Archive | October 2013

Osteoarthritis

Guest post by Angi Hronek, herbalist

In America today, about 1 in 6 people have Osteoarthritis (1). It occurs at varying
levels of severity and often requires a complex treatment regimen. A well-rounded
treatment plan includes lifestyle changes, pain-relieving techniques, and supportive
supplementation.

Osteoarthritis, also known as Degenerative Joint Disease or Wear and Tear
Arthritis, primarily effects the cartilage of the body causing it to wear and decay. This
often leads to pain and even disability. Osteoarthritis involves less inflammation than
other types of arthritis. Symptoms are, but not limited to- early morning stiffness, joint
pain, loss of function and/or range of motion, etc. It primarily effects weight bearing
joints. The most common of these are fingers, neck, low back, knees and hips. Women
have a higher incidence of Osteoarthritis, especially after age 45 (1,2). It is usually broken
down into two categories: 1.) Primary Osteoarthritis- or wear and tear- which involves
no predisposing abnormalities. 2.) Secondary Osteoarthritis- involves a predisposition
for joint degeneration from joint abnormalities or previous joint inflammation issues.

There are many factors that have been found to play a role in developing
Osteoarthritis. Misalignments and skewed musculoskeletal dynamics influence both
types mentioned previously. Some studies have shown a link between estrogen levels
and the occurrence of arthritis. Higher estrogen levels were found in women with
Osteoarthritis, and estrogenic medicines like Estradiol were shown to worsen arthritic
symptoms (2). High levels of stress can also increase the severity of Osteoarthritis
onset. Stress increases pain, muscle tension, and makes one more prone to illness (4).
All of these varying factors naturally produce a wide array of treatment possibilities.

One of the first considerations for treatment is reducing pain. Pain reduction will
often provide the relief necessary for someone to follow through with other helpful
treatments like exercise, which benefits the body and mind. Relaxing the mind can help
one deal with pain. There are many relaxation techniques like meditation or deep
breathing that have proven to help reduce pain. Some find relief using a cane or shoe
inserts to take pressure off of certain joints, allowing them to rest. Hydrotherapy uses
hot or cold water treatments to reduce pain. It helps to relax muscles and improves
strength and joint movement. Many people turn to over-the-counter pain killers like
NSAIDS, or Non-Steroidal Anti-inflammatory Drugs, like Aspirin or Ibuprofen. NSAIDS
aren’t the best choice for this condition because they work by reducing inflammation,
which isn’t the primary issue with Osteoarthritis. NSAIDS can actually be
counterproductive by increasing the rate of cartilage degeneration and inhibiting
collagen synthesis (2). Osteoarthritis may respond to Acetominaphins like Tylenol for
pain relief, but responds best of all to supplementing with Glucosamine.

Glucosamine sulfate treats and prevents Osteoarthritis at the root of its cause,
cartilage degeneration. It has proven to reduce pain better than NSAIDS. Long term use
will wield the best results. Overweight patients may require higher doses to see results,
and people with peptic ulcers should always take this with food. If you are also taking a
diuretic, you should increase the dose to compensate for the amount that may be
getting flushed out- this goes for most supplements. Many have seen results after 8
weeks of taking glucosamine, but it can take longer. There are many other vitamins and
minerals suggested to improve this condition. Chondroitin has similar effects on
Osteoarthritis, but it is widely viewed to be less effective than glucosamine. Taking
these two together has not proven to make them more effective. Another beneficial
supplement which improves joint function, strength, endurance and range of motion is
Niacinamide. One to three years of continual use is recommended. Vitamins can also
have favorable affects on someone dealing with Osteoarthritis. Vitamin E is fat soluble
and has an antioxidant and membrane stabilizing action. It is found in whole grains and
nuts. Vitamin C deficiency can lead to altered collagen synthesis and compromised
connective tissue repair. It has a synergistic effect when taking with Vitamin E on
cartilage stability. It is a water soluble vitamin. Good sources of Vitamin C are broccoli,
leafy greens, and citrus to name a few. Vitamin D depletion is also linked to increased
risk and progression of Osteoarthritis. Though most people get Vitamin D through
supplements especially during the winter months, the best source is time spent in the
summer sun. It is also found in sardines, salmon, and wild mushrooms. Vitamin A, E,
Copper, Zinc and Boron are all required for the synthesis and maintenance of normal
cartilage.

