The Natural Therapist - ANTA Journal - Winter 2018

The

Natural

Therapist

EDITION 33 No. 2 | WINTER 2018

ISSN 1031 6965

Winter 2018 Glucose

& Metabolic Imbalance

Meet Our

2018 Round 1 Graduate Award Winners!

Introducing Your New

Online Membership Management System

18

34

44

A review of the use of herbal extracts

A review of commonly used TCM

Recent developments on the

and dietary therapy for treating hypertension

formulas for the treatment of

effectiveness of Withania for the treatment

with associated prostatic hyperplasia

Polysistic Ovarian Syndrome

of low thyroid function

BPH Case Study

PCOS Part II

Herbs & Thyroid Function

Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 1 The Official Journal of The AUstralian NaturalThe Therapists Association www.anta.com.au

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Introducing Your New

Contents.

Edition 33 No. 2

ANTA Membership Management System

Your Membership Details Registered Clinic Locations Public Practitioner Profile

CPE Activity Membership Alerts ANTA eNews Archive

| Winter 2018

18

28

About 1 in 7 Australian men over 40 will suffer

This article highlights some basic nutritional

from problems with their prostate: the most

concepts related to glucose homeostasis

11 TGA Issues Arbutin Regulation 12 Members Services Updates

common Benign Prostatic Hyperplasia. This

and related health issues, and reviews some

case study reviews the use of herbal extracts

complementary medicines and micronutrient

and dietary therapy for BPH associated

substances that may assist.

34

40

44

50

TCM for Polycystic Ovarian Syndrome

Part 2:2 - TCM Patterns

Recent Developments

Superfoods at our Fingertips

Part 2 of this article reviews commonly

In this issue Tony Reid reviews Chinese herbal

The effects of Withania tests reveal stunning

Australian native plant foods have the poten-

used formulas and clinical protocols for the

formulas for the treatment of Yu (Stagnation

results that open new therapeutic ground for

tial to be used as function ingredients due to

treatment of PCOS in contemporary TCM.

Syndrome) at various stages.

this important medicinal plant!

their potent bioactivity, which is a result of

From the Chair

7 Executive Officers Report 26 2018 Graduate Award Winners

Introducing our Round 1 Recipients

14 ANTA CPE Guidelines 46 Upcoming Seminars & Courses

ANTA News 10 ANTA Submission for

Registration of Remedial Massage & Myotherapy

Updates to the IMGateway Interactions Database

PCOS Part II

Emotions in TCM

Hypertension with associated prostatic hyperplasia (BPH)

Nutritional aspects of Glucose and Metabolic Imbalance

hypertension.

Herbs & Thyroid Function

Australian Native Foods

their phytochemical composition developed over thousands of years.

The

Natural Therapist

Volume 32 Number 2 - Winter 2018 ISSN 1031 6965 The Natural Therapist is published by the Australian Natural Therapists Association (ANTA) for natural therapy practitioners. The opinions and views expressed by the contributors and advertisers are not necessarily the opinions and views of ANTA. Every effort is taken to ensure accuracy and ANTA accepts no responsibility for omissions, errors or inaccuracies. ANTA relies on contributors and advertisers to make sure material provided for The Natural Therapist complies with Australian Laws. ANTA accepts no responsibility for breaches of Australian Law by contributors or advertisers.

Material in The Natural Therapist is subject to copyright and may not be reproduced in any form without the permission of ANTA and authors.

anta branch chair persons Jeanetta Gogol - President National Remedial Massage & Myotherapy Branch Chair Healthfund / Workcover Chair AHRPRA PRG Rep Director of ANTA ANTAB/ANTAC Committee Member ANRANT Committee Member Justin Lovelock - Vice President Director of ANTA Director of CMPAC Constitution & Policy Chair ANTAB/ANTAC Committee Member ANRANT Committee Member Jim Olds - Treasurer National Multi-Modality Branch Chair Director of ANTA Director of CMPAC ANTAB/ANTAC Chair Ethics Panel Chair

Elizabeth Greenwood National Naturopathy Branch Chair CPE / Seminar Chair Director of ANTA ANTA Registration Chair ANTA Media/Web Chair ANTA CPE/Seminar Chair ANTAB/ANTAC Committee Member ANRANT Committee Member Warren Maginn National Nutrition Branch Chair Director of ANTA TGA Chair ANTAB/ANTAC Committee Member ANRANT Committee Member Brian Coleman Company Secretary Executive Officer Director of CMPAC ANRANT Chair Business Plan Chair

ANTA National Administration Office T: 1800 817 577 F: (07) 5409 8200 E: info@anta.com.au P: PO BOX 657 MAROOCHYDORE QLD 4558 australiannaturaltherapistsassociation.com.au

The

Natural Therapist

Executive Officer Brian Coleman

Marketing/Production Lily Lewis Circulation Enquiries 1800 817 577 Editorial & Advertising Enquiries thenaturaltherapist@anta.com.au Membership Enquiries info@anta.com.au General Enquiries thenaturaltherapist@anta.com.au

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ANTA Welcome Winter 2018

Executive Officer's Report

A warm welcome to all new ANTA practising members and ANTA student members.

If you require any information, advice or assistance please feel free to contact the team in the ANTA National Administration Office on 1800 817 577 or info@anta.com.au

July 2018

It is still not too late for associations to get onboard and support the ANTA formal submission currently with the Health Workforce Principal Committee for the registration of Naturopathy, Western Herbal Medicine and Nutrition.

FREE ANTA National Seminars

Advanced Diplomas - Naturopathy, Western Herbal Medicine, Nutritional Medicine & Homeopathy - Cease December 2018

The free ANTA seminars held around Australia continue to be a huge success and feedback regarding the presentations has been fantastic. The quality of the presentations and presenters has been outstanding and we intend to continue to provide members Members are reminded of the decision by ASQA to cease delivery with this outstanding resource as part of their ANTA membership of Advanced Diploma programs. Colleges have also been given package. We will contact members by email to advise when the an extension of time until December 2018 in which to teach out next Free ANTA seminar is being held in their State. All ANTA these courses and award graduates with their qualifications. members including students can register to attend ANTA seminars ANTA has been in contact with colleges to advise graduates who free of charge. complete accredited HLT Advanced Diploma courses that they will be eligible to join ANTA. FREE ANTA Webinars At some stage after Advance Diplomas cease in December 2018 We are continually adding outstanding webinars to this collection minimum qualification requirements will be adjusted to Bachelor and I recommend members log into the ANTA Member Centre and degree level. check them out. Viewing of the webinars is a great way to keep up with the latest developments and earn CPE points.

IMPORTANT – Members with Advanced Diploma qualifications who have joined ANTA are not required to upgrade to Bachelor degree level qualifications providing they remain compliant with New ANTA Membership Management System We are in the process of installing the latest software to manage health funds with up-to-date First Aid, Professional Indemnity membership information. The new software brings exciting insurance and CPE hours. Also, as long as members with promotional opportunities for members and their practice. Over Advanced Diploma qualifications maintain continuous ANTA the coming months we will be introducing members to the membership and continue to be ANTA members they are not required to upgrade their qualifications to Bachelor degree level. features of our new system.

One of the exciting features of our new system is “Practitioner Profile”. This feature has been specifically set up so that members can log into to our new system and create an online profile about The Minister for Health Greg Hunt PM announced on the 13th themselves and their practice. The profile allows members to October 2017 as part of an overhaul of private health insurance upload their photo, information about their practice, what they cover that from the 1st April 2019 private health insurance specialise in, clinic hours etc. The information you provide on your cover for the following natural therapies will be removed from profile will be available to the public when they do a practitioner all private health insurance products: Alexander Technique, Aromatherapy, Bowen Therapy, Buteyko, Feldenkrais, Herbalism, search on the ANTA website and ANTA App. Homeopathy, Iridology, Kinesiology, Naturopathy, Pilates, We are sending regular ANTA eNews updates to members on the Reflexology, Rolfing, Shiatsu, Tai Chi and Yoga. Remedial new system and how to take advantage of the great promotional Massage and Nutrition cover will remain in place. ANTA has opportunities. We recommend that you log into the Member sent out several ANTA e-News to members regarding this Management System via the Member Centre on the ANTA development and the action that ANTA is taking. website ASAP and start creating your profile.

ANTA has had several meetings with the Minister, his advisors Stay informed and up to date and health funds on this important issue. Since the initial announcement by the Minister in October last year, the Minister To stay in touch with the latest information make sure you visit and his advisors have confirmed health funds will be able to the ANTA website, ANTA Member Centre and ANTA Facebook make decisions to provide cover for natural therapies however, page. Updates containing a wealth of information are sent to the government will not provide rebates to health funds for members by ANTA e-News and posted on Facebook regularly. natural therapies. From our discussions with health funds it The new ANTA Membership Management System also is still not clear what natural therapies cover health funds will allows members to update their contact details and also view provide to the public. As this becomes clearer we will keep information we have recorded about them and where necessary members informed. notify us of any changes/updates required. A history of emails It is worth noting that Acupuncture and Chinese Herbal Medicine sent to members is also contained on the new system and were not part of the review of private health insurance as they members will be able to view and review all of the emails sent to are registered under the NRAS administered by AHPRA. If all them. associations had come onboard and supported registration in the past it’s possible that some natural therapy modalities Important Dates and Actions (i.e. naturopathy, western herbal medicine) could have been Another new feature of the new ANTA Membership Management registered with AHPRA and not be part of the removal from Software is that members will be able to logon at anytime and see private health insurance. Sadly this wasn’t the case and alerts on their profile regarding important dates and actions for: some associations have openly opposed registration. Those associations need to take a hard look at themselves and their

• First aid renewals indefensible position of not supporting registration. The

• Professional Indemnity Insurance renewals Minister and his advisors stated they believe registration is a

• CPE key component in maintaining cover for natural therapies. If the associations who have opposed registration supported the ANTA • Membership renewals submission to the government for registration it is highly likely These alerts will remain on your profile as a reminder. we would not be in the current position we find ourselves in.

Private Health Insurance Cover–Natural Therapies

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 7

Executive Officer Winter 2018 Changing your contact details or clinic address Members can logon to the Member Management System via the ANTA Members Centre, and view their contact and clinic information. Please advise us if any changes are required.

ANTA National Student Bursary Awards for 2018 The submissions for the ANTA National Student Bursary Awards for 2018 will be closing on the 31st July 2018. To date ANTA has provided more than $140,000 to students to assist them with their study and careers.

ANTA will again be providing another 12 x $1000 Student Bursary Awards in 2018. Recipients of ANTA Bursary Awards will be announced later in 2018.

Free Legal Advice for ANTA Members The facility provided to ANTA members through our supplier of professional indemnity insurance Arthur J Gallagher (incorporating OAMPS) has been a huge success with numerous members taking advantage of this free service.

30 minutes of free legal advice is available for: • ANTA members who have a professional indemnity policy with Arthur J Gallagher • Issues regarding professional indemnity policies and/or claims • Any other issues regarding your practice such as employment contracts, employment disputes, tenant agreements, leases, ownership of client records, restraint of trade etc To obtain 30 minutes of free legal advice contact the Arthur J Gallagher Specialty Risks team on: • Free call - 1800 222 012 • Email - specialtyrisks@ajg.com.au This offer is provided to ANTA members by Arthur J Gallagher in conjunction with White & Mason Lawyers.

Insurance. We are pleased to advise Arthur J Gallagher insurance broker Eva is permanently located full time in the ANTA office.

Current members and new members can now simply contact Eva in the ANTA office to discuss all of your insurance issues and requirements on free call 1800 817 577 or email your enquiry to insurance@anta.com.au.

Advertising and Promotion of ANTA Members in national magazines Due to the success of our advertising and promotion of ANTA members in national lifestyle magazines, we have expanded our promotion to include banner advertisements on magazine e-News and newsletters. This program has been successful in raising public awareness on the benefits of consulting with an ANTA accredited practitioner.

Natural Therapies App ANTA is the only association with an App that promotes natural therapies and ANTA members to the public. We have recently upgraded the iphone and android versions and we recommend you download the new version to your phone. The ANTA App is free and the public can complete instantaneous searches for an ANTA member on their phone and at the same time set up an appointment with an ANTA member in a matter of seconds.

Members details are updated on the App regularly. For more information go to www.naturaltherapiesapp.com.au Contact us if you require any advice, support or assistance – we value your feedback Any members requiring advice, support, assistance or has feedback on ways in which we can improve our member services please feel free to contact either myself or the team in the ANTA National Office at anytime on 1800 817 577 or info@anta.com.au Our Administration team is ready to assist you.

Regards

Professional Indemnity Insurance

Brian Coleman

We have been working with our preferred professional indemnity insurance provider Arthur J Gallagher to deliver improved services and to simplify the process for obtaining PI

Bupa $2M PI Insurance Requirement for Provider Registration Bupa notified Associations in 2017 that they have increased the level of Professional Indemnity Insurance required for provider registration from $1m to $2m for all natural therapy practitioners (excluding Chinese Herbal Medicine and Acupuncture). Details of the increase are as follows: Bupa will not register practitioners as providers unless they have a minimum of $2m.PI Ins cover (note acupuncture and chinese herbal medicine is a minimum of $5m.PI Ins cover).

Bupa is the only health fund that requires a minimum of $2m.PI Ins cover for modalities other than acupuncture and chinese herbal medicine.

The additional cost for members to upgrade their PI Ins policy with Gallagher from $1m to $2m is approx. $21.00 pa (this can vary slightly depending on stamp duty rates levied by State Governments).

Please contact Eva the Arthur J Gallagher insurance broker in the ANTA office if you want to increase your PI Ins cover to $2m for Bupa provider registration.

ANTA Executive Officer

Mobile Clinic Services Update Please note that if you wish to provide mobile clinic services to your clients in their home, you must register your home address as a clinic (mobile clinic) and have facilities that will also allow you to see clients in your home. Refer to each health fund’s requirements for registered providers on their websites.

Health Funds that DO allow mobile services for rebates: Australian Unity – to claim mobile services receipts must include the practitioner name, clinic address, ANTA membership number and Australian Unity provider number and indicate that it is a mobile service CBHS – to claim mobile services receipts must include the practitioner name, clinic address, ANTA membership number and CBHS provider number GU Health - to claim mobile services receipts must include the practitioner name, clinic address, ANTA membership number and Australian Unity provider number and indicate that it is a mobile service NIB – to claim mobile services receipts must include the practitioner name,clinic address and ANTA membership number Health Funds that DON’T allow mobile services for rebates: • AHM • ARHG • BUPA

PAGE 8 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

• HCF • Medibank Private

Mobile Clinic guidelines can be downloaded from the ANTA Member Centre

Delivering tradition wrapped in science

Coming July 2018

www.bioceuticals.com.au 1300 650 455

ANTA News Winter 2018

News

Announcing the Winners of the 2018 ANTA Graduate Awards 1st Round

ANTA Graduate Awards consist of 12 months complimentary ANTA membership and $200.00 Graduate Awards are provided several times a year and are open to all graduates who have completed a course recognised by ANTA. Students who graduate and join ANTA are automatically included for assessment for an ANTA Graduate Award.

Congratulations go to the recipients announced in our feature article this edition (p 26) on their achievements, and being selected to receive an ANTA Graduate Award.

The ANTA Graduate Awards are ongoing throughout 2018 and for further information on how to participate in the ANTA Graduate Awards click on the following link: www.australiannaturaltherapistsassociation.com.au/bursary/anta_graduate_awards.

ANTA Registration Submission for Registration of Remedial Massage and Myotherapy The Australian Natural Therapists Association made a submission in April 2018 to the Chair of the Health Workforce Principal Committee for Registration of Remedial Massage and Myotherapy.

The submission was prepared on behalf of ANTA by Professor Michael Weir from the Faculty of Law Bond University and can be seen by visiting the ANTA home page at www.australiannaturaltherapistsassociation.com.au along with the existing submission for Registration of Naturopathy, Nutritional Medicine and Western Herbal Medicine

WorkCover (NSW) 2018 Massage Therapy Rates All myotherapy and remedial therapists should be aware of 2018 rates for NSW WorkCover associated treatments.

Please be sure you are charging the correct fees for NSW WorkCover associated with Workers Compensation NSW .

Myofascial Dry Needling Course Guidelines Guidelines have been developed to assist ANTA members who are considering undertaking a course in Myofascial Dry Needling so they can practice Dry Needling safely and obtain insurance cover for Dry Needling.

The NSW WorkCover new massage rates for 2018 and the Myofacial Dry Needling Course Guidelines can be downloaded from the ANTA Member Centre (Policies)

PAGE 10 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Recent updates to the IMGATEWAY Interactions Database - May 2018 The IMGateway Interactions Database on the ANTA website continues to expand, now including over 1000 interactions.

Recent additions include comprehensive advice on interactions between commonly consumed traditional medicines, supplements with a range of conventional medicines.

New information includes interactions in the following areas: • Cinnamon • Ginkgo • Horsetail • Chinese herbal medicine formulations • Continuing addition of new and updated herb-drug interaction monographs Each interaction monograph contains specific advice on the evidence supporting the interaction, a commentary on the clinical significance of potential interactions, and recommended advice for consumers receiving the combination.

