Allergies notes for April.

A re-blog for Allergy Season….

PROMEDICS PRO BLOG

dr-pincott-header-pinkThis is the time of year that you start seeing patients with seasonal allergies as well as year round allergies. Over the years I have had good success with these patients using the following approach.ingrid-croppedIdentify food allergens and sensitivities and help the patient make dietary changes. This will lower their overall allergen load so they can handle their environmental allergens easier. I suggest avoiding their food sensitivities for 2 months then do a retest as some foods can be added back. I also look at their blood type dietas a long term recommendation. I also offer my patients a list of some of the new foods on the market that I have noticed (link in original email) You can also point your patients to my recipe book on my website www.drpincott.com. Giving patients the tools for diet changes will create more success for them.

Treat the Yeast: If…

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HPA Axis Support!

dr-pincott-header-pinkingrid-croppedDr. Bob Scott in his lecture at ANM (Oct 2018) encouraged the use of the term HPA Axis support rather than adrenal insufficiency. The adrenal gland produces 20mg of cortisol per day and is important for the following: metabolism of insulin, thyroid hormones and DHEA, balancing blood glucose, immune system response (NK cytotoxicity) Secretory IgA, microbiota, bone turn-over rate, mood and thought, REM versus delta wave sleep and protein catabolism.

Some common herbal adaptogens and nervines to consider include ashwagandha (withania) Korean ginseng, rhodiola, schisandra, astragalus, bacopa, saffron, skullcap and St. John’s wort.

Adaptogenic herbs are those that conserve adaptation reserve and work overtime. The promote regeneration, improve mental capacity, sensitizes the HPA axiS making the stress response more efficient and increase glucocorticoid action. These herbs include Eleutherococcus, ashwagandha, (withania), rhodiola and tribulus and can be taken over long periods of time for the best effect. I suggest rotating them in combination every month or two over the period of a year or more depending on the pathology. For example asthma, autoimmune disease and those with PTSD benefit from long term HPA axis support.

Mediherb supplies Withania Complex which contains Withania extract 950mg, Glycyrrhiza dry root 750mg, Scutellaria lateriflora dry herb 470mg and Panax ginseng dry root 100mg.
This formula is for the wired but tired patient. It helps support cognitive function, learning and memory retrieval, Reduces mental fatigue, helps enhance physical performance, promotes vitality and nervous system health when experiencing temporary stress, works as a tonic to benefit the entire body and increases production of T4. Take 3-6 per day. Monitor blood pressure and thyroid function.

  • Postpartum fatigue and stress
    (some controversy regarding licorice in breastfeeding)
  • monitor mom for BP and potassium
  • licorice can be helpful for improving infant weight
  • Overwhelmed feelings
  • Promotes restful sleep
  • Mild anxiety and depression

Withania somnifera:

  • Improves growth in children age 8-12
  • Improves Hgb and RBC counts in men aged 50-59 (3 grams per day)
  • Improved stamina of mountaineers at 1g/OD
  • Improved semen quality in men 5g/OD
  • Improves cognition 0.5g/OD in healthy volunteers
  • Similar potency to Korean Ginseng

 Skullcap (Scutellaria lateriflora)

  • Traditionally used to treat nervous tension and epilepsy
  • Disorders arising from physical and mental overwork
  • Insomnia and depression
  • Tonic, nervine and antispasmodic
  • Neuralgias, muscle twitching, tremors and restlessness
  • Watch for adulterations Mediherb supplies Skullcap (Scutellaria lateriflora)

Korean Ginseng (Panax ginseng)

  • Tonifies vital energy and spleen
  • Calms the nerves
  • Chronic general weakness with irritability and insomnia
  • HPA axis adaptogen
  • Improves mental health and social functioning
  • Improves well-being in post-menopausal women
  • Improved symptoms of COPD with an anti-fatigue effect on respiratory muscles

 Licorice

  • Anti-inflammatory
  • Mucoprotective and expectorant
  • Demulcent
  • Antiulcer
  • Antitussent
  • Mild laxative
  • May lower testosterone at high doses
  • Licorice extract exhibits evident anti-inflammatory properties mainly by decreasing TNF, MMPs (matrix metalloproteinase enzymes), PGE2 and free radicals,
  • Indicated for primary adrenocortical insufficiency and Addison’s Disease (in doses of 10-45g of extract OD
  • Synergistic with cortisone in Addison’s extending the effects of steroids and may aid the withdrawal early in onset.
  • Study found that 262mg OD increased cortisol levels by 20%.
  • It is a traditional Chinese medicine that tonifies the QI
  • Spleen weakness: decreased appetite and weight loss
  • Harmonizes and moderates other herbs
  • (monitor blood pressure!)

