By Ellen Kamhi PhD, RN, AHG, AHN-BC and  Eugene Zampieron, ND, AHG www.drznaturally.com

Osteoporosis is a disease of the skeletal system, which is characterized by deterioration of bone tissue, along with a decrease in bone mass. It can strike anyone at any age, although it is most prevalent in Caucasian and Asian, small boned woman over 50 years old. Osteoporosis is recognized as a major public health issue. Over 10 million Americans are afflicted, with 34 million more who may already be exhibiting signs of low bone mass, which increases the risk of developing osteoporosis. Bone mass can be determined by a bone mineral density test (BMD), such as a dual-energy x-ray absorptiometry (DXA). Low bone mass increases the risk of developing osteoporosis and fractures.  Osteoporosis can effect any bone in the body, although the most common sites are the wrist, spine and hips. It is credited with more than 1.5 million fractures in both the United States and Canada per year, causing a huge amount of personal suffering and loss of quality of life. (3) (4) This disease also has a high cost to society. The cumulative economic burden of care for fractures due to osteoporosis from 2008-2028 is estimated at $474 billion dollars in the United States alone. (5) 

The term, ‘osteoporosis’, describes the condition of the inside of the bones in people who have this disease, where large porous areas develop, weakening the bone structure. Throughout life, bone is a living tissue that maintains a balance through the bone building activity of osteoblasts, with the reabsorptive activity of osteoclasts. When factors such as advancing age cause a change in this balance towards reabsorption, bone mass decreases. After reaching a ‘fracture threshold’, bone that was normally able to withstand a minor stress, such as a fall or blow, becomes subject to break or fracture more easily. Osteoporosis is most often diagnosed in the senior years. However, the most important time to focus on building healthy bone is during the first 3 decades of life. Providing sufficient bone building nutrients, along with weight bearing exercise, may be the best protection against this disease. (6)   

There are several risk factors that increase the chance for an individual to develop osteoporosis: family history, female (six to eight times more likely than male) especially post-menopausal, due to decreased estrogen levels, advancing age, Caucasian , low calcium intake, smoking, alcohol consumption, a sedentary lifestyle , (7)  and soft drink consumption. (8)  (9)

Since many of these contributing factors are self regulated, health care providers can have a direct impact on this health issue by diligently educating clients. Risk of osteoporosis is also directly linked to the use of many prescription and OTC drugs: corticosteroids/steroids, thyroid hormones, anticonvulsants, aluminum containing antacids(ironically often recommended as a calcium source by mainstream physicians), loop diuretics,  gonadotropin-releasing hormones, and many others. (10)   Wherever possible, health care providers can instruct clients about natural therapies that may be equally effective for specific health conditions, but present a substantially lower risk for interfering with bone density.

Drug therapies for osteoporosis include bisphosphonates, such as alendronate and risedronate. A growing list of concerns is linked to the use of these drugs, including research that suggests a link between the use of these agents and esophageal cancer. (11)   A once per month tablet, ibandronate sodium, claims the advantage of greater convenience, but still has a host of possible adverse effects such as esophageal irritation, heartburn, and ulcers. In addition, it is not recommended that women with hypocalcemia take these drugs. Hormone replacement therapy was previously touted as a treatment, and may, in fact be quite useful for decreasing bone loss. However, this benefit decreases if hormone therapy is discontinued. In addition, many women refuse hormone therapy due to other known or perceived adverse effects. (12)  (13) Although pharmaceutical agents can be effective, there is an increased interest in non pharmacological prevention and treatment of osteoporosis. (14) 

Health care providers can be proactive on this front by supporting the improvement of nutritional status through diet and nutritional supplementation, along with suggestion for an increase in exercise training.

There are several natural interventions that promote increased bone health. These include sufficient consumption of bone supportive nutrients through healthy eating, regular exercise, and nutritional supplements including calcium, magnesium, vitamin D, boron, strontium, soy isoflavones and Vitamin K. Novel supplements such as  bone morphogenic proteins are also under investigation.   (15)  

Exercise

Exercise has an important impact on bone health. Several studies have increased awareness on how exercise can most constructively be used to prevent the development of osteoporosis. (16)  

Starting to exercise at a young age is best to achieve long term positive effects, since maximum bone mass is usually achieved during the first third of the life cycle. However, exercise at any age can improve bone health. Weight bearing exercises, including weight training, hiking, climbing stairs and walking, and other exercises that force the bones to work against gravity, are effective at increasing bone mass. (17)   Researchers from the Bone & Joint Injury Prevention & Rehabilitation Center at the University of Michigan investigated a host of exercise studies from 1961 to 2009 to determine the kind of exercise that had the greatest impact on bone health and density. They concluded that three factors were most important in predicting the best exercise outcome: Strain magnitude (how much impact the exercise has on the bones and muscles), strain rate (how often maximum vs minimum strain is applied ) and strain frequency ( how often strain occurs in a given amount of time).  (18) 

A combination of these three factors determines how helpful a given exercise regime is in helping increase bone density. However, there is no consensus about the exact combination of these three factors that is most likely to maximize osteogenic activity. (19)  For most individuals, practicing weight bearing exercise three times per week for 12 to 20 minutes is sufficient to increase bone density.  Since each joint will respond to the strain load individually, its best to rotate exercise sites, and focus on each one for a limited time period. Continuing to exercise throughout life helps to reduce bone loss and the risk of falls. (20)  

Dietary Interventions

The best approach to getting sufficient nutrients to build and maintain strong bones is by consistently making healthy food choices. As we discuss each nutrient below, food sources will be included, along with suggestions for possible supplementation, which is secondary to whole food ingestion.

Calcium

Calcium is the most abundant mineral in the human body. It is well-recognized for its importance in the development of bones and teeth, and has many other functions as well. The ability of calcium supplements to “maintain good bone health and reduce the high risk of osteoporosis later in life.” is one of the few health label claims allowed by the United States FDA.   The best food sources of calcium, other than dairy, include whole grains, beans, almonds and other nuts, and dark green leafy vegetables, such as kale. (21) Milk and dairy products contain a substantial amount of calcium; however, it is interesting to note that individuals who avoid dairy due to lactose intolerance do not experience a corresponding increase in osteoporosis. (22) Calcium supplements have been shown in several studies to be effective at slowing bone loss in both peri-menopausal and post menopausal women. (23)   A Cochrane Database Review Article (2004), states that “calcium supplements ….. at 500 to 2000 mg per day, are the simplest and least expensive way to prevent bone loss.”  (24) A comprehensive literature review published in the British Medical Journal (2010) questioned the commonly held belief in the  benefits of using calcium supplements. In this meta-analysis the reviewers concluded that subjects who took a 500 mg/day calcium supplement (without Vitamin D), experienced an increased risk of myocardial infarction, when compared to those who did not take calcium supplements. These results will likely lead to further investigation of current recommendations. (25) 