Under the National Code of Conduct all practitioners are required to be aware of interactions.

To assist ANTA members, ANTA provides free access to this outstanding resource by logging into the ANTA Member Centre and following the links to Resources > IMGateway.

ANTA News Winter 2018

Recent Herbal Arbutin Regulation Issued by TGA This includes Extemporaneous Herbal Compounding (e.g.

Tinctures), which although not requiring an AUST-L number, cannot employ the use of any ingredients scheduled as an S4 (which is restricted for medical prescription use only), which ingredients with above levels of Arbutin must now be classed under.

You may have heard that there has been some recent changes to the allowable levels of Arbutin in your clinical herbal formulas. However, it would perhaps be more accurate to state that some long standing regulations (since 2010) surrounding the allowable Arbutin levels in herbal medicines, have recently become more proactively enforced by the Therapeutic Goods Administration (TGA).

In order to assist you with being informed on this issue, as well as aware of your compliance obligations in practice, please consult the following summary.

Arbutin is an active compound found in numerous plants, but most notably the following:

Arctostaphylos uva-ursi

(Bearberry)

Achillea millefolium

(Yarrow)

Chimaphila umbellata

(Umbellate Wintergreen / Prince’s Pine)

Kalmia latifolia

(Mountain Laurel)

Ledum palustre

(Wild rosemary)

Origanum majorana

(Marjoram)

Pyrus communis

(Pear)

Pyrus pyrifolia

Rhododendron ferrugineum (Alpine rose)

Turnera diffusa

Vaccinium vitis-idaea

A submission to the TGA is being prepared by the CMA to propose increasing the allowable limit slightly (to 0.0025%) on the basis of the theoretical Arbutin conversion to Hydroquinone not being a 1:1 conversion. This may be the quickest way of ensuring that more of the herbs on the above list can avoid restriction (however it leaves much more time and research required in order to demonstrate that any of the higher levels found in Uva Ursi or other concentrated formulas can be made safe and appropriate for Australian Practitioners to use).

Please therefore note that until such research has been conducted (and does indeed demonstrate an acceptable level of safety to the TGA), it may not be appropriate to campaign for further changes on the immediate steps being taken by the TGA to follow through on this matter.

We trust this assists your ongoing awareness and understanding of current matters affecting your Practice, and will update all members as soon as any notable changes occur.

(Asian pear)

(Damiana) (Lingonberry leaf)

Arbutin may theoretically convert to Hydroquinone in the Liver or Gut and circulate within the body (via certain metabolic interactions with gut flora). However the degree to which this occurs in numerous scenarios in humans has not been fully demonstrated, and the amounts of Arbutin in most of the above plants remains relatively small.

Hydroquinone is sometimes used within skin whitening products overseas (due to its inhibition of enzymatic Melanin hyperpigmentation) in concentrations of 2%, and sometimes 4% in prescription-only topical formulas, however it has been banned for OTC cosmetic use by the European Union in 2001, due to a potential carcinogenic toxicity risk indicated in animal studies.

The TGA has responded to this concern on behalf of Australian citizens by conservatively limiting the allowable amount of Arbutin in Listed Complementary Medicines to the lowest acceptable equivalent level of Hydroquinone shown in those studies (equivalent to 0.001%), even in cases where the above herbs are to be taken orally for other purposes (such as for digestive antimicrobial effects).

This very low threshold means that any plants with notable levels of Arbutin, in particular Uva Ursi (Bearberry), which may commonly include levels around 6-7% in standard dried leaf material (albeit only making up a smaller portion of any final formula), should not be prescribed or supplied by Australian Natural Therapists until any further regulatory changes are made (as the use of such concentrations has technically not been compliant since 2009 on this basis).

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 11

ANTA News Winter 2018

ANTA launches your new Membership Management System

Member Services As part of the ongoing major upgrade to our Membership Management System the ANTA team are pleased to announce that our Member Centre upgrades for 2018 are complete, and your ANTA Membership Management System now includes the following detail/information which you should check and update regularly.

ANTA Membership Management System The following items are available for viewing via the Member Management System which you can access via the ANTA Member Centre:

accreditation status or health fund recognition is required to be assessed and updated by the ANTA administration team.

Please notify ANTA administration via info@anta.com.au if you need to update any details that you don’t have access to change.

Membership Alerts To simplify managing your active practitioner status, the new management system will display a range of alerts to remind you of important upcoming dates such as your First Aid and Public Indemnity insurance expiries.

Additionally our health funds team now have an SMS facility to alert members if your health fund provider status is at risk.

Should you receive an SMS please contact our administrative team via phone, to ensure timely resolution of any issues.

•

Membership Status & Contact Details

•

Accredited Modalities

•

Active Clinic Addresses

•

CPE Activity

Accessing & Activating Your Member Account

•

Public Profile Page

To access the ANTA Member Centre click on the “Member Login button” from the ANTA homepage.

Updating Your Membership Details All information in your ANTA Member Account should now be up to date. You will be able to update general details on your account, however any information that relates to your

Your ANTA Practitioner Profile

The first time you log in to our new Member Centre you will be required to retrieve your new Username and set a new Password. Please follow the instructions on the sign in page.

Taking Your Professional Profile Picture

Your ANTA Practitioner Profile can be now be viewed and edited from inside the Member Centre. When our new public site goes live, this is the page that the public will see when they search our directory, so now is a good time to visit your page to review and modify your practice details.

Items that will show on your Public Profile Page are: •

Your Profile Photo

•

Your Full Practitioner Name

•

ANTA Accredited Modalities

•

Health Fund Approved Clinic Locations

•

Customisable Description of Your Services

•

Customisable Availability Notes

Your Practitioner Profile should look professional and presentable to the public and we have included some tips below on achieving a great profile picture.

1. Wear clothes that are appropriate for your profession.

2. Smile, but don’t go overboard. You want to appear approachable and inviting without looking like you’re laughing.

3. Avoid hats, glasses, and other accessories. They not only make you look too casual, they tend to hide or obscure your eyes, which are the most important part of a great portrait.

4. Stick with the tried and true head and shoulders shot.

Close-cropped head shots can feel a little overwhelming for the viewer, and full body shots don’t work well in the confines of a small profile pic.

5. Avoid using effects or filters. Traditional black and white can also lend a nice touch of class to your professional portrait.

PAGE 12 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

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ANTA News Winter 2018

ANTA Continuing Professional Education (CPE) Hours Guidelines What is CPE: Continuing Professional Education is the upgrading or acquisition of knowledge and skills in the accredited modalities that will aid the practitioner in providing the patient with a high standard of health care.

Why is CPE Necessary: CPE is an important part of providing professional healthcare services to patients and ensures practitioners regularly update their clinical skills and professional knowledge.

• • • • • • •

ANTA requires members to complete 20 CPE hours annually (Jan – Dec).

•

Completion of 20 CPE hours annually is a requirement for ongoing provider recognition with all Health Funds and WorkCover Authorities. Note: If you do not complete 20 hours of CPE annually, Health Funds and WorkCover Authorities can terminate your provider recognition.

•

Each year Health Funds carry out audits of members records to ensure 20 hours of CPE are completed by all members annually.

• • • • • •

viewing seminar videos and seminar presentations - free access for members on www.anta.com.au completing courses on ANTA e-Learning Centre -free access for members on www.anta.com.au giving lectures/tutorials giving CPE seminar presentations undertaking further study completing short courses contributing an article to the ANTA journal “The Natural Therapist” and ANTA website contributing an article to other relevant journals, magazines and publications reading articles in the quarterly ANTA journal “The Natural Therapist” subscribing to and reading other professional publications and journals attending webinars viewing online, DVD’s or videos on relevant topics listening to recordings on relevant topics radio/tv broadcasting on relevant topics reading and researching information on topics relevant to your practice attending local practitioner groups/ workshops volunteer work with community groups involving natural therapies Note: First Aid and CPR courses are not recognised or accepted as CPE by Health Funds

Make sure you lodge online or send to ANTA, details of 20 hours of CPE you have completed by the end of each year.

•

Other Benefits of CPE: • members are kept informed and up-todate with the latest developments • facilitates communication and networking • encourages further study • enhances professional standing within the community

•

Required CPE Hours: ANTA members must accumulate a minimum of 20 CPE Hours per annum (Jan – Dec).

At least 50% of CPE hours undertaken must be related to the modalities you are accredited in

by ANTA. Note: Hours in excess of 20 completed in the current year are not able to be carried over to subsequent years.

ANTA and other CPE seminars are communicated to members via the ANTA website, ANTA e-News and in “The Natural Therapist”. Members should regularly check the ANTA website for details of seminars.

Members registered with CMBA/AHPRA must abide by CMBA CPD/CPE Guidelines (http:// www.ahpra.gov.au/chinese-medicine.aspx) for the modalities of acupuncture and chinese herbal medicine and also submit their CPE to ANTA. CPE Activities: Members can undertake CPE hours in many ways including the following: • • • • •

attending ANTA free seminars – details of seminars are regularly posted on www. anta.com.au researching scientific information on IMGateway - free access for members on www.anta.com.au researching scientific information on EBSCO - free access for members on www.anta.com.au researching scientific information on eMIMS Cloud – free access for members on www.anta.com.au participating in research projects involving or related to natural therapies

•

CPE Seminars: ANTA National CPE seminars are held in each state annually and are free for all ANTA members

Maintaining your own personal online CPE Record: ANTA provides members with simple easy to use online facilities to complete and lodge their CPE hours in their own personal and permanent CPE online record fully maintained on the Membership Management section of the ANTA website (Note: your CPE history is retained for future reference and you should not delete any of your online CPE records).

ANTA members can as an example, undertake research on EBSCO, IMGateway scientific resources, view videos of ANTA seminars etc and then record those CPE hours on their personal CPE record all in the one session via the ANTA website.

To submit/view your CPE hours online with ANTA: • Log onto the “Members Login” section of www.anta.com.au using your username & password • click on “Your Profile” • then click on “Submit CPE Hours” • key in your CPE activity (date, description, hours) • allow approx 30 seconds for page to refresh with recalculation of your CPE activity

PAGE 14 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Maintaining your own manual CPE Record: Members not wishing to take advantage of the ANTA online CPE record can keep their own manual CPE Hours record which should include the following minimum information shown in the example below: Maintaining your own manual CPE Record: Members not wishing to take advantage of the ANTA online CPE record can keep their own manual CPE record which should include the following minimum information shown in the example below: CPE Hours Record Year: (insert year) Name of Member: ANTA Member Number: Date of CPE

Description of CPE Activity Completed

C P E Hours

(Note: the following CPE activities are provided as examples) 22nd March

Attended ANTA Free Seminar

5

3rd April

Remedial Therapy research on EBSCO

3

4th May

Naturopathy e-learning module IMGateway

2

30th June

Read ANTA Journal – The Natural Therapist June edition

1

1st July

ANTA Seminar videoKerry Bone Presentation

1

11 August

ANTA e-Learning articles

2

5th September

Completed short course Stress & Wellness

4

30 October

Attended webinar-Herbal Remedies

2

TOTAL CPE HOURS

20

Members who are unable to record and maintain their CPE hours in their own personal online file via the ANTA website, can maintain their own manual record as shown in the example above and submit their CPE Hours Record to ANTA prior to the end of each year in the following ways: • by email to info@anta.com.au • by fax to (07) 5409 8200 • by post to ANTA PO Box 657 Maroochydore Qld 4558 We recommend members retain a copy of their CPE Activity for their own records and this can be downloaded via your Member Account Management System inside the ANTA Member Centre.

We recommend members keep a record of required CPE activity with ANTA, to minimise any inconvenience in the case of a health fund audit.

CPE reinforces ANTA’s natural health philosophy

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ANTA News Winter 2018

Working Smarter, Not Harder

T

with online bookings

he natural health industry in Australia is continuing to grow rapidly, currently at a rate of 7% per year, with more Australians than ever choosing to visit complementary practitioners.

As this industry grows so does the `on-demand` economy, a term penned to cover the unrelenting shift towards mobile commerce and instant resolution for consumers (your clients). One in four 18 to 35 year olds would rather not speak to a real person, instead opting for an online process whenever possible, and today it is common place to summon a car on your mobile, jump in, get to your destination and leave without handing over any cash. Think about it, Uber didn’t exist 10 years ago and their customers (also likely to be your customers) now find this normal because consumer behaviours are rapidly changing.

Convenience is now becoming a major deciding factor alongside cost and service quality. Consumers simply want to find their desired treatment, assess the cost and availability, then book in an instant. If they can do this on their mobile device and in ‘their own time’, even better. In 2018 over 64% of bookings are processed after business hours. So, if you are unable to meet the demands of today’s consumers, how many opportunities are you missing?

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This means customers finding you through the ANTA Natural Therapies Mobile App and new ANTA website, can link to your booking calendar. To take online bookings via the ANTA directories, simply set up your Nabooki account, create your calendar and add your Nabooki link to your ANTA Profile in the new ANTA Member Management System and customers can book an appointment with you online, any time of day.

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PAGE 16 | The Natural Therapist Vol 33 No. 2 | WINTER 2018 ANTA june Diabecure.indd 1

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Member Case Study Winter 2018 Dr. Simon Cichello1,4 Ph.D. R. Nutr. (NSA) Grad. Dip. HSc. (Herb. Med.)1* Nimisha Singh Adv. Dip. Naturopathy (ANTA)2 School of Agricultural and Veterinary Science, The University of Melbourne, Victoria, Australia

Herbal extract and dietary therapy for the treatment of

hypertension with associated prostatic hyperplasia (BPH) Introduction Overview of hypertension and prostatic hyperplasia Blood pressure is nominally represented in units mmHg and is the force of blood pushing against the walls of the arteries. The highest blood pressure is post left ventricle ejection (systolic pressure), and conversely at rest (between beats), blood pressure falls (diastolic pressure).

Hypertension is technically represented as; Numerical pressure (mmHg) (Systolic)/ Numerical pressure (mmHg) (Diastolic) As a general range, blood pressure of 120/80 mmHg is considered normal, 120-139 mmHg / 80-89 mmHg is considered pre-hypertensive, whereas >135/85 mmHg is stage 1 hypertension and common in numerous disease states including obesity, diabetes and chronic kidney disease (Sanghavi & Vassalotti 2014).

failure are imminent. High systolic pressure may lead to morphological changes of the left ventricle and endocrine changes i.e. epinephrine, cytokine hormones or blood biomarkers such as unregulated fibrogen, C-reactive protein, low magnesium, nitric oxide status (Blache et. al. 2006). Hypertension also shares co-morbidities with obesity, hypercholesterolemia, smoking, alcohol and sodium consumption and age (Stamler 1991). Hypertension may also be a result of arteriosclerosis or blockage of a coronary artery that supplies the heart with oxygenated blood. Arteriosclerosis is a result of plague formation, hyperhomocysteinemia, which can be caused by lower dietary sources of vitamin B6, vitamin B9 (folate), and vitamin B12 (Cook and Hess 2005).

Dan Shen (Salvia miltiorrhiza) and Beetroot juice which contains nitric oxide, and protect against cardiovascular diseases (Salehi-Abargouei et. al. 2013; Fugh-Berman 2000).

An enlarged prostate as per hypertension is correlated with middle to later aged men with testicles. The prostate gland chiefly produces fluids for ejaculation and thus reproduction. Anatomically it surrounds the urethra and thus enlargement causes increased pressure on the urethra and thus urinary dysfunction (i.e. not being able to urinate) and associated bladder problems.

Symptomology is observed in less than 40% of patients; i.e. dribbling at the end of urinating, urinary retention in bladder, or incomplete emptying, incontinence, increased frequency to urinate with pain with urination or bloody urine with also slowed urinary stream which can be relieved with the use of non-steroidal anti-inflammatory pharmaceutical drugs (Kahokehr et.al.

2013).

Hypertension is usually treated with pharmaceutical medication that blocks pain or lifestyle, dietary approaches and also the use of herbal medicines (i.e. increase aerobic Symptoms do not usually exercise 30 minutes daily, arise until stage 2 hypertenProstate hyperplasia can be lower sodium intake, DASH sion >160/95 mmHg when the detected by doing a digital recdiet, increase cardioprotective relative risk of stroke, heart tal exam to feel the prostate anti-oxidants such as Hawfailure, heart attack and kidney gland, urine flow rate, urinalythorn berry (Crataegus spp.), PAGE 18 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

sis/ urine culture i.e. presence of blood or infection, prostatespecific antigen (PSA) blood test to screen for prostate cancer but lacks specificity for early detection (Duffy 2014).

Allopathic medical treatment methods for BPH include waiting, pharmaceutical medicines, surgery if the prostate cancer is malignant and growing aggressively. Naturopathy and or Nutritional Medicine suggests lifestyle changes (i.e. avoid alcohol, caffeinated drinks), herbal and nutritional medicines i.e. Saw Palmetto, Zinc, essential fatty acids, stress reduction via yoga, Tai Qi practice as nervousness and tension can lead to more frequent urination.

Several pharmaceutical medicines exist such as a-1-blockers that relax the muscles of the bladder neck and prostate, finasteride and dutasteride lower prostate released hormones reducing prostate gland size, increase urine flow rate whereas surgery can entail transurethral resection of the prostate (TURP), simple prostatectomy.