It is recommended for those with Osteoarthritis to have a well balanced diet of
whole unprocessed foods, including a high intake of fruits and vegetables-especially
greens. Dietary fiber and complex carbs are also recommended. Liberal consumption of
flavanoids, often found in brightly colored fruits and vegetables, is beneficial. Diets high
in antioxidants can help reduce risk of cartilage loss. Some examples of antioxidant rich
foods are berries, garlic, broccoli, and green tea. Avoid nutrient-thieving foods that
accumulate as toxins in your body, like processed foods containing additives and
preservatives. Reducing toxins can help to benefit the healing process. It is
recommended to drink a lot of fluids to help flush out your system. Also if you find
yourself reacting to any food, whether mildly or severely with an allergy, it is best to
avoid these foods all together. Most common food allergies tied to Osteoarthritis are
gluten and dairy intolerances. There is a wide variety of food suggested to avoid or
minimize intake of. I think this long list shows that different things will work for different
people, and each individuals reaction can vary. Some foods from this list are: red meat;
dairy; sugar; high acid foods (not including citrus); nightshades like tomatoes, peppers,
eggplant, and potatoes (studies of a certain alkaloid which nightshades contain have
shown that they may inhibit normal collagen repair (2); and oxalic acid containing foods
like rhubarb, currants and sorrel; coffee and alcohol. A good diet can also contribute to
weight loss, which in itself can improve joint function by relieving stress on the joints. A
study by the CDC showed 66% of arthritic adults are overweight or obese.

Exercise lessens joint pain and stiffness, increases flexibility and muscle
strength. The type and amount needed will vary case by case. The best exercises are
Isometrics and swimming. This can include range of motion exercises, strength training,
aerobics, and yoga. Swimming helps to increase circulation and strengthens
surrounding muscles without straining joints. Diet and exercise used together help one
to reap the maximum potential healing benefit.

Herbs can also be used to support the healing process. Herbal therapy for
Osteoarthritis should focus on liver function, circulation, elimination, pain relief and
quality of life improvement (1). Here are some actions performed by herbs that would be
beneficial for Arthritis. Anti-inflammatory herbs are indicated when inflammation is
present. Inflammation isn’t the main issue with Osteoarthritis but it can still play a part.
Anti-rheumatic herbs help to relieve the pain of rheumatism (joint pain). Diuretics can
help reduce the rate of joint deterioration, and help to flush the system. Adaptogens help
the body adapt to many different kinds of stress. Cholagogues help support normal liver
functioning, helping the body to process and reduce toxins. Alteratives are known as
blood cleansing herbs and are helpful for systemic problems.

Many herbs can perform more than one of these actions. Each herb has unique
ways in which they best benefit the body. Some are best drunk as a tea, while others
are more beneficial taken in tincture form. For most, either option will work well.
Remember to check contraindications for each herb, especially if someone is taking
medications to be sure there are no complications. Better results will emerge with
regular long-term use, but remember to check each herb for their specific intake
recommendation. Here is a list of some herbs that can be helpful for Osteoarthritis, and
the actions they perform.
-Dandelion Root (Taraxacum officinale)-anti-rheumatic, diuretic (leaf), cholagogue,
alterative.
-Yarrow (Achillea millefolium) leaves and flower- anti-rheumatic, diuretic.
-Black Cohosh Root (Actaea racemosa)-anti-rheumatic, anti-inflammatory.
-Cayenne (Capsicum spp.) external and internal- anti-rheumatic, increases circulation.
-Ginger (Zingiber officinale)-anti-inflammatory, increases circulation, specifically
indicated for knee pain.
-Stinging Nettle (Urtica dioica) external and internal- anti-rheumatic, diuretic, alterative.

Other herbs that are indicated for performing one or more of these actions I
mentioned are: Horsetail (Equistetum spp.), Arnica (Arnica spp. use topically for pain),
Oregon Grape Root (Mahonia spp), Chickweed (Stellaria media), Tulsi (Ocimun
tenuiflorum), Lavender (Lavendula spp. essential oil effective topically) and
Licorice (Glycrrhiza glabra). Licorice also acts as a phytoestrogen, helping to balance
high estrogen levels in the body.

Here is a sample tincture formula by David Hoffman
from his book, Medical Herbalism:
2 parts Bog Bean (Meyanthes trifoliata), 1 1/2pt Meadowsweet (Filipendula umlaria), 1pt Black Cohosh, 1pt Prickly Ash (Zanthoxylum
americanum), 1pt Celery Seed (Apium graveolens), 1pt Angelica (Angelica archangelica)
and 1pt Yarrow. Take up to 5mL 3 times a day. It is possible to obtain most of these
herbs from an herbalist in your area. Something that may be more accessible would be
to drink a tea of Ginger, Nettles, Yarrow and Dandelion 2-3 times a day, or any
combination of the previously mentioned herbs. Dry herbs often make a more potent
tea. You can get more medicine out of your roots by simmering them in hot water for
10-15 minutes rather than just steeping. There are many topical herbal preparations for
pain on the market. Salves that contain Arnica and Cayenne have helped relieve pain for
people who deal with arthritis.

