White Paper - Botanicals Strategies for CV Support

8/2/2019 White Paper - Botanicals Strategies for CV Support

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Botanical Strategies orCardiovascular Support

Beverly Yates, ND

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Table o Contents

Introduction ..........................................................................1

Common cardiovascular problems ......................................2

Consequences o inaction .....................................................2

Consequences o unchecked inammation.........................2

Consequences o cardiac cellular compromise ....................3

Consequences o cardiac rhythm disorders .........................3

Cardiac and systemic blood ow compromise ....................4

Patients who may beneft rom botanical interventions ....4

Botanical partners or cardiovascular healing ....................4Hawthorn (crataegus) .................................................................................................4

Hawthorn and CHF ..............................................................................................5

Hawthorn and cholesterol ....................................................................................6

Hawthorn saety, contraindications and dosing ..................................................6

Turmeric and curcumin (curcuma longa) ...................................................................7

Curcumin research ................................................................................................8

Curcumin saety, contraindications and dosing ..................................................8

Ginkgo (gingko biloba) ..............................................................................................9

Ginkgo research ....................................................................................................9

Ginkgo saety and contraindications ... .............................................................10

Ginkgo dosage or intermittent claudication or peripheral vascular disease ....11

Ginkgo dosage or dementia ..............................................................................11

Ginkgo dosage or cerebral insuciency ...........................................................11

The bottom line ...................................................................12

Contributors biography .....................................................12

2012 Diversied Business Communications


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Introduction

Practitioners in the world o natural medicine who use holistic, integrative approaches

may think they cant help people with serious or moderate cardiovascular problems

because they are not experienced in working with those patients. However, i

practitioners dont provide specic support to their patients with ailing cardiovascular

systems, those patients ace increased risk o heart attacks, strokes, continued buildup

o artery-clogging plaque, and urther decay o their blood vessels. As patients get sicker,

the number o pharmaceutical drugs prescribed or them will increase.

Practitioners can help such patients avoid these negative outcomes, sometimes with

simple measures. In this paper, Dr. Beverly Yates reviews treatment options with botanical

agents. This paper outlines:

Common cardiovascular problems

The consequences o inaction

Which patients may benet rom botanical interventions

The science behind these botanical agents or cardiovascular healing,and their clinical applications:

Hawthorn (crataegus)

Turmeric and curcumin (curcuma longa)

Ginkgo (ginkgo biloba)

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Common cardiovascular problems

Infammation is problematic or many body systems, including the cardiovascular system.

Infammation makes cholesterol sticky, which can lead to negative cardiovascular

events. In the heart tissue itsel, the energy o the cardiac cell tissue can be compromised.

I the cardiac cellular level is compromised, then the unction o the heart and the blood

vessels around the body will also be aected.

Cardiac rhythm disorders are rampant, and the causes can be dicult to ascertain. These

disorders are not all readily explained by hormonal changes, stress, or other events that

might seem to be a contributing actor to cardiac rhythm disorders. Additionally, cardiac

blood fow (blood fow to the heart itsel) and systemic blood fow (blood fow all over the

body) can both be compromised.

Consequences o inaction

What happens i a practitioner ails to act?Practitioners in the world o natural medicine who use holistic or integrative approaches

sometimes say: I dont see a lot o heart disease patients, or, I dont eel comortable

treating them and am not sure I would know how. Without specic support to an ailing

cardiovascular system, the patient who sought out a practitioners care is at increased risk

or such outcomes as myocardial inarction, ischemic stroke, buildup o artery-clogging

plaque, urther deterioration o the vasculature, and exposure to an increased number o

medications and their potential side eects.

Consequences o

unchecked inammationWhile many people believe cholesterol alone is an issue, the real problem is underlying

infammation. As was noted above, infammation causes cholesterol to become sticky,

increasing the probability o building up artery-clogging plaque. The reasonable sequelae

o unchecked infammation include atherosclerosis, arteriosclerosis and peripheral venous

disease, also known as intermittent claudication. Infammation can also have a negative

impact on the immune system and lead to neurotransmitter imbalances.