AdrenoCo (consider alternating with Withania Complex)
Contains Licorice root 1.75grams and Rehmannia 750mg.
Take one tablet twice per day –

  • Ideal in Phase 2 ( adrenal stress) or 3 (adrenal exhaustion)
  • These adrenal tonics (used more short term) preserve, protect and restore adrenal cortex function
  • Licorice neither stimulates nor inhibits the production of cortisol, but rather preserves, protects and restores the cortisol producing machinery (adrenal cortex). See above.
  • Rehmannia in TCM reduces heat in the blood, nourishes yin and promotes the production of body fluid, in Western medicine it is used as an adrenal tonic (ie curcumin can be too hot for some patients).
  • Rehmannia may lower blood pressure
  • Promotes the production of body fluids
  • General debility
  • Prevents senility
  • Adrenal and pituitary tonic
  • Inhibits the breakdown of cortisone products thereby extending their effects.
  • Autoimmune diseases such as RA
  • Boosts resistance to colds and flus.

Note: if patients cannot tolerate licorice refer to Rehmannia Complex and Rhodiola and Ginseng formulas below.

Rhodiola and Ginseng

  • Contains Rhodiola rosea 3.6grams and Panax ginseng 500mg.
  • Take 2-4 tablets per day. 2 tablets upon waking works within one week to improve energy and resilience. Alternate with Rehmannia Complex.
  • Rhodiola & Korean Ginseng are powerful tonic and adaptogenic herbs which help the body cope with stress
  • In clinical studies both Rhodiola & Korean Ginseng have been shown to increase physical and mental efficiency and produced significant improvement in physical fitness particularly when under stress
  • Fatigue, mental and/or physical exhaustion
  • Improving mental performance, concentration and memory, especially when under stress
  • Improving physical performance and endurance
  • Improving mood in mild to moderate depression
  • Promotion of healthy glucose levels

Rhodiola

  • Combines with other adaptogens well
  • reduced the frequency of recurrence of superficial cancer of the bladder,
  • improved sleep in 67% of patients with chronic sleep- related problems;
  • improved sexual function in men with erectile dysfunction and/or premature ejaculation
  • produced normal menstruation in over 60% of women with amenorrhoea
  • sped up the recovery of patients with acute infections of the mouth (as adjunctive treatment)

Korean Ginseng (see above effects)

Rehmannia Complex

Rehmannia glutinosa (Rehmannia) dry root          350 mg
Bupleurum falcatum (Bupleurum) dry root            700 mg
Hemidesmus indicus (Hemidesmus) dry root        500 mg
Tanacetum parthenium (Feverfew) dry herb          165 mg

This formula is recommended for, Chronic inflammation, Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, anklosing spondylitis, Graves’ disease, Hashimoto’s thyroiditis, Migraine or headache, especially where there is liver involvement.

  • Rehmannia is an anti inflammatory which acts via the adrenal glands through antagonizing the depression of the adrenals caused by exogenous steroid hormones. It also inhibits the breakdown of cortisone products in the body, thereby extending their effects
  • Feverfew’s MOA includes the inhibition of granule secretion from platelets (antimigraine effect) and polymorphs (anti-arthritic effect). More recent traditional uses include headache, common cold, coughs, difficult breathing, to stimulate digestion and to relieve facial and ear pain in dyspeptic and rheumatic patients.
  • Bupleurum falcatum Chinese herb used for liver disharmony, it is anti-inflammatory, adaptogenic, hepatoprotective and a mild sedative
  • Hemidesmus indicus Ayurvedic root used as a depurative (purifying and detoxifying) and tonic, used to treat chronic rheumatism, kidney, skin disorders and constitutional debility

