Transcript black cohosh

Black Cohosh
By: Stephanie
Russell
Overview
Background Info.
Historical Uses
Reported Benefits
Phytoestrogens
Estrogenic effects
Research
Harmful effects
Conclusion
Learning Objectives
1.What are the historical uses of black cohosh?
2. Name the common symptoms associated with
menopause.
3. What are the physiological changes that
occur during menopause?
4. What are phytoestrogens? What specific
foods are they found in?
Learning Objectives
5. What does current research say about the
possibility that the isoflavone formononetin is
found in black cohosh?
6. What are some of the potential side
effects/warnings that should be considered
before using black cohosh?
Background Information
Belongs to the buttercup family
Latin names: Actaea racemosa, Cimicifuga
racemosa
Common names: black snakeroot, macrotys,
bugbane, bugwort, rattleroot, rattleweed
Root is black in color when harvested from the
wild
Cohosh = Algonquin Indian word meaning
“rough” - refers to the plants gnarly root
structure
Background Information
Shrub-like Plant
Native to eastern
deciduous forests of
North America
Flowers of plant have
a strong odor, which
acts as an insect
repellant (bugbane)
Background Info.
Underground
Root/rhizome
Used to make tea
Liquid Extracts
Pills/Capsules
Sold as a dietary
supplement in U.S.
Notable Ingredients
Triterpene
Glycosides
actein related
compounds,
cimigoside
Other ingredients
tannins, fatty
acids,
phytoesterols
Isoflavones
formononetin
very controversial
Historical Uses
Native Americans
Ceremonial treatment of snakebites
Rheumatism
Kidney Disease
Respiratory Illnesses
Skin Problems
Used root to make a tonic
Poultices were made by pounding leaves
Historical Uses
19th Century American Physicians
Fever
Menstrual Cramps
Arthritis
Insomnia
Reported Benefits
Treat menopause symptoms
Hot Flashes
Night Sweats
Vaginal Dryness
Bone Loss
Mood Swings
Rheumatoid Arthritis
Premenstrual Syndrome
Other Reported Benefits...
Asthma
Back Pain
Muscle Spasms
Sleep Disorders
Depression
Induce labor
Diarrhea
Dizziness
Edema
Fever
High Blood Pressure
Menopause
Natural process that occurs in women
Marked by cessation of menstrual cycle
Physiological changes occur
• Decreased production of estrogen/progesterone
• Higher levels of luteinizing hormone/follicle-stimulating
hormone
• In some women, these hormonal imbalances cause
undesirable symptoms (climacteric)
• LH/FSH oppose the action of estrogen
– If high levels of LH/FSH = low levels of estrogen
Hormone Therapy
Until recent years, was the “gold
standard” treatment for symptoms
associated with menopause
Uses estrogen, progesterone, or combination
of both to increase hormone levels
Due to recent safety concerns, many women
are seeking alternative remedies
Increases risk for: stroke, breast cancer, heart
attack, blood clots, gall bladder disease
Alternative remedies for
symptoms of menopuse
Phytoestrogens
Plant-derived compounds w/ weak estrogenic
activity - similar in structure to estrogen
isoflavones, lignans, coumestans
• found in legumes, soybeans, vegetables, cereals
Isoflavones (found in soy)
genistein, daidzein (most studies)
can bind to estrogen receptors
• may enhance estrogen’s beneficial effects, or block
negative effects
Structures
Estradiol
(major estrogen in humans)
Genistein
Estrogenic effects of
Black Cohosh
Is black cohosh estrogenic?
Evidence is conflicting
formononetin - estrogenic isoflavone
• mainly found in red clover - some in soy
• some research suggests it is a constituent of Black
Cohosh
• recent studies say it is not
– older studies may have been compromised by
adulteration of plant materials, or misidentification
of formononetin
• has not been found in commercial extracts
Estrogenic effects of
Black Cohosh
Suppresses secretion of luteinizing
hormone
Studies are conflicting
No single chemical component has been
identified for this action
Possibly through synergetic effect of several
chemical fractions
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD;
Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin,
Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083
Objective:
To compare the efficacy and tolerability of
the isopropanolic black cohosh extract in the treatment
of climacteric complaints compared with placebo.
Methods: Randomized, double-blind clinical trial. 304
patients randomly allocated to receive tablets of 40mg
drug, or matching placebo daily for 12 weeks.