The most likely sign o chronic infammation may be up regulation o infammatory

markers. Sometimes the patient presents in the early stages with a ew infammatory

markers elevated, but additional markers can become elevated over time. Helping the

patient reduce infammation on a ew markers can positively aect others.

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Consequences o cardiaccellular compromise

With cardiac cellular compromise, the heart tissue is exhausted at the undamental cel-

lular level. The hearts primary role o pumping and circulating blood around the body

removing deoxygenated blood rom the blood stream and resupplying it with reshly

re-oxygenated blood is compromised.

Pharmaceutical treatments can sometimes deplete the heart o the nutrients it needs to

stay strong. For example, statins deplete the cardiac tissue o coenzyme Q10, along with

other nutrients, which can compromise the heart.

A compromised heart can negatively aect daily living. Everyday activities can become

dicult, particularly or patients who have conditions such as atrial brillation, conges-

tive heart ailure, and, to some degree, mitral valve prolapse. This condition can also

have a psychological impact. Patients worried about their hearts can become earul and

urther limit their physical activities.

Consequences o cardiacrhythm disorders

For patients with cardiac rhythm disorders (heartbeat irregularity), ear can be magnied.

Patients who have atrial brillation, ventricular brillation, and other types o disorders

or dysrhythmias o the heart can become rightened and challenging to treat. Frightened

patients can sometimes be noncompliant. For example, they may exceed dosage guide-

lines, believing more is better, or reuse to do what is advised, worsening their condition.

In terms o dierential diagnosis, practitioners should be aware that a variety o actors

can lead to cardiac rhythm disorders. For example, some women develop temporaryrhythm disorders as they enter menopause. Hyperthyroid conditions can also be associ-

ated with heart dysrhythmias. Anxiety disorders, such as panic attacks, can lead to heart-

beat irregularities. Arrhythmias can also be a prominent side eect o certain medications.

However, practitioners should not dismiss a real risk o cardiovascular disease as a case o

anxiety or depression as can oten happen with emale patients. I there is a concern o

undiagnosed cardiovascular disease, it is prudent to work with a cardiologist and make

sure a thorough evaluation is completed.

Never dismiss a patient expressing ear about heart rhythm problems; a heartbeat irregu-

larity that continues or an extended period o time can lead to death.

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Cardiac and systemic bloodow compromise

Blood fow compromise in heart tissue, when the heart itsel isnt getting enough blood,

classically leads to myocardial inarction, which can be mild, moderate, or severe. In heart

attack survivors, what is let o the unctional heart tissue must work harder to compen-

sate or the aected heart tissue.

Gender infuences the way a body compensates or compromised heart blood fow.

Women tend to orm extra blood vessels and compensate or weakened areas in the heart

oten bypassing the heart attack or minimizing it. Women are also more likely to have

smaller blood vessels o the heart, but many more microvasculature. Men are much more

likely to have large blood vessels and not as many small micro-vessels.

When systemic blood fow (blood fow throughout the body) is compromised, and theres

not enough tissue perusion particularly in the periphery tissue damage or desensi-

tization may result. Areas o the body at risk or damage rom inadequate tissue perusion

include ngers, toes, nose, the clitoris, penis, and ears.

Insucient tissue perusion in the brain can lead to problems with dementia via a

syndrome called cerebral insuciency. Diabetes also can accelerate systemic blood fow

compromise because o its infammatory prole.

A simple test can provide a quick assessment o peripheral blood fow compromise. To

perorm the test, press on a patients ngertips or palms and then release. Failure o the

blood fow to immediately return indicates possible compromise.

Patients who may beneft rombotanical interventions

In general, patients who do not respond well to pharmaceutical interventions they

experience signicant side eects and realize minimal benets tend to do well with

botanical interventions or cardiovascular healing.

Patients who want to preserve their current level o cardiovascular unction are also good

candidates or using botanical agents, even i they are quite ill. Additionally, those who

want to maximize their cardiovascular unction can benet rom botanicals.

Botanical partners or cardiovascular healing

Hawthorn (crataegus)A number o hawthorn (crataegus) species have been ound to be benecial or healing.