Considerations - Factors Impacting Treatment/ Management The greatest possible factor impacting on dietary and physical management of both hypertension and prostate hyperplasia is compliance to the prescribed food, nutraceutical, medical herbal extracts and exercise therapies as prostate cancer may be linked with metabolic syndrome and insulin resistance (Barnard 2007), with anti-oxidant containing diet i.e. tomatoes (lycopene) may be beneficial for the condition (Ilic & Misso 2012).

Hypertension is effectively treated nutritionally by the DASH diet, as well as a reduction in insulin, triglycerides and very-low-density lipoprotein cholesterol (LDL) and associated significant increase in total anti-oxidant capacity (TAC) and GSH (Glutathione) levels, thus a cancer protective diet (Asemi et. al. 2014), especially in men with hypertension (Dixon et. al. 2007).

Dietary Intervention for Stage-1 Hypertension and Prostate Hyperplasia Hypertension is treated with a number of dietary methods including sodium reduction, increased potassium (i.e. indirectly via vegetable consumption), low sucrose, and the DASH diet (composite of previously mentioned points).

On the other hand, prostate hyperplasia is treated using essential fatty acids, zinc supplementation, Saw palmetto (Serenoa repens), and the use of pumpkin seeds. Further, the preferential consumption of lean meat, fish, soy, increased fibre, fruit and vegetable rich diet such as DASH diet leads to a reduction in the relative risk of cancer.

Presenting Complaint A-69-year old male presented with complaints of fatigue, enlarged prostate, high PSA (prostate specific antigen) with suspected malignant 3mm growth on the prostate (as confirmed by MRI). He is a large food manufacturing business owner and in the past 5

years had been experiencing mild malaise, with mild myalgia. The patient had previously had a biopsy of his prostate (2 years prior) with results indicating the benign nature of the neoplasm however, the patient felt that his health was sub-optimal as he has progressively becoming fatigued. He enjoys playing golf (18 rounds) twice per week as well as a light weight exercise routine lasting 15 minutes daily. He generally dines out at restaurants 2-3 days per week and enjoys eating meat, and dishes laden with sauces as well as 1-2 glasses of wine with his meals.

Past Medical History • (prostate specific antigen) >6pg/mL blood. Also the patient had a >7 year history of hypercholesterolemia, and stage 1 hypertension which was controlled with pharmaceutical medication. The patient remarked that worries regarding the BPH and prostate lesion affected his sleep and also caused anxiety, thus affecting the nervous system.

• There was no pain present, other than rheumatoid nodules on the right hand (second phalanges; distal).

terolemia which he controls using a number of pharmacological medications in the absence of dietary counselling.

• Caduet 5/10, 5mg amlodipine besylate (atorvastatin calcium) 10mg o.i.d. Atorvastatin calcium (AVC). AVC is known as a selective, competitive inhibitor of HMG-CoA reductase. This enzyme is involved in the synthesis of cholesterol and is a rate-limiting step. The enzyme catalyzes the conversion of 3-hydroxy-3methylglutarylcoenzyme A to mevalonate (sterol precursor i.e. cholesterol).

• Further the patient was prescribed Zantac 300mg (o.i.d) (Ranitidine-hydrocholride) a histamine 2 blocker, which blocks acid production from the parietal cells thus treating gastro-oesophageal reflux (GOR) due to a duodenal ulceration two years previous of which he currently still takes. The patient does not use recreational drugs and consumes 1-2 glasses of wine with meals 3-4 days per week and is a non-smoker, however he also enjoys coffee.

• In relation to BPH, the patient has been advised to ‘watch and wait’ by his GP and urologist

• No associated symptoms other than at some irregular times throughout the day, the client suffered from poor concentration.

• The patient’s social history includes friendships through golf locally and four overseas golf tours/ trips with friends and also family interaction on a daily basis through the family business and social events.

Previous Blood Biomarkers The patients fasting glucose had previously been high (prior to consultation) >6mM, as well as liver enzymes ALT, AST, GGT. Coinciding with a white coat on his tongue at consultation and the lack of bitter herbs in the diet it was concluded that the patient had previous liver dysfunction/ injury due to alcohol and high saturated fat intake. Historically low WCC (White Cell Count), and neutrophils were also evident from pathology reports.

A review of the bodily systems showed a history of hypercholesterolemia, stage 1 hypertension, and BPH with

use of medication as discussed previously and also watching waiting in respect to the BPH. Physical Examination & Body Systems Review The patient displayed normal anthropometric measurements, with a WH ratio of 0.89 The Tongue coating was white, with rheumatoid nodules on the right and left 2nd distal phalanges. Face appeared slightly tired due to malaise related to anxiety/ worry.

Body weight: 72kg; height: 165cm; body mass index (BMI): 26.5kg/m2; Pulse/ B.P. 64 beats per minute (bpm); blood pressure (BP): 148/80 mmHg. Cardiovascular and respiratory systems were normal, as confirmed by a previous consultation with a general practitioner of medicine.

The patient’s symptoms include mild malaise without recovery, worry/ anxiety and mild insomnia as a result of the unknown benign/ malignant nature of the prostate MRI result. Clinical signs include the patient has a white coating on his tongue which in other publications has been linked with gastrointestinal diseases and spleen deficiency, liver cholestasis, gall bladder dysfunction in traditional Chinese medicine (Anastasi et al 2014, p.16). However, the patients’ hematological results are contrary to these ‘traditional diagnosis’ and not substantiated as the patient did not display gastrointestinal disturbances nor elevated ALT, AST, GGT.

General History The client suffers from hypertension and mild hypercholesThe Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 19

Member Case Study Winter 2018

herbal treatments for prostatic hyperplasia

Table 1. Historic Blood Pressure (4 months) and Heart Rate (beats per minute; bpm); prior and after treatment Date

18/07/2014 Pre-Treatment

18/8/2014

18/9/2014

20/10/2014

Blood Pressure (mmHg)

148/80; 64bpm

128/68; 68bpm

124/69; 69bpm

133/76; 62bpm

Biochemical Investigations

Dietary Influences

- Blood test results review and place in appendix - MRI result; 3mm spot on prostate awaiting biopsy

A summary of current diet revealed the following macro and micronutrient deficiencies (see table 2 below) – 24 hour food recall

Table 2. 24 Hour Dietary Recall Abbreviations; G.I. = glycaemic index, GSH = glutathione, SOD = super-oxide dismutase Meal

Food Type

Estimated Deficiencies

Breakfast

Chinese Bread Dumpling (Baozi) + Coffee

↑refined carbohydrates and consummated meat; ↑G.I. - ↑ risk of type 2 diabetes ↓fruit, vegetables, fibre, i.e. vitamins and minerals except Thiamine (B1); ↑ risk of colorectal cancer. ↑ caffeine; anxiety

Lunch

Ham cheese and tomato sandwich

↑refined carbohydrates and consummated meat, some vitamin C, however generally deficient in vitamins and minerals. ↑G.I., and ↓ endogenous anti-oxidant systems such as GSH, SOD etc. ↑ sodium, caffeine

Snack

coffee, ½ chicken sandwich

↑ caffeine, processed white bread, ↓fruit, vegetables, fibre, i.e. vitamins and minerals except thiamine (white bread)

Dinner

Bowl of rice, meat (chicken), vegetables, coffee, glass of wine

↓fruit, green leafy vegetables, fibre, i.e. vitamins and minerals, especially folate, vitamin B6, vitamin B12. ↑G.I.

Diagnosis The patient was previously diagnosed with hypercholesterolemia and stage 1 hypertension as confirmed by a general practitioner of medicine. To date, these conditions have been managed using pharmaceutical medication with dietary counselling/ therapy. Hypertension was further confirmed measuring blood pressure thrice. Further, after dietary survey, influences include low/ lower folic acid, vitamin B6 and vitamin B12 intake which are related to hyperhomocystenemia, development of atherosclerosis and

stage 1 hypertension (Haynes 2002). These are supported by pathology tests of folate/ iron anaemia (macrocytic anaemia) with non-optimal bone marrow stem cell function and with subsequent neutropenia as observed in pathology reports.

Further, a high G.I. diet, or with lower anti-oxidant intake is linked with hypercholesterolemia (Patel et. al. 2013), fatigue/ malaise (Ni et. al. 2013), and prostate cancer (Yoo et. al.

2010), which can be reduced by the use of certain polyphenols and polysaccharides found in the fruit, herbs and vegetables mentioned in these studies (i.e.

Goji berry, ginseng).

The fatigue associated with anxiety/ stress is related to unknown nature of the prostatic hyperplasia (benign/ malignant), which was later revealed to be a slow growing malignant tumour.

Differential Diagnoses – with rationale

Probable Underlying Cause(s)

• Malaise related to anxiety of high PSA, 3mm growth (MRI) and probable malignant prostate tumour.

The pre-disposing factors related to hyper-cholesterolemia, stage 1 hypertension are related to diet i.e. micronutrient deficiency (as previous discussed) and also age.

Moreover, high PSA is related to age and tumourgenesis may be exacerbated by sustaining factors i.e. micronutrient deficiencies.

Treatment Plan

A herbal formulation was prescribed consisting of hydro-ethanol extracts of:

Pau d’Arco (Tabebuia avellanedae) Sheep sorrel (Rumex acetosella Astragalus (Astragalus membranaceus) Cat’s Claw (Uncaria tomentosa) Siberian ginseng

• Neutropenia (low neutrophil levels); related to lower folate, vitamin B6, B12 intake and magnesium as interacting with cholesterol, hyperhomocystenemia.

Treatment Objectives Included:

The patient requested herbal prescription with dietary therapy for the assumption of malignant prostate carcinoma fatigue and also associated fatigue.

Immune stimulatory/ anti-cancer formulations (See Table 3)*

• Hypertension (Stage 1); B.P. >140/80 related to dietary hypercholesterolemia (prediagnosed and treated with pharmaceutical medication)

• Increase micronutrient intake; minerals, vitamins • Increase endogenous anti-oxidant production • Increase exogenous anti-oxidant intake • Reduce sodium intake

Hypertension/Hypercholesterolemia • Reduce sucrose intake Formulation (See Table 4)* (↓refined carbohydrate, ↑fibre intake) Hawthorn Berry (Crataegus monogyma)

Garlic – (Allium sativum) Globe Artichoke (Cynara scolymus) Turmeric (Curcuma longa)

(Eleutherococcus senticosus)

The patient also requested dietary intervention without use of nutraceutical or mineral supplementation. The treatment plan itself was dietary modification as detailed in the following sections.

PAGE 20 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

• Reduce caffeine and alcohol consumption Dosage and Timeframes The dosages prescribed can be seen in the discussion section of this case study. As the patient was attending regular follow-up consultations (monthly), both blood pressure and also pathology analysis and thus treatment is continued until systolic blood pressure decreases with a remission of growth of the prostate (on-going therapy). The pharmacological intervention was as per current medication as has been previously described in this case study.

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Member Case Study Winter 2018

Dietary Advice Broad Dietary Instructions

• Potassium (2000mg/ d); (hypotensive action, water balance regulation, muscle and nervous system function); found in fruit and vegetables such as banana where the potassium: sodium ratio is 300:1 (Hummel et al, 2012, p.6)

The patient’s diet and lifestyle were assessed through a questionnaire.

• Co-enzyme CoQ10 (myocardium function) (30-120mg/d) (Fumagalli et al, 2011)

It was revealed that the patient was drinking a lot of coffee (caffeinated drinks per day) i.e. 5 x 250mL cups, and also as he ate out most nights dining at a restaurant the food was usually cooked in sauces that contained added sucrose, salt and corn starch. He consumed red wine with his meals (i.e. 2-4 glasses).

• Calcium (600-1200mg/d) & Magnesium (200-600mg/d)

As with the hypertension, possible hyper-homocystenemia, and the low WCC, specifically neutrophils are consistently at borderline low concentrations over a number of years of testing. These observations suggest dietary deficiency of a number of minerals and vitamins (confirmed by dietary survey both usual diet and 24-hour recall) suggesting mild myelodysplastic syndrome, suggested low iron phosphate, folic acid (Folate) intake i.e. absence of green leafy; spinach in diet. Further, low Vitamin B12 i.e. yeast, meat, Vitamin C i.e. orange, kiwi fruit, tomatoes, Zinc i.e. seafood, Vitamin B6 i.e. banana, wheat bran, cabbage, capsicums, Vitamin A i.e. yellow/ orange green vegetables, milk, eggs, liver, Magnesium i.e. dried apricots/ figs, nuts, seeds, almonds, corn, lemons, fruit and vegetables, spinach (green leafy vegetables).

Higher meat and refined carbohydrate consumption with lower fruit and vegetable intake is linked with stage 1 hypertension as indicated by historic and current blood pressure >140/90mmHg as recorded.

• Omega 6 linoleic acid (i.e. sunflower oil) acts as a vasodilator, and fish oil (1-3g/daily) anti-inflammatory action (Hui et. al.

1989)

Hypertension Specific Dietary Instructions Dietary suggestions for the stage 1 hypertension present were aimed at reducing systolic blood pressure (<5-10mmHg) in 1-3 month timeframe. The patient was instructed to reduce sodium and sucrose intake (<1500mg/d and 20g/d respectively), although it was unknown if the patients stage 1 hypertension was sodium dependent.

Further, the patient was instructed to reduce caffeine intake and instead drink peppermint tea (Mentha x piperita) as it acts as an intestinal carminative (i.e. GOR) to aid digestion or Roobois (antiinflammatory action) and may assist to reduce arteriosclerotic related inflammation. Further, alcohol and caffeine consumption were recommended to be reduced and the implementation of the potassium rich DASH diet which has been shown to reduce hypertension Hinderliter, et al 2014). The DASH diet provides nutritionally sound, eating behaviour modification which has been found to successfully lower blood pressure, but more importantly provides a healthy eating approach 144 obese and hypertensive individuals could successfully maintain for a year, which is ideal for longer term blood pressure management in clients with hypertensive tendencies (Hinderliter, et. al. 2014). Moreover, higher calcium, magnesium (beneficial for myocardial function), vitamin C and essential fatty acid supplementation were also recommended. Potassium rich foods are mostly contained in a vegetarian diet, as well as a raw food diet including onions, whole oats, garlic, legumes, low-fat dairy products, pomegranate juice (Lin, et. al. 2015). With concern regarding hypercholesterolemia, the patient was further instructed to use cholesterol free cooking oil such as olive, sesame oil (contains sesamin; lignin that has anti-hypertensive properties).

The patient was also offered nutraceutical supplementation in addition to dietary changes suggested. Supplementation included using;

• Vitamin D (800-2000 IU/d) & Vitamin C (500-1000mg/day) (anti-tumorgenesis & and hypocholesterolemia properties) (Johnson and Kligman 1992)

• Flavonoids (i.e. quercetin) (anti-oxidant & anti-tumorgenesis effect) (Paydar et. al. 2013) • Folic acid (vitamin B9) & vitamin B6 synergistically reduce hypertension (i.e. via homocysteiene regulation), although studies suggest the intake of folate and vitamin B6 is preventative rather than curative (Xun et. al. 2012).

A diet containing a higher percentage of vegetables, especially green leafy vegetables (i.e. spinach, bok choy, lettuce, celery) and thus vitamins K, C, A, which have been implicated to be beneficial to reduce the development of various cancer, acting synergistically rather than one particular vitamin/ phytonutrient (Linnewiel-Hermoni et. al. 2015). Further, these vegetables also contain fibre, which can be introduced to the diet as a means of calorie restriction with no food quantity restriction, as diet quality rather than CR is related to chronic illness and longevity (Rizza et. al. 2014). Further, high vegetable intake relative to red meat and also saturated fat has been shown to be beneficial to reduce the relative risk of cancer and also hypertension (Linnewiel-Hermoni et. al. 2015).

The instructions regarding dietary modification were communicated both via email and also in person. Food substitution was suggested rather than specific dietary planning as the patient cooks for himself and understands food/ dietary planning quite well.

Specific Dietary / Herbal Therapy for Cancer A number of herbal extracts were prescribed for the patient, but due to the scope of the case study they will not be mentioned, and rather specific food/ dietary advice is mentioned instead. Specific cancer dietary recommendations included a number of modifications to the patients current diet such as increase the fruit and vegetable proportion of the diet (i.e. flavonoids; anti-oxidants), especially fibrous and sulphur containing vegetables, especially shown to be correlated with lower incidence of renal and colorectal carcinomas (Brock et. al. 2012). The patient was encouraged to eat these vegetables raw (i.e. as per the Gerson therapy), or only lightly steam/ boil them to retain their vitamin and mineral content. Also it was suggested that instead of coffee, the patient drink green tea/ and Pu’erh tea which both contain anti-oxidants such as catechins and gallic acid and display anti-angiogenic properties (Vance, et. al. 2013).

Further, oil change for the diet was suggested in the form of dietary fat to sunflower, olive or flaxseed oil, especially the former which contains alpha-linoleic acid which inhibits 5 alpha-reductase (Liang and Liao 1997), that is also implicated in the pathogenesis of prostate cancer. Further, canola oil versus animal fats i.e. pork lard, have been shown to reduce colon cancer tumorgenesis (He et. al. 2014, He et. al. 2015).

