also used) since the active ingredients are fat soluble, and a tea made from the berries would not make these components usable. The dose of extracts in the studies is usually 320 mg per day, in two divided doses.

Pygeum africanum (the bark of an African evergreen) is another herb used extensively in France and elsewhere in Europe, and recently imported into the U.S. In several double-blind studies, a fat-soluble extract of this herb improved prostate symptoms significantly without many side effects (stomach irritation was the most common). In fact, in one study sexual ability was increased as well. The herb seems to work, again, by limiting the formation of DHT and by lowering prolactin levels ( a pituitary hormone related to prostate and sexual function). It also is a mild antibiotic, which may explain its good effect in prostatitis as well as BPH. A usual dose is 50-100 mg twice daily, as an extract. Several studies have shown that the two herbs work well together.

A third herb, Urtica dioica, or Stinging Nettles, has also been studied in Europe and has beneficial effects on the prostate, again by blocking DHT. The dose is 300 mg of an extract. Finally, there is a Swiss extract of flower pollen (Cernilton) which has potent anti-inflammatory actions and has been effective in prostatitis in a number of clinical studies.

Of course, the diagnosis of prostate conditions is still best done by an MD (digital exam, urine and blood tests) but natural medicine offers a wealth of safe and easy methods of treatment.

“Arthritis” means inflammation of a joint, and can refer to many different conditions, from an infection in a joint, to an auto-immune disease such as rheumatoid arthritis. But most commonly, it refers to a condition called Osteoarthritis, or Degenerative Joint Disease (DJD). This is the wear and tear on a joint, leading to the disappearance of the protective cartilage of a joint and to damaging of the bone itself. It is not primarily an inflammation at all, but more of a degradation of a joint. It occurs in women around and after menopause, in men during and after middle age, and in athletes or others who have had trauma to a joint.

The medications used by conventional medicine are called NSAIDs, or non-steroidal anti-inflammatory drugs, a class which includes Ibuprofen, Motrin, Aleve, Naprosyn, Advil, and a host of others. Since these are anti-inflammatory, they will help any inflammation around the joint, and relieve pain. However, since the main problem is wearing away of tissue, they do not address the cause of the problem. In fact, NSAIDs slow down cartilage growth and repair. Which is where more natural treatments may be useful.

The substance in joints which stimulates new cartilage growth and is used for connective tissue repair is called glucosamine sulfate. Glucosamine is made in the body from sugar (glucose) and the amino acid glutamine, and it is the main component of the cartilage substance glycosaminoglycans (GAG), which holds water and acts as a shock absorber to joints. Glucosamine sulfate is easily absorbed from the digestive tract, and once inside the cartilage cell, stimulates new growth if needed. Several studies involving hundreds of patients have found glucosamine sulfate to be helpful in lessening the pain and stiffness of arthritis, and even to repair arthritic joints. The concept that you can actually grow back cartilage in an arthritic joint is bold, but supported by studies in both animals and humans. Furthermore, at least one study of arthritic hips suggested that arthritic joints can get better on their own! This would seem to suggest that NSAIDs might slow the natural course of osteoarthritis, and it certainly encourages the use of substances like glucosamine sulfate to promote joint healing. A safe beginning dose of glucosamine sulfate is 500 mg three times per day.

A number of cartilage builders have been used successfully in DJD, mostly because of their glucosamine content. Chondroitin sulfate, green lipped mussel, and sea cucumber have this effect, but they are not always absorbed as well, do not have as many studies backing their use, and tend to be expensive. Likewise, cartilage extracts from cows, chickens, or sharks have been studied in arthritis. The most successful study has involved injection of these products. Shark cartilage is currently being studied for its use in arthritis and in cancer, though ecological considerations do not make it a desireable product.

Other nutrients helpful in arthritis are vitamin C (anti-oxidant protection, stimulates cartilage production, helps heal damaged tissues), vitamin E (anti-oxidant), and several nutrients required for proper cartilage health: vitamin A, B6, zinc, boron and copper (the latter suggests that the old folk remedy of wearing a copper bracelet for arthritis may have some basis in fact). Magnesium is useful in bone repair and tissue health, and some products use salicylates (like aspirin) in combination with magnesium for additive effect. In addition, a form of vitamin B3 called niacinamide was studied by Dr. William Kaufman in hundreds of people with osteoarthritis, and was helpful the majority of time, particularly with DJD of the knees. Niacinamide (niacin doesn’t work and is riskier) is taken frequently and for a long time to be effective, and needs to be taken under a doctor’s care due to its rare liver toxicity.