Tribulus Forte

Tribulus terrestris (Tribulus) dry herb (aerial parts) 9g standardised to contain furostanol saponins as protodioscin 110 mg

  • Improves sperm and semen parameters in men with infertility
  • Improves libido in men
  • Improves ovulation in some women with infertility
  • Relieves menopausal symptoms
  • Possibly enhances the body’s natural production of sex hormones, especially when at low levels (DHEA) but is unlikely to increase beyond normal range
  • Male infertility, impotence, lowered libido
  • Female infertility, menopause
  • Suboptimal physical performance
  • Recovery of vitality after convalescence or surgery
  • Elevated stress

Tribulus terrestris might be a safe alternative for the treatment of premenopausal women with Hypoactive Sexual Desire Disorder as it was effective in reducing the symptoms (desire, sexual arousal, orgasm and satisfaction), probably due to an increase in the serum levels of free and bioavailable testosterone.

When fatigue presents with a decrease in libido or athletic performance, I often prescribe this formula. I also use it for my menopausal hot flash patients along with Wild Yam Complex, at a dose of 2 bid of each. Most hot flashes are greatly diminished within one week, then we adjust the dose to support long term improvement.”

Reishi Referred to as the Ten Thousand-Year Mushroom, Medicine of Kings, The Sacred Mushroom or Mushroom of Immortality
It has been used for over 2000 years in China
Best mushroom for general tonic to improve overall health and increase longevity
It is considered an adaptogen.

This mushroom as much of a reputation as Korean Ginseng for the treatment of chronic diseases.(consider alternating them)

  • Inhibits histamine release
  • Anti-inflammatory via suppression of TNF-α, IL-6, nitric oxide and PG E2, shifts immune dominance from TH2 (allergies, inflammation) to TH1
  • Anti-microbial to help treat and avoid dysbiosis
  • Anti-oxidant
  • Anti-cancer via reducing cell adhesion due to Beta D Glucans
  • Anti-Allergic /Anti-Inflammatory Activity
  • Immune system support
  • Increases T helper cells, interferon gamma, TNF-alpha, and interleukin-2(IL2) in mice studies.
  • Decreases CD8 counts
  • Reduced side effects of nausea and vomiting from chemotherapy and radiation (4-8 grams per day).
  • Improved postoperative recovery
  • Anti-tumor activity in animal studies
  • In a Chinese study of 2000 patients with chronic bronchitis there was 60-90% improvement within two weeks of taking reishi syrup.
  • Hepatoprotective
  • triterpenes block PDGF beta R
  • Small study showed improvement of GGT and GST in hepatitis B within 3 months of taking 6 grams of Reishi per day
  • Used daily to treat Hepatitis C and liver failure
  • Cardiovascular effects
  • Lowers cholesterol by inhibiting HMG-CoA reductase
  • Inhibits absorption of cholesterol from food
  • Lowers blood pressure
  • Inhibits platelet aggregation
  • Altitude Sickness
  • It is used for altitude sickness and by Chinese athletes
  • Works by oxygenating the blood at higher altitudes
  • Daily use for 10-14 days prior to a climb as high as 17,000 feet
  • Hypoglycemic Effect
  • Polysaccharide effect of Ganoderans A, B, and C
  • Elevates plasma insulin
  • Enhances peripheral tissue utilization of glucose
  • Enhances liver metabolism of glucose

Over the years of clinical practice adrenal support is an underlying therapy in many of my protocols for chronic stress, anxiety, PTSD, insomnia, fatigue, hormonal imbalances including hypothyroid, autoimmune diseases and allergy. I will alternate the most efficacious formulas over 1-3 months for one to two years and have the patient take the remedy at least 5 days per week. I explain that the HPA axis can take a long time to regulate, to help the patient build up their reserves in order they may handle future stresses much better. Once they understand this they are very compliant with the alternating or formulas.