PAGE 22 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

herbal treatments for prostatic hyperplasia Furthermore, vitamin C (ascorbic acid) at 5g/day has been suggested to have anti-carcinoma properties both in vitro and also in vivo (Vance, et. al. 2013). Lastly, both wheatgrass juice and also probiotics in chemotherapy are suggested for support due to myelotoxicity of the chemotherapy (toxic to myeloid tissue, i.e. bone marrow). These will be suggested if the patient elects for chemotherapy.

Benign Prostate Hyperplasia / Suspected Malignant Cancer Specifically for dietary treatment of potential prostate cancer, the patient was suggested to increase his dietary intake of essential fatty acids which the omega 3 category have antiinflammatory properties (Lin et. al., 2015). Further increasing Zinc to 150mg/d (i.e. sesame seeds, lentils). Moreover, intake of 3-5g of pumpkin seeds/day (unsalted) also reduced benign prostate hyperplasia and thus suggested for intake as well.

Specific Dietary Advice for Prostate Cancer The patient requested specific assistance with his situation. He requested to be treated on the basis that he actually had prostate cancer (no benefit of doubt). In addition to the previously mentioned information, I also suggested the reduce red meat intake, increase vegetable based protein i.e. soy/ tofu, reduce animal fats, including dairy, reduce processed food intake (Lin et al.

2015). Moreover, increased intake of tomatoes, watermelon and strawberries/ berries were suggested, as they contain lycopenes which are anti-oxidant and been implicated as anti-carcinogenic compounds with respect to PI3K/Akt pathway in prostate cancer (Chen et. al. 2014).

Thus, the dietary suggestion for the client was a berry and soy milk smoothie in the morning if hungry and the consumption of either Pu’er and oolong tea throughout the day as both have

anti-carcinogenic compounds (i.e. gallic acid and catechins), and also associated with higher fat/ cholesterol malabsorption and excretion (Vance et al, 2013).

Specific results from the Healthscope Pathology revealed; • Low MCH (Mean corpuscular hemoglobin (MCH) • High RDW (Red cell distribution width); large average width of red blood cells • Low WCC (White Cell Count) • Low Neutrophils It was concluded from dietary analysis and also pathological results, the patient suffered from a dietary deficiency of folate and vitamin B6 (i.e. not eating daily quantities of spinach, green leafy vegetables) and thus stem cells in the bone marrow as well as red and white blood cells are not being formed correctly. These culminated to induce folic acid anemia (macrocytic) and neutropenia. Also I suggest consuming eggs and fish in replacement of red meat for vitamin B12 which is important for nervous system function and red blood cell synthesis i.e. macrocytic anaemia. It was suggested to the client to consume 1 x 400mg B-vitamin complex daily or for folic acid intake as a wholefood equivalent; spinach (100g) daily as defined by USFA Food Database, as the RDI for folate is 400µg per day, so 100g of raw spinach contains 196 µg (i.e. 250g of spinach). In addition, it was suggested the client consume lentils, asparagus, cos lettuce, which also contain folate, with raw broccoli.

Another simple strategy for the client was incorporating turmeric within the diet which will provide flavour to his food and health benefits, because curcumin within turmeric has been found to induce apoptosis in androgen dependent and androgen independent prostate cancers (Dorai et al, 2000). The mechanism by

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Member Case Study Winter 2018

which this occurs is via down regulation of apoptosis suppressor proteins within prostate cancer cells (Dorai et al, 2000).

Turmeric has negligible systemic toxicity, rather it has hepatoprotective and hypocholesterolaemic properties which would be of overall benefit in this client’s scenario (Kim and Kim, 2010). The hypocholesterolaemic action is due to upregulation of cholesterol-7a hydroxylase enzyme which is responsible for catalysing the synthesis of bile from cholesterol in the liver, which increases cholesterol elimination (Kim and Kim, 2010). A teaspoon of turmeric can easily be added when preparing food and it can be added to drinks as well.

Lastly, the client was advised to reduce table sugar intake (i.e. sucrose, and thus glucose) and limit intake of starch containing foods as tumours use glucose to grow (i.e. from sucrose; table sugar) as tumour metabolism requires to catabolise glucose via glycolysis and produces pyruvate and lactic acid and thus acidifying the environment surrounding the tumour, providing an advantageous opportunity to expand its sphere of influence (Lin et al, 2015).

herbal treatments for prostatic hyperplasia BHP

Expected Outcomes and Outcome Measures • The expected outcomes were the reduction in anxiety / stress associated with the patient’s diagnosis of BPH • Increase the anti-oxidant status of the patient’s diet.

• Increase immune cells (i.e. WCC) and thus immune systems endogenous ability to act mitogenically • Reduce systolic blood pressure by 5-10mmHg to <135mmHg • Reduce the growth of the prostate lesion to a static 3mm lesion or to reduce its size or actual presence • No referral plan was created as the patient was primary in consultation with a general practitioner of medicine and also an oncologist

Follow-Up 1 month, 4 month; blood pressure, qualitative feedback (anxiety/ fatigue), pathology tests.

3 months (10/12/2014): Acknowledgement of a malignant 3mm tumour on the prostate (slow growing type); onocologist with-holding further details.

Please refer to table 1 which details the changes in

1 week (17/08/2014):

blood pressure.

Prostate Biopsy Report (End of December 2014)

Lifestyle Advice

Presence of 3mm prostate lesion. The client is tolerating the dietary change as well as herbal extract treatment and comments that his ‘energy levels’ are higher than usual.

Stress

1 month (10/09/2014):

This client’s occupation involves a high degree of responsibility and stress (CEO and Owner of a medium sized Australian Food Company), with stress depleting nutrients from the body and also inducing mild inflammation. It was suggested the client continue his weekly meditation class on a daily basis to reduce stress as meditation has been shown to reduce stress via cortisol modulation (Carlson et. al. 2004).

As per the previous follow up, the client continues to comment that he feels he has more energy and also seems less fatigued than before. A pathology test was ordered in which neutropenia and low iron statuses are present.

Exercise Sedentary behavior is associated with increased severity of sleeping difficulties and anxiety with moderate exercise such as yoga would improve sleep quality and quantity which would be a non-pharmaceutical anxiolytic intervention (Halpern et. al. 2014). The client opted to use a weights/ aerobics training exercises from Youtube and observed that with the slow increased the duration of the exercise, he felt less fatigue with both increased exercise frequency to four times per week using a exercise and non-exercise day.

The prostate biopsy confirmed the presence of a malignant carcinoma but the carcinoma was slow growing and not of a major concern. The patient’s general well-being had improved over the 4 month period, and he felt more healthy and confident and less fatigued after playing golf. His blood pressure decreased without further use of pharmaceutical medication which was attributed to the combination of dietary change, herbal extracts and also exercise.

Conclusion After 4 months of dietary and exercise therapy, the patient’s systolic blood pressure has decreased and at the same time his anxiety and worry about his condition had also dissipated. I learnt that care, respect and constant communication are necessary with a patient who has cancer as their mental state can affect dietary and nutraceutical treatment as well.

Compliance was not an issue, but in setting future treatment goals, treatment is required until the tumour reduces in size and spontaneously regresses.

Depending on the patient’s immune system, this may take several months or years to achieve.

Article References, Tables and Appendices for this article can be viewed by visiting the full case study file via the ANTA Member Centre > Resources > The Natural Therapist > Journal Articles PAGE 24 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

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MEET THE

2018 Round 1 ANTA Graduate Award Winners!

ANTA is pleased to announce the 1st round of ANTA Graduate Awards for 2018 ANTA Graduate Awards consist of 12 months complimentary ANTA membership and $200.00 Graduate Awards are provided several times a year and are open to all graduates who have completed a course recognised by ANTA. Students who graduate and join ANTA are automatically included for assessment for an ANTA Graduate Award.

Congratulations go to the following recipients on their achievements and being selected to receive an ANTA

Graduate Award. ANTA will contact each recipient to present them with their award.

The ANTA Graduate Awards are ongoing throughout 2018 See the ANTA website at www.anta.com.au for further information on how to participate.

When graduating high-school, I was torn between a career in natural health and a career the corporate world. I chose the latter and had an incredible time however, the pull of the natural health industry held strong and eventually lured me back years later. Looking back, I always knew I’d end up here and I’m so glad I did.

Alyse Co-cliff

My passion for natural therapies came from the need to understand the simple relationship between cause and effect. My passion for clinical practice arose the moment I realised this understanding could help others. My love for the industry as a whole arose from the ability for us as practitioners to collaborate across an array of disciplines in order to achieve what’s best for the patient that in itself is something special.

Wow, thank you so much. I am honoured!

Kylie Reed

Jessica Gammon

I discovered my passion for holistic health & nutritional medicine on the other side of 15 years of debilitating health conditions- a first hand experience of the fundamental need for empowered healthcare. After completing a Bachelor of Health Science (Nutritional Medicine) I integrated my passions, talents & health philosophies and quickly became a recognised health & wellbeing advocate in the GC wellness space.

As a wellness artist, consultant & workshop facilitator, I harness the power food, tai chi & self-mastery offers us to heal, connect & unify, and seek to bridge gaps between health-information and positive health-behaviours by providing comprehensive services that promote health-literacy, autonomy and authenticity in self-care.

I am honoured to have been chosen to receive a graduate award and thank you for the acknowledgment and your congratulations.

Jo Marlu I was raised with principles of natural medicine and eating nutritiously, so it was the obvious choice when raising my own family, and it has instilled in me a passion for natural health and preventative medicine.

I would love to see the choice to use natural health medicine be more accessible to the broader community and for conventional and complementary medicine to work more collaboratively.

Thank you for choosing me to receive an ANTA Graduate Award, it is a lovely surprise and I feel very fortunate.

PAGE 26 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

I became a naturopath to empower others to proactively manage their physical and mental wellbeing. After working as an engineer for nearly 10 years I felt I wanted to impact on people’s lives on a personal level. My own health challenges lead me to take a break from engineering and enrol in a Bachelor of Health Science. It was a tough 4 year degree, but the best time of my life.

Since I was a kid I have always wanted to learn just how the human body works and how to optimise its function. I love understanding the science behind how different foods, nutrients and herbs can improve our health. Tailoring this to meet the complex needs of a client is very satisfying.

I am now running my own naturopathic clinic, ‘Vitamin J’, and love that the learning is never ending.”

Thank you very much for the award, it means a lot!

Ashleigh Homewood Choosing to study Naturopathy is one of the best decisions I have ever made. It has not only been instrumental in helping transform my own health, but ignited a passion and fulfilment in me by helping others, for which I am truly grateful.

I am ecstatic and honoured to work in a profession that celebrates the individual, aims to establish balance to the WHOLE person and educates the community on the importance of taking responsibility of their own health.

Thank you so much for this unexpected and wonderful gift, I am so grateful!

Laurelle Usher I decided to study Nutritional Medicine to follow in my mother’s footsteps. I was extremely lucky to grow up with a mother who was a Naturopath, and realised just how lucky I am that she set me up for success with her knowledge of health.

Planning for my own family, I wanted to be able to do the same thing for both my children and help others the way that my Mum did.

Currently I am practicing by referral and plan to complete a Masters in Research in the future with a focus on nutritional interventions and fertility.

Wow, thank you, I was blown away to have received this graduate award!

I commenced my studies in 2010 excited to learn all about botanical medicine after becoming interested in kitchen pharmacy while living overseas without access to medical care. I loved growing herbs and using them to make a tea or to add to cooking to boost mine and my housemate’s immunity. It took a full 8 years for me to complete a degree in of Health Science (Naturopathy) as I gave birth to two beautiful children during this time.

Lucy McTiernan

My youngest child developed moderate eczema during my final year of studies and I was amazed at how successful dietary changes, supplements and herbal creams were at managing this challenging condition. This rewarding process inspired me to help other families with children struggling with eczema, food allergies, food intolerances and infant gut disturbances. These have become my main areas of interest while setting up my mobile naturopathy practice with another friend and naturopath in the inner west of Melbourne.

I am both surprised and excited to hear that I have been selected as a recipient for an ANTA graduate award, thank you!

Becoming a Mum to a child with food intolerances sparked an awareness of the power of food as medicine. I decided to study nutritional medicine to expand my knowledge and help other people with similar issues. It was a long haul studying part-time over 6 years but I’m excited now to be at the end of my degree and setting up a home clinic. I have a special interest in gut health and the microbiome, and I don’t think the learning will ever stop.

Emily Connell With two boys under two and my own emerging health issues, following career burn out, ‘mum-hood’ and years of not prioritising my own health, I knew it was time for a change. I began to discover the power of food as medicine, combined with a love of all things bioscience after a previous career in Occupational Therapy and mental health. I was curious, and eager to learn more. At the time I was living in North East Arnhem Land (NT) so commenced study remotely, until moving to the Gold Coast to study on campus.

Studying Nutritional Medicine has allowed me to understand the ‘why’ and problem solve individualised approaches to optimal health for me, my family and now my patients.

Thank you very much that is amazing!

Paula Corban

Thank you so much to ANTA for the award. It was a great surprise as well as a huge honour.

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 27

Member Article Winter 2018

M

etabolic imbalance is associated with suboptimal diet and eating habits that are incompatible with our physiological needs. This problem involves subtle but progressive adaptations to factors such as excessive intake of food rich in carbohydrates, fats, protein and salt, but lower in micronutrient value.

Metabolic imbalances may escalate and complicate over time to conditions such as hyperglycemia and metabolic syndrome, which are marked by insulin resistance, high blood pressure and cardiovascular problems, all of which are invariably linked to becoming overweight or obese.

While these changes may be considered reversible if we simply improve dietary habits and content, there are proven natural approaches toward enabling this improvement in a timely manner. This article highlights some basic nutritional concepts related to glucose homeostasis and related health issues, and reviews some complementary medicines and micronutrient substances that may assist.

Nutritional aspects of

Glucose and Metabolic Imbalance

by George Thouas, PhD

Head of Research and Development Max Biocare Pty Ltd

An energy equation out of balance

T

he essential common denominator to this problem is energy supply and demand. Food represents our main dietary source of carbohydrates and fats, which the body digests and metabolizes to obtain energy via basal metabolism. This drives all physiological functions, including muscular and neuronal signaling, immunity, cellular turnover and repair mechanisms.

When there is an oversupply of ‘fuel’ beyond these demands, the body begins to store the energy for future usage. This is typically in the form of subcutaneous and intra-abdominal adipose tissue and hepatic lipid deposits. Fatty acids are actually a very efficient form of stored energy, representing about six times the caloric value of glucose. This basic concept helps to explain the obesity epidemic and associated health problems that are becoming increasingly prevalent in both developing and developed countries.

Some obvious but often overlooked nutritional concepts include the following: • Energy rich food: weight gain is more prevalent where there is an abundance of cheap and freely available foods, particularly fast foods and convenience foods. A high proportion of these foods have excessive levels of ‘stored’ energy (i.e. as fats, carbohydrates and protein). Hence even small amounts of energy-dense foods can present the body with more than it requires.

• Energy versus time: physiological metabolic rates peak during the day and decline at night as physical activity decreases.

Hence, caloric intake at times when caloric demand is lower is likely to result in energy storage as lipid.

• Energy usage: people with higher energy demands, such as those who participate in increased levels of physical activity, have higher energy requirements and more efficient metabolic rates. Hence they can process higher caloric loads, whereas similar intakes without a concomitant increase in physical activity, or sedentary lifestyle, is also likely to result in energy storage as lipid.

• Energy deficits: the common misconception about restricting caloric intake, such as during crash dieting, is that it will encourage adipose tissue breakdown and weight loss. In contrast, reducing caloric intake inhibits basal metabolic rate, triggers energy conservation and reduces metabolic efficiency, which impacts on general health.

PAGE 28 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Glucose and insulin – simplified view of a complex regulatory mechanism

C

arbohydrates play an essential role in human physiology.

All tissues in the body require a constant supply of glucose for normal metabolic function and in particular, those with higher energy demands such as the brain, skeletal muscle and cardiac muscle. Fasting blood glucose is therefore maintained within a strict physiological range at all times, even during sleep.

When levels fall below this range, the liver releases more glucose from glycogen stores to compensate. Following a meal, complex carbohydrates and oligosaccharides are catabolized into monosaccharides, including

with a shift in this delicate mechanism. For example, the simple activity of chronic overconsumption of carbohydrates can progressively elevate the glucose load in the bloodstream. Hence the pancreas begins to adjust its sensitivity to an increasing frequency of elevated glucose, and peripheral tissues adapt to more frequent episodes of increased glucose availability.

The net result is that more insulin is released over time to compensate, a phenomenon called insulin insensitivity or insulin resistance. A sustained increase in the basal level of fasting blood glucose also leads to hyperglycemia (above normal blood glucose levels, also called type II diabetes

glucose, which enters the bloodstream via the small intestine. Upon sensing this increased glucose, pancreatic beta cells secrete insulin into the bloodstream. This peptide hormone is a potent activator of glucose uptake in the peripheral tissues, by mobilizing glucose transporter proteins at the cell surface upon binding to insulin receptor. Thus, insulin triggers removal of glucose from the blood stream. In addition, insulin inhibits the production of new glucose (gluconeogenesis) by the liver during glucose uptake by skeletal muscle and other peripheral tissues.