What about diet itself? There are two approaches which seem to work for some people. The first is to eliminate foods containing nightshade alkyloids, including peppers, tomatoes, eggplants, potatoes and tobacco. This is based on research by Dr. Norman Childers, and is supported anecdotally by a variety of patients. The second is to eliminate foods which have so-called allergic responses in the body (actually, these reactions are more properly termed sensitivities since many of them are not strictly allergies), then re-introduce the foods and chart the effects. Joint pains are common results of food sensitivities, and the most common offending foods are wheat, dairy, yeast, citrus, coffee and foods with additives and preservatives. Some people also lessen joint pain by proper blood sugar balance, avoiding sugars and heavy flour use, and balancing protein and carbohydrate to limit the production of inflammatory hormones in the body (the so-called “Zone” approach).

Several herbs are useful in osteoarthritis. Boswellia extracts, from an Indian tree of the same name, have been studied both internally and as a topical cream, and seem to be anti-inflammatory and cartilage-stimulating. Salix alba (white willow) and meadowsweet contain salicylates which act similar to aspirin. Guaiacum has been studied successfully in arthritis. And anti-oxidant herbs such as turmeric and green tea may be helpful as well.

One natural substance that has been used world-wide for arthritis is honeybee venom. Many beekeepers have neighbors who come for “stings” when their arthritis acts up. Honey bee venom has been very well studied and contains the most potent anti-inflammatory activity known, as well as enzymes and substances which break down and remold damaged tissue. Allergy is relatively rare (almost all stinging insect allergies are to wasps and yellow jackets). Many people learn to self-administer bee stings using tweezers, and a handful of physicians around the U.S. use bee venom therapy in injectible form in the treatment of arthritis.

Finally, natural treatments for osteoarthritis include the forms of movement which keep the joints limber and energy and blood flowing. We are familiar with pictures of hundreds of elderly Chinese doing Tai Ch’i each morning. Tai Ch’i is a form of QiGong, a gentle set of energy-moving and building exercises which can keep joints mobile and improve vitality. Yoga, from the Indian tradition, is another movement system which can improve and prevent arthritis. In fact, many types of activity which involve range motion without wear and tear on a joint, can be useful in positioning this common reminder of age.

It pounds, it throbs, it brings life to a halt when it attacks. Each day, tens of thousands of migraine sufferers lose days of productivity. Migraines are poorly understood by conventional medicine, and the treatments are mostly pain relievers or vasoconstrictor drugs such as sumatriptan (Imitrex). However, and Integrative Medicine approach can be effective in lessening or eliminating the need for such drugs.

The first issue to explore with the patient who has migraines is that of diet, and specifically, food sensitivities. Estimates of food allergy and sensitivity as a trigger for migraines have been as high as 70%. Wheat and dairy seem to be the most notable culprits, as they are in many other food-related conditions, and withdrawing both at once seems to be easier than doing one at a time, since many of our common foods (bagel and cream cheese, cereal and milk, pizza, pasta with cheese, etc.) are wheat and dairy based. We ask the patient to completely withdraw wheat and dairy foods for a three week minimum. Then, the patient “challenges” with a wheat or dairy meal. Many times, a migraine will be activated by this challenge, implying that the food is a trigger. Aspartame (NutraSweet„¢)and various preservatives and additives can also effect a migraine history, so a patient should withdraw those, and the common migraine-associated foods (chocolate, red wine, etc.) as well.

The second piece to look for is a structural imbalance. Most patients with a diagnosis of migraine have muscle spasm that makes the pain worse, and some have other musculoskeletal problems such as a misalignment of their neck vertebrae or ligament strains. To find this, we press along and beside the cervical spine, looking for painful areas. We can also find areas of tenderness along the back of the skull, and in the trapezius and shoulder muscles.

Some of these tender points can actually send pain to the areas of the migraine; these are called trigger points. Trigger points were first described by Dr. Janet Travell, who was President Kennedy€™s back physician. These points in the muscles can refer pain to the top of the head and to the temples. The jaw is another area of tightness and pain that can worsen a migraine. Although migraine is thought to be a vascular phenomenon, it is surprising how much the problem can be modified by good body work, chiropractic and/or osteopathic adjustments.

The next area to investigate is whether there is a hormonal variation. Quite commonly, a female patient comes in whose migraines appear at ovulation and at the beginning of menses, or premenstrually. Other symptoms can also occur, suggesting a relative estrogen/progesterone imbalance. Documenting this imbalance can be difficult since standard blood tests give only a single snapshot of the hormones. Recently, salivary assays have been developed to measure estrogen and progesterone over the course of a monthly cycle. Most commonly, it is the progesterone that is relatively deficient. We sometimes treat this with topical progesterone cream, although oral progesterone is also useful and might have more reliable absorption. For relative estrogen deficiency we might use black cohosh extract, soy-based phytoestrogens, or (if other symptoms co-exist) natural estrogen preparations.

