Phytotherapy Review & Commentary

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Phytotherapy Review & Commentary

- Ginkgo biloba Extract - Efficacy in Early Stage Alzheimer's Disease

Hofferberth B; The efficacy of EGb761 in patients with senile dementia of the Alzheimer type, a double-blind, placebo-controlled study on different levels of investigation. Human Psychopharmacol 9: 215-22, 1994.

Summary: In a randomized, double-blind study, 40 patients with a diagnosis of senile dementia of the Alzheimer type received either 80 mg. Ginkgo biloba Extract (EGb 761) or placebo three times daily for three months. Patients were assessed with a test battery that included the SKT (test of cognitive function, memory and attention), the Sandoz Clinical Assessment Geriatric Scale, choice reaction time, saccadic eye movements and EEG. These tests were performed at baseline and at 1, 2 and 3 months. Memory and attention, as measured by the SKT, improved significantly in the EGb 761 group after one month. Improvement was also noted during this time in psychopathology, psychomotor performance, functional dynamics and neurophysiology. Improvement continued to be noted in the EGb 761 group over the three month course of the study. EGb 761 was well tolerated and no side effects were recorded during the trial.

Commentary: This is the study we've been waiting for with Ginkgo biloba Extract (GBE). Research and clinical reports over the past two decades have pointed to the potential of GBE as both a preventive measure and early therapeutic intervention for Alzheimer's disease. This study takes the first step toward establishing GBE as a strong therapeutic choice in the early stages of the condition to slow progression and improve quality of life. While long-term studies with Alzheimer's patients need to be completed, these results can be added to the host of other conditions unique to the geriatric population that can either be prevented or treated with GBE (e.g. resistant depression, macular degeneration, intermittent claudication).

It is important to point out that the effective daily dose in this study was 80 mg. tid. This is significantly higher than the 120 mg. daily dose most of us are used to recommending for GBE. As mentioned in previous reviews, this dose may cause transient headaches or dizziness initially in some elderly patients. If this occurs, starting at the lower dose of 120 mg. daily and then increasing to the 240 mg. level over a period of six to eight weeks will usually be effective.

Accumulating evidence suggests that free radical oxidation and platelet-activating factor (PAF) play important roles in the cognitive decline noticed in dementia. GBE's antioxidant, PAF-inhibiting, and neuronal-protective properties, make it one of our most useful clinical tools for slowing cognitive decline in the elderly. Based on the current evidence, GBE may be one of the few "smart drugs" that actually lives up to its billing.

- New Journal on Phytomedicines!

A new journal called Phytomedicine: International Journal of Phytotherapy and Phytopharmacology is now available for healthcare professionals and other parties interested in phytotherapy. The journal features a stellar editorial board made up of international leaders in phytotherapy and phytopharmacology. The editors-in-chief are Dr. Norman Farnsworth of the University of Illinois and Dr. H. Wagner of the University of Munich.

Published by Gustav Fischer of Stuttgart, the premiere issue was released in late 1994 and will be published quarterly. The first edition features articles on St. John's Wort for depression, Ginkgo biloba Extract for cerebral insufficiency and prevention of atherosclerosis, Hawthorn Extract for congestive heart failure, and local treatment of herpes with Melissa officinalis.

Phytotherapy promises to be one of the fastest growing areas of natural healthcare in the next decade - particularly in light of the passage of the Health Freedom Act. This journal, the first English language professional, peer-reviewed publication on phytotherapy, will do much to add to the credibility and acceptance of this field in U.S. health care.

Natural Health Care Update - Pediatrics

- Role of Food Intolerance in ADHD

Boris M & Mandel FS: Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 72: 462-8, 1994.

Summary: The role of foods, preservatives and artificial colorings in attention deficit hyperactive disorder (ADHD) remains controversial. Twenty-six children meeting the diagnostic criteria for ADHD were treated with a multiple item elimination diet. Nineteen children (73%) responded favorably. On open challenge, all of the 19 children reacted to many foods, dyes, and/or preservatives. A double-blind placebo controlled food challenge was completed with 16 children. There was significant improvement on placebo days when compared to challenge days. Atopic children with ADHD had a significantly higher response rate than the nonatopic children in this group. The authors conclude that eliminating reactive foods and artificial colors in children with ADHD is beneficial and that dietary factors may play a significant role in the etiology of children with ADHD.

Commentary: I sympathize with parents of ADHD children who continue to be "screened" from this information. Instead they are pressured into accepting drug therapy and advised to ignore dietary measures as unproved. A case in point are the recent studies claiming that sugar has no effect on ADHD children (even though the study was with "normal" children) and that aspartame is safe in this population. Of course, these "controlled" studies are a complete contradiction to the common sense observations of parents.

It is interesting to note that in 1982 NIH came out with a consensus paper regarding the three major areas that needed more research and clarification in ADHD. Besides further epidemiological studies and a closer look at psychosocial issues, the other major issue was diet.( 1) As most readers are aware, the theory of diet contributing to ADHD has been around since the turn of the century. In 1922, Dr. Shannon and colleagues postulated that learning and behavior could be influenced by diet.( 2) Of course, the most outspoken proponent of a role for diet came from the food additive and salicylates theory of Dr. Feingold in the mid-70's. His work, which must be considered a breakthrough, was somewhat anecdotal and poorly controlled.