Those most commonly used with a strong evidence base in the research literature are

Crataegus oxyacantha, monogyna, laevigata and pentagyna. Hawthorn promotes im-

proved cardiac unction, strengthens the heart tissue, and promotes vascular and cellular

stability. Hawthorn also has anti-infammatory properties, including strong antioxidant

activity. It promotes a riendly cholesterol prole, increasing HDL while lowering LDL,

and decreasing the stickiness o cholesterol. Hawthorn also helps decrease triglycerides,

and improve the recovery o blood vessels rom prior oxidative damage, rom such causes

as smoking or stress. It also helps improve atherosclerotic lesions.

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A number o large human clinical trials have demonstrated the saety and ecacy o the

hawthorn lea and fower or Class I and Class II mild congestive heart ailure, as dened

by the New York Heart Association, and hawthorn has been widely used in Europe or

treating Class I-II heart ailure, with preparations based on its favonoid content.

The therapeutic equivalence o hawthorn extracts to drugs that are considered standard-

o-care or heart ailure, including angiotensin converting enzyme (ACE) inhibitors,diuretics and beta-adrenergic receptor blockers, remains to be established, along with

urther study o the eect o concomitant use o hawthorn with these drugs. Nonethe-

less, hawthorn appears to be sae and well-tolerated and is a potentially benecial therapy

or patients who cannot or will not take prescription drugs, and may oer additive

benetswith monitoringto prescription drug therapy.

Hawthorn can increase the eciency o the cardiovascular system so much that a pa-

tient may not require as much prescription medication, something the patient and other

health proessionals treating the patient should be made aware o.

Hawthorn and CHFA research study in the Drug Saety Journal looked at mono-preparations o hawthorn or

Class I or Class II congestive heart ailure. The study involved standardized 18.75% oligo-meric procyanidins and 2.25% favonoids.1

A study in Planta Medica was a randomized, double-blind, controlled trial o 102 subjects

with moderate congestive heart ailure, New York Heart Association Class II and Class III.

During the initial two weeks, hawthorn extract tablets at 180 mg/ day in three equal

doses o two tablets or a placebo were administered. The overall cardiac perormance

was improved in the hawthorn versus the placebo group, with almost a 25% dierence. A

more detailed analysis o the data showed that a signicant improvement was only seen

in the patients with congestive heart ailure Class II, not Class III. Clinical improvement

was only signicant or subjective symptoms o dyspnea, palpitations, and edema. There

were no clear echocardiogram dierences ound between the two groups, and radiograph-

ic signs o heart ailure improved in 82% o the hawthorn users as compared with 45% o

the placebo group, a signicant dierence.

1 Drug Sa. 2006;29(6):523-35. Hawthorn monopreparations standardized to 18.75% oligomeric procyanidins

and 2.25% favonoids.

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In a dose-dependent hawthorn study, a randomized and controlled trial o 209 patients

with Class III congestive heart ailure, participants took either 1,800 mg o crataegus

extract, 900 mg or a placebo. Ater 16 weeks o therapy with 1,800 mg per day, the

maximal tolerated workload during bicycle exercise showed a statistically signicant

increase in comparison with both the placebo and the 900 mg dose. Typical heart ailure

symptoms, as rated by the patient, were reduced to a greater extent or doses o either

1,800 mg or 900 mg o hawthorn than they were by placebo. It appears that the placebo

patients did not perceive the kinds o benet perceived by those taking crataegus. Both

ecacy and tolerability were rated highest by the 1,800 mg group. The incidence o ad-

verse events was lowest in the 1,800 mg group, particularly with respect to dizziness and

vertigo. The studys results suggest that perhaps 900 mg wasnt quite enough or a Class

III congestive heart ailure patient and that giving them twice as much (1,800 mg) was

more benecial.

Hawthorn and cholesterolIn the case o hypercholesterolemia, hawthorn is very benecial. It helps increase the

binding o LDL to liver plasma membranes, removing it rom circulation. Hawthorn

increases bile acid excretion and decreases the livers cholesterol synthesis.

To some degree, hawthorn depresses hepatic cholesterol synthesis. I a patient with nor-

mal cholesterol taking hawthorn becomes hypocholesterolemic, it is likely an eect o

hawthorn, via an up regulation o the hepatic LDL receptors. The benecial outcome is

an infux o plasma cholesterol into the liver and less in circulation in the blood vessels.2

Hawthorn saety, contraindications and dosingThe dosing ranges suggested or congestive heart ailure are: 160 mg to 900 mg o haw-

thorn extract per day, in two to three divided doses, taken with or without ood. For

extracts that are standardized 18.75% oligomeric procyanidins, the dosage range is 240

mg to 480 mg per day.

