Black Cohosh By: Stephanie Russell. Overview zBackground Info. zHistorical Uses zReported Benefits...

Black Cohosh

By: Stephanie By: Stephanie Russell Russell

Overview

Background Info.Historical UsesReported BenefitsPhytoestrogensEstrogenic effects

ResearchHarmful effects Conclusion

Learning Objectives

1.What are the historical uses of black cohosh?

2. Name the common symptoms associated with menopause.

3. What are the physiological changes that occur during menopause?

4. What are phytoestrogens? What specific foods are they found in?

Learning Objectives

5. What does current research say about the possibility that the isoflavone formononetin is found in black cohosh?

6. What are some of the potential side effects/warnings that should be considered before using black cohosh?

Background Information

Belongs to the buttercup familyLatin names: Actaea racemosa, Cimicifuga

racemosaCommon names: black snakeroot, macrotys,

bugbane, bugwort, rattleroot, rattleweed Root is black in color when harvested from the

wild Cohosh = Algonquin Indian word meaning

“rough” - refers to the plants gnarly root structure

Background Information

Shrub-like Plant Native to eastern

deciduous forests of North America

Flowers of plant have a strong odor, which acts as an insect repellant (bugbane)

Background Info.

Underground Root/rhizome Used to make

tea Liquid Extracts Pills/Capsules

Sold as a dietary supplement in U.S.

Notable Ingredients

Triterpene Glycosides actein related

compounds, cimigoside

Other ingredients tannins, fatty

acids, phytoesterols

Isoflavones formononetin

very controversial

Historical Uses

Native Americans Ceremonial treatment of snakebites Rheumatism Kidney Disease Respiratory Illnesses Skin Problems

Used root to make a tonicPoultices were made by pounding leaves

Historical Uses

19th Century American Physicians Fever Menstrual Cramps Arthritis Insomnia

Reported Benefits

Treat menopause symptoms Hot Flashes Night Sweats Vaginal Dryness Bone Loss Mood Swings

Rheumatoid ArthritisPremenstrual Syndrome

Other Reported Benefits...

AsthmaBack PainMuscle SpasmsSleep DisordersDepression Induce labor

DiarrheaDizzinessEdemaFeverHigh Blood

Pressure

Menopause

Natural process that occurs in women Marked by cessation of menstrual cycle

Physiological changes occur• Decreased production of estrogen/progesterone• Higher levels of luteinizing hormone/follicle-

stimulating hormone• In some women, these hormonal imbalances

cause undesirable symptoms (climacteric)• LH/FSH oppose the action of estrogen

– If high levels of LH/FSH = low levels of estrogen

Hormone Therapy

Until recent years, was the “gold standard” treatment for symptoms associated with menopause Uses estrogen, progesterone, or

combination of both to increase hormone levels

Due to recent safety concerns, many women are seeking alternative remediesIncreases risk for: stroke, breast cancer, heart

attack, blood clots, gall bladder disease

Alternative remedies forsymptoms of menopuse

Phytoestrogens Plant-derived compounds w/ weak estrogenic

activity - similar in structure to estrogenisoflavones, lignans, coumestans

• found in legumes, soybeans, vegetables, cereals

Isoflavones (found in soy) genistein, daidzein (most studies)

can bind to estrogen receptors• may enhance estrogen’s beneficial effects, or block

negative effects

Structures

GenisteinGenisteinEstradiolEstradiol(major estrogen in humans)(major estrogen in humans)

Estrogenic effects ofBlack Cohosh

Is black cohosh estrogenic? Evidence is conflicting

formononetin - estrogenic isoflavone• mainly found in red clover - some in soy• some research suggests it is a constituent of

Black Cohosh• recent studies say it is not

– older studies may have been compromised by adulteration of plant materials, or misidentification of formononetin

• has not been found in commercial extracts

Estrogenic effects ofBlack Cohosh

Suppresses secretion of luteinizing hormone Studies are conflicting No single chemical component has been

identified for this action Possibly through synergetic effect of

several chemical fractions

Efficacy and Safety of Isopropanolic Black Cohosh Extract for Climacteric Symptoms

Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD; Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin, Hans-Heinrich PhD

Volume 105(5, part1) May 2005, pp1074-1083

Objective: To compare the efficacy and tolerability of the isopropanolic black cohosh extract in the treatment of climacteric complaints compared with placebo.