The real champion of dietary contributions to ADHD in the last decade has been Dr. Joseph Egger of London. In 1985, Dr. Egger provided what is considered the "breakthrough" study connecting food intolerance and ADHD. Seventy-six children with ADHD were placed on an oligoantigenic diet with 62 improving markedly (21 achieved "normal behavior"). Twenty-eight of the group showing improvement during the oligoantigenic diet trial were then placed in a double-blind rechallenge phase. Although 48 foods were incriminated, the most common provoking substances were artificial colorants and preservatives. It was interesting to note that physical symptoms of food allergy such as headaches and abdominal pain also cleared during the elimination phase.( 3) In 1992, he showed that an oligoantigenic diet was extremely successful in the management of children with enuresis and concomitant migraine headaches and/or ADHD.( 4) Recently, he has developed an enzyme-potentiated desensitization program that can be used as a substitute for the difficult oligoantigenic diet in children.( 5)

The study summarized above serves to reinforce Egger and colleagues' findings regarding food intolerance and ADHD. It also serves to reinforce the need to rule out atopy in ADHD children. Atopic children in this study were far more likely to manifest food sensitivities and to respond favorably to the elimination diet. It is also interesting to note that the Conners hyperactivity index score was at its lowest in the group of "responders" while they were on the multiple elimination diet. This is a fairly typical finding in other food intolerance related conditions like atopic dermatitis and migraine headaches.

The other area of note with ADHD is the role of adrenal function. Dr. Tintera, in his brilliant work with hypoadrenocorticism, postulated that children born to mothers with low adrenal function ran a greater risk of hyperkinetic behavior. I frequently place my ADHD patients on a modified hypoglycemic diet (keeping complex carbohydrates in the mix), use daily chromium supplementation, and also support adrenal function with phytomedicines like Eleutherococcus senticous (Siberian ginseng).

References
(1.) NIH Position Paper: Defined diets and childhood hyperactivity. JAMA 248: 290-2, 1982.

(2.) Shannon WR: Neuropathic manifestations in infants and children as a result of anaphylactic reactions to foods contained in their diet. Am J Dis Child 24: 89-94, 1922.

(3.) Egger J, Carter CM, et al: Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet March 9, 1985, pp. 540-5.

(4.) Egger J, Carter CH, et al: Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior. Clin Ped May 1992, pp. 302-7.

(5.) Egger J, Stolla A & McEwen LM: Controlled trial of hyposensitization in children with food-induced hyperkinetic syndrome. Lancet 339: 1150-3, 1992.

- Iron Supplementation in Iron-Replete Children Unnecessary?

Idjradinata P, Watkins WE & Pollitt E: Adverse effect of iron supplementation on weight gain of iron-replete children. Lancet 343: 1252-4, 1994.

Summary: The effect of iron supplementation on growth rate in 47 iron-sufficient young children (12-18months) was studied. The children were randomly assigned either ferrous sulfate (3 mg/kg/day) or placebo every 4 months. Before treatment, the length, weight, and arm circumference of the two groups was comparable. During the 4 months of supplementation, the rate of weight gain was significantly greater in the placebo group than in the iron group. Rates of gain in length and arm circumference did not differ. There was no difference between the groups in respiratory or gastrointestinal infections. The results suggest that iron supplementation of iron-replete children may retard growth.

Commentary: Since iron-deficiency anemia is the most common nutritional deficiency worldwide, there has been an assumption among healthcare practitioners that extra iron among iron-replete individuals is a kind of safety net. In recent years, this theory has been developing some cracks. The most obvious point of difference is supplemental iron in iron-replete males. Not only is this unnecessary but recent evidence suggests it may be dangerous to the cardiovascular system due to the pro-oxidant aspects of iron. Iron has also been associated with competitive inhibition in the uptake of essential nutrients like zinc and enhanced growth of enteric pathogens.

This study suggests that iron-replete children should be added to the potential list of candidates for whom iron supplementation is unnecessary. The results of the study suggest that additional iron in iron-replete children may actually retard growth. This, of course, is in contrast to studies indicating that iron-deficient anemic and non-anemic children will actually experience an increase in growth with iron supplementation.

It would be interesting for supplement companies producing children's multiple vitamin/mineral formulas to explore whether the low amount of iron in these daily supplements may be either unnecessary or harmful for iron-replete children.

Note: The reviews in this "Phytotherapy Review and Commentary" (with the exception of the announcement regarding Phytomedicines) were previously published in the Winter 1994 Quarterly Review of Natural Medicine. Readers interested in subscribing to the QRNM can contact NPRC, Inc. at 206-623-2520 or by fax 206-623-6340.

Article copyright Townsend Letter for Doctors & Patients.

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By Donald J. Brown

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