As mentioned, metabolic imbalance is associated

mellitus). Excessive glucose is lost through excretion via the kidney in an effort to restore blood glucose to the normal range.

A further consideration is that excess glucose is also stored as lipids in adipose tissue.

So as adipocyte numbers increase, insulin-dependent uptake of glucose into these cells also increases. Hence more adipose tissue equates to a higher glucose demand, further insulin requirements and lipid synthesis, in a type of snowball effect. People with metabolic syndrome therefore exhibit hyperinsulinemia, or above normal blood insulin levels over time, especially as their adiposity and BMI increase.

The Glucose Level

Common confounding dietary factors include:

the gut. This has the effect of lowering metabolic efficiency, as many vitamins and trace elements are required for glucose metabolism and other energy producing mechanisms within cells. Alcohol also decreases the metabolic efficiency of the liver, which has a direct bearing on beta-oxidation and hepatic lipid clearance.

• “Hidden” sugars: processed foods contain additives such as syrups and refined starches, which are used to alter its consistency and palatability. These are a rich source of glucose and fructose, with the latter generally regarded as a sweeter than glucose, but less readily metabolized and more likely to be stored as lipid in the liver rather than as glycogen. Higher carbohydrate content may also go undetected in the presence of other substances, such as flavor enhancers.

• Fats and oils: many carbohydrate rich foods also contain complex fatty acids. While these can be broken down into usable carbon sources for energy, this takes longer and is less efficient than glycolysis, so they are more likely to be stored as lipids in the liver or adipose tissue. This ultimately contributes to states of elevated circulating triglycerides (hyperlipidemia) and cholesterol (hypercholesterolemia).

• Alcohol and caffeine: these are worth mentioning as they are widely consumed in excess. Both have a dehydrating effect on the body and lead to micronutrient depletion via

• Protein: sources of dietary protein are required for the supply of amino acids in all tissues, for growth and repair.

They also contain many essential vitamins and minerals, which are required for metabolism of glucose, as well as saturated fats. Overconsumption of such sources on a regular basis can overload liver metabolism and further impact on hepatic lipid and urate clearance, as well as renal clearance. Western diets are characterized by routine inclusion of higher levels of protein than what may be physiologically usable on a daily basis, even for cardiomyocyte and skeletal muscle turnover.

• “Low fat” foods: to compensate for lower fat content, many foods contain increased levels of carbohydrates, which may be greater than short-term physiological demands.

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 29

PAGE 30 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Glucose and Metabolic Imbalance

Member Article Winter 2018

The cardiovascular connection

P

erhaps the most worrying variable in the energy supply and demand equation is the effect that elevated glucose and metabolic imbalances can have on cardiovascular health. If left unmanaged, metabolic imbalance can progress to the more severe condition referred to as metabolic syndrome, characterized by a cluster of symptoms including increased adiposity, hyperlipidemia, hyperglycemia,

hypertension and changes in circulating HDL. The “energy distribution network” of the vascular tree therefore becomes more preoccupied with waste removal, by analogy. This sets in motion a cascade of cardiovascular dysfunction, besides insulin resistance. Adipose tissue has a rich blood supply, which puts additional strain on cardiac output in an effort to provide increased levels of nutrients to this growing tissue. This can cause elevations in blood pressure (potentially

Confounding factors in cardiovascular dysfunction include:

• Oxidative and nitrosative stress: decreased metabolic efficiency leads to increased levels of incompletely utilized metabolic by-products that are highly reactive (reactive oxygen and nitrogen species, or ROS and RNS). Increased production of these chemical intermediates is associated with cellular and tissue damage and plays a major role in vascular inflammation. In the liver, ROS’s react with lipids in lipoproteins (LDLs and HDLs) to form lipid peroxides, which are distributed throughout the blood stream, thereby becoming a systemic problem.

• Circulating fats: increased levels of circulating triglycerides and cholesterol can sometimes become deposited along blood vessel walls, resulting in plaques. This further restricts blood flow, and commonly occurs in the coronary vessels.

Plaques can develop into sites of increased accumulation of fatty acids, and may release clots that can become lodged in smaller vessels of the lung and brain

leading to hypertension), increased heart rate and respiration rate. Hypertension progressively changes the physical compliance of cardiac muscle and arterial walls. Gradual loss of arterial wall elasticity (atherosclerosis) makes them more susceptible to damage and inflammation. This damage may be in the form of tearing or weakening in vessel walls, and subsequent scar formation.

• Vascular inflammation: smaller peripheral blood vessels, including microvessels, appear to be more prone to the effects of local inflammation and lesions. Retinopathy and nephropathy are examples of vascular damage associated with type II diabetes, whereas diabetic ulceration represents a prolonged vascular inflammation with delayed healing rates.

• AGEs: circulating lipids or proteins exposed to excessive glucose for prolonged periods become glycosylated. These molecules known as advanced glycation end products (AGEs) participate in vascular inflammation in a similar manner to ROS and RNS. Glycosylated A1C subunit of hemoglobin (HbA1c) is a commonly used biomarker of glycosylation in the blood stream.

• Salt: sodium chloride in excessive amounts can cause dehydration, transient increases in blood pressure, and over time may affect cardiac and kidney function. Many processed foods also contain large amounts of sodium that can often be masked by other additives.

Management of glucose and metabolic imbalance

T

he Australian Institute of Health and Welfare estimates that more than 60% of adults are either overweight or obese, with levels continuing to increase [1].

This is especially evident in indigenous populations, which have gradually transitioned away from traditional natural diets to more westernized foods and eating habits. As a consequence, more than 50%

of the diabetes burden has been due to becoming overweight or obese. A person with weight management problems and/ or insulin resistance would most likely benefit from regular physical exercise, coupled with a nutrient rich, balanced diet and adequate sleep. Dietary choices would obviously involve restriction of carbohydrates and free glucose, along with reduction in fats, proteins and any other

of the substances described here that contribute toward metabolic imbalance.

Management of hyperglycemia, depending on its severity, usually requires intervention by a practitioner, with the general objective of optimizing glycemic control and managing cardiovascular complications.

Therapeutic targets of glucose metabolism include: • Reduction of glucose availability (e.g. restriction or modification of dietary supply) • Glucose lowering:

- Stimulation of glucose uptake in peripheral tissues

- Facilitation of glucose metabolism in peripheral tissues

- Modulation of gluconeogenesis by the liver

- Reduction of glucose absorption in the digestive tract

- Stimulate glucose excretion

• Insulin sensitizing/potentiating:

- Support of insulin signaling pathways

- Stimulation of insulin secretion

- Provision of insulin or insulin analogs

• Improvement of systemic metabolism and general health

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 31

Member Article Winter 2018 Some of these mechanisms are defined pharmacological targets of a range of mainstream anti-diabetic medications.

These comprise of several classes of

medications [2, 3] including insulin itself in the form of the recombinant human peptide. Despite the abundance of treatment options, some evidence

suggests that many hyperglycemic individuals are not achieving optimal metabolic control of their condition [2].

Complementary medicines for glucose homeostasis Complimentary medicines have gained much attention in the context of improving glycemic control, because of their cost effectiveness, multi-faceted actions and their relatively fewer side-effects [2, 4-6]. Several traditionally used herbal preparations also possess lipid lowering properties that can further enhance their effectiveness and assist in addressing cardiovascular complications.

Phytochemicals Cinnamomum cassia Extracts of this widely used culinary and medicinal herb have multiple actions on glycemic control. They have been shown to stimulate glucose uptake in peripheral tissues (skeletal muscle, adipose tissue) via the

translocation of glucose transporter 4 (GLUT-4) [4, 7], as well as support insulin receptor activity.

Specific actives in cinnamon can also interact with the peroxisome proliferatoractivated receptors (PPAR-Îą and PPAR-Îą) [4, 7], which are involved in the genetic

Figure 1. Glucose response to bitter melon consumption [21].

Trigonella foenum graecum The three main actives of fenugreek seeds that exert beneficial metabolic effects include the saponins, branched-chain amino acids and soluble fibre [22, 23].

Fenugreek actives have been shown to confer hypoglycemic effects by decreasing lipid accumulation (via PPAR-Îą activation), stimulating islet cell insulin release, lowering hepatic lipid accumulation and gluconeogenesis [22].

The 4-OH-isoleucine content of fenugreek seed has insulin stimulating effects [24] as well as insulin sensitizing effects in skeletal muscle and liver tissue

control of glucose metabolism [8]. In line with the digestive roles of cinnamon, it has also been shown to delay gastric emptying and inhibit both pancreatic amylase and intestinal glycosidase enzymes [4, 7], resulting in suppressed glucose absorption. In several clinical trials, administration

of 1-6g of cinnamon has been shown to attenuate fasting blood glucose, improve blood lipid (total cholesterol, LDL and triglyceride) profiles and improve HbA1c levels in as little as 12 weeks [9, 10].

Mormordica charantia

enhance glucose uptake in muscle [15], acting on the insulin receptor pathway [16]. This is due in part to the intriguing insulin-mimetic effects of polypeptide-P [17] and the hypoglycemic effects of the compound vicine.

Several studies have reported statistically significant effects of fresh or extracted bitter melon in improving glucose tolerance, fasting and postprandial blood glucose and HbA1C levels in hyperglycemic subjects [18-20] and those with metabolic syndrome (Fig. 1) [21].

Bitter melon fruit has widespread culinary usage in India and South Asia. Extracts of bitter melon have been shown in animal models to act on the liver to increase glucose oxidation to pentose sugars, while also decreasing gluconeogenesis by acting on the glycolysis pathway [11].

In the pancreas, bitter melon extracts promote insulin release and potentiate its effect, while increasing the number of insulin producing beta cells [12-14]. In addition, bitter melon extracts can

[25]. Fenugreek administration has been shown to halt the development of type II diabetes in metabolic syndrome sufferers by as much as four-fold, relative to a placebo (Fig. 2) [26].

Improvements in fasting blood glucose, serum HbA1c, serum lipid profiles and insulin sensitivity have also been reported following fenugreek administration [26-30]. Further reductions in the inflammatory marker, C-reactive protein, along with a 2.6-fold reduction in the use of conventional antidiabetic medications were also reported [30].

Figure 2. The cumulative incidence of pre-diabetic patients developing T2DM in the fenugreek group was significantly lower than that of the control group [26].

PAGE 32 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Glucose and Metabolic Imbalance Micronutrients Îą-lipoic acid

Zinc

Alpha-lipoic acid (ALA) is produced by all cells in the body and is present in most protein containing foods. Biologically, it is an important cofactor in several mitochondrial enzymes, with additional roles in antioxidant defense and inflammatory responses. It has been reported that ALA stimulates the insulin signaling pathway and promotes membrane transport of glucose via GLUT4 [31-33]. Administration of lipoic acid has been reported in several studies to enhance glucose clearance, reduce HbA1C levels and lower total serum cholesterol in hyperglycemic subjects [34-37]. Lipoic acid consumption also appears to reduce vascular inflammation as indicated by lower circulating markers of damaged endothelium [38].

Zinc is versatile. Among its hundreds of critical roles in the cellular and molecular control of growth, metabolism and immune responses, zinc also regulates pancreatic control of blood glucose levels. After a blood glucose spike, insulin and zinc are co-released from both alpha and beta cells [46].

The zinc â&#x20AC;&#x153;burstâ&#x20AC;? that accompanies the insulin release also acts in an endocrine manner to co-ordinate gluconeogenesis in the nearby liver [47]. Both zinc and glucagon act on glucose metabolism through an independent mechanism, leading to either release or uptake of glucose [48], while zinc inhibits the liver uptake of insulin. Furthermore, zinc can also potentiate glucose uptake by stimulating insulin receptor signaling events in peripheral tissues [49]. The net result is highly responsive system of monitoring and controlling glucose balance, during either hyperglycemic or hypoglycemic states. This response is disturbed in type 2 diabetics who are often zinc deficient [50] and several studies have reported improvements in these responses following zinc supplementation [51-53].

Colecalciferol (vitamin D3) Vitamin D3 has diverse and complex regulatory roles in the molecular control of tissue growth, repair and inflammatory response. In the pancreas, vitamin D receptors and binding proteins are produced within beta islet cells [42]. These cells show reduced glycolytic activity, altered mitochondrial metabolism and lowered insulin secretion when vitamin D is deficient [43]. People with vitamin D deficiency are also prone to developing pro-inflammatory and altered metabolic states, which can predispose them to an increased risk of metabolic syndrome. A meta-analysis of studies of vitamin D3 supplementation has revealed that this risk can be decreased by as much as 30% [44]. One of the reviewed studies showed that co-supplementation of vitamin D3 with calcium for 3 years, in adults with suspected pre-diabetes, blunted increases in fasting blood glucose and lowered insulin resistance scores by as much as 20-fold, relative to placebo subjects [45].

Chromium and biotin (vitamin B7) Chromium and biotin are essential trace elements involved in the intra-cellular control of carbohydrate and lipid metabolism [55].

Chromium is also required for the circulating protein, chromodulin, which binds to insulin receptor to stimulate glucose uptake in peripheral tissues. Combined usage of chromium with biotin has been shown to reduce fasting blood glucose and HbA1c levels in obese subjects with type II diabetes [39, 40]. The same treatment also significantly reduced total cholesterol, LDL-cholesterol and indeces related to arterial plaque formation [41].

Summary

T

here are several useful candidates that may be implemented therapeutically in an integrative manner to enable restoration of glucose balance and metabolic function. These substances may also be useful for supplementation to reinforce routine therapies, although this remains at the discretion of the therapist, and requires careful consideration of confounding factors on an individual basis. Micronutrients on their own play an additional, highly valuable role in improving the general

health of those with metabolic dysfunction, especially where only marginal shifts in glucose homeostasis are indicated.

In combination with correction of nutritional parameters, avoidance of other risk factors and incorporating more physical activity, it may indeed be argued that conditions like metabolic syndrome are reversible and avoidable, notwithstanding genetics and other confounding variables. Energy spent in these endeavors may even contribute to reducing the probability of progression to chronic disease states.

Article References, Tables and Appendices for this article can be viewed by visiting the full case study file via the ANTA Member Centre > Resources > The Natural Therapist > Journal Articles The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 33

PCOS Introduction

Over the past decade our understanding of the pathogenesis as well as diagnosis and treatment for Polycystic Ovarian Syndrome (PCOS) has improved dramatically, both in Western medicine and in TCM. While the quality of Western clinical studies has been high, and the research into causes and pathophysiology has burgeoned, treatment outcomes are still quite poor, specifically in terms of infertility.

Additionally, recent estimates of the incidence of PCOS in the community have doubled compared with those accepted only a few years ago, and they are only expected to increase over the coming years (NHMRC, 2015).

Despite the overall low quality of evidence for

Chinese herbal medicines (CHM) in the treatment of infertility in these women, the effectiveness of CHM for infertility from all causes (of which PCOS is a major component) is estimated to be around 2-fold compared with Western drug treatments (Reid, 2015).

However, at best this still means that less than half of the women affected can be helped. In light of these facts, clear and frank communication with patients is required, and a flexible approach that includes openness to all forms of treatment is most likely to provide the best chance of a successful outcome.

See the previous issue for Part I of this article or view the full article via the ANTA Member Centre > Resources > The Natural Therapist > Journal Articles

Pathogenesis and diagnosis According to our current understanding of PCOS, there are four main pathodynamic factors: • Kidney deficiency • Phlegm-Damp • Blood stasis • Liver constraint, Qi stagnation with Heat or Fire.

These factors may interact to perpetuate or exacerbate the condition. Thus, the variable manifestations of this disorder may be accounted for by the varying degrees of predominance of each factor. For example, a woman diagnosed with PCOS who is lean and shows no marked ovarian changes on ultrasound would be deemed to manifest

very little Phlegm-Damp. On the other hand, a patient with a florid complexion, facial acne, infrequent periods, severe PMS before menstruation, emotional volatility and a deep red tongue would be diagnosed with predominant Liver Fire.

As the goal of treatment is to manage the condition by

PAGE 34 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

providing symptom relief and the restoration of fertility, the practitioner needs to be able to discriminate the various syndrome-patterns and prescribe accordingly.

Therefore, it is important to be able to link the key symptoms and signs with the corresponding TCM pattern.

Member Article Winter 2018

Polycystic Ovarian Syndrome A review of approaches in contemporary TCM, together with clinical protocols using prepared Chinese herbal medicines

PartII

BY TONY REID Master of Acupuncture, Master of Traditional Medicine (Dist) (UWS), Dip TCM (SITCM)

The Kidney deficiency refers to deficiency of the Kidney Essence, which directly impairs fertility. This may manifest in three ways: deficiency of the Kidney Yin, deficiency of the Kidney Yang, or deficiency of both the Kidney Yin and Yang (referred to simply as deficiency of the Kidney Essence).

Deficiency of the Kidney Yang manifests with signs of Cold, i.e. pale and swollen tongue with a moist coat; cold hands and feet, cold lower abdomen, and intolerance to cold temperatures. In addition, there may also be other more general signs of Kidney Yang

deficiency, such as lower back pain with a cold sensation, polyuria, nocturia, loss of libido, deep and slow pulse.