Most hawthorn treatment strategies should continue or at least three months, and

patients with congestive heart ailure Classes II and III may need treatment or lie. Just

as patients may have a permanent need or a walker or wheelchair as a physical aid, a

compromised heart may need a cardiac aid, and hawthorn might serve that purpose.

2 Atherosclerosis. 1996 Jun;123(1-2):235-41.

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In the case o high cholesterol, studies have shown 160 mg to 400 mg o hawthorn

extract per day in two to three divided doses to be benecial, and 180 mg to 300 mg a

day in divided doses or extracts that have been standardized to 18.75% oligomeric

procyanidins.

Taking hawthorn has not been associated with nausea or other adverse gastro-intestinal

eects.Only limited adverse eects have been reported in human trials as contraindica-tions or hawthorn. Practitioners should monitor patients who are on anticoagulant

and antiplatelet therapy. Based on in vitro study, some o the constituents o hawthorn

were ound to inhibit thromboxane A2 biosynthesis, which could aect coagulation and

platelet unction. Using hawthorn along with the classes o drugs that include anticoagu-

lants and antiplatelet agents might increase the risk o bleeding through the inhibition

o platelet aggregation.3 For patients who are hypotensive, hawthorn may be contraindi-

cated because it may increase the hypotensive eect. Patients who are taking antihyper-

tension medications, however, may have additive eects and hawthorn may help them

regulate their blood pressure and get it to within a normal range.4

Patients taking antilipemic medications may also experience additive eects because o

hawthorns antihypercholesterolemic eects.

Animal studies have shown that hawthorn may cause additive vasodilation and hypoten-sive eects, so practitioners should be aware o a potential interaction with hawthorn or

patients taking beta blockers. Similarly, based on data rom animal studies, hawthorn may

cause vasodilation when used with calcium channel blockers.

Turmeric and curcumin (curcuma longa)Another botanical strategy or cardiovascular support is curcumin, which is known or

its anti-infammatory properties. It is a prominent part o the cuisine o India, and other

countries in Southern and Southeast Asia, where people do not seem to have a high

incidence o infammatory disease. Many have speculated that this low rate o

infammatory disease is due to the amount o turmeric, ginger, and other helpul ood

agents, favorings and spices ound in the cuisine o these regions.

Curcumin helps to lower systemic infammation, which may be caused by suchconditions as excessive weight or obesity or Type 2 diabetes. Decreasing systemic and

local infammation is important when treating heart disease, poor circulation and

compromised cardiac unction since infammation causes problematic plaque to orm,

leading to potentially damaging, i not atal, consequences.

Curcumin inhibits the infammation o a number o markers, including phospholipase,

lipo-oxygenase, cyclo-oxygenase 2, leukotrienes, thromboxane, prostaglandins, nitric

oxide (NO), monocyte chemoattractant protein 1 (MCP-1), and tumor necrosis actor,

along with interleukin-12.5

3 Prostaglandins Leukot Essent Fatty Acids. 1994 Apr;50(4):173-5

4 Petkov V. Plants with hypotensive, antiatheromatous and coronarodilatating action.Am J Chinese Med 1979;7(3):197-236.

5 J Altern. Complement Med. 2003 Feb;9(1):161-8. Saety and anti-infammatory activity o curcumin:a component o tumeric (Curcuma longa).

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Curcumin researchOne study on the National Institutes o Health (NIH) website, titled Curcumin Attenu-

ates Tumor Necrosis Factor Induced Expression o Intercellular Adhesion Molecule-1,

Vascular Cell Adhesion Molecule-1, and Proinfammatory Cytokines in Human Endome-

triotic Stromal Cells, discusses the eect o curcumin on infammation on endometriosis

and the emale uterus. The study identied strategies by which combinations o dietaryphytochemicals can be put together to help to strengthen the immunoregulatory mecha-

nisms that normally prevent infammation rom leading to disease.6

A study in the Acta Physiology Journal showed that HO-1 products maintain healthy tis-

sue unction and remediate oxidative tissue damage, including damage to the cardiovas-

cular system.

