Summer is often a good time to reset our goals for health with quiet time perhaps at the beach or in the backyard, to contemplate how we can rejuvenate ourselves.
Here are some remedies to consider for your patients who want to take charge of their moods, sleep and memory. Don’t forget about yourself and take time also for Physician Heal Thyself!
Basic support for mood, sleep and memory treatment plan should include a B complex, Ultimate Omega fish oils or Vital Nutrients Ultra Pure Fish oil (3000mg per day), Magnesium especially taken at bedtime for restless and poor quality sleep, and a multi-vitamin and mineral complex lke Vital Nutrients: Minimal and Essential. It has amazed me over the years how the above can help in a matter of weeks! Most people who live off the SAD (Standard American Diet) are terribly deficient. Many females are low in iron with serum ferritin less than 60. Once this is treated they feel so much better.
Adrenal function: Make sure in all cases of mood, sleep and memory that adrenal and thyroid function is addressed. See Pincott Perspective HPA Axis Blog Feb 2019 and Jan 2018 Thyroid Support. Consider especially – Withania Complex which contains Withania extract 950mg, Glycyrrhiza dry root 750mg, Scutellaria lateriflora dry herb 470mg and Panax ginseng dry root 100mg and Rhodiola and Ginseng Contains Rhodiola rosea 3.6grams and Panax ginseng 500mg. Both of these formulas help with mental fatigue and promote vitality of the nervous system in mild and moderate depression. Rhodiola improves depression, insomnia and emotional instability. It was as effective as sertraline without the side effects in some studies. Withania complex also increases the production of T4 so useful in thyroid support.
St John’s Wort increases nocturnal melatonin and helps with sleep disorders as well as anxiety. However because of photo sensitivity do not use this herb in the summer months unless for short term use for acute viral infections. St. John’s Wort is also effective for shift workers. For the treatment of depression it is NOT the serotonin effect but the effect it has on BDNF! Best to start St. John’s wort in the fall for the optimal treatment of SAD and depression. St. John’s wort is also great for the treatment of viral infections such as shingles, cold sores, chicken pox and herpes. Use higher dosages such as 6 per day for these conditions and always warn your patient about sun sensitivity.
Nevaton contains Hypericum 750mg, Schisandra 675mg, scutellaria lateriflora 500mg and saffron 22.5mg. It is known as a “road rage” formula for out of control stress, PMS, wired, aggressive and agitated patients. It also has an anti-depressant effect from the St. John’s Wort. 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 a 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. Kerry Bone uses 4 per day for low mood and debility and uses it instead of straight St. John’s Wort. Be aware of possible sun sensitivity due to St. John’s Wort.
Valerian complex contains passion flower, zizyphus (especially for dream disturbed sleep) and valerian. If the patient does not have a paradoxical reaction to valerian then may be as effective as the benzodiazepines and valium in improving sleep quality. It is also a great muscle relaxant. It has been used at 1 tablet 3-4 times during the day for severe insomnia, panic attacks, restlessness, depression and anxiety. It has been studied to not impair driving performance.
Kava Forte: improves anxiety and depression and can be combined with rhodiola and saffron but NOT St. John’s wort. Kava kava increases GABA receptors and regulates GABA transmission. It also inhibits re-uptake of noradrenaline and dopamine. It is meant to be taken during the day as needed for generalize anxiety disorder (GAD) at 1-3 per day. It improves the quality and recuperative effects of sleep and mood and used for treatment of PTSD. It can also increase libido. It can be used in benzodiazepine withdrawal. It is safe for short term use of 1-24 weeks with mild, transient and infrequent adverse events reported.
Ancient Minerals Magnesium with Melatonin: This transdermal formula provides 560 mg of elemental magnesium per teaspoon of lotion. Apply topically at night to sore muscles, soles of the feet or to bath water to aid in sleep. Apply to abdomen for menstrual cramps. Not to be ingested orally. Great for use in children.