Remember everyone’s situation is different, therefore it will depend on the person
as to what aspects of treatment are most important or will have the greatest effect. The
best path to healing is to incorporate dietary changes along with a supportive exercise
routine, ample supplementation, supportive herbal medicines, stress reduction and
relaxation, and most importantly pain relief to support the body and mind of an individual
dealing with Osteoarthritis. A healthy state of mind, unhindered by extreme pain, will
help one find the correct path to healing. An individually tailored treatment plan involving
these modalities can bring about great change.

Sources
1.)Medical Herbalism by David Hoffman
2.)The Clinicians Handbook of Natural Medicine by Joseph Pizzorno Jr, Michael Murray, Herb Joiner-Bey.
3.)CDC.gov
4.)Orthop.washington.edu.

5.) The Yoga of Herbs by Dr Vasant Lad & David Frawley.

Angi Hronek is an herbalist currently residing in Leicester, NC.

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Alternative Approaches to Hypothyroidism

Guest post by Sarah Clarkson, herbalist

Many of us know a friend or family member with hyper- or hypothyroidism,
disorders that appear to be increasingly common in North America. This article will
focus on hypothyroidism, or a slowdown of thyroid hormone production, resulting in
decreased metabolism. While conventional medical treatment of hypothyroidism is
fairly safe and well-accepted, dietary and and lifestyle changes, as well as certain
herbs, can play an important role in the successful management of the disorder.

The thyroid gland is a small butterfly-shaped organ located at the base of the
neck, just below the Adam’s apple. Its proper functioning depends upon a cascade of
hormonal reactions, beginning in the hypothalamus. The hypothalamus produces
thyrotropin-releasing hormone (TRH) and sends it to the pituitary gland, which responds
by secreting thyroid-stimulating hormone (TSH). TSH then signals to the thyroid gland
to use iodine to produce thyroid hormone (TH), which actually consists of two
hormones: thyroxine (T4) and triiodothyronine (T3). T4 is the primary hormone produced
and released into the bloodstream and it is then converted to T3, mainly in the liver.

TH, considered the bodyʼs major metabolic hormone, is responsible for body
temperature regulation; carbohydrate, lipid, and protein metabolism; and the normal
development and function of the gastrointestinal, nervous, cardiovascular, muscular,
skeletal, reproductive, and skin systems. TH essentially works on every cell of the body
aside from those in the thyroid gland itself, the adult brain, spleen, uterus, and testes.1
Healthy thyroid function is vital to human life.

Early signs and symptoms of hypothyroidism are not always easily associated
with the disorder. For example, symptoms such as “fatigue, lack of energy, cold
intolerance, severe constipation, heavy menstrual periods, and weight gain despite a
diminishing appetite may go unnoticed or be attributed to other conditions, such as
stress, depression, and overwork.” 2 Because the onset of hypothyroidism is most likely
to occur in oneʼs 50s or 60s, such symptoms may also be mistaken for the normal
process of aging. Symptoms that can occur as the condition progresses include slowed
speech, droopy eyelids, muscle loss, puffy eyes and face, slow pulse, dry skin and hair,
and sluggish reflexes and mental function.3

Hypothyroidism is diagnosed by measuring T4 and TSH levels in the blood. The
pituitary gland continually receives feedback regarding TH levels in the bloodstream. If
those levels are low, it will produce more TSH in order to stimulate the thyroid gland to
produce more TH. Therefore, if the thyroid is underactive, a blood test will show an
elevated level of TSH and a low to normal level of T4, depending on the stage of the
disorder. A health practitioner may also test for antithyroid antibodies that attack the
thyroid gland. The presence of these antibodies points to Hashimotoʼs thyroiditis, an
autoimmune condition which usually develops into hypothyroidism.

Hashimotoʼs is the most common cause of hypothyroidism in the United States
and it is about seven times as likely to occur in women than in men.4 Hypothyroidism in
general has been estimated to affect between 4.6 and 9.5% of the US adult
population.5,6 Aside from Hashimotoʼs, hypothyroidism can be caused by surgical
removal or radiation of the thyroid due to hyperthyroidism, congenital hypothyroidism,
excessive iodine in the diet, or a chronic lack of dietary iodine (the most common cause
in non-industrialized countries). A family history of hypothyroidism increases the
likelihood of developing it.