Curcumin saety, contraindications, and dosingCurcumin is considered sae when used in amounts commonly ound in ood. It appearsto be non-toxic even when used in large amounts. In patients prone to GI distress, there

have been reports o epigastric burning and nausea when taken at higher levels levels

the equivalent to eating ve to six roots o turmeric ar more than typically consumed

in a meal.

Contraindications or curcumin include allergy to turmeric or its constituents, and an al-

lergy to the larger ginger amily, Zingiberaceae. Curcumin is also contraindicated in cases

o kidney stones, because turmeric has high oxalate content, and in cases o bile duct

obstruction, it helps promote bile fow. Similarly, i a patient has gallstones i they are

at risk or have had prior episodes o cholelithiasis curcumin is contraindicated.

In tea orm, 1 gram to 1.5 grams o dried curcumin root can be steeped in 150 mL o

water or about 15 minutes and taken twice a day. Patients may take 1.5 mg to 7.5 mg oturmeric daily in three to our divided doses.

A review o the saety and anti-infammatory action o curcumin noted a lack o toxicity

in a phase 1 human trial with 25 subjects using up to 8,000 mg o curcumin per day or

up to three months, as well as other studies using rom 1,125 mg to 2,500 mg o curcum-

in daily.7

6 Phytother Res. 2011 Dec 20. doi: 10.1002/ptr.3694. [Epub ahead o print]

7 J Altern Complement Med. 2003 Feb;9(1):161-8

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Ginkgo (ginkgo biloba)Ginkgo is an herb with many dierent uses, including memory enhancement, but it can

also be benecial in cardiovascular wellness and healing. It has traditionally been used in

Chinese medicine as a treatment or conditions such as circulatory disorders, pulmonary

diseases, skin lesions (when applied topically) and memory loss. Ginkgo is most com-

monly used in Europe and the United States or dementia, memory enhancement andclaudication. The German expert panel, Commission E, approved Ginkgo or the symp-

tomatic treatment o disturbed perormance in organic brain syndrome (memory decits

and disturbances in concentration), and or claudication, vertigo and tinnitus.

Ginkgo is benecial in treating vascular diseases, such as peripheral vascular disease,

intermittent claudication, Alzheimers dementia and multi-inarct dementia caused by

multiple, small strokes in the brain. Ginkgo also has an impact on blood vessels, includ-

ing the peripheral circulation in the brain.

Ginkgo researchA published randomized trial studied ginkgo and intermittent claudication. The study

included 42 men, aged 47 to 82. Angiographs proved the participants met the criteria o

having peripheral arterial occlusive disease o the lower extremities and intermittent clau-dication or at least six months prior to the study. The therapeutic groups were treated

with ginkgo biloba special extract at a dose o one lm-coated tablet o 40 mg three times

per day by mouth, or a placebo, or 24 weeks ollowing a two-week placebo run-in phase.

The trial ound that, or those taking ginkgo, walking distance improved by two to ve

times over a placebo. The Doppler index did not change in both groups, so imaging may

stay the same despite improvement with treatment.

Another study or intermittent claudication compared two dierent dose levels o ginkgo

biloba extract a dosage o 240 mg was compared to the standard dose o 120 mg to 160

mg. All extract doses were taken daily. Both dosage levels led to improvement in pain-

ree walking distance ater 24 weeks o therapy. Superiority o the higher dosage over

the standard dosage was statistically signicant. Doubling the dose led to less pain rom

intermittent claudication or patients.

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Some scientists think o cerebral insuciency syndrome as secondary to atheroscleroticdisease. It is characterized by impaired concentration, conusion, decreased physical

perormance, atigue, headache, dizziness, depression and anxiety. Patients with conges-

tive heart ailure or other cardiovascular diseases oten complain o symptoms that may

indicate problems specically in the brain.