To maintain bone health, 1000- 1500mg/day of calcium (including food sources and supplements) is recommended (varies with age, weight, sex, etc.) by the National Academy of Sciences. (26)  Sufficient  calcium intake  is important in preventing osteoporosis, because if thebody’s stores of calcium is low, calcium will be leached from bones, which can lead to decreased bone mass and the initiation or worsening of osteoporosis.   While diet is the ideal source for all nutrients, calcium supplementation is often recommended to ensure that adequate amounts of this important mineral are ingested daily. This can be confusing, due to the many forms of calcium on the market, the differences in dosage levels, absorption rates, delivery forms (ie tablets, vs. liquids), cost, etc.  Several studies have shown that calcium citrate is absorbed better than tricalcium phosphate, calcium lactate and calcium carbonate, (the kind of calcium in antacid tablets). (27)   Calcium citrate does not tend to cause gastric distress, and has a pleasant taste. One study surmised that calcium formate is better absorbed than either calcium citrate or calcium carbonate. (28) Microcrystalline hydroxyapetite (MH) is a form of calcium that was demonstrated to be more effective at slowing bone loss than calcium carbonate. (29)   MH was also shown to support bone density in a randomized double blind 2007 control study.   (30)   Since calcium is so intimately involved in an array of metabolic reactions, it is not surprising that there is a long list of possible interactions with pharmaceutical drugs. Examples follow: Calcium decreases the absorption of bisphosphonates, (31) levothyroxine (32)  , tetracycline and quinolone antibiotics (33) Thiazide can reduce calcium excretion, leading to hypercalcemia, metabolic alkalosis and renal failure. (34) Health care practitioners can assist customers to choose a calcium supplement that best meets their needs.

Magnesium

Magnesium is the second most common mineral in the body (after calcium). Magnesium is important for many metabolic processes, including building bone, formation of ATP, and promoting calcium absorption. Dietary sources of magnesium include nuts, whole grains, dark green vegetables, fish, meat and legumes. Magnesium is often deficient in the Standard American Diet, due to eating a diet low in this nutrient, and soil depletion due to commercial farming practices such as overcroping. (35)  Low levels of blood magnesium correlates with low bone density, (36) and several studies have supported the use of oral magnesium supplementation  to increase bone density. (37) (38) (39) (40)  Even a moderate magnesium deficiency has been documented to cause bone loss in rats. (41) Magnesium deficiency may impair the production of parathyroid hormone and 1,25-dihydroxyvitamin D, which negatively effects bone mineralization. (42)  Supplementing with 250-400 mg a day of magnesium is usually recommended. Magnesium glycinate or gluconate are preferable to magnesium oxide, and are less likely to cause loose stools. Adverse effects of magnesium usually occur at higher dosages, and are most often associated with intravenous magnesium. These may include: diarrhea, drowsiness, loss of tendon reflexes, thirst, hypotension,  muscle weakness and respiratory and cardiac irregularities. (43)   Drug interactions include neuromuscular weakness and possible paralysis when combined  with aminoglycoside antibiotics, decreased absorption of biphosphates, tetracycline antibiotics and calcium channel blockers(take at different times). Conversely, many drugs cause hypomagnesemia, including aldesleukin, aminoglycosides and amphotericin-B(common). (44)   Magnesium supplementation helps to balance a number of health issues in addition to osteoporosis, such as insomnia, headaches, chronic constipation, restless leg syndrome, anxiety and irritability, and is often the first supplement we recommend in our clinical practice, after implementing a whole food based diet.

Vitamin D

Vitamin D is essential for the formation and maintenance of bone tissue, due to several complex mechanisms, including the regulation of calcium and phosphorous absorption. If Vitamin D levels are low Parathyroid hormone (PTH) increases, and triggers osteoclasts to release calcium into the blood via bone adsorption. If this process continues over time it weakens bone and leads to osteoporosis. In addition, vitamin D stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood. (45) 
Vitamin D is called ‘the sunshine vitamin’ because the best source of vitamin D is from sensible sun exposure. Vitamin D is synthesized when sunlight hits the skin and transforms 7-dehydrocholesterol into vitamin D3 (cholecalciferol). D3 is shuttled to the liver where it is converted to 25-hydroxycholecalciferol, which is then transformed into 1,25 dihydrocholecalciferol (calcitriol); 10 times more potent than Vitamin D3.  Magnesium and boron act as co-factors in this reaction. Food sources of vitamin D include fish and fish oils.  Vitamin D deficiency is now recognized as an epidemic in the United States (46), and is especially common in dark skinned persons, the elderly, people living in northern areas, and anyone who has limited sun exposure. Deficiency can create secondary hyperparathyroidism, leading to a loss of collagen matrix and minerals, which increases the risk of osteoporosis and fractures. Poor bone remodeling due to higher osteoclast vs. osteoblast activity can be due to low levels of vitamin D, reduced synthesis of calcitriol in the kidneys or a lack of calcitrol receptors in target organs (47) Vitamin D is available as a supplement in several forms. Vitamin D 3 ( cholelcalciferol) Vitamin D 2( ergocalciferol) and Alfacalcidol are three common forms. Studies indicate that alfacaldidol  has been shown to prevent osteoporosis in women on high dose corticosteroids, (48)  as well as increasing muscle power and walking distance in the elderly. (49) A study which compared results using alfacalcidol with ergocalciferol (Vitamin D 2) in elderly women with vertebral fractures, discovered that alfacalcidol has a greater effect than D2 at stimulating calcium absorption by bones.  (50)  Vitamin D 3 is more effective than Vitamin D 2, and is a better supplement choice for most individuals. (51) An exception would be vegans, who prefer not to use any product that may have been animal sourced, since the starting material for D 3 is fish or lanolin. Mechanisms of action of Vitamin D’s role in building healthy bones includes increasing the number and activity of osteoblasts, (52) reducing the activity of osteoclasts, (53)  and normalizing the turnover of bone in osteoporosis. (54)  

Vitamin D appears to be most effective as a therapy for osteoporosis when combined with calcium. (55)     While 400 IU’s of oral vitamin D (cholecalciferol) is the current RDA, this level of supplementation appears to be insufficient to prevent fractures, while 700 to 800 IU/d appears to reduce the risk of hip and any nonvertebral fractures in both institutionalized and ambulatory elderly persons. (56)  Vitamin D is well tolerated at doses of 400 -800 IU. Current studies are moving towards increasing the RDA of Vitamin D, and many health practitioners are already recommending much higher doses. Scandinavian countries are considering ways to increase levels of Vitamin D through both supplementation and the use of UV lights. (57)Vitamin D has a low incidence of adverse effects, although intoxication can result if higher doses are used long term. Symptoms include weakness, nausea, vomiting and poor appetite. Toxicity may be seen when serum 25(OH)D concentration is consistently >200 ng/mL (>500 nmol/L) (58) More problematic are drugs which deplete Vitamin D. These include carbamazepine, (59)  cholestyramine and colestipol. (60)