  • A few favorites include ADR adrenal glandular from Physica that I alternate with a formula I devised that I call Female Adrenal Tonic. This contains equal amounts of Ashwagandha, Astragalus, Siberian Ginseng, Reishi, Shatavari, Rehmannia. Whenever possible I used Mediherb liquid tonics so I used Mediherb Ashwagandha in this. Patients often prefer to vary taking liquids versus tablets or capsules and this formula is pleasant tasting. Sometimes I will use both at the same time if the stress is severe. The ADR could also be alternated with Rhodiola and Ginseng or Withania Complex or Adrenoco if there is no sensitivity to licorice.
  • I also have a Male Adrenal Tonic: Panex Ginseng, Ashwagandha, Astragalus which is effective for fatigue and low libido in males
  • I love Siberian Ginseng (Eleutherococcus) and have used it in formulas such as Astragalus Combination (liquid tincture) Astragalus, Codonopsis, Reishi Mushroom, Siberian Ginseng, Ligustrum, Schizandra, White Atractylodes;or Astragalus Complex. I do not hesitate to use these formulas for months at a time to improve HPA axis health as well as the immune system.
  • Always evaluate and support the thyroid in these cases. Hypothyroid consider: Withania Complex or Rehmannia Complex. If hyperthyroid consider Nevaton, Valerian complex, Astragalus complex. A hyperthyroid tonic I use contains: skullcap, eleutherococcus, astragalus, bugleweed, motherwort, valerian,
  • Reishi or Cordyceps: Medicinal mushrooms add wonderful adaptogenic effects that can be taken long term and have few contraindications.
  • Sleep remedies such as Nevaton can be added to other sleep aids such as Magnesium SRT, Kava Forte, St. John’s Wort and Valerian Complex, Reishi and Withania Complex.
  • The liquid herbs that Mediherb does supply makes a lovely nervine to be taken at bedtime: (Withania, Skullcap, Licorice, St. John’s wort) (I avoid usage of St. John’s wort in summer months due to sun sensitivity)
  • For PTSD (See Phytotherapist Dec 2001) consider the following:
  • Nevaton: Saffron, St. John’s wort, Schisandra and Skullcap
  • Valerian complex: Zizyphus, Valerian, Passiflora
  • Withania Complex: Scuttelaria lateriflora, Licorice, Withania, Korean ginseng
  • Kava kava
  • Licorice
  • Others: Chamomile, lavender,

In Summary Consider the Following in your HPA Axis cases:

  • Cardiovascular support
    • Cordyceps, Reishi and Nevaton, Astragalus (palp, SOB).
  • Diabetes
    • Reishi, Cordyceps, Rhodiola and Korean Ginseng, Eleutherococcus (Astragalus Complex)
  • Male health
    • Tribulus, saffron,
  • Cognition
    • Saffron, rhodiola, Nevaton, Astragalus Complex (Eleutherococcus)
  • Immune
    • Reishi, Astragalus, Cordyceps, licorice
  • Liver support
    • Nevaton (Schisandra), Reishi, Astragalus complex, cordyceps
  • Chemo and radiation
    • Eleutherococcus, Reishi, Cordyceps
  • Sleep
    • Eleutherococcus, Reishi, Withania complex
  • COPD
    • Reishi, Rhodiola and Korean Ginseng, Rehmannia Complex, Astragalus Complex,
  • Altitude sickness
    • Rhodiola, reishi and gingko

Neuroinflammation Summary!

dr-pincott-header-pinkNeuroinflammation: The Key to Complex Brain Disorders
(Summary of Dr. Bob Scott’s Lecture Oct ANM 2018)

ingrid-cropped

Inflammation of the nervous system has been shown to the be the pivotal causation of neurodegenerative diseases such as Alzheimer’s, Parkinson’s, traumatic brain injury and stroke. Recent research also indicates that the key element of neuroinflammation is also the cause of neurotransmitter dysregulation that leads to depression and anxiety, schizophrenia and chronic pain. This article will review the inflammatory pathways and treatment protocols to prevent and treat this pathway for optimal brain health.

The biggest causes of neuroinflammation include neurotoxins (environmental and lifestyle), pathogens (ie toxoplasmosis), head trauma or traumatic brain injury (TBI), autoimmunity, aging and microbleeds.

Neurotoxins

Diet: alcohol, smoking, trans fats and deep fried foods. HgA1c is a measurement of glycation of the brain. Want to keep this below 5.4. It is the #1 marker of the size of the brain. (Diet high in phytochemicals such as garlic, green tea, turmeric, rosemary and spices lowers inflammation in the brain.)