These patients are more likely to exhibit hyperandrogenism and less likely to have hyperinsulinemia.

Kidney Yin deficiency manifests with signs of Heat, i.e. red cheeks or malar flush; constipation; night sweating; hot sensations in the hands, feet and centre of chest, red tongue with a dry and scanty coat. Other signs of Kidney Yin deficiency include: low grade fever or tidal fever or afternoon fever; dry mouth and throat; thirst that is not

alleviated by drinking; lower back pain. These patients tend to have hyperinsulinemia as well as hyperandrogenism.

Kidney Essence deficiency may manifest with a mixture of signs of Kidney Yang deficiency and Kidney Yin deficiency with neither predominating.

Phlegm-Damp may arise from disordered Fluid metabolism due to Kidney deficiency. Other factors that may contribute include Spleen Qi deficiency and Liver Heat or Liver Fire. This manifests in obesity, cysts on the ovaries, a thick greasy tongue coat and a slippery pulse.

Blood stasis may arise from Kidney deficiency, retained Phlegm-Damp or Liver constraint. The main manifestations are amenorrhea, oligomenorrhea, menstrual blood with clots.

Liver constraint, Qi stagnation with Liver Fire, may arise due to prolonged emotional strain. Such patients are susceptible to anxiety, depression, irritability and anger, as well as premenstrual syndrome. Additional signs include thirst, constipation, headaches and a wiry pulse.

Commonly used formulas As discussed above, there are various approaches to the treatment of this disorder, and a variety of formulas may be used to address the different TCM patterns that are detected Kidney Essence deficiency:

Kidney Yin deficiency:

Blood stasis:

• Qi Bao Mei Ran Dan (Polygonum & Cuscuta Formula) a.k.a. Hair Growth Formula

• Zuo Gui Wan (Left Returning Formula)

• Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination) a.k.a. Blood Moving 2 Formula

• Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron & Rehmannia Formula) a.k.a. Empty Heat Formula – with marked signs of Heat

Kidney Yang deficiency:

Blood stasis with Phlegm-Damp:

Liver Heat or Liver Fire:

• Zhuang Yang Yi Jing Wan (Epimedium & Ginseng Formula)

• Nei Xiao Luo Li Wan (Prunella & Scrophularia Formula)

• Long Dan Xie Gan Tang (Gentiana Formula) a.k.a. Anti-Inflamm. Formula

• Fu Gui Ba Wei Wan (Rehmannia Eight Formula) a.k.a. Rehmannia Eight Vitality Formula – with marked signs of Cold

• Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Combination) – for women with a delicate or weak constitution

• Yin Chen Hao Wan – Jia Wei (Artemisia & Rhubarb Combination) – with milder signs of Heat

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 35

Member Article Winter 2018

PCOS Continued

Clinical protocols The clinical syndrome patterns in PCOS may be classified as follows: • Kidney deficiency with Phlegm-Damp and Blood stasis in the lower Jiao • Liver Fire with Kidney Essence deficiency and Blood stasis • Deficiency Cold of the Chong-Ren Channels with Blood stasis By judiciously applying the formulas listed above, we can have a flexible approach that allows for individual variation as well as observed changes during the course of treatment. (a) For patients with Kidney deficiency without any clear signs of Yin or Yang deficiency, the formula: Qi Bao Mei Ran Dan (Polygonum & Cuscuta Formula) a.k.a. Hair Growth Formula is the most suitable. (b) For those with Kidney Yang and

Essence deficiency the formula: Zhuang Yang Yi Jing Wan (Epimedium & Ginseng Formula) is appropriate.

While patients exhibiting Kidney Yang deficiency with marked signs of Cold (e.g. sensitivity to the cold, cold hands and feet) together with disruption of Fluid metabolism (i.e. obesity, polyuria,

nocturia, ankle oedema, etc.), would be prescribed the formula Fu Gui Ba Wei Wan (Rehmannia Eight Formula) a.k.a.

Rehmannia Eight Vitality Formula.

Kidney Essence deficiency with Blood stasis in the lower Jiao

Kidney Yin deficiency with Phlegm-Damp and Blood stasis in the lower Jiao

Key clinical features: Infertility, amenorrhea or irregular periods, no clear signs of Cold or Heat, deep and weak pulse.

Formulas:

Key clinical features: Red tongue with a dry and scanty coat; other signs of Kidney Yin deficiency (e.g. flushed face or red cheeks or malar flush; low grade fever or tidal fever or afternoon fever; dry mouth and throat; thirst that is not alleviated by drinking; low back pain; night sweating; hot sensations in the hands, feet and centre of chest, rapid-thready pulse).

Qi Bao Mei Ran Dan (Polygonum & Cuscuta Formula) a.k.a.

Hair Growth Formula plus

P/T: Nourish the Kidney Yin and clear deficiency Heat, resolve Phlegm and break up Blood stasis.

Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination) a.k.a. Blood Moving 2 Formula

Formulas:

P/T: Nourish the Kidney and enrich the Kidney Essence, activate the Blood and dispel stasis

Liver Fire with Kidney Essence deficiency and Blood stasis Key clinical features: Headaches; facial flushing; bitter taste in the mouth; conjunctival congestion; possibly excessive vaginal discharge; red tongue with a thick yellow coat; rapidfull pulse.

P/T: Drain Fire from the Live, clear Damp Heat, activate the Blood to dispel stasis, nourish the Kidney Essence.

Formulas: Long Dan Xie Gan Tang (Gentiana Formula) a.k.a. AntiInflamm Formula plus Nei Xiao Luo Li Wan (Prunella & Scrophularia Formula) plus Qi Bao Mei Ran Dan (Polygonum & Cuscuta Formula) a.k.a.

Hair Growth Formula In patients with milder signs of Heat: Yin Chen Hao Wan – Jia Wei (Artemisia & Rhubarb Combination) plus Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination) a.k.a. Blood Moving 2 Formula plus Qi Bao Mei Ran Dan (Polygonum & Cuscuta Formula) a.k.a.

Hair Growth Formula

(a) Zuo Gui Wan (Left Returning Formula) or Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron & Rehmannia Formula), a.k.a. Empty Heat Formula – with marked signs of Heat plus (b) Nei Xiao Luo Li Wan (Prunella & Scrophularia Formula) or Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Combination) ) – for women with a delicate or weak constitution.

Kidney Yang deficiency with Phlegm-Damp and Blood stasis in the lower Jiao Key clinical features: Pale and swollen tongue with a moist coat; other signs of Kidney Yang deficiency (e.g. low back pain with a cold sensation; intolerance of cold; the hands, feet and lower abdomen are cold to the touch; polyuria, nocturia; low libido, deep-slow-weak pulse).

P/T: Warm-tonify the Kidney Yang, resolve Phlegm and break up Blood stasis.

Formulas: a) Zuo Gui Wan (Left Returning Formula) or Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron & Rehmannia Formula), a.k.a. Empty Heat Formula – with marked signs of Heat

plus (b)Nei Xiao Luo Li Wan (Prunella & Scrophularia Formula) or (b) Gui Zhi Fu Ling Wan (Cinnamon & Hoelen Combination) – for women with a delicate or weak constitution.

PAGE 36 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

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The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 37

Member Article Winter 2018

PCOS Continued Deficiency Cold of the Chong-Ren Channels with Blood Stasis

Protocols for acne and hirsutism

Key clinical features: Cold lower abdomen with pain and distention, low grade tidal fever, dry mouth and lips, (possibly also: hot hands; dark or purple tongue; thready-choppy pulse).

Qing Re An Chuang Wan (Salvia & Scute Formula BP079) a.k.a.

ACNE FORMULA plus

P/T: Warm the uterus and dispel Cold, nourish and activate the Blood, dispel Blood stasis.

Acne:

Long Dan Xie Gan Tang (Gentiana Formula) a.k.a. Anti-Inflamm.

Formula – with marked signs of Heat or

Formulas:

Yin Chen Hao Wan – Jia Wei (Artemisia & Rhubarb Combination) – with milder signs of Heat

Wen Jing Tang (Danggui & Evodia Formula) plus

Hirsutism:

Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination) a.k.a. Blood Moving 2 Formula

Tao Hong Si Wu Wan (Persica, Carthamus & Dang-gui Combination) a.k.a. Blood Moving 2 Formula

Concluding Remarks In terms of the most important outcomes, i.e. full-term pregnancy and healthy delivery, the best available evidence suggests that TCM herbal treatment may be at least as effective as Western pharmaceutical management; and possibly up to twice as successful. (Ried, 2015) However, the TCM evidence is of poor quality, so we need to be cautious, as well as optimistic, in our discussions with patients.

A recent systematic review on Chinese herbal medicines for subfertile women with PCOS was inconclusive, due to the low quality of the evidence available (Zhou et al, 2016), suggesting that Chinese herbal treatments may be no more successful than Western pharmaceutical treatments.

However, it should be noted that all the various pharmacological interventions have significant down-sides (Ong et al., 2017; Williams, et al., 2016), unlike the herbal medicines that may be used for the same purposes. Moreover, there is a growing body of evidence validating the efficacy of Chinese herbs in correcting the various abnormalities associated with PCOS. ‘Current research demonstrates that the compounds

isolated from herbs have shown beneficial effects for PCOS and when combined in an herbal formula can target both reproductive and metabolic defects simultaneously….

One advantage of herbal medicine, especially Chinese herbal medicine, is that multiple herbs are combined in a formula and can therefore have multiple targets while still remaining low risk with minimal side-effects.’ (Ong, et al., 2017) Based on recent studies, the outcomes from Western pharmaceutical interventions have improved steadily over the past ten years, together with improved study design and reporting. However, translating this evidence into information that may be easily understood by patients is not always easy, both for the reasons discussed above, as well as the fact that the frequency rates (e.g. for ovulation or pregnancy) have quite a large margin of error (e.g. in studies with 50 or less women in each group, a difference in the order of 10% between pregnancy rates is not deemed to be statistically significant). Thus, it is not possible to provide precise figures

for the expected results of treatment. Based on the most recent study cited above, (Ghahiri et al., 2016) we may tell our patients that Western pharmaceutical treatment, continued over four to six cycles, could be expected to give the following outcomes: ‘Your chances of resuming regular menstruation (with ovulation) are very good, up to around 70%.

If you begin having periods the chances of becoming pregnant are also very good, up to around 80%.

However, your chance of losing the pregnancy within the first trimester are quite high, almost 50%.

If your pregnancy continues past the first trimester, your chances of going to full term and giving birth are around two out of three.

Unfortunately, you are at greater risk of complications during pregnancy (e.g. diabetes, hypertension, pre-eclampsia) and labor (e.g. preterm birth, requirement for Caesarian section), which are almost twice that of women who do not have PCOS. However, the

risks for your new born are no higher than normal.’

As already stated, based on best available evidence, treatment with TCM is likely to provide similar outcomes to pharmaceutical management, and most likely with fewer adverse effects. Therefore, a similar conversation to the one in the previous paragraph may be warranted, in discussing the option of TCM herbal treatments with your patient.

Unfortunately, the TCM clinical studies (and summaries of such studies) available to date are still inadequate. While ovulation rates, which are generally high, along with pregnancy rates are generally given, full-term pregnancy rates are not reported. (Zhou et al, 2016) It is also possible that the risks to the mother during pregnancy and labor would be similar in women treated with TCM. Again, there is a complete lack of evidence in this regard. Thus, the services of an obstetrician are crucial, and the best course of action would be for the TCM practitioner to work together with the patient’s gynecologist and obstetrician, with all parties sharing information freely.

Article References, Tables and Appendices for this article can be viewed by visiting the full case study file via the ANTA Member Centre > Resources > The Natural Therapist > Journal Articles PAGE 38 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

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The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 39

Member Article Winter 2018

BY TONY REID Master of Acupuncture, Master of Traditional Medicine (Dist) (UWS), Dip TCM (SITCM)

The Emotions in Traditional Chinese Medicine

Part 2:2 - TCM Formulas

Introduction In Part 2:2 of this paper, we focus on some of the key Chinese herbal formulas that may be used in the treatment of emotion-related disorders. The central concept is that extremes of emotion not only impair normal mental and emotional functioning; but also become pathogenic factors, affecting the internal organ systems to produce physical, emotional and behavioural abnormalities.

Yu (Stagnation) Syndrome The progression of pathological changes that may arise due to emotional distress is best illustrated by examining the disease class referred to in Chinese as yu zheng. This term is often translated as ‘depression’, ‘melancholia’, ‘stagnation syndrome’, etc. (Maciocia, 1995, pp.344-5; Peng, 2000, p.350,

Zhang, 2007, pp.87-104). However, there are no precise English words that capture the full meaning. The term yu (pronounced with the German vowel sound: ‘yü’) refers to stagnation, or disruption to the free movement, of the Qi (vital energy) that occurs as a direct result of emotional strain, primarily affecting the Liver, the main function of which is to ensure the smooth and even flow of the Qi throughout the body. Moreover, the Liver is the organ most readily affected by extremes of emotion.

The term zheng (pronounced with a short vowel: ‘jung’) refers to diagnosis according to syndrome (or pattern) differentiation and is often translated as ‘disorders’, ‘patterns’ or ‘syndromes’.

Rather than being a single syndrome, however, the term, ‘Yu syndrome’, refers to several different, yet related, syndromepatterns that may arise as a result of the impact of extreme emotions on the Liver. The preferred terms in the following discussion are ‘Yu syndrome’ and ‘Stagnation syndrome’, which are used interchangeably.

Chart of representative Chinese herbal formulas in Yu (Stagnation Syndrome) STAGE 1: Liver imbalance At this stage, herbal formulas that address Qi stagnation due to Liver constraint are prescribed. Patients may present with either a deficiency or an excess pattern.

Accordingly, the main formulas are: • Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. Stress Relief 2 Formula • Chai Hu Shu Gan Wan (Bupleurum & Cyperus Combination) a.k.a. Qi Mover Formula For patients who present with Liver constraint in a deficiency pattern, the appropriate treatment formula is Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. Stress Relief 2 Formula.

Formula Ingredients • Bupleurum falcatum, root (chai hu) • Paeonia lactiflora, root (bai shao) • Angelica polymorpha, root (dang-gui) • Atractylodes macrocephala, rhiz. (bai zhu) • Poria cocos, fruit. body (fu ling) • Glycyrrhiza uralensis, root (gan cao)

• Mentha haplocalyx, herb (bo he) • Zingiber officinale, rhiz. (sheng jiang) The major herb in this formula is Bupleurum, which has been pre-prepared by dry frying. This focuses the herb’s action on the Liver and accentuates two of its main actions; one is to promote the Liver’s primary function of spreading the Qi to ensure its smooth and even movement throughout the body and the other action is to disperse the stagnant Qi. In addition, dry-fried Bupleurum acts as ‘envoy’ to direct the actions of the other herbs to the Liver. The formula acts to disperse the stagnant Qi (Bupleurum, Zingiber, Mentha) and to promote free movement of the Qi by nourishing and strengthening the Liver (Paeonia, Angelica). In addition, there is a group of herbs that strengthen the Spleen to promote Qi and Blood production (Atractylodes, Poria, Glycyrrhiza) as the Spleen’s functions may have become inhibited due to Liver constraint. This formula is suitable for patients experiencing the initial effects of emotional strain or stress, whose main symptoms are irritability, depressed mood, fatigue, and withdrawn disposition. There

PAGE 40 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

may also be signs of deficiency, such as pale complexion, fatigue, loss of appetite, pale tongue, and a weak-thready pulse (which is also wiry).

Patients presenting with Liver constraint in an excess pattern, require a slightly different treatment approach; the appropriate formula in these cases is Chai Hu Shu Gan Wan (Bupleurum & Cyperus Combination) a.k.a. Qi Mover Formula.

Formula Ingredients • Paeonia lactiflora, root (bai shao) • Cyperus rotundus, rhiz. (xiang fu) • Citrus aurantium, fruit (zhi ke) • Bupleurum falcatum, root (chai hu) • Ligusticum wallichii, rhiz. (chuan xiong) • Corydalis turtschaninovii, root (yan hu suo) • Curcuma longa, root (yu jin) • Glycyrrhiza uralensis, root (gan cao) The major herb here is also Bupleurum, which has been pre-prepared by dry frying. It acts in the same way within this

formula: to promote Liver function and disperse the stagnant Qi while also acting as envoy to direct the actions of the other herbs to the Liver. In contradistinction to the formula discussed above, this one does not have pronounced tonifying or nourishing actions - only Paeonia and Glycyrrhiza are included, to soothe the Liver and relieve muscular tension.

This formula’s actions are focused on promoting Qi movement and dispersing stagnant Qi (Bupleurum, Cyperus, Citrus, Ligusticum, Corydalis, Curcuma) as well as activating the Blood (Ligusticum, Corydalis, Curcuma). The formula is used in conditions that have more severe stagnation of the Qi, together with the accompanying tendency to Blood stasis.

Patients will have a robust constitution, a more outgoing temperament, be more expressive of their emotions and may also complain of physical discomfort due to muscular tension. The main symptoms are irritability, angry outbursts, and sensations of muscular tension and discomfort, with a full and wiry pulse.