Boron

Boron is ubiquitous throughout the human body with the highest concentrations found in the bones and dental enamel. Although there is currently no RDA, boron appears to be indispensable for healthy bone function, possibly via effects on reducing the excretion and absorption of calcium, magnesium and phosphorus,

( 61)  and by affecting signal transmissions across cell membranes by acting indirectly as a proton donor, which influences ion gradients that are involved with cell/cell communication. (62)   (63)   Boron may be involved in the synthesis of steroidal vitamins and hormones, such as Vitamin D, 17 beta-estradiol and testosterone  and  inhibits a range of microsomal enzymes which catabolize  these steroids, thus delivering a net up-regulatory effect, which could explain its bone building properties. (64) Boron clusters or carboranes have a high binding affinity for steroidal receptors (65)  and are being formulated into medications such as specific protease enzyme inhibitors. (66) Boron may be beneficial in the treatment of osteoporosis, especially in the case of vitamin D, magnesium, and potassium deficiency. (67)  One study found that boron supplementation as an isolated nutrient was not useful in terms of preventing bone loss.  (68)   Fruits, vegetables, soybeans and nuts can be rich sources of boron, but the level depends on the soil in which it is grown. A safe daily intake is estimated to be between 1 and 10 mg. Breast cancer patients are often cautioned not to use more than 3 mg a day due to references of boron’s ability to increase endogenous estrogen. (69) Sodium borate and boron chelated with glycinate, aspartate or citrate are the most common forms used in dietary  supplements. Toxic effects appear at intakes of about 100 mg. A fatal dose in adults is 15 to 20 g and in children 3 to 6 g. Repeated intakes of small amounts can cause accumulative toxicity, so pulse dosing is recommended, rather than continuous use.

Strontium

The mineral strontium is a powerful agent in the treatment and prevention of osteoporosis. Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton, where it is adsorbed at the matrix crystal surface of bones. The Spinal Osteoporosis Therapeutic Intervention study is a double-blind, randomized, placebo-controlled trial, which compared two groups of postmenopausal women who already had a diagnosis of osteoporosis. One group was given two grams daily of non-radioactive strontium ranelate , while another group received a  placebo. The strontium group illustrated a significant reduction (41%) in the relative risk of experiencing a new vertebral fracture. (70) Other promising studies showed reduced risks for non-vertebral fractures, including hip fractures following the use of strontium. (71)  In addition to reducing the risk of fracture, strontium ranelate increased bone mineral density throughout the study, peaking at 3 years, with augmented scores of 8.2% in the femoral neck and 9.8% in the hip. Japanese pharmaceutical researchers have trade named the strontium salt PROTELOS and are in phase two drug trials. The mechanism of strontium’s bone strengthening effect is believed to be decreased bone resorption and increased bone formation which increases bone mass, microarchitecture and strength. (72) 

In the US, strontium is available as a dietary supplement in the form of strontium citrate. Theoretically, this form may have similar action to strontium ranelate, which has been used in most studies. UC Davis is investigating the use of Sodium Citrate for the prevention of osteoporosis, but the results are not yet available. (73) Most practitioners recommend that strontium should be taken at bedtime, and not at the same time as calcium supplements, since they compete for adsorption into bone matrix.It is important to ensure calcium and vitamin D intakes are adequate when supplementing with strontium.  This is underscored by earlier research on animals suggesting that increasing the intake of strontium via diet may de-mineralize bone when calcium is deficient. (74)   In rats with chronic kidney failure, strontium has been shown to cause osteomalacia, a condition in which bone is softened due to lack of mineral content. (75)  For this reason, it is suggested that people on kidney dialysis should not use strontium supplements.

Isoflavones

Research supports the positive effects of soy isoflavones for reducing the risk of developing osteoporosis. (76)  Diets high in soy may decrease bone re-absorption in postmenopausal women. (77)  Although ipriflavone, a semi synthetic flavone comparable to genistein and diadzein found in soy foods, was ineffective in restoring bone density in rats, it modulated IGF-I(insulin growth factor I), (78) which is linked to bone mineral density and increased bone remodeling through several mechanisms. (79) IGF-I (Somatomedin C) is currently being measured by holistic health practitioners as one of the parameters to assess overall aging. Ipriflavone yielded positive results on bone mass in elderly women with osteoporosis in human trials at doses of 200 mg per day, (80)  and seems particularly beneficial when combined with calcium.  (81)   Moderate soy consumption (2-4 ounces per day) is likely a reasonable and prudent measure due to scientific validation of its positive effects, combined with a low incidence of adverse reactions.  Soy can cause allergic reactions in some individuals, and may inhibit thyroid hormone synthesis. (82)  Fermented soy is less likely to cause these adverse effects.

 Vitamin K

Vitamin K is a fat soluble vitamin known for its effect in blood clotting, which it accomplishes by regulating the coagulation cascade via its ability to bind calcium ions (Ca2+), among other mechanisms. (83) There are three known vitamin K dependent proteins that have been isolated in bone: MGP (matrix Gla protein), protein S and osteocalcin. One of Vitamin K’s roles in helping to maintain healthy bone mass is linked to its importance in the formation of osteocalcin by osteoblasts. The synthesis of osteocalcin requires both Vitamin D and Vitamin K. There are two naturally occurring forms of vitamin K: Vitamin K 1 (phylloquinone), synthesized by plants, and Vitamin K 2 (Menaquinone-n) synthesized by bacteria. The ‘n’ signifies the number of 5 carbon chains that a specific kind of K 2 contains. Vitamin K 2 is available as both M-4 and M-7 as a dietary supplement. Research supports the use of both Vitamin K 1 and Vitamin K 2 in terms of benefits associated with osteoporosis. Vitamin K 1 supplementation has been shown to support a favorable bone biomarker profile. One study included vitamin K 1, along with Hop rho iso-alpha acids, berberine, vitamin D. The treatment group showed a significant decrease in  biomarkers that indicate bone turnover. (84) However, in a double blind study which followed patients who were given 500 mcg of Vitamin K 1 for three years their bone density scores were no better than the placebo group. (85)   Patients who undergo transplants have an increased risk for osteoporosis. A randomized, double blind, prospective longitudinal study investigated the effect of a dietary supplement which included vitamin K2 (180 mcg menakinon-7) on bone mass of 94 subjects who were followed for the first year after lung and heart transplantation. The outcome showed a favorable effect on bone mass density of the lumbar spine. (86)  Although Vitamin K 2 is currently gaining popularity as the preferred form to use in supplementation, Vitamin K 1 is more cost effective, and therefore may be the better choice for some patients.