Exercise: 30 minutes at 70% maximum heart rate 3 times per week increases expression of SIRT1 indication mitochondrial biogenesis.

Environment: pollution increases risk of suicide!

Gut Health: dysbiosis in the gut drives neuroinflammation and makes the gut leaky. Gluten makes the gut more leaky for 4 hours after ingestion. Gut molecules interfere with tryptophan metabolism leading to depression and cognitive impairment. Niacin (B3) prevents this process of forming the inflammatory kyurenic acid. Anti-depressants deplete B3! (Detoxification herbs to consider include schisandra, rosemary and milk thistle.)

Stress: Nrf2 pathways in the cells that help protect the cell against stress and prevents NF Kappa B inflammatory activation. Nutrients and phytochemicals that protect this pathway include turmeric, rosemary, green tea, garlic, broccoli, pomegranate, ginkgo, grapeseed, schisandra NAC and cruciferous vegetables. NrF2 is the true anti-oxidant pathway.

Nrf2: combats neuroinflammation, relieves depression, increases BDNF (brain derived nerve factor), protects the body against toxins, (increases phase II and phase III transporter proteins), decreases oxidative stress, enhances mitochondrial and exercise performance, protects against hypoxia, slows aging and improves the vascular system.(Phase III detox happens in the intestinal tract, this is how arsenic from rice is eliminated from the body).

Stress can be measured in the blood looking for IL-1B, IL-6, TNF alpha (not CRP). Chronic stress suppresses SIRT1 leading to atropy of the hippocampus the region most associated with depression and memory loss.

Pathogens: lyme and other stealth organisms

Head trauma: contact sports such as hockey, soccer and football or accident resulting in any blow to the head starts the inflammatory process. Auto-antibodies start to form as do Tao proteins that build up over time that contributes to the cognitive decline seen in NFL players. (see the movie Concussion). Curcumin has been shown to protect the cytoskeleton of tau proteins and when taken preventively by people playing contact sports, can prevent the tangling of tau proteins post trauma.

Autoimmunity: There are now blood tests to measure auto-antibodies to the blood brain barrier (BBB). Chronic systemic inflammation resulting in elevated CRP correlates to the shrinking of the hippocampus the brain’s memory center. DHA essentials fats is the #1 nutrient to increase the size of the hippocampus.

What is driving mental health is a change in the immune system. Microglia is the hallmark for activation of neuroinflammation that ultimately leads to the production of auto-antibodies to the brain. Taking 1 gram of RNA per day stops this leakage of inflammatory molecules into the brain.

Immune modulating herbs: echinacea, ashwagandha, eleuthero and Korean Ginseng.

Aging: melatonin, the main anti-oxidant of the brain, decreases with age.

Treatment Targets

System inflammation resulting from the above factors can be down regulated with diet, exercise and phytonutrients. Specific brain anti-inflammatories include boswellia, turmeric, omega 3 essential fats (emphasizing DHA) and bacopa.  Down regulating systemic inflammation requires the above nutrients in addition to resolving dysbiosis, stealth organisms; supporting detoxification pathways in the liver, supporting the HPA axis with adrenal tonics and upregulating Nrf2 pathways. (Detoxification of the brain and the liver happen through Nrf2 pathways).

Mitochondria: Increased production (biogenesis) of mitochondria in the brain can occur with the following:

  1. Hawthorn and ginkgo.
  2. Increasing Sirt-1 is the anti-aging gene and this is activated with schisandra and Korean ginseng.
  3. Nrf2 herbs
  4. Omega 3 essential fats
  5. Medium chain fatty acids (coconut oil MCFA)
  6. Magnesium and B vitamins
  7. High intensity interval training (HIIT)
  8. Sun exposure (vitamin D)
  9. Cold thermogenesis
  10. Ketogenic high fat diet
  11. Increase nitric oxide by eating beets
  12. Caffeine (100mg of caffeine reduces risk of depression).

Enhance Neuroprotection and Microcirculation: with key herbs such as saffron, turmeric, B12, magnesium, omega 3 EFA’s. Microcirculation is enhanced with grapeseed extract, ginkgo and diet.