STAGE 2: Other organs involved

Qi and Blood deficiency, affecting Heart and Spleen

additional role of envoy and directs the actions of the other herbs to the Heart.

This formula is suited to patients with depressed mood, anxiety and insomnia with poor appetite, fatigue (both physical and mental), forgetfulness, a pale tongue and a weak-thready pulse.

Heart Blood deficiency When Heart Blood deficiency develops, the main clinical manifestations are centered on disturbed sleep and mood.

Initially these symptoms may be transient and readily reversible. However, once this condition becomes established, the characteristic symptoms will persist, in spite of removal of the original source of emotional strain. The appropriate treatment formula at this stage is An Shen Ding Zhi Wan (Ziziphus & Polygala Formula).

Formula Ingredients • Fallopia multiflora, stem (ye jiao teng) • Ziziphus jujuba var. spinosa, seed (suan zao ren) • Poria cocos, hyphae (fu ling) • Poria cocos, inner part with pine wood (fu shen) • Pseudostellaria heterophylla, root (tai zi shen) • Oyster shell (mu li) • Polygala sibirica, root (yuan zhi) • Anemone altaica, rhiz. (chang pu) The major herbs are Fallopia and Pseudostellaria; the former nourishes the Heart Blood and the latter tonifies the Qi. Polygala acts as envoy to direct the actions of the formula’s ingredients to the Heart. The formula is composed mostly of Heart nourishing herbs (Fallopia, Pseudostellaria, two types of Poria, and Zizyphus), supported by the ‘settling’ action of Oyster shell and the ‘opening’ action of Polygala and Anemone. These supporting ingredients clear and calm the mind while also stabilizing the emotions.

This formula has tonifying and nourishing actions on the Heart, and is effective for insomnia, mood swings, anxiety and depressed mood. Such patients will also show other clinical signs of Heart Qi and Blood deficiency, such as forgetfulness, palpitations, pale tongue and a weakthready pulse.

Commonly, the repercussions of Liver constraint involve both the Heart and the Spleen. This is due to failure of the Liver to nourish the Heart with Blood, on the one hand; and failure to regulate and promote the functional activities of the Spleen, on the other. In addition, the repeated mental and emotional overstimulation that results from worrying or obsessing about unpleasant events, both real and imagined, has a direct effect on these two organs, which further contributes to the state of deficiency.

The classic formula to address this dual deficiency condition is Gui Pi Wan (Ginseng & Longan Combination) a.k.a.

Restore the Spleen Formula.

Formula Ingredients • Astragalus membranaceus, root (huang qi) • Ziziphus jujuba var. spinosa, seed (suan zao ren) • Poria cocos, fruit. body (fu ling) • Codonopsis pilosula, root (dang shen) • Atractylodes macrocephala, rhizome (bai zhu) • Glycyrrhiza uralensis, root (zhi gan cao) • Angelica polymorpha, root (dang-gui) • Dimocarpus longan, fruit flesh (long yan rou) • Cyperus rotundus, rhizome (xiang fu) • Polygala siberica, root (yuan zhi) • Ziziphus jujuba, fruit (da zao) • Zingiber officinale, rhizome (sheng jiang) The two principal herbs are Astragalus, which tonfies the Spleen Qi, and Zizypus seed, which nourishes the Heart and calms the spirit. The former herb is supported in its actions by Codonopsis, Atractylodes, Poria, Zizyphys fruit, Zingiber and Glycyrrhiza. The therapeutic actions of Zizyphus seed are supported by Angelica and Dimocarpus, which nourish the Blood, and also by Poria and Polygala, which calm the Spirit. Polygala has the

Liver constraint, Qi stagnation develops stagnant Heat Although this particular pattern on its own belongs in stage 1, it is discussed here because it is an important precursor to Heart Fire, discussed below as well as Phlegm (stage 3) and Yin deficiency (stage 4). It is a general principle in TCM that stagnation leads to the development of pathogenic Heat. This correlates closely with the concept of inflammation, whereby the body attempts to resolve or remove pathogenic substances. In addition, the Liver has certain innate properties that predispose to the development of Heat. It is classified as a Wood organ, and belongs to the ‘young’ or developing stage of Yang, the nature of which is to readily flare up at the slightest provocation.

This pattern is commonly encountered in the clinic. The development of Heat (known as ‘stagnant’ Heat) due to Liver constraint leads to a marked worsening of the initial symptoms. Patients complain of extreme irritability, short temper, insomnia, stomach upset (particularly when stressed) and a general state of mental and emotional unrest. The classical formula suitable for such patients is Jia Wei Xiao Yao San (Bupleurum & Peony Formula) a.k.a. Stress Relief 1 Formula. This formula is the same as Xiao Yao San (Bupleurum & Danggui Formula) a.k.a. Stress Relief 2 Formula (discussed above), with the addition of two ingredients that address the stagnant Heat: Paeonia bark and Gardenia fruit (both dry-fried). The two formulas are used clinically in much the same way; the main difference being that the former is stronger and acts more rapidly. However, the latter formula (Xiao Yao San) would be favored in patients presenting with fatigue; and the former (Jia Wei Xiao Yao San) in patients with irritability, sleep disturbance and obvious signs of Heat,

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 41

Member Article Winter 2018 e.g. sensations of Heat, red eyes, redness on the tongue and a rapid pulse (which is also wiry).

Heart Fire When the stagnant Heat within the Liver has progressed to the point where it becomes Fire, it may transfer to the Heart. There is now a dramatic worsening of symptoms: the patient is in a constantly over-excited state that is no longer only brought on by stressful events. This is an excess type

pattern, which is marked by a relatively sudden onset, and absence of fatigue or dizziness. It is referred to as Heart Fire.

The classical formula that is used for such cases is Huang Lian Jie Du Wan (Coptis & Scute Formula) a.k.a. Antitox 2 Formula.

Formula Ingredients • Coptis chinensis, root (huang lian) • Scutellaria baicalensis, root (huang qin) • Phellodendron amurense, stem bark (huang bai)

• Gardenia jasminoides, fruit (shan zhi zi) The principal herb is Coptis, which purges Fire from the Heart. It is supported by the other herbal ingredients which purge Fire from various internal organ systems. This formula is suitable for patients with severe irritability, agitation, impulsiveness, insomnia and prominent signs of Heat, e.g. fever , dark urine, mouth ulcers, dry mouth and throat, bitter taste in the mouth, red tongue with a yellow coat, and a rapid-forceful pulse.

STAGE 3: Development of Phlegm or Blood Stasis Once the disruptive effects of emotional imbalance have affected the internal organs, their impaired functioning may lead to the development of endogenous pathogens, principally Phlegm and Blood stasis. These pathogens both worsen and perpetuate the original emotion-based problem, and this is the reason why the two formulas discussed below are able to provide dramatic relief in these patients, in spite of the fact that neither formula contains specific herbs that act to calm the Spirit and nourish the Heart.

Phlegm may manifest in various ways, which are classified into two broad categories: external Phlegm and internal Phlegm. External Phlegm manifests as sputum or excessive mucous, which is commonly seen in certain respiratory and digestive disorders. Internal Phlegm, as the name suggests, is more hidden and, although pathogenetically related to the external type of Phlegm, does not manifest with the clinical signs of excessive mucous or sputum.

Amongst the various internal manifestations of Phlegm, the ones that concerns us here are those that relate to the psyche, where internal Phlegm may cloud the mind and create obstruction to normal mental functions. Clinically this is seen when patients begin to entertain a skewed view of their present circumstances, e.g. worrying excessively about events that have not yet happened and may likely never happen; the belief that one will never again be happy; as well as the various suspicions and delusions, which in normal circumstances would be dismissed with a light-hearted sense of self-deprecation.

The main representative formula for Phlegm that has developed as part of Yu syndrome is Wen Dan Tang (Bamboo & Hoelen Formula) a.k.a. Clear the Phlegm Formula. This formula is generally used in combination with one of the other

formulas discussed in this section.

Formula Ingredients • Phyllostachys nigra, stem wood (zhu ru) • Poria cocos, fruit. body (fu ling) • Pinellia ternata, tuber (ban xia) • Citrus aurantium, fruit (zhi shi) • Citrus reticulata, fruit peel (chen pi) • Glycyrrhiza uralensis, root (gan cao) • Ziziphus jujuba, fruit (hong zao) • Zingiber officinale, rhiz. (sheng jiang) The major herb is Phyllostachys, which resolves Phlegm and clears Heat. It is supported in these actions by Citrus fruit, Pinellia, Poria, Citrus peel and Zingiber.

In addition, Phyllostachys, Pinellia and Zingiber promote the descending action of the Stomach Qi and, in so doing, have a normalizing effect on the digestion and assimilation of nutrients, preventing the further development of Phlegm.

The other effect of these three herbs is to facilitate the Spleen in its function of sending fresh Qi to the mind and senses, aiding mental clarity. This latter action is assisted by Glycyrrhiza, Poria and Ziziphus, which tonify the Spleen and the Stomach. This formula assists in the amelioration of agitation, insomnia, lack of mental clarity and mood swings that are related to one or more of the other pathological developments in Yu syndrome. In addition, there are generally also signs of poor digestion, including loss of appetite or excessive appetite, bloating, eructation, loose stools and a thick or greasy tongue coat.

Blood stasis Blood stasis may readily develop when the two factors of Qi stagnation and Blood deficiency co-exist. In the view of TCM, consciousness is Blood based, in

PAGE 42 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

that the Spirit, which resides in the Heart, depends upon an adequate supply of good quality Blood to remain tethered to the physical reality, which includes the body, the input provided by the senses, working memory, and also an awareness of the social conventions, together with empathy and consideration for others.

Blood stasis, i.e. impeded movement of the Blood, with localized obstruction due to static Blood, severely disrupts these faculties. The classic formula for this type of clinical scenario is Tao Hong Si Wu Wan (Persica, Carthamus & Danggui Combination) a.k.a. Blood Moving 2 Formula. It is generally prescribed together with one or more of the other formulas discussed in this section.

Formula Ingredients • Rehmannia glutinosa, root (di huang) • Angelica polymorpha, root (dang-gui) • Paeonia lactiflora, root (bai shao) • Paeonia veitchii, root (chi shao) • Ligusticum wallichii, rhiz. (chuan xiong) • Prunus persica, seed (tao ren) • Carthamus tinctorius, flower (hong hua) The major herb is Angelica which has the dual actions of nourishing as well as activating the Blood, and thus epitomizes the therapeutic actions of this formula. It is supported on the one hand by Paeonia (white), Rehmannia and Ligusticum, to nourish the Blood; and on the other, by Ligusticum, Paeonia (red), Prunus, and Carthamus, to activate the Blood and dispel stasis. This formula assists patients with worsening insomnia, anxiety and poor concentration, together with signs of Blood stasis, such as dark complexion, various aches and pains (e.g. headaches), purple patches on the tongue, and a thread-choppy pulse.

The Emotions in Traditional Chinese Medicine STAGE 4: Injury to the Yin Clinically, there are two types of injury to the Yin that may develop during the course of the Yu syndrome. The more severe form involves the Kidney system, while the less deep-seated condition is confined to the Liver and Heart. As the Liver Blood becomes depleted and the stagnant Heat develops into Fire, the Yin of the Liver and Heart may become injured, particularly in those who are predisposed to develop deficiency syndromes. Thus, the pattern of Heart and Liver Yin deficiency may arise in these patients as a consequence of the Fire from Liver constraint, instead of Heart Fire, as discussed in Stage 2, above.

The classical formula for this type of presentation is Jin Gui Suan Zao Ren Tang (Ziziphus Combination).

Formula Ingredients • Ziziphus jujuba var. spinosa, seed (suan zao ren) • Fallopia multiflora, stem (ye jiao teng) • Poria cocos, hyphae (fu ling) • Anemarrhena asphodeloides, rhiz. (zhi mu) • Ligusticum wallichii, rhiz. (chuan xiong) • Albizia julibrissin, flower (he huan hua) • Polygala sibirica, root (yuan zhi) • Glycyrrhiza uralensis, root (gan cao) The major herb is Ziziphus seed, which nourishes the Liver and Heart and calms the Spirit. It is supported by Fallopia, Albizia, Polygala and Poria. The deficiency Heat and associated irritability are addressed by Anemarrhena and Glycyrrhiza; while Ligusticum and Albizia soothe the Liver to relieve constraint and also regulate the movement of the Qi and Blood. Polygala has the additional action as envoy to direct the actions of the other herbs to the Heart. This formula is prescribed for patients with anxiety, inability to remain asleep due to vivid and disturbing nightmares, palpitations, night sweats, restlessness and irritability, who present with a Liver-Heart Yin deficiency pattern. The clinical signs of dizziness, fatigue, a red tongue without a coat and a rapid but thready (weak and thin) pulse help to distinguish this pattern from that of Heart Fire.

Kidney Yin deficiency In severe cases the Yin of the Kidney is affected. Due to the co-existing deficiency condition of the Heart, there may arise a pattern where the Kidney and Heart lose their normal harmonious

interaction. The cooling, calming, stabilizing and grounding action of Water (i.e. the Kidney) fails to exert its influence on Fire (i.e. the Heart), leading to instability and hyperactivity within the latter. Thus, all the essential attributes of Fire, both physical and psychological, tend to become exaggerated and extreme, in the absence of the restraint that would normally be provided by Water. This particularly pertains to the Spirit, which is ‘housed’ in the Heart. We need to bear in mind that the essential features of pattern involve not only excess in Fire, but also a concomitant deficiency in Water. On the psychological level this is epitomized in the lack of effective functioning of the zhi. This term is often translated as ‘will’. However, it is a broader concept that includes the faculties of will, determination, power of concentration and long-term memory.

Thus, the condition of disharmony between the Kidney and Heart may also be described as a separation of the will (in the broad sense) from the Spirit.

The classical formula used to correct this imbalance is Tian Wang Bu Xin Wan (Ginseng & Ziziphus) a.k.a. Calm the Spirit Formula Formula Ingredients • Rehmannia glutinosa, root (di huang)

Part 2:2 formula’s ingredients are directed to the Heart by the envoy herbs, Polygala and Platycodon. This formula is suitable for patients complaining of over-excitability and hyperactivity, with anxiety, inability to concentrate, severe insomnia, loss of focus and self-control. There may also be palpitations, night sweats, oral ulcers, tidal fever, red tongue without coating, and a thread-rapid pulse.

Combined syndromes As discussed above, by the time a person is experiencing a sufficient degree of distress to be motivated to seek professional help there are usually several syndrome-patterns present. The patient may have more than one of the following: Liver constraint, Qi stagnation, deficiency of the Heart, deficiency of the Spleen, Phlegm, Heat and Blood stasis. The formulas discussed below address several syndrome patterns simultaneously, in commonly occurring clinical presentations.

Mood-Uplift 2 Formula This is an empirical formula that was developed to address the combined syndrome-patterns of: • Spleen Qi deficiency • Heart Blood deficiency • Liver constraint, Qi stagnation

• Ziziphus jujuba var. spinosa, seed (suan zao ren)

• Phlegm-Heat

• Biota orientalis, seed (bai zi ren)

This formula has been designed to address the common factors underlying stage 3 presentations where the initial Liver constraint leads to Heart and Spleen deficiency together with Phlegm-Heat in a complex and frequently seen clinical scenario.

• Salvia miltiorrhiza, root (dan shen) • Asparagus cochinchinensis, tuber (tian men dong) • Ophiopogon japonicus, tuber (mai men dong) • Codonopsis pilosula, root (dang shen) • Angelica polymorpha, root (dang-gui) • Poria cocos, fruit. body (fu ling) • Scrophularia ningpoensis, root (xuan shen) • Schisandra chinensis, fruit (wu wei zi) • Polygala sibirica, root (yuan zhi) • Platycodon grandiflorus, root (jie geng) The major herb is raw Rehmannia, which nourishes the Kidney and Heart Yin, while also clearing the Fire from Yin deficiency. It is supported by Asparagus, Ophiopogon, Scrophularia and Salvia.

These actions are complemented by herbs that nourish the Heart and calm the Spirit (Ziziphus, Biota, Salvia, Schisandra and Polygala) and herbs that tonify the Qi and nourish the Blood (Codonopsis, Poria, Angelica, Salvia). The actions of the

Formula Ingredients • Astragalus membranaceus, root (huang qi) • Pseudostellaria heterophylla, root (tai zi shen) • Angelica polymorpha, root (dang gui) • Paeonia lactiflora, root (bai shao) • Poria cocos, fruiting body (fu ling) • Pinellia ternata, tuber (ban xia) • Phyllostachys nigra, stem (zhu ru) • Citrus reticulata, fruit peel (chen pi) • Bupleurum falcatum, root (chai hu) • Curcuma longa, tuber (yu jin) • Cyperus rotundus, rhiz. (xiang fu) • Anemone altaica, rhiz. (shi chang pu) • Polygala sibirica, root (yuan zhi)

Continues Page 45 > The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 43

Member Article Winter 2018

BY KERRY BONE Founder and Director of Research at MediHerb Principal of Australian College of Phytotherapy Professional Associate of New York Chiropractic College

Herbs for Low Thyroid Function: Recent Developments Details of the case report readings. Ten (of the original For many years there has been mentioned above are as 60) patients showed abnormal a dearth of clinical information follows. A 32-year-old woman about herbs that can boost the results in one of the thyroid developed symptoms of measures (TSH, free T4 and function of a sluggish thyroid thyrotoxicosis (weight loss, T3) either at the beginning gland. Such herbs would be palpitations, confusion) while or end of the 8-week study. relevant in cases of obesity, taking capsules containing Since there was no subsubclinical hypothyroidism Withania for symptoms of stratification for treatment (an elevated TSH value (on at chronic fatigue. She was assignment by thyroid least 2 occasions) with normal reportedly not taking any status, unequal numbers of thyroid (T4) hormone levels), other treatments and her TSH patients received Withania and even the early stages of was tested at < 0.01 mIU/L (n = 3) or placebo (n = 7). One overt hypothyroidism and and serum thyroxine at 33.9 Withania-treated patient had Hashimoto’s thyroiditis, while pmol/L. All symptoms and subclinical hypothyroidism there is still some functioning abnormal laboratory values (TSH 5.7 mIU/L) at baseline thyroid gland remaining. For example, a recent review of Chinese herbal medicines (CHM) searched The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Literature Database on Disc, The effects of Withania tests reveal stunning results that open and the China National new therapeutic ground for this important medicinal plant!

