Supplement Detective

By Curtis Alexander, Pharm.D.

Summary: Chasteberry is actually a fruit from the chaste tree and has a long history of use in many disease states – especially gynecological.  There is some good evidence surrounding it’s use for premenstrual syndrome (PMS) and it also appears to be safe and well-tolerated.

Q: My periods are very painful.  I’ve taken ibuprofen in the past but I don’t like it as it upsets my stomach and I’d rather take something natural.  I’ve heard that Chasteberry might help.  Any opinion good or bad?

A: First of all, from the questions I get you’re not alone.  A lot of women would love to have an alternative to painful periods outside of over-the-counter drugs that upset their stomach and are just not generally well tolerated.  So, lets look at Chasteberry by breaking your question down into two main parts:

Chasteberry is actually a fruit from the chaste tree and has a long history of use in many disease states – most of them gynecological.  Because a lot of women who have painful periods.  Most of them resort to over-the-counter painkillers like Ibuprofen and the like.  Often times, these drugs can upset their stomachs or cause other side effects.

I’m often asked if there is anything they can try that is more natural.  One of the first options that comes to mind is a fruit from the Chaste Tree: Chasteberry  The two main things I’m going to be concerned about when recommending something new is:

1. Effectiveness and…
2. Safety

What the Evidence Says…

In the few studies that we do have regarding Chasteberry and premenstrual syndrome (PMS) Chasteberry does appear to be effective.  The only drawback to the studies was that they weren’t the best designed in the world.

However, a recent, double-blind (that’s the ‘gold standard’ for medical studies and gives them a lot more clout with the medical establishment) did show significant improvement in self-assessed symptoms of PMS along with physician-assessed symptoms.

The women in the study received a standardized extract of Chasteberry or a sugar pill for three full menstrual cycles.  Over 50% of the women saw a 50% or greater improvement in symptoms.

And, as far as safety goes in the trial, patient acceptance of the extract was high with few reported side effects.

One other area that needs to be addressed is possible drug interactions.  While you didn’t mention that you are taking any prescription drugs it’s always something you should think about.  Chasteberry is no different.

While there have been no significant reported drug interactions with Chasteberry you need to remember that it acts on the dopaminergic system in your body.  What this means is that if you are taking any medications that act on the dopaminergic system like Parlodel (bromocriptine which is used for Parkinson’s disease) or Reglan (metoclopramide which is used for stomach issues) there may be drug interactions.

As a woman, remember that Chasteberry cannot be taken during pregnancy and it’s use is discouraged during lactation.

Chasteberry Side Effects

Chasteberry, for the most part, is very well tolerated.  If there are any side effects they are generally mild and reported as stomach complaints, dizziness, headache and dry mouth.

How Much to Take

I was not able to come up with a specific dose of Chasteberry for PMS symptoms.  Additionally, there are different preparations of Chasteberry which makes dosing recommendations even more difficult.  An often quoted dose of the Chasteberry fruit extract is 20mg to 40mg daily.  While as little as 4mg of the standardized extract have been used in trials.  So you may have to experiment a bit with a dose that works for you.

Bottom line is that Chasteberry looks promising for PMS as well as proving to be very safe.  It’s probably worth a shot but you will want to make sure your not taking any dopaminergic drugs first.

By Curtis Alexander, Pharm.D.

Summary: Black Cohosh Plant has been used for centuries to treat menopausal symptoms and is approved in Germany for that use.  However, each woman responds differently during menopause in regard to how far your hormones drop.  That’s why I’d caution against adding Black Cohosh Plant (or any substance) until you have performed a basic saliva test to see where your hormones are at right now.  Black Cohosh does appear to help short term but also has some side effects to watch out for.

Q: Curt, I’m going through menopause right now and it’s driving me (and my husband) crazy.  I know some women take Premarin® but I’m a little scared of it. I’ve heard about Black Cohosh Plant for menopausal symptoms but is it any better, or safer, than Premarin®?

A: Black Cohosh has been used, literally, for centuries to primarily treat menopausal symptoms.  It’s also approved in Germany for that use.  However, there is conflicting evidence out there about how effective it really is and I have some personal concerns about some women taking it because of its estrogen-like activity.

First of all, before we get into specifics on the Black Cohosh Plant, it’s important for you to understand what we know about menopause at this point.  Menopause is an ovary issue.  It’s a natural process where your body begins shutting down your production of estrogen, progesterone and testosterone (yes, even as a female you have testosterone).

Here’s the kicker though: the hormones don’t all fall to zero.  Estrogen can often see a 40%-60% drop in production.  While progesterone (in some women) can fall nearly to zero.  Menopause therefore can mean more estrogen for some women and less for others.