5 Point Microcirculation diet by Kerry Bone includes: dietary nitrates sources include: green leafy vegetables especially beetroot or juice; 85% dark chocolate; berries to include pesticide free blueberries, strawberries, raspberries and blackberries; raw garlic and spices such as turmeric and ginger. All of these will protect the endothelium of the microvasculature.

Sleep: During sleep the lymphatic system of the brain called “glymphatic system” increases dramatically during non-REM sleep. Metabolic waste products of neural activity are cleared out at a faster rate than during the awake state. Brain cells shrink during sleep allowing for this process to occur. Less sleep increases amyloid plaque, the underlying cause of Alzheimer’s disease. Taking turmeric at bedtime enhances this cleansing process.

Sleep onset recommendations: valerian, kava kava, passion flower, Jujube, corydalis, Californian poppy, chamomile.

Sleep maintenance: valerian, kava, licorice or rehmannia

Non-restorative sleep is due to adrenals so consider withania, rhodiola, Korean ginseng, licorice and rehmannia.

HPA axis support: (new term for adrenal insufficiency) adaptogens and nervines: ashwagandha, Korean ginseng, rhodiola, schisandra, astragalus, bacopa, saffron, skullcap and St. John’s wort.

Neurogenesis: The brain renews and upgrades itself in two areas; the olfactory and the hippocampus area. Most trauma happens in the hippocampus where neurons are regenerated. The brain requires an enriched environment for the neurogenesis which is provides by BNDF and NGF (Nerve growth factor).

NGF pulls mitochondria into the area which is required for the process of neurogenesis. Low NGF is associated with increased risk of depression. Romantic love increases NGF.

NGF is stimulated by: omega 3 EFA’s, green tea, curcumin, grape seed extract, ginseng extract, ginkgo, melatonin and rhodiola. To a lesser degree: vitamin E, tryptophan, 5HTP, DHEA and pregnenolone, blueberries, whole soy foods, quercetin, piperine, mulberry, lithium, goji berries, lotus root extract, apigenin, luteolin.

BDNF governs the formation of new neurons and the development of synapses and various lines of communication within the brain. Low levels of BDNF are associated with Alzheimer’s, memory loss and other brain processing problems. Intermittent fasting from 16-18 hours has been shown to boost BDNF levels. (This is eating less often, not eating fewer calories).

BDNF is stimulated by ashwagandha, St. John’s wort, milk thistle, vitamin D, cocoa and chocolate and resveratrol. To a lesser degree: B5, huperzine A, phosphatidylserine, cinnamon, alpha lipoic acid, magnesium-L-threonate, beta-alanine, L-carnosine and magnolol.

Specific Phytonutrient Effects

Tumeric: increases Nrf2, normalizes mitochondrial genesis, repairs hippocampus of Tao proteins, hepatic protective, neuroprotective, kidney protective, anti-cancer (flags and destroys metastatic cells in the blood stream), slows progression of neurological diseases including Parkinson’s Disease, improves cognition and memory and concentration, powerful anti-depressant, increases serotonin in the body, boosts stem cell production in the brain (as does exercise and fasting).

Boswellia slows the progression of Parkinson’s Disease and Alzheimer’s Disease. It is a specific herb to prevent and treat neuroinflammation. It crosses the BBB and is best absorbed when taken with fat within a meal or with fish oils.

Saffron: 30mg per day has the same effect as the drug Prozac for the treatment of depression. (Those who have had a heart event have three- fold increase risk of depression). It blocks glutamate receptors, it is an anti-oxidant, it is a neuroprotective and has no effect on serotonin. It is as effective for early AD as donepezil and memantine.

St. John’s wort: for the treatment of depression is NOT the serotonin effect but the effect it has on BDNF!

Rhodiola: Improves depression, insomnia and emotional instability versus no improvement in placebo groups. It was as effective as sertraline without the side effects.

Kava: improves anxiety and depression and can be combined with rhodiola and saffron but NOT St. John’s wort.

 

Resources

The Neurogenesis Diet and Lifestyle, Upgrade Your Brain, Upgrade Your Life by Dr. B Cortright
End of Alzheimer’s by Dr. Dale Breseden M.D.