Vitamin K is a fat soluble substance; however the body does not store a significant amount at any given time. The need to constantly replenish vitamin K through dietary intake is decreased due to the vitamin K cycle, which allows a small amount that is present to be used by the body several times. Vitamin K deficiency is rare, due to the reuse via the vitamin K cycle, and wide availability in the diet. Vitamin K is found in dark green vegetables such as kale, swiss chard, parsley and spinach, and to some extent in Olive and Soybean oils. Deficiency may occur in those taking anti-coagulant pharmaceutical drugs, or who have difficulty with fat metabolism. People who develop osteoporosis have been documented to have a low dietary intake of vitamin K containing foods, (87) as well as low  blood levels of Vitamin K. (88)   Health practitioners can emphasize the importance of eating high quality (preferably organic) green vegetables as part of the diet. If supplementation with vitamin K is recommended, common doses include the RDA amount of 65-80 mcg/day.

Bone Morphogenic Proteins

In the early 1960’s, orthopedic surgeon Dr. Marshall Urist discovered a family of proteins that stimulates osteoblasts and cartilage chondrocytes, and named these proteins Bone Morphogenetic Proteins – or BMPs. The impact of Dr. Urist’s contribution to medicine and healthcare was first realized in the 1990’s when commercial bone-protein preparations containing BMP’s and key growth factors were used by orthopedic surgeons for bone healing and spinal fusions. In 2002, the FDA approved select individual BMPs for use in surgical procedures as a more effective way to grow and heal bone. BMP’s account for the major proportion of the osteoinductive potential of bone extracts. (89)  BMP’s bind to one of the two types of serine and threonine kinase membrane receptors, and upon binding, initiate an intracellular signaling cascade which modulate the activity of transforming growth factor beta ligands. (90) This in turn leads to the expression of the transcription factorCbfa1 (Runx2), which results in the expression of several proteinscritical for bone formation, ultimately leading to regulation of target genes involved in bone remodeling. (91)  BMPs are thought to be key regulators of embryonic skeletogenesis (92), endochondral ossification (93), bone remodeling (94) (95), fracture repair (96), and bone regeneration. (97)  Over 20 BMPs family members have been identified.  (98) It was once thought that BMP’s  could only be applied locally by orthopedic surgeons  for a procedure known as “screw and glue” as they attempt to mend a fracture, but recent research in animals suggest that that systemically administered  BMP-6 restores the bone inductive capacity, micro-architecture, and quality of the skeleton in osteoporotic rats. Human trials are needed. (99) Somehealth practitioners are now recommending the use of oral BMP’s for osteroporosis and osteopenia at a dosage of 200-1000 mg/day with minimum adverse effects, except for occasional GI upset in some patients.

Health care practitioners can be instrumental in educating their patients to the fact that, with intelligent dietary and lifestyle choices, osteoporosis is largely preventable for most people.

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Image Credit:

By BruceBlaus – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46602308

By Ellen Kamhi, Ph.D., R.N. and Eugene Zampieron, N.D., A.H.G.

Allergies are the 6th leading cause of illness in the United States. The National Institute of Health approximates the number of allergy sufferers at 40 to 50 million Americans, with a higher number that remains undiagnosed. [1] Yearly visits to physicians due to allergic symptoms is estimated at 17 million. [2] The overall prevalence of some forms of allergies, such as allergic rhinitis and atopic eczema, are increasing substantially. [3]

Genetic predisposition is clearly indicated in the development of allergies. There is a 40%-60% chance of developing allergies if both parents have allergies, 20%-40% if one parent is allergic, and 5%-15% if neither parent is affected. In addition to genetics, the development of allergies may to due to multi-factorial causes, which includes overexposure to particular substances that initiates an ‘overreaction’ response by the allergic individual’s immune system. Some theories of the increased rate of allergies is that it is due to a decrease in breastfeeding along with early introduction of potentially allergenic foods to an infant’s diet, [4] and high levels of air and water pollution. [5]

The term ‘allergy’ refers to a grouping of symptoms that affects different body systems. The allergic patient may experience symptoms in only one, or several body systems. People may experience allergies that are due to a wide array of antigens (triggering substances), such as foods, pollen, environmental particles, animal dander, dust mites, cigarette smoke, ingredients in soaps, newsprint, latex and almost anything else that a person may come into contact with. Although many of the antigens that provoke allergic reactions are proteins, many non-protein components can illicit allergic reactions, such as toluene diisocyanate found in dry cleaning fluid. [6] The following is a grouping of symptoms that are commonly associated with different body systems. Respiratory symptoms: stuffy/runny nose, sneezing, coughing, watery eyes, wheezing, recurring ear infections, tickling or sore throat, asthma. Integumentary symptoms: swelling of hands and feet, itchy, dry, red scaling skin patches, dark circles under the eyes, swollen tongue. Digestive symptoms: bloating, flatulence, diarrhea, constipation, weight loss or gain, burning anal and underarm rash, abdominal discomfort.

Allergic reactions are initiated by the immune system’s over- response to substances it deems as distinct from itself. Although well tolerated by most people, in the allergic person contact with the offending substance (antigen), is the basis of the hypersensitivity reaction. [7] Immunoglobulins are specific antibodies that have the responsibility of tracking down and destroying antigens that are recognized by the body. There are five different classes of antibodies, IgE, IgA, IgG, IgM, and IgD. Each of these specifically attack different categories of antigens. Every antibody is ‘antigen specific’, and is programmed to react to a specific kind of invader. In the case of allergies, these antibodies become overzealous, and begin to recognize substances that are usually benign, as if they were dangerous invaders. Once an antibody recognizes a suspected antigen, it attaches to it and forms an ‘antigen-antibody’ complex. This complex initiates the release of histamines and other chemicals that lead to inflammation, the common theme to all hypersensitivity reactions (allergies). The inflammatory response causes the release of chemical mediators, vasodilation, increased vascular permeability, edema and tissue damage. [8] Allergic reactions can range from a trivial annoyance such as an itchy rash and runny nose, to a fatal incident.