Bacopa complex: This contains Bacopa 3.75mg, Schisandra 660mg, Eleutherococcus 500mg and Rosemary 10mg. Great research outlining its efficacy in ADD and ADHD to enhance concentration and focus. Helps executives and students to stay sharp and enhance memory recall, also can maintain cognition in people suffering from cognitive decline. For distracted kids/students, busy adults who want the mental edge and for seniors looking for a proactive approach to mental aging and memory loss. Increases conversion of short-term memory to long term memory. Very useful in brain fog due to thyroid abnormalities as it increases production of T4, excellent as an adjunct to thyroid supplementation and hormonal treatment. For “baby brain” postpartum as it not only helps to improve memory but also acts as an adaptogen to improve stress tolerance. Also for post-concussion syndrome or acute concussion recovery in combination with Ginkgo Forte for optimal results. Adult dosage 2 BID until see clinical effect then 2 per day. May take 3 months to see improvement in memory.
Ginkgo Forte: Ginkgo has been effective for the treatment of cerebral insufficiency which includes the following conditions: dementia, dizziness associated with labyrinth or vestibular disorders, acute cochlear deafness, senile cognitive decline, vertigo, healing loss or tinnitus. Ginkgo was also found to be of benefit in the treatment of recent stroke victims improving cerebral blood flow, motor recovery, intellectual performance, memory, mood and behavior. Ginkgo was also found to effective for the improvement in cognitive function in Alzheimer’s disease. Kerry Bone talks about using Gingko at 9 per day (in divided doses) to help with jet lag when he is lecturing internationally so I recommend this for jet lag control. It is also very popular in Europe for stroke prevention which I dose at one per day and stronger if I am concerned about cognitive decline as well. There is no evidence that gingko increases bleeding time contrary to popular belief by most surgeons. Use with caution with blood thinners such as warfarin and aspirin but it is not a contraindication. Please see Ginkgo monograph for all the benefits of this wonderful herb to educate your patients).
Tranquilent (Raspberry flavoured chewable 30 tabs). This chewable inositol 1000mg, L theanine 25mg and 5TP 20mg combination is effective for pediatrics (not more than 2 per day in 75 pounds or more, less than 75 pounds is ½ -1 tablet per day.) and adults (up to 8 per day) for the treatment of anxiety and obsessive thoughts that will support serotonin and GABA production in the body. I encourage patients to keep this in their purse or desk and take as needed throughout the day and especially in the evening to help with sleep. Suntheanine promotes relaxation, reduces stress and nervous tension. Supports both serotonergic and GABAergic neurotransmission. Offers both acute relief as well as a rebalancing effect for Anxiety and OCD and insomnia.
Other considerations: BCQ or Tumeric Forte (coming soon) has been helping to improve cognitive decline. Tumeric: increases Nrf2, normalizes mitochondrial genesis, repairs hippocampus of tau 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. Lion’s Mane by JHS Naturals has the ability to stimulate the production of Nerve Growth Factor (NGF) and provide other benefits that enhance cognitive function.
Parasympathetic balancing: unplug from devices, exercise, yoga, meditation, the Arts are all great for balancing moods, insomnia and memory. When patients are prescribed “The Arts” visits to MD’s and hospitals are reduced by up to 40%!
Enjoy your Summer and check out my Summer First Aid Kit from 2017!
This deal is currently available on short dated Kava from MediHerb.
A re-blog for Allergy Season….
This 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.Identify 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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Dr. 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
- 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
- Mucoprotective and expectorant
- 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.
- 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
- 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 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 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-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.
- 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
- Others: Chamomile, lavender,
In Summary Consider the Following in your HPA Axis cases:
- Cardiovascular support
- Cordyceps, Reishi and Nevaton, Astragalus (palp, SOB).
- Reishi, Cordyceps, Rhodiola and Korean Ginseng, Eleutherococcus (Astragalus Complex)
- Male health
- Tribulus, saffron,
- Saffron, rhodiola, Nevaton, Astragalus Complex (Eleutherococcus)
- Reishi, Astragalus, Cordyceps, licorice
- Liver support
- Nevaton (Schisandra), Reishi, Astragalus complex, cordyceps
- Chemo and radiation
- Eleutherococcus, Reishi, Cordyceps
- Eleutherococcus, Reishi, Withania complex
- Reishi, Rhodiola and Korean Ginseng, Rehmannia Complex, Astragalus Complex,
- Altitude sickness
- Rhodiola, reishi and gingko