Stress, lifestyle, and environmental factors, such as endocrine disruptors, may
also contribute to the development of hypothyroidism. Endocrine disruptors, or
hormone disruptors, “are human-made chemicals in the environment that interfere with
the development and function of body systems in animals, including humans.” These
chemicals, such as those found in plastics, pesticides, municipal drinking water, and
body care products may bind to thyroid hormone receptor sites, thereby preventing our
thyroid hormones from doing their job.7 Ryan Drum, herbalist and seaweed harvester,
strongly believes that exposure to iodine-131, a radioactive iodine isotope regularly
released by nuclear plants, is responsible for most current thyroid disorders.8

Conventional treatment of hypothyroidism consists of thyroid hormone
replacement therapy. Supplementation with synthetic T4 (Synthroid) is most common,
though synthetic T3 (Cytomel) supplementation may occasionally be necessary. Dried
animal thyroid (Armour Thyroid), preferred by naturopathic doctors, is another option,
but synthetic T4 supplementation is generally prescribed because hormone levels can
be more precisely controlled.9 Those who require hormone replacement therapy must
continue daily treatment for life, according to most conventional sources.

Little research has been performed on the influence of plant medicine on thyroid
function, so some herbalists tend toward working to support the thyroid “to help the
body deal with the repercussions of the condition and its treatment.” 10 Herbal medicine
can be effective in managing a mild case of hypothyroidism without the use of
pharmaceuticals. However, for more advanced cases, particularly those in which the
thyroid has been removed or radiated, thyroid hormone replacement therapy is often the
best or only option. Additionally, if one does decide to pursue alternative treatment, it is
important to continue to monitor thyroid levels every six months and to avoid combining
herbs that significantly increase thyroid function with synthetic thyroid hormone
replacement therapy.

Given the cautions mentioned above, natural treatment plans for hypothyroidism
will vary depending on the stage of the disease, its origins, and whether someone is
taking pharmaceuticals. However, anyone dealing with hypothyroidism can begin by
making dietary and lifestyle changes. Stress reduction and a regular exercise plan are
essential for increasing metabolism and strengthening the endocrine system, including
the adrenal glands, as “supporting adrenal function is often a necessary component in
treating hypothyroidism.”11 Adaptogens, or herbs that help the body “adapt to and
defend against the effects of environmental stress,” provide support in working toward
stress reduction, increased energy, and mental clarity.12 Some adaptogens specific to
hypothyroidism include Ashwaganda (Withania somnifera), Gotu Kola (Centella
asiatica), Siberian Ginseng (Eleuthrococcus senticosis), Licorice (Glycyrrhiza glabra),
and Reishi (Ganoderma spp.).

As for dietary changes, begin with an elimination diet to remove antigenic foods
that might elicit a response from antibodies, such as gluten, dairy, and soy. It may also
be useful to reduce intake of goitrogens, foods that interfere with iodine absorption.
These foods include most soy products, peanuts, turnips, cabbage, and other
vegetables in the broccoli family. On the other hand, do consume brown seaweeds
such as kelp, kombu, and wakame in moderate amounts, especially if iodine levels or
absorption are low. Also consider consuming or supplementing with nutrients essential
to thyroid function, including Omega-3 fatty acids, Zinc, Selenium, Vitamins A, B, C, and
E, plus Tyrosine for vegans and vegetarians with low-protein diets.

Several other herbal actions are indicated for hypothyroidism. Immune
modulators will help with the autoimmune component by supporting the immune
system. There is some overlap with adaptogens here, with Ashwaganda, Licorice, and
Reishi indicated. Hypothyroidism speeds up the development of atherosclerosis and
increases the risk of coronary artery disease. Cardiotonics, or herbs that support the
cardiovascular system, are therefore recommended. David Hoffman suggests
Hawthorn (Crataegus spp.), Gingko Biloba (Gingko biloba), and Garlic (Allium
sativum).13 FInally because T4 is primarily converted into T3 in the liver, “thyroid
metabolism may be stressed by liver congestion.”14 Hepatics, such as Dandelion root
(Taraxacum officinale), are herbs that tone, strengthen, and help clear stagnation from
the liver, so they may be helpful in increasing T3 levels.