There are four different classes of allergic reactions: Type I (Immediate Hypersensitivity Reactions), Type II (Cytotoxic Reactions), Type III (Immune Complex Mediated Reactions) and Type IV(Cell Dependent Reactions). [9] Type I reactions occur almost immediately after exposure to an antigen, and range from a temporary outbreak of hives, skin rash, headache, GI symptoms, rhinitis, and asthma-like symptoms, to fatal Anaphylactic shock characterized by difficulty breathing, closing of the throat, decreased blood pressure, tachycardia, seizures and loss of consciousness. The symptoms can be local or systemic, depending on the port of entry of the antigen. [10] IgE immunoglobulins are widely believed to be responsible for Type I reactions. However, recent studies report that IgG, previously thought to only be involved with DELAYED reactions, may also be involved in the initiation of Type I reactions. [11] [12] [13] [14] This evidence supports complementary health care practitioners, who have been regularly testing patients for both IgE AND IgG mediated reactions for decades, although most conventional physicians still disregard IgG testing.

Type II- Type IV reactions are referred to as DELAYED reactions, since they can occur 24- 72 hours after encountering the offending substance. They involve IgG, and to some degree IgM, although many allergic reactions do not involve any antigen-antibody complex, but are due to the direct release of histamines and other inflammatory compounds by mast cells and other white blood cells.

Food allergies are widespread, and remain an under-diagnosed phenomena. Delayed food allergies are often the culprit behind eczema, difficulty concentrating, recurrent ear infections, chronic rhinitis and immunodeficiency in both children and adults. [15] Severe reactions to common allergens such as milk, egg, peanut and sesame are on the rise. The threshold needed to trigger a severe reaction can be as low as a molecular amount. [16] Pharmacists can advocate for patients by suggesting that they see a physician who regularly performs both IgG and IgE testing to search for food sensitivities. In addition, pharmacists can instruct clients in keeping a food diary, and practicing avoidance and re-introduction of specific foods, in an attempt to track down offending substances.

Conventional medical treatment of allergies involves the use of a variety of pharmaceutical agents that are mainly focused on the reduction of symptoms. These include antihistamines that stop histamine release, decongestants to constrict the mucous membranes and decrease secretions, cromolyn sodium that interferes with the mast cell release of inflammatory chemicals, and steroidal inhalants. Drug therapies can be useful for acute symptom relief, but do not address the underlying cause of allergies, and often have a variety of adverse effects including insomnia, nervousness, irritability, dry mouth, constipation, urinary retention, rapid heartbeat, blurred vision, drowsiness and dependency.

Naturally oriented practitioners take a different approach. The first line of defense for the allergic individual is to address diet and lifestyle issues. HEPA air filters reduce exposure to mold, pollen, dust mites and dander. Neti pots, small ‘tea-pot’ like devices, are excellent to use as saline irrigators. This removes particle allergens from sensitive mucous membranes, and has been shown to decrease the inflammatory mediators histamine and leukotriene C-4. [17] Pharmacists can recommend the use of air filters and Neti Pots to their clients. The allergic person must avoid foods discovered to initiate an allergic response, while increasing the consumption of anti-inflammatory foods, such as cold water fish, Omega 3 oils, and dark green leafy vegetables. One study examined how the consumption of ALA (alpha-linolenic acid), effects the level of C- reactive protein(CRP), a known marker for inflammation, and found that dietary supplementation with ALA for 3 months significantly decreased CRP. [18] Eliminating food allergens ALSO tends to decrease sensitivity to inhalant allergens. The authors have had numerous clinical reports from patients with seasonal inhalant allergies, who were able to get through their previous ‘allergy season’ without the use of any medications, after removing common foods such as wheat and dairy from their diet. This makes sense, because many grains are in the grass family and cross react with other grass species. Several studies have documented cases of cross reactivity between food and pollen antigens. [19] Stress reduction, through techniques such as meditation and yoga, can help to decrease the frequency and intensity of allergic reactions. Endogenous serum cortisol acts as a natural anti-inflammatory mediator. Stress reduces serum cortisol, which leads to increased inflammation. [20]

Nutritional supplements such as vitamin C (500- 1000 mg) and magnesium (400 mg) have shown promise in clinical studies involving asthma patients, and may also be useful for allergies. [21] Other herbs and natural remedies can also be helpful.

Quercetin

Quercetin is an active bioflavonoid found abundantly in plants, including evening primrose leaf, onion and green tea. It is a strong inhibitor of basophil and mast cell degranulation. [22] Degranulation of mast cells is an active process that requires the influx of calcium, along with an increase in cAMP (adenosine monophospate). This activity leads to phosphorylation of the membrane around mast cell granules, which renders them permeable to water and calcium. The mast cell uses calcium-activated enzymes to assemble contractile microtubules, which pulls the granules towards the cell membrane, where the inflammatory contents are spilled outside the cell, unleashing an allergic reaction. [23] Quercetin prevents calcium from influxing into the cell. [24] Secondary mediators of inflammation, such as arachidonic acid metabolites, are released outside the cell via the action of the enzyme phospholipase A2. (Steroids act as anti-inflammatory agents due to their ability to inhibit phospholipase A-2.) Quercitin inhibits many steps along the eicosanoid membrane pathway, including phospholipase A2 and lipoxygenase. [25] Quercetin taken along with vitamin C has been reported to reduce hay fever symptoms. [26] The authors have used quercetin clinically for a number of pathological processes, including inhalant allergies, food allergies, atopic dermatitis, chronic sinusitis, bronchitis, asthma, serous otitis media reoccurrences, and ITP.

Recommended dosage: 500 -1000 mg three times a day on an empty stomach as a capsule, tablet or nasal spray.

Cautions : Quercetin may raise levels of estradiol and should be used with caution with hormone intervention. [27] Quercetin may inhibit the activity of enzymes that break down Felodipine into an inactive form, thereby raising blood levels of Felodipine. [28]

Baikal Skullcap Root (Scutellaria baicalensis)

The root of the Chinese Skullcap, Radix Scutellaria baicalensis, called Huang Qin in traditional Chinese Medicine, has been used for thousands of years, especially for inflammation and high fevers. It contains the flavonoids baicalin and wogonin, well researched for their anti-allergy and free radical scavenging properties. [29] [30] These components are similar in structure and mechanism of action to Quercetin. [31] Another component of Scutellaria baicalein, has even a stronger anti-inflammatory and anti-allergic effect, specifically reducing leukotriene B4 and C4 production by inhibiting lipoxygenase. [32]

The dose is typically 2-6g/day of the dried root or 4 to 12 ml per day of a 1:2 fluid extract.

Cautions: No specific adverse reactions have been reported. However, due to structural similarity to quercetin similar cautions may apply.