Drug contained 2.5mg isopropanolic extract corresponding to
20mg root stock
Placebo corresponded to the active medication w/out
isopropanolic extract
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD;
Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin,
Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083
Inclusion criteria:
Postmenopausal women (>12 months since last
regular menstruation), or >6 months since the last
regular menstruation plus FSH >50 U/L
45 years and older
Climacteric complaints as defined by menopause
rating scale (MRS) - >0.4 in at least 3 items
MRS is used to measure intensity of menopausal symptoms
* Includes 10 items, each ranging from 0 (no complaints), to
1 (severe symptoms), in increments of 0.1
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD;
Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin,
Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083
Exclusion Criteria:
Cancer - diseases that could interfere w/ the
assessment of climacteric symptoms
Drug abuse
Women taking hormone replacement therapy
Women taking supplements such as: soy/red clover
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD;
Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin,
Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083
Clinical examinations and interviews were
performed before treatment began, and 4, 12
weeks after
Intensity of symptoms were assessed according
to MRS ratings
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric Symptoms
Osmers, Ruediger MD, PhD; Friede, Michael PhD; Liske, Eckehard PhD;
Schnitker, Joerg PhD; Freudenstein, Johannes PhD; Henneicke-von Zepelin,
Hans-Heinrich PhD Volume 105(5, part1) May 2005, pp1074-1083
Findings:
The isopropanolic black cohosh extract was
more effective than placebo
Difference was 0.03-0.05 on MRS units
Hot flashes, “atrophy,” and “psyche” decreased
statistically significantly in the Black Cohosh
extract compared w/ placebo
Most effective in relieving symptoms in early
climacteric women
Effects of black cohosh on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD:
The North American Menopause Society; 13(2) April 2006 pp 185-196
Objective:
To analyze the effects of Cimicifuga
racemosa (CR) preparation on markers of bone
metabolism, hormones, sex hormone-binding globulin,
lipometabolism, and vaginal maturity
Design: Double blind, placebo-controlled, and
conjugated estrogens (CE) controlled study. Included 62
postmenopausal women given a daily dose of 40mg
herbal drug(CR), 0.6mg CE, or placebo for 12 weeks.
Effects of black cohosh on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD:
The North American Menopause Society; 13(2) April 2006 pp 185-196
Inclusion Criteria:
Postmenopausal, aged 40-60 years
Last menstrual bleeding > 6 months ago
Postmenopausal hormone values (E2 < 40pg/mL,
FSH >= 25mU/mL) baseline and wk 2
at least 3 hot flashes/day
Sum score of MRS >= 1.7 at wk 2 and baseline, sum
scores of MRS item 1 (hot flashes) >= 0.3 at wk 2
and baseline
Effects of black cohosh on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD:
The North American Menopause Society; 13(2) April 2006 pp 185-196
Exclusion criteria:
Hysterectomy
Endometriosis
Current treatment w/ estrogenic substances
Alcohol/drug abuse
hypertriglyceridemia or hypercholesterolemia
Effects of black cohosh on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD:
The North American Menopause Society; 13(2) April 2006 pp 185-196
Methods of assessment
Markers of bone turnover, estradiol, FSH, LH,
SHBG, triglycerides, total cholesterol, high
density cholesterol, low-density cholesterol,
and routine clinical chemistry parameters
were determined from blood samples.
Vaginal “maturity index” was determined
from vaginal smears
Configured by counting 500 cells and calculating
the % of parabasal, intermediary, and superficial
cells
Effects of black cohosh on bone turnover, vaginal mucosa,
and various blood parameters in postmenopausal women
Wuttke, Wolfgang MD; Gorkow, Christoph DVM; Seidlova-Wuttke, Dana MD:
The North American Menopause Society; 13(2) April 2006 pp 185-196
Results: CR has estrogen-like effects on vaginal
mucosa (increased number of superficial cells)
Not as strong of an effect as CE, but significantly
higher than placebo
CR has beneficial bone-remodeling effects
At wk 12, markers for bone formation significantly
increased in CR group, compared w/ placebo
Conclusion: CR has beneficial effects on climacteric
symptoms - beneficial bone remodeling and weak
estrogenic-like effects on the vaginal mucosa
Harmful Effects
Liver Toxicity:
1 case of acute liver
failure
2 cases of hepatitis
Other cases reported
in people using
multiple herbal
remedies
No scientific research
to support these claims
General side effects:
Nausea, vomiting,
dizziness, stomach
discomfort
Not recommended for
use during pregnancy
or breastfeeding
Do not take with ER
therapy
No noted drug
interactions
Conclusion
Black Cohosh may be a relatively safe/effective
alternative to HR therapy, but dosage/duration
should be monitored by physician to avoid
potential harmful effects
However, more studies are needed to
understand the active components, and
mechanisms of action responsible for the
beneficial effects on menopausal symptoms.
References:
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The American College of Obstetricians and Gynecologists; Volume 1.5 (5, part 1),
May 2005, pp 1074-1083
The North American Menopause Society; Volume 11 (5), September/October 2004,
pp 575-577
The Medical Journal of Australia; Volume 177 (8) 2002 pp 440-443
http://www.womenshealth.gov
U.S. Department of Health and Human Services
http://www.nccam.nih.gov/health/blackcohosh/
The North American Menopause Society; volume 13 (2), March/April 2006 pp 185196
http://www.health-care-beauty.com/Amerifit-Estroven-Extra-Strength-60-CapletsB00014FUTQ.htm
http://www.bodyandfitness.com/Information/Herbal/Research/black.htm
http://www.holisticonline.com/Herbal-Med/_Herbs/h32.htm
http://www.allnatural.net/herbpages/black-cohosh.shtml
http://www.drugdigest.org/DD/PrintablePages/herbMonograph/0,11475,4079,00.h
tml
http://www.healthcentral.com/peoplepharmacy/408/20554.html
http://ods.od.nih.gov/factsheets/BlackCohosh.asp
Questions?