Methods: Randomized, double-blind clinical trial. 304 patients randomly allocated to receive tablets of 40mg drug, or matching placebo daily for 12 weeks. Drug contained 2.5mg isopropanolic extract corresponding to

20mg root stock Placebo corresponded to the active medication w/out

isopropanolic extract




Inclusion criteria: Postmenopausal women (>12 months since last

regular menstruation), or >6 months since the last regular menstruation plus FSH >50 U/L

45 years and older Climacteric complaints as defined by menopause

rating scale (MRS) - >0.4 in at least 3 itemsMRS is used to measure intensity of menopausal

symptoms * Includes 10 items, each ranging from 0 (no complaints), to 1 (severe symptoms), in increments of 0.1




Exclusion Criteria: Cancer - diseases that could interfere w/ the

assessment of climacteric symptoms Drug abuse Women taking hormone replacement therapy Women taking supplements such as: soy/red

clover




Clinical examinations and interviews were performed before treatment began, and 4, 12 weeks after

Intensity of symptoms were assessed according to MRS ratings




Findings: The isopropanolic black cohosh extract

was more effective than placeboDifference was 0.03-0.05 on MRS unitsHot flashes, “atrophy,” and “psyche”

decreased statistically significantly in the Black Cohosh extract compared w/ placebo

Most effective in relieving symptoms in early climacteric women

Effects of black cohosh on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women

Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD: The North American Menopause Society; 13(2) April 2006 pp 185-196

Objective: To analyze the effects of Cimicifuga racemosa (CR) preparation on markers of bone metabolism, hormones, sex hormone-binding globulin, lipometabolism, and vaginal maturity

Design: Double blind, placebo-controlled, and conjugated estrogens (CE) controlled study. Included 62 postmenopausal women given a daily dose of 40mg herbal drug(CR), 0.6mg CE, or placebo for 12 weeks.



Inclusion Criteria: Postmenopausal, aged 40-60 years Last menstrual bleeding > 6 months ago Postmenopausal hormone values (E2 <

40pg/mL, FSH >= 25mU/mL) baseline and wk 2

at least 3 hot flashes/day Sum score of MRS >= 1.7 at wk 2 and

baseline, sum scores of MRS item 1 (hot flashes) >= 0.3 at wk 2 and baseline



Exclusion criteria: Hysterectomy Endometriosis Current treatment w/ estrogenic

substances Alcohol/drug abuse hypertriglyceridemia or

hypercholesterolemia



Methods of assessment Markers of bone turnover, estradiol, FSH, LH,

SHBG, triglycerides, total cholesterol, high density cholesterol, low-density cholesterol, and routine clinical chemistry parameters were determined from blood samples.

Vaginal “maturity index” was determined from vaginal smearsConfigured by counting 500 cells and calculating

the % of parabasal, intermediary, and superficial cells



Results: CR has estrogen-like effects on vaginal mucosa (increased number of superficial cells) Not as strong of an effect as CE, but significantly

higher than placebo CR has beneficial bone-remodeling effects At wk 12, markers for bone formation significantly

increased in CR group, compared w/ placebo

Conclusion: CR has beneficial effects on climacteric symptoms - beneficial bone remodeling and weak estrogenic-like effects on the vaginal mucosa

Harmful Effects

Liver Toxicity: 1 case of acute liver

failure 2 cases of hepatitis Other cases

reported in people using multiple herbal remedies

No scientific research to support these claims

General side effects: Nausea, vomiting,

dizziness, stomach discomfort

Not recommended for use during pregnancy or breastfeeding

Do not take with ER therapy

No noted drug interactions

Conclusion

Black Cohosh may be a relatively safe/effective alternative to HR therapy, but dosage/duration should be monitored by physician to avoid potential harmful effects

However, more studies are needed to understand the active components, and mechanisms of action responsible for the beneficial effects on menopausal symptoms.

References:

The American College of Obstetricians and Gynecologists; Volume 1.5 (5, part 1), May 2005, pp 1074-1083

The North American Menopause Society; Volume 11 (5), September/October 2004, pp 575-577

The Medical Journal of Australia; Volume 177 (8) 2002 pp 440-443 http://www.womenshealth.gov U.S. Department of Health and Human Services http://www.nccam.nih.gov/health/blackcohosh/ The North American Menopause Society; volume 13 (2), March/April 2006 pp 185-

196 http://www.health-care-beauty.com/Amerifit-Estroven-Extra-Strength-60-Caplets-

B00014FUTQ.htm http://www.bodyandfitness.com/Information/Herbal/Research/black.htm http://www.holisticonline.com/Herbal-Med/_Herbs/h32.htm http://www.allnatural.net/herbpages/black-cohosh.shtml http://www.drugdigest.org/DD/PrintablePages/herbMonograph/

0,11475,4079,00.html http://www.healthcentral.com/peoplepharmacy/408/20554.html http://ods.od.nih.gov/factsheets/BlackCohosh.asp

Questions?

Black Cohosh By: Stephanie Russell. Overview zBackground Info. zHistorical Uses zReported Benefits...

Documents

Transcript of Black Cohosh By: Stephanie Russell. Overview zBackground Info. zHistorical Uses zReported Benefits...