Nettles (Urtica dioica)

Stinging Nettles is a common plant found in damp waste areas around the United States and Europe. Touching the stingers on the nettle plant, causes an allergic reaction, probably due to the formic acid found in the stingers which initiates a localized histamine release. Traditional herbalists have historically recommended the juice of the nettle as an antidote to the rash caused by the nettle stinger, as well as the prophylactic use of nettle tea for spring allergies. In addition, the homeopathic remedy made from nettle, Urtica, is successfully used for hives and other allergic skin irritations. One preliminary study found that freeze dried nettles were helpful for symptoms of allergic rhinitis. [33] The authors have also encouraged the use of nettle herb for allergic patients, with favorable results.

Typical dosage is 600 mg dried herb or 2-4 ml per day of fluid extract in divided doses.

Cautions: may occasionally cause mild gastrointestinal irritation when used internally.

Mimosa (Albizzia lebbeck, Albizzia kalkora)

Albizzia is a member of the mimosa family that has been used in Ayurvedic practice for asthma and dermatitis, and as a sedative in Traditional Chinese Medicine. Several studies were performed on a bark extract of this plant, which showed advantageous actions against allergic symptoms, including anaphylaxis, [34] atopic allergy [35] and gastrointestinal allergic symptoms such as diarrhea. [36] Albizzia has been shown to stabilize mast cell degranulation , depress levels of anti-allergy antibodies, and decrease the overaggressive action of T and B lymphocytes.

A therapeutic dose of Albezzia is 3-6 ml/day of the 1:2 extract. [37]

Cautions: No adverse reactions have been reported.

Coleus (Coleus forskohlii )

Coleus is a member of the mint family, and grows wild in Thailand , India and other areas. It has been used in traditional Ayurvedic medicine for allergic symptoms such as bronchitis and breathing difficulties. [38] In 1974 Hoechst Pharmaceuticals, along with the Indian Central Drug Research Institute, conducted studies on Coleus extract and found that it had muscle relaxant and antihypertensive effects. The active constituent forskolin, extracted from the root of Coleus forskohlii , has been found to increase Cyclic AMP [39] [40] , which causes bronchial relaxation. Forskolin has the added advantage of being receptor independent, which avoids the desensitization caused by the repeated use of B-adrenergic agonist pharmaceuticals. [41] Forskolin also inhibits the release of histamine from basophils, which decreases the allergic response. [42]

The recommended dosage of Coleus is 50 mg 2 times a day of an extract standardized to contain 18% forskolin.

Cautions: Coleus may lower blood pressure.

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Marone G, Columbo M, Triggiani S, et al. Forskolin inhibits the release of histamine from human basophils and mast cells. Agents Actions. 1986;18:96–99.

By Ellen Kamhi Ph.D., R.N., and Eugene Zampieron, N.D., A.H.G.

The word “cholesterol” has acquired a negative connotation in modern culture. Yet this important fatty substance, produced naturally by the liver, is an essential component of every cell membrane in the body, and is used by the body for synthesizing pregnenolone, the precursor of all endogenous steroid hormones. During chronic stress, the body shunts an increased fraction of pregnenolone toward the production of cortisol. As pregnenolone levels decrease, the liver manufactures more cholesterol in an attempt to meet the demand for pregnenolone, thus raising cholesterol levels in the blood. As a result, the indiscriminate reduction of blood cholesterol levels without a holistic understanding of why they may be elevated can be detrimental to hormonal balance and health.

Blood Cholesterol

The blood contains cholesterol in several different forms, including low-density-lipoprotein (LDL) or “bad” cholesterol and high-density- lipoprotein (HDL) or “good” cholesterol. Conventional recommendations for cardiovascular health include an HDL cholesterol level above 60 mg/dL, since every percent increase in this form of cholesterol is accompanied by a corresponding decrease of 3 to 4% in heart attack risk. LDL cholesterol should be kept below 100 mg/dL, and the total blood cholesterol level should be no higher than 200 mg/dL, since a total cholesterol above 240 mg/dL increases the overall risk of coronary heart disease (CHD). Nevertheless, American Heart Association statistics show that at least 102 million Americans have total blood cholesterol levels above 200 mg/dL.

The conventional treatment for high LDL or total cholesterol or both, includes recommending a healthy diet and regular exercise, often accompanied by a prescription for a statin drug that interferes with the endogenous hepatic synthesis of cholesterol. Statin drugs may also be effective in protecting against coronary heart disease through non-lipid-related mechanisms of action, which go under the general allopathic rubric of “pleiotropic effects”. For instance, the development of atherosclerosis is retarded by reducing the synthesis of thromboxane by platelets, since this blocks the risk of vascular inflammation and thrombosis. But statin drugs may have undesirable effects, including liver damage and the depletion of certain essential nutrients, such as coenzyme Q10 (CoQ10), an essential factor in oxidative metabolism. This latter effect may be linked to muscle debilities among some users of statin drugs. Because of this, pharmacists should suggest that clients using statin drugs take supplemental CoQ10 in a dose of at least 30 to 50 mg/day.

Nor do statin drugs increase “good” or HDL-cholesterol, or address other risk factors for heart disease that may in fact be more important than an elevated cholesterol level, and which include a low antioxidant status; increased blood levels of the amino acid homocysteine, recently identified as an independent risk factor for CHD ; low levels of essential fatty acids (EFAs), consumption of trans hydrogenated fats; mineral and flavonoid deficiencies; smoking; inactivity; obesity; the effects of infectious agents ; and Type “A” behavior, with its sense of urgency, impatience, and competitiveness. In fact, studies show that 50% of patients who develop CHD do not have high cholesterol levels, although they do usually have other risk factors for such disease. As a result, reliance on statin drugs for preventing CHD may lull patients into a false sense of security.

Diet

Practitioners of both allopathic and naturopathic medicine agree that diet plays a major role in controlling cholesterol levels. The main culprits in raising LDL-cholesterol include hydrogenated oil?found in almost all commercial baked goods, trans fats, as noted earlier, “junk foods,” and “fried foods.” Research has shown that a diet with a low carbohydrate content (“low-carb” diet) significantly lowers blood cholesterol levels while promoting a high level of satiety. The Portfolio Diet study combined a variety of foods known to have specific cholesterol-lowering properties, and compared the effect of this to the use of a statin drug combined with a low-fat diet.10 The foods used included plant sterols found in vegetables; nuts (almonds); seeds and legumes, which interfere with intestinal absorption of cholesterol; soy protein, which decreases hepatic production of cholesterol and reduces blood levels of LDL-cholesterol; and soluble fiber, which binds intestinal bile acids, stopping them from being recycled into cholesterol. After 1 month, the Portfolio Diet group showed a cholesterol reduction of 28%, which was comparable to that in the statin/low-fat-diet group. The pharmacist can therefore also encourage clients to follow a dietary regimen that ensures adequate and safe cholesterol control.