Ginkgo was administered or the purposes o trying to address cerebral insuciency at

doses o 120 mg to 160 mg, three divided doses daily by mouth or up to 12 weeks. It was

shown to improve concentration and unctional status and also reduced headaches, dys-

pnea, depression, and anxiety. This study suggested that brain perusion was improved.8

Another ginkgo and cerebral insuciency study consisted o a randomized, double-blind,

placebo-controlled trial o 23 weeks duration, with a computer-based evaluation. It

showed a statistically signicant improvement in short-term memory and basic learning

rates or the test substance group, but not in the placebo group.9

Ginkgo saety and contraindicationsGinkgo appears to be generally sae when taken orally by otherwise healthy adults in

suggested doses or up to six months. It may be unsae in children, and patients with a

history o seizure, and those with diabetes or those using hypoglycemics, because ginkgo

has been ound to increase plasma insulin concentrations in healthy volunteers. It was

also ound to decrease these concentrations in subjects with type 2 diabetes. Ginkgo may

also be unsae in patients using antihypertensive drugs.10,11,12

The lea extract o gingko is most commonly used. The resh seeds are toxic and poten-

tially deadly, possibly due to their content o 4-methoxypyridine

8 Fortschr Med. 1990 Oct 10;108(29):557-60

9 Fortschr Med. 1992 Feb 20;110(5):73-6

10 J Clin Pharmacol. 2000 Jun;40(6):647-54

11 J Clin Pharmacol 2001 Jun;41(6):600-11

12 Pediatrics. 2002 Feb;109(2):325-7

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Ginkgo should be avoided or pregnant patients or those trying to conceive. It should

also be avoided or patients with known clotting disorders or those taking anticoagulants.

Ginkgo is likely unsae when administered intravenously.

The handling o ginkgo ruit pulp can lead to severe allergic reactions. Ginkgo may also

aect the outcome o electroconvulsive therapy (ECT).

Ginkgo dosage or intermittent claudication orperipheral vascular diseaseFor intermittent claudication or peripheral vascular disease, the ollowing are dosing sug-

gestions or ginkgo:

Products containing 24% favoglycosides also called favone glycosides or favones

and 6% terpene: The range is 80 mg to 240 mg o a 50:1 standardized lea extract daily,

or 3 to 6 mL o a 40 mg/mL liquid extract in two to three divided doses or at least our

to six weeks.

For a tea: 30 mg to 40 mg o extract in the tea bag, prepared as a tea, or at least

our to six weeks.

The higher end o the dosing range is warranted in more severe cases. Body weight alsoshould be considering in calculating dosage, and the benecial eects may take a month

or longer.

Ginkgo dosage or dementiaIn the case o dementia, doses or ginkgo o 120 mg to 240 mg daily in three divided

doses have been studied. This represents 24% ginkgo favone glycosides (primarily querce-

tin, kaemperol, and isorhamnetin) and 6% terpenoids (2.8 to 3.4% ginkgolides A, B, and

C and 2.6 to 3.2% bilobalide).

Ginkgo dosage or cerebral insufciencyFor cerebral insuciency, the dosage suggested is 120 mg to 160 mg in three divided

doses daily or up to 12 weeks. That amount was shown to improve concentration andunctional status, and to reduce headaches, dizziness, depression and anxiety.

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The bottom line

Hawthorn is a helpul botanical agent or treating mild to moderate congestive heart

ailure as well as aiding in lipid management. It also can be useul in improving overall

cardiac unction and eectiveness. Curcumin is helpul in reducing infammation that

can trigger cardiovascular problems. Ginkgo is benecial in treating claudication,

dementia and cerebral insuciency caused by circulatory issues.

Contributors biography

Dr. Beverly Yates is a Caliornia-licensed doctor o naturopathic medicine and a

graduate o the National College o Natural Medicine (NCMN) in Portland, Oregon.

She maintains a clinical practice in Caliornia, where she ocuses on the use o

plant-based, nature-derived solutions to chronic health problems. Dr. Yates, an integrative

medicine pioneer, has served as the lead supervising doctor or the rst ully accredited

naturopathic and integrative medical residency in Caliornia. She also serves as a

governor-appointed member o Caliornias Naturopathic Medicine Committee.

Dr. Yates is a national media representative or the American Association o Naturopathic

Physicians, and an accomplished author and speaker, eatured requently on television

and radio, and in print media.

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