Knowledge Infrastructure resolved spontaneously after that normalised, and all three for randomised clinical trials discontinuing the herb. The Withania-treated patients (RCTs). The date of the last reported dose was 500 mg/day experienced T4 increases from search was September 2014 of Withania, possibly of a dry baseline (7%, 12%, and 24%). for all databases. Based on extract.

Six of seven placebo-assigned this extensive searching, patients showed decreases in the authors concluded there Despite this case report, the T4 from baseline (4% to 23%), was no evidence available above study in bipolar patients and one patient’s TSH moved from RCTs on CHM for the did not see any adverse impact from normal to the subclinical treatment of hypothyroidism. of Withania on normal thyroid hypothyroid range (6.96 They also did not find any function. Of the remaining mIU/L). The authors concluded ongoing registered trial. patients who had normal that in spite of the limitations, thyroid laboratory readings, Considering one case report the subtle laboratory there was no significant of Withania-associated changes noted in thyroid difference between the thyrotoxicosis, and preclinical indices in this 8-week study Withania and placebo groups studies showing marked suggest that Withania may for TSH, T3 and T4 by the increases in thyroid hormone increase thyroxine levels, and conclusion of the study. levels, a group of US scientists therefore vigilance regarding revisited the results of a clinical hyperthyroidism may be Interestingly, there has also study of Withania (Withania warranted. Nonetheless, the been a case report for celery somnifera) in bipolar patients thyroid-enhancing properties inducing hyperthyroidism. to understand any impact on of Withania would also A 48-year-old man, with thyroid function. As thyroid represent a clinical opportunity no history of any thyroid indices were done for safety, for the treatment of subclinical diseases, was diagnosed with and not the primary goal of hypothyroidism, and these hyperthyroidism due to daily the original study, only a small results suggested the need for consumption of 4 g of dried fraction of trial participants further study. celery leaves for 45 days. After exhibited abnormal thyroid cessation of consumption and

PAGE 44 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

treatment with methimazole, the symptoms remitted. Drug medication was discontinued when the lab tests and ultrasound were normal and indicated the patient’s definite recovery. In the two month follow-up, he was normal and thyroid-stimulating hormone (TSH), T4, T3, anti-TSH receptor, anti thyroperoxidase and antithyroglobulin were in normal ranges. Perhaps celery also has clinical potential for a low functioning thyroid gland?

Now in the past two years there have been two RCTs of commonly used herbs in patients with hypothyroidism.

The most recent trial looked at Withania, which is often prescribed for thyroid dysfunction in India. Presumably the above reports also stimulated interest in examining this herb further. A pilot study was initiated to evaluate the efficacy and safety of Withania root extract (600 mg daily) in subclinical hypothyroid patients. Fifty people with elevated serum TSH levels (4.5-10 μIU/L) aged between 18 and 50 were randomised to either treatment (n = 25) or placebo (n = 25) groups for an 8-week treatment period.

A total of four participants (two from each group) withdrew their consent before the second visit. Eight weeks of treatment with Withania improved serum TSH (p < 0.001), T3 (p = 0.0031), and T4 (p = 0.0096) levels significantly compared to placebo. Four people (8%) out of 50 reported few mild and temporary adverse effects during this study.

Finally, and perhaps a surprising result (although this herb is so versatile it might not actually be so amazing),

The Emotions in Traditional Chinese Medicine Part 2:2 < From Page 43

Formula Ingredients

Astragalus and Pseudostellaria are the two major herbs, which together tonify the Qi and strengthen the Spleen.

Angelica and Paeonia nourish the Blood to replenish the Heart and Liver, and are supported by herbs that soothe the Liver and regulate the Qi (Bupleurum, Curcuma, Peony and Cyperus). Herbs that resolve Phlegm (Poria, Citrus, Pinellia, Phyllostachys) act in concert with Polygala and Anemone to clear and calm the mind, while Polygala has the additional action of envoy to direct the actions of the other herbs to the Heart.

This formula is prescribed for patients with depressed mood, anxiety and mood swings, and obvious stress factors in their lives. Signs of deficiency are also apparent, e.g. fatigue, loss of appetite, pale complexion, pale tongue, weak and/ or thread pulse.

Mood-Uplift Formula This is also an empirical formula, developed to address the following combined syndrome-patterns: • Heart Blood deficiency

• Astragalus membranaceus, root (huang qi) • Codonopsis pilosula, root (dang shen) • Angelica polymorpha, root (dang gui) • Paeonia lactiflora, root (bai shao) • Ligusticum wallichii, rhiz. (chuan xiong) • Lycium barbarum, fruit (gou qi zi) • Cinnamomum cassia, stem bark (rou gui) • Fallopia multiflora, stem (ye jiao teng) • Albizzia julibrissin, stem bark (he huan pi) • Ziziphus jujuba var. spinosa, seed (suan zao ren) • Biota orientalis, seed (bai zi ren) • Poria cocos, fruit. body (fu shen) • Schisandra chinensis, fruit (wu wei zi) • Pinellia ternata, tuber (ban xia) • Curcuma longa, tuber (yu jin) • Anemone altaica, rhiz. (shi chang pu)

• Spleen Qi deficiency • Phlegm clouding the mind and senses It is similar to Mood-Uplift 2, above, but more focused on the Heart and Spirit.

It is therefore suitable for patients manifesting severe mood disturbance due to deficiency of the Heart Blood and Qi.

• Polygala sibirica (yuan zhi) The herbal ingredients essentially fall into four main groups: those that tonify the Qi and strengthen the Spleen to promote the production of Qi and Blood (Astragalus, Codonopsis, Atractylodes, Poria); those that nourish the Blood, replenishing the Heart and Liver (Paeonia, Angelica, Ligusticum, Lycium);

those that calm the Sprit (Fallopia, Albizzia, Ziziphus, Biota, Poria and Schisandra); and those that clear away Phlegm and open the mind (Pinellia, Poria, Curcuma, Anemone and Polygala).

In addition, Angelica, Ligusticum and Curcuma activate the Blood to address Blood stasis, while Polygala functions as envoy to direct the actions of the formula’s ingredients to the Heart. The use of Cinnamon bark is notable here as it has warming and activating actions that assist the Spleen to produce the Qi and Blood, while also assisting to activate the Blood and dispel Blood stasis. This formula is prescribed for patients with depressed mood, together with insomnia, forgetfulness, poor concentration and other signs of reduced mental functioning.

This completes the detailed discussion of some key TCM formulas that may be used in the treatment of emotionbased disorders, organized according to the paradigm of Yu syndrome. These particular formulas provide the basis for the majority of therapeutic strategies that may be devised when addressing such clinical problems. Part 3 of this series provides a more comprehensive approach to therapeutics, introducing a wider array of formulas and a return to the Five Elements system of classification. Having reached this point, it is hoped that the understanding gained from the above exposition of Yu syndrome will provide a necessary complement to the limitations of the Five Elements paradigm, and vice versa.

Article References, Tables and Appendices for this article can be viewed by visiting the full case study file via the ANTA Member Centre > Resources > The Natural Therapist > Journal Articles

the seeds of Nigella sativa have shown a benefit in a 2016-published RCT. The aim of the study was to evaluate the effects of Nigella on thyroid function, serum vascular endothelial growth factor (VEGF) - 1, nesfatin-1 (a neuropeptide produced in the hypothalamus that participates in the regulation of hunger and fat storage) and anthropometric features in patients with Hashimoto’s thyroiditis. Forty patients with Hashimoto’s thyroiditis, aged between 22 and 50 years old, participated in the trial and

were randomly allocated into two groups of intervention and control, receiving powdered Nigella seed (2 g/ day) or placebo daily for 8 weeks.

Treatment with Nigella significantly reduced body weight and body mass index (BMI). Serum concentrations of TSH and anti-thyroid peroxidase (anti-TPO) antibodies decreased, while serum T3 concentrations increased in the Nigella-treated group after 8 weeks. There was

a significant reduction in serum VEGF concentrations in the intervention group.

None of these changes had been observed in the placebo treated group. In stepwise multiple regression model, changes in waist to hip ratio (WHR) and thyroid hormones were significant predictors of changes in serum VEGF and nesfatin-1 values in Nigella sativa treated group (P < 0.05).

Quite a stunning result that opens new therapeutic ground for this important medicinal plant!

References Ke LQ, Hu Y, Yang K, Tong N. Cochrane Database Syst Rev. 2015 Feb 12;(2):CD008779. doi:10.1002/14651858. CD008779.pub2 Gannon JM, Forrest PE, Roy Chengappa KN. J Ayurveda Integr Med 2014; 5(4): 241-245 Van der Hooft CS, Hoekstra A, Wintr A et al. Ned Tijdschr Geneeskd 2005; 149(47): 2637-2638 Rouhi-Boroujeni H, Hosseini M, Gharipour M, Rouhi-Boroujeni H. ARYA Atheroscler. 2016 Sep; 12(5): 248-249 Sharma AK, Basu I, Singh S. J Altern Complement Med. 2018 Mar; 24(3): 243-248 Farhangi MA, Dehghan P, Tajmiri S, Abbasi MM. BMC Complement Altern Med. 2016 Nov 16; 16(1): 471. https://doi.org/10.1186/s12906016-1432-2

The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 45

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Former Australian Cricketer and TV personality Mike Whitney has been taking Arborvitae Arthritis Pain Relief and Health Supplement and is happy with the results by stating: “I have been using Arborvitae for 4½ months and the results have been amazing. For years I have had pain in my right shoulder, left elbow, both knees and lower back from my cricket career.

The shoulder and elbow paid have gone and there is less pain in my back and swelling in my knees.

The results have been very positive!”

Arborvitae Arthritis Pain Relief and Health Supplement assists with pain relief, inflammation and joint mobility – with many customers now taking the supplement for pain relief and various forms of arthritis, with amazing results.

Kirk Murillo has been taking Arborvitae Health and Wellbeing supplement for more than 12 months now and says;

One of the best things that came into my life are the Arborvitae products, particularly the green label. I had been battling with my cholesterol problem for about ten years b e f o re I found the right answer. In 2016, my cholesterol level was extremely elevated.

At this time, I started accepting the fact that I genetically have 'Familial hypercholesterolaemia'.

On March 2017, my friend from work got my attention when she told me that the Arborvitae supplement caused her cholesterol level back to normal.

I started my research by reading some reviews and the Current Affairs segment on YouTube. I bought the product, and without any hesitation, I gave 2 bottles of Arborvitae a try, After a month, I was hesitant to see my GP to asked for a blood test, but it was a big surprise when I found out the results.

All the red flags in my previous blood tests that were troubling me for many

years were back to normal levels, including my cholesterol level which has reduced significantly.

Arborvitae stands on the frontline of health complementary medicine, particularly when it comes to sharing the benefits of Pycnogenol and has several different supplements to assist customers with a range of conditions.

Arborvitae is an Australian-owned company that has been formulating and developing health supplements.

Arborvitae’s supplements are listed with the TGA. "The key to wellness is the ability to reduce inflammation within the body, as well as strengthening the immune system whilst enhancing the removal of free radicals," Arborvitae says.

"Arborvitae gives the body the raw materials to attack the free radicals that come from chemicals we are all exposed to on a daily basis."

Arborvitae believes that for anyone over 40, it's essential that they not only have regular health checkups, but also protect their body daily (on the inside) to keep it in the best shape possible.

Arborvitae is now stocked in over 350 Chemists and Health Food Stores Australia wide.

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The Natural Therapist Vol 33 No. 2 | WINTER 2018 | PAGE 49

Member Article Winter 2018

By Julie Merlet - NATIF - Australian Native Superfoods

PART 3

The Nutritional Benefits of

Australian Native Foods

Native foods have been the main diet of Indigenous people for thousands of years but “growing the growers” of native foods has never been so important as we provide for an insatiable appetite for it, where demand is outweighing supply, where overseas enquiries are unfilled and the industry struggles to supply this incredible ‘new’ (old) food.

In current times native produce is mainly supplied dried, frozen, fresh or valueadded. Chefs, home cooks, nutraceutical and pharmaceutical companies hover over the quantities grown waiting for current research and supply to grow.

The more we learn about native foods the more we discover their true potential, not only the different flavours and aromas but their bioactive potentials.

Wattelessed from The Acacias are found all around Australia.

Not all wattles are palatable but the victoriae and coriacea are some of the industry favourites.

They have been a stable food source for Indigenous people for thousands of years.

Wattleseeds are usually roasted and ground into powder and used as a valueadded product or as a kitchen staple in baking or beverages.

Generally, they provide about a third protein, a third fibre and a third low-GI carbohydrate as well as other nutrients like magnesium, zinc, calcium, iron and selenium.

Some species have been growing in Africa to provide food and fuel to droughtaffected populations. The compounds responsible for Wattleseed aroma

(chocolate, coffee, hazelnut) are pyrazines.

Wattleseed extracts have strong emulsifying and stabilizing potential for the food industry.

Strawberry Gum can be used as a flavor enhancer and Kakadu Plum has proven to extend shelf-life of some foods. Davidson Plum can be used as a natural food colour and Native Mint has been found to have great free radical scavenging activity, followed by Lemon Ironbark, Quandong, Forest Berry, Lemon Myrtle and aniseed Myrtle.

Pepperberry and Tasmanian Pepperleaf have strong activities against human pathogens and spoilage bacteria.

Riberry (also known as Lily pilly) is a native sub-tropical fruit growing in Queensland, NSW, Victoria and other parts of Southern Australia. Fruiting starts from late November to January and until late May in the south.

Indigenous people ate them raw as a snack and used them as medicine.

More often used for culinary purposes due to its strong clove and spice flavouring, the Riberry also offers high levels of anthocyanins, plant pigments responsible for the Riberries pink, magenta colourings.

Riberry has shown superior antioxidant capacity (compared to the blue-berry) and potential for preventing and delaying diseases such as Alzheimer’s, autoimmune and cardiovascular disease, cancer and diabetes.

Riberries are a good source of calcium, they also contain high levels of folate, needed for healthy growth and development, especially of for the developing fetus during early pregnancy.

Extracts found were phenolic acids, flavonoids and ellagic acid in Anise Myrtle, Lemon Myrtle and Davidson Plum.

Davidson plum and Anise Myrtle showed high total reducing capacity. Tasmanian Pepperleaf had high oxygen radical scavenging ability.

These compounds during research appeared to be bioavailable to human cells. Anise Myrtle and Quandong phenolic compounds show high bioavailability, in fact 2 times more than Tasmanian Pepperleaf.

Phenolic compounds of all the native extracts tested were able to enter a live cell and act as antioxidants within the cell, especially Tasmanian Pepperleaf extract and Anise Myrtle extract.

This has potential protective effects on cell components from damaging free radicals.

Tests have shown protective effects on liver cells and cytoprotective against exogenous reactive oxygen species.

Tests have also shown anti-proliferative activity against isolated human cancer cells (especially by Aniseed Myrtle). These extracts tested didn’t affect normal cell activity.

Aniseed Myrtle and Davidson Plum extract have shown high pro-apoptotic activities.

Anise Myrtle has shown an important source of bioavailable phytochemicals.

Aniseed Myrtle, Lemon Myrtle and Davidson plum extracts suggest a potential for suppression of metabolic syndrome with clinical trials needed to confirm the effects shown.

Future trials of Australian food products are showing potential due to their bioavailable health-promoting compounds.

Ongoing research and consumer interest in native foods is growing and definitely worth keeping an eye on.

REFERENCES:

RIRDC – Pub. No. 14/112 2009.

Davidson Plum, Tasmanian Pepperleaf, Aniseed Myrtle and Lemon Myrtle extracts have rich phenolic compounds per dry weight than most other common native foods.

PAGE 50 | The Natural Therapist Vol 33 No. 2 | WINTER 2018

Recommended reading:

Dark Emu Black Seeds by Bruce Pascoe and The Oldest Food on Earth by John Newton.

MORE INFO

See NATIF.com.au Fruits, Herbs & Spices

Images: Top Right: Riberry Left: Wattleseed Bottom Centre Davidson Plum

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