Knee-Jerk Reaction

Unfortunately, too few doctors actually measure the hormone levels of women who are going through menopause before they give hormone supplements.  That’s like saying you want to make it to Las Vegas but don’t know if you are starting in Omaha, Miami or Seattle.

Compounding the lack of hormone testing is the fact that hormone most commonly used – Premarin® – is undergoing a great deal of scrutiny.

In the Women’s Health Initiative Study Premarin® (from Pregnant Mares Urine) led to an increased risk of dangerous blood clotting disorders.  Estrogen (or, more correctly, estrogen-dominance) is also being looked at in:

• Fat and weight gain in women
• Poor moods, mood swings and even depression.
• Lowered libido (most women’s sex drives rise shortly after ovulation.  No wonder, this is your bodies way of saying that the egg is ready.  After ovulation estrogen plummets and progesterone rises dramatically).  One of the most common side effects from birth control pills is lowered sex drive – and no wonder…the pills are designed to stop a natural process and are loaded with estrogen (and, to be fair, synthetic progesterone).
• Breast Cancer

I am going to write more articles on this subject as they come up because I think with all the estrogen’s in our environment today most men and women have much more estrogen in our systems today than early human did.  Leading to many problems that we don’t fully understand.  Including problems in menopause.

Another Big Push for Estrogen Supplementation in Menopause

Before I get back to Black Cohosh, let me address one other point: osteoporosis.

Many docs prescribe estrogen during menopause to prevent osteoporosis.  The only problem is estrogen isn’t all that effective.  It does cause a 2-3% increase in bone density per year.  But strength training (or, more correctly, force training) can cause a 12-15% increase in bone density each year.

Another step would be to limit your intake of anything containing phosphoric acid (soda is a big culprit but milk also contains this).  Your body will pull calcium from wherever it is available (often times the bones) to neutralize the phosphoric acid.

Back to the Black Cohosh Plant

Here is what I know at this point: Black Cohosh does appear to help (albeit temporarily) the side effects of menopause.  The reputable studies that have been performed to this point for treating menopause symptoms lasted only six months, though.  So, I would NOT consider Black Cohosh a long-term solution.

I also do not consider Black Cohosh a first line agent.

As I talked about above, I prefer to see your doctor measuring your hormone levels before you decide to supplement with anything – natural or synthetic.  This type of test can run anywhere from $50-$200 depending on how many different levels you have drawn and measured.  Saliva testing can also be performed.

Just willy nilly throwing in a hormone or estrogen replacement without knowing the baseline levels isn’t something I’d recommend.

Secondly, are you ovaries intact?  I don’t mean to get personal but it makes a difference.  Having you ovaries seems to permit women to ‘regulate’ hormone levels better.  Without them, supplementation with a natural estrogen may be required.  If you have your ovaries change your diet first.  I know that most people, probably you included, hate hearing this.  But it’s said so much because it’s true.

The interplay of hormones in your body is complex.  I have my doctorate and I still have a tough time keeping it straight.  Trust me when I say in 99% of cases your body really does know best when you give your body what it wants – which is natural foods.  So, cut out any processed foods, soy products and milk for the time being.

Other steps you can take are related to your adrenal function.  And, in addition to the points above, you can improve that naturally by getting to bed before 10PM.  Also, I would avoid any food two to three hours prior to bedtime, otherwise you’ll likely raise cortisol (stress) hormones.

Give yourself at least a couple of months – that’s how long it will take to make a difference.

If, after doing that, you find things aren’t improving and the symptoms aren’t tolerable you’ll want to talk with your doctor.

Black Cohosh and Estrogen

The medical community doesn’t understand at this point how Black Cohosh works.

Women who are in menopause undergo a bunch of changes.  Not only is their estrogen lower, but their Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH) levels are higher.  Some scientists thought that Black Cohosh may be altering LH or FSH.  But that does not appear to be the case.  So that led to the theory that Black Cohosh has estrogen activity in the body.

At this point, the evidence is contradictory.  Black Cohosh does not appear to have binding activity on estrogen receptors in the body.  But the jury is still out on that, so short term use is the rule.

Things to Look For

If you and your doctor decide that Black Cohosh Plant is something worth trying keep a few points in mind:

Short term use only.  From the evidence I’ve seen I wouldn’t recommend taking Black Cohosh beyond six months.

Is not without side effects.  While the Black Cohosh plant is technically an herb, that doesn’t mean it isn’t without problems.  Here is a short list of the most common side effects users report with Black Cohosh (these are all side effects seen with normal estrogen supplementation):

• Headaches
• Weight Gain
• Heaviness in the legs
• Gastric complaints

Dosing

Most Black Cohosh comes in an extract form.  Suggested Dosing:  40mg once or twice daily depending on severity of symptoms.  Preferably before meals or as directed by a health care professional.  Frankly, this is another area where the studies are misleading because many different dosages were used.  However, the dosage range above should be a good starting point.