Exercise

Exercise is an important means for reducing cholesterol levels. Any kind of regular exercise is acceptable, as long as it is practiced for 30 to 45 minutes per day for 6 days per week. Here again the pharmacist can provide support by offering exercise videos and becoming a source of referral for local health clubs and physical therapy facilities.

Supplements

Various natural agents can help reduce undesirable levels of blood cholesterol. Practitioners of natural health care suggest that they be used along with a healthy diet, exercise, and a stress-reduction program. In many cases these supplements have multiple mechanisms of action that support overall cardiovascular health, in addition to reducing cholesterol levels. These mechanisms of action include decreasing the oxidation of LDL-cholesterol—an important factor in atherosclerosis, and decreasing platelet aggregation, endothelial damage, and smooth-muscle-cell proliferation.

Many of the natural anticholesterolemic agents are potent antioxidants, protecting collagen and elastin from oxidative damage and thereby strengthening connective tissue. Although natural cholesterol-lowering agents are not free of adverse effects, the incidence and severity of these are usually substantially lower than with pharmaceutical agents. Among the many dietary supplements that can be useful for cholesterol control are gamma-linolenic acid (GLA), garlic, and soy, as well as the agents discussed in detail below.

Hawthorn

Various species of hawthorn (Crataegus spp.), a shrub native to Europe, are used as official medicines on that continent. The summer green berries, flowers, and young spring leaves of hawthorn contain the highest percentage of medicinal components, which include flavonoids such as quercetin, vitexin, and rutin, as well as oligomeric procyanidins (OPCs). Several studies have shown the therapeutic value of hawthorne value in lowering blood cholesterol levels. – In addition, this botanical may help reduce blood pressure, increase coronary blood flow, and decrease the size of existing atherosclerotic plaques. OPCs stimulate the release of endothelial nitric oxide synthase (ENOS), an enzyme that increases the levels of nitric oxide (NO), which is a vasorelaxant and acts to decrease platelet aggregation and adhesion, as well as inhibiting the oxidation of LDL- cholesterol, all of which can protect against atherogenesis and thrombus formation.

In using hawthorn to reduce blood cholesterol, we recommend a 6:1 preparation, providing 2 g of concentrated solid extract of hawthorn in one-fourth teaspoon of water, juice or other liquid three times daily. Hawthorn may be standardized to 2% vitexin, 1.8% vitexin-4’-rhamnoside, and/or 20% procyanidins per dose. European products are often standardized to 2.2% flavonoids. Other popular preparations include hawthorn capsules and tablets, which vary from 200 to 900 mg per dose.

There is no restriction on the long term use of hawthorn. Although adverse effects of its use have not been reported, hawthorn may potentiate antiarrhythmic medications, antihypertensive medications including angiotensin converting enzyme inhibitors (ACE), cardiac glycosides, and beta-blocker drugs. Dose modification of the prescription medication may be required.

Guggulipid

Guggulipid, or gum guggulu, is a yellow gum oleoresin extracted from the stem of the Commiphora mukul tree, which is native to India. Ancient Sanskrit texts suggest that guggulipid was traditionally used as a treatment for obesity and associated lipid-related disorders, for arthritis and bronchitis, and topically for skin diseases. , The active components of guggulipid are lipid-soluble steroids classified as guggulsterones. Although one short-term study found that guggulipid did not improve serum cholesterol levels in adults with hypercholesterolemia, many other clinical trials have illustrated that it has positive effects on the cardiovascular system. These include reductions in hyperlipidemia, inhibition of platelet aggregation, and anti-inflammatory and antioxidant effects. Guggul also inhibits LDL oxidation, thereby protecting against atherogenesis.

Guggul preparations are usually standardized to contain 2.5 to 10% guggulsterones Z and E per dose. A common dosage range is 500 to 1,000 mg of standardized extract taken 3 times a day.
Adverse reactions linked to guggul have included skin rashes, diarrhea, headache, mild nausea, indigestion, and hiccoughs. Guggul should not be used in acute kidney infections, and alcohol and exposure to the sun should be avoided when taking this herb. Additionally, because guggul has been shown to reduce both serum cholesterol and triglycerides, it should be used with caution for persons taking drugs designed to have these same effects. Guggul may also have an additive effect with anticoagulants, and can act as a thyroid stimulating agent, which can affect the dosage of thyroid medications. Contrastingly, guggul can decrease the absorption of beta blockers and calcium-channel blockers, and dosage levels of these drugs may have to be adjusted if guggul is used concomitantly with them.

Policosanol

Policosanol is a mixture of long-chain aliphatic alcohols isolated from sugar cane (Saccharum officinarum) wax, whose main component is octacosanol. This supplement has been shown to lower blood cholesterol levels in animal models, healthy human volunteers, and patients with type II hypercholesterolemia. While conventional statin drugs directly inhibit the enzyme HMG-CoA reductase, which is the rate-limiting enzyme in the hepatic metabolic pathway to cholesterol synthesis, policosonal limits this same enzyme indirectly. Policosanol has proven equivalent to or better than several statin drugs?simvastatin, pravastatin, lovastatin, probucol, or acipimox?in reducing cholesterol levels in patients with hypercholesterolemia, and has fewer side effects. This dietary supplement also decreases several other risk factors for CHD by decreasing the oxidation of LDL cholesterol, platelet aggregation, endothelial damage, and smooth-muscle-cell proliferation.

Fifteen double-blind, placebo-controlled trials, ranging in duration from 6 weeks to 12 months and collectively involving more than 1,000 subjects, have found policosanol to be effective for lowering total and LDL cholesterol, the ratio of LDL to HDL cholesterol, and the ratio of total cholesterol/ to HDL cholesterol. Most of these trials have been done at the Surgical Medical Research Center in Havana, Cuba with policosanol derived from Cuban sugar cane. One randomized, double-blind, placebo-controlled trial examined the effects of 5 to 10 mg of policosanol per day for 12 months on the lipid profile of 589 older patients with hypertension and type II hypercholesterolemia, and without a history of congestive heart disease. The study found that policosanol improved all parameters of the lipid profile with great statistical significance.

A number of comparative studies have been done of policosanol versus commonly prescribed statin drugs. In one such study in which policosanol was tested against pravastatin over an 8-week period in an older population with hypercholesterolemia, it proved more effective at improving all lipid profile markers, and with a high degree of statistical significance. In another study, comparing policosanol at 10 mg/day with atorvastatin at 10 mg/day, the latter was slightly more effective than policosanol at reducing total cholesterol, while policosanol was more effective at raising HDL cholesterol, by 5.3% vs. no increase with atorvastatin, without any reported adverse reactions.