Chinese medicine gives a good framework for understanding and treating migraine, and we look for certain patterns in evaluating the patient. These patterns, if present, suggest that the patient is a good candidate for acupuncture and/or Chinese herbs. In Chinese medicine, Wood energy (characterized by the Liver and Gall Bladder channels) is associated with “wind” conditions. Wind is the quality that brings a symptom rapidly and furiously into being, and migraines frequently are associated with wood patterns of imbalance. Patients with wood imbalances tend to have a feeling of frustration, of impatience, and (sometimes) of underlying anger. Physically they can manifest spasm of the digestive organs, abnormal menstrual cycles with crampy periods, and lack of musculoskeletal flexibility. Migraines also tend to be “yang” illnesses, that is, they are sharp, pounding, and hot in nature. Thus a frequent treatment of migraines in Chinese medicine involves “cooling” the Liver Yang which has risen to the head, giving pain in the Gall Bladder channels which run along the temples and parietal areas.

Since symptoms hardly ever happen in a vacuum, we frequently see migraines associated with other signs of a neurological or circulatory system that is hyper-functioning. For instance, there might be high or labile blood pressure, cold hands and feet, palpitations or other signs of nervous system imbalance. The portion of the nervous system that controls these activities is called the autonomic nervous system, and includes the fight-or-flight response. There is a body of literature on using biofeedback to retrain the autonomic nervous system, and on its use in migraines specifically. Commonly, we send patients for biofeedback training after the acute phase of migraine treatment is completed.

Even simple relaxation techniques can be effective in warding off migraine. Yoga, meditation and qigong exercises all can be useful in quieting down a hyperactive nervous system, provided they€™re done regularly.

Several specific therapies are worth mentioning. Magnesium is useful in any condition involving spasm, and migraines can respond to magnesium therapy. However, oral magnesium is limited in its usefulness, since it is dependent on proper stomach acid, and will tend to cause diarrhea if too much is given. Intramuscular magnesium can be useful in an acute attack, and weekly as a preventive. Sometimes an intravenous slow injection of magnesium, usually given in conjunction with vitamin C, B vitamins, and trace minerals, is given. Called a Myers’ Cocktail (named after Dr. John Myers who developed it, and popularized by Dr. Alan Gaby), this infusion seems to deliver nutrients directly into the cells by temporarily changing the concentration in the bloodstream. The Myers€™ Cocktail infusion is used by physicians in a variety of conditions related to fatigue and nutrient depletion. In the case of migraines, the magnesium content of the infusion is increased a bit, and the “cocktail” is repeated weekly as necessary.

The herb we use most commonly for migraine is feverfew, which has been studied a lot for its migraine prevention abilities. Feverfew preparations vary, so a standardized extract is important to look for. Ginger is also useful in dealing with migraines. Frequently, a migraine sufferer is sensitive to caffeine withdrawal, and so they self-medicate with coffee, tea or cola to ward off a headache. In these cases we try to wean the patient off their substance and onto green tea. One of the common Chinese medicine herbal formulas that can be used for migraine, Cnidium and Tea Formula, probably works partially through its tea content.

Ultimately some people with migraines require medications, and our strategy becomes one of lessening the toxic effect of longterm medications on the body. We can do this by giving nutritional substances (usually called lipotropic factors) which provide the liver with the nutrients it requires for proper detoxification. Milk thistle and artichoke are herbs that are particularly useful in protecting the liver from the effects of medications. And, for patients who are on opiate derivatives such as codeine and Percocet, proper attention to bowel cleansing and digestion is essential.

Migraines provide a good demonstration of the ways that the mind and body interact in sickness and in health. With so many options available, we can hopefully shorten or eliminate the days spent in a dark room with a cold rag over the eyes.
To implement a program based on Dr. Rothfeld€™s recommendations, you may order the following supplements:

Lipotropic Factors (take 2 after each meal)

Other supplements that may be helpful for headache relief are:

Valsed(an herbal formula containing relaxing herbs and nutrients) 2 after each meal

SpectraChrome (a nutritional formula for low blood sugar headaches) 2 after breakfast and lunch

If you wish to have more information about salivary hormone testing, click here.

[Please notify your doctor that you are planning on taking these supplements. This program is not a substitute for regular medical care, and does not purport to treat specific medical illnesses.]