Included below is a sample treatment plan for subclinical to mild hypothyroidism
that does not include the use of pharmaceuticals. For those on thyroid hormone
replacement therapy, Bladderwrack (Fucus spp.) is unnecessary and the tincture
formula may need to be adjusted to reduce or eliminate herbs that increase thyroid
function (Ashwaganda), as well as hepatics that will affect the rate of drug clearance
from the liver (Licorice). For more information on safely using Bladderwrack to limit or
eliminate oneʼs dependence on synthetic hormones, Ryan Drum offers a protocol based
on his experience with hypothyroid clients.15

Hypothyroidism clearly requires a multifaceted approach to address the various
factors that can affect thyroid function, from autoimmunity to liver congestion.
Fortunately, a nutrient-dense diet, stress-reducing lifestyle habits, and herbs offer
excellent support for those affected by the disease. We can also nourish and protect
our thyroid glands with these practices even without a diagnosis of hypothyroidism, as a
preventive measure to ensure a lifetime of optimal health for such an important organ.

Sample treatment plan

1. Dietary and lifestyle changes described above
2. Vitamin and mineral supplementation as necessary
3. Bladderwrack (Fucus spp.), 2-5g powdered, divided evenly and taken three times a
day; consume in capsule form or as a slurry.
4. Tincture blend, modified from Aviva Rommʼs formula:16
(Dosage: 5mL, twice a day – morning and noon)
• 20 mL Coleus root (Coleus forskohli) – hepatic
• 20 mL Ashwaganda root (Withania somnifera) – adaptogen, may increase T4 levels
• 10 mL Licorice root (Glycyrrhiza glabra) – adaptogen, adrenal and liver support
• 10 mL Dandelion root (Taraxacum officinale) – hepatic
• 10 mL Stinging Nettle leaf (Urtica dioica) – detoxification
• 10 mL Reishi fruiting body(Ganoderma spp.) – immune modulator
• 10 mL Hawthorn berry (Crataegus spp.) – cardiotonic
• 5 mL Ginger root (Zingiber officinale) – stimulant

References
1
Hoehn, K. & Marieb, E. N. (2007). Human Anatomy & Physiology (7th ed.). San Francisco, CA:
Pearson Benjamin Cummings.
2
Hoffman, D. (2003). Medical Herbalism: The Science and Practice of Herbal Medicine. Rochester, VT:
Healing Arts Press.
3
Beers, M. H., Fletcher, A. J., Jones, T. J., Porter, R., Berkwits, M., & Kaplan, Justin L. (Eds.). (2003).
The Merck Manual of Medical Information (Second Home Edition). New York, NY: Pocket Books.
4
National Endocrine and Metabolic Diseases Information Service (NEMDIS). (2009). Hashimotoʼs
Disease. Retrieved from http://www.endocrine.niddk.nih.gov/pubs/hashimoto/
5
Canaris, G. J., Manowitz, N. R., Mayor, G. & Ridgeway, E. C. (2000). The Colorado thyroid disease
prevalence study [Abstract]. Archives of Internal Medicine, 60(4):526-34. Retrieved from http://
http://www.ncbi.nlm.nih.gov/pubmed/10695693
6
Hollowell, J. G., Staehling, N. W, Flanders, W. D., Hannon, W. H., Gunter, E. W., Spencer, C. A., &
Braverman, L. E. (2002). Serum TSH, T4, and Thyroid Antibodies in the United States Population (1988
to 1994: National Health and Nutrition Examination Survey (NHANES III). The Journal of Clinical
Endocrinology & Metabolism, 87(2):489-99. Retrieved from http://jcem.endojournals.org/content/
87/2/489.long
7
Blankespoor, J. (2011). Endocrine Disruptors. Retrieved from http://www.blog.chestnutherbs.com/
endocrinedisruptors
8
Drum, R. Thyroid Function and Dysfunction. Retrieved from http://www.ryandrum.com/thyroid1.html
9
Caldecott, T. Hypothyroidism. Retrieved from http://www.toddcaldecott.com/index.php/healing/conditions/
210-hypothyroidism
10
Romm, A. J. (2010) Botanical Medicine for Womenʼs Health. St. Louis, MO: Churchill Livingstone/
Elsevier.
11 Caldecott, T.
12 Hoffman, D.
13 Hoffman, D.
14
Frances, D. (2002). Botanical Approaches to Hypothyroidism: Avoiding Supplemental Thyroid
Hormone. Medical Herbalism, 13(1):1-5. Retrieved from http://www.encognitive.com/files/Botanical
Approaches to Hypothyroidism– Avoiding Supplemental Thyroid Hormone.pdf
15 Drum, R.
16 Romm, A. J.