The American Heart Journal evaluated the peer-reviewed literature on placebo-controlled lipid-lowering studies using policosanol and found that at doses of 10 to 20 mg/day, policosanol reduced both total and LDL cholesterol while raising HDL cholesterol. The Journal further stated that at dosages of up to 20 mg/day, policosanol is safe and well tolerated. The study concluded that policosanol is a “very promising phytochemical alternative to classic lipid-lowering agents such as the statins, and deserves further evaluation.”

The usual dosage of policosanol is from 5 to 20 mg twice daily. Cautions include possible adverse reactions including migraine, insomnia, dizziness, irritability, stomach upset, and skin rash. Since policosanol can inhibit platelet aggregation, it may have an additive interactive effect with antiplatelet and anticoagulant drugs. Its concomitant use with these drugs may also theoretically increase bruising and bleeding. Furthermore, policosanol can reduce blood pressure and may enhance this effect of beta-blocker drugs. Its concomitant use with the latter drugs therefore requires careful and regular monitoring of blood pressure.

Red Yeast Rice

Red yeast rice is the fermented product of rice on which red yeast (Monascus purpureus) has been grown. Dietary supplements prepared from red yeast rice have been shown to significantly decrease total cholesterol levels in hyperlipidemic subjects. One of the ingredients in red yeast rice, monacolin K, inhibits the production of cholesterol by retarding the action of HMG-CoA reductase in the liver, therefore reducing the endogenous manufacture of cholesterol. This mechanism of action mirrors the activity of the statin drugs. Although red yeast rice contains several naturally occurring lipid-lowering substances, such as mevinolin, its statin content is believed to be too small to explain its hypolipidemic effects. Other components of red yeast rice, such as sterols and isoflavones, may be instrumental in its cholesterol-lowering activity.

A 12-week, double-blind, placebo-controlled trial conducted at the Center for Human Nutrition of the UCLA School of Medicine evaluated the effects of 2.4 g/day of red yeast rice versus placebo in 83 patients with hyperlipidemia who were not being treated with lipid-lowering medication. The study found significant reductions in total cholesterol and LDL cholesterol in the red yeast rice group as compared to the placebo group, without a significant change in HDL cholesterol. An earlier Chinese multi-center study reported similar results.

The usual dosage of red yeast rice is 1.2 to 2.4 g/day. Mild adverse reactions to this supplement include gastrointestinal gas, heartburn, and dizziness. More serious adverse reactions include elevation of liver enzymes, and persons with liver disorders should therefore not use this supplement. Because red yeast rice inhibits HMG-CoA reductase, its use should be accompanied by daily supplementation with 30 to 60 mg of Coenzyme Q10.

References

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2. Lloyd-Jones DM, Wilson PW, Larson MG, et al. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med 163(16):1966-1972, 2003.

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5. Mortensen SA. Overview on coenzyme Q10 as adjunctive therapy in chronic heart failure. Rationale, design and end-points of “Q-symbio”–A multinational trial. Biofactors 18(1-4):79-89, 2003.

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9. Johnston CS, Tjonn SL, Swan PD. High-protein, low-fat diets are effective for weight loss and favorably alter biomarkers in healthy adults. J Nutr 134(3):586-591, 2004.

10. Jenkins DJ, Kendall CW, Marchie A. Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive protein. JAMA 290(4):502-510, 2003.

11. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 116(10):682-692, 2004.

12. Ernst E. Cardioprotection and garlic. Lancet 349(9045):131, 1997.

13. Anderson JW, Cook-Newell ME, Johnstone BM. Meta-analysis of the effects of soy protein intake on serum lipids. NEJM 333:335, 1995.

14. Crataegus spp. in: Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Materia Medica. London: Churchill Livingstone, 2000, pp. 440-447.

15. Shanthi S, Parasakthy K, Deepalakshmi PD, et al. Hypolipidemic activity of tincture of Crataegus in rats. Indian J Biochem Biophys. 1994 Apr;31(2):143-6.

16. la Cour B, Molgaard P, Yi Z. Traditional Chinese medicine in treatment of hyperlipidaemia. J Ethnopharmacol 46(2):125-129, 1995.

17. Walker AF, Marakis G, Morris AP, et al. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res 16(1):48-54, 2002.

18. Taskov M. On the coronary and cardiotonic action of crataemon. Acta Physiol Pharmacol Bulg 3(4):53-57, 1977.

19. Wegrowski, J., Robert AM, Moczar M. The effect of procyanidolic oligomers on the composition of normal and hypercholesterolemic rabbit aortas. Biochem Pharm 33:3491-3497, 1984.

20. Fitzpatrick DF, Bing B, Rohdewald P. Endothelium-dependent vascular effects of Pycnogenol. J Cardiovasc Pharmacol 32(4):509-515, 1998.

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1998, p. 87.

22. Commiphora mukul, in: Bone, K. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Practitioner. Chapter: Warwick, Queensland, Australia: Phytotherapy Press, 1996, pp. 108-111.

23. Szapary PO, Wolfe ML, Bloedon LT, et al. Guggulipid for the treatment of hypercholesterolemia: A randomized controlled trial. JAMA 290(6):765-772, 2003.

24. Verma SK, Bordia A. Effect of Commiphora mukul (gum guggulu) in patients of hyperlipidemia with special reference to HDL-cholesterol. Indian J Med Res 87:356-360, 1988.

25. Singh BB, Mishra LC, Vinjamury SP, et al. The effectiveness of Commiphora mukul for osteoarthritis of the knee: An
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26. Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of Commiphora mukul as an adjunct to dietary
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29. Dalvi SS, Nayak VK, Pohujani SM, et al. Effects of Gugulipid on Bioavailability of Diltiazem and Propranolol. J Assoc Physicians India 42(6):454-455, 1994

30. Menendez R, Amor AM, Rodeiro I, et al. Policosanol modulates HMG-CoA reductase activity in cultured fibroblasts. Arch
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42. Burnham TH, Sjweain SL, Short RM (eds). Monascus. In: The Review of Natural Products. St. Louis, MO: Facts and Comparisons, 1997.

Allergies are the 6^th leading cause of illness in the United States. The National Institute of Health approximates the number of allergy sufferers at 40 to 50 million Americans, with a higher number that remains undiagnosed. (1) Yearly visits to physicians due to allergic symptoms  is estimated at 17 million. (2) The overall prevalence of some forms of allergies, such as allergic rhinitis and atopic eczema, are increasing substantially. (3)

Genetic predisposition is clearly indicated in the development of allergies. There is a 40%-60% chance of developing allergies if both parents have allergies, 20%-40% if one parent is allergic, and 5%-15% if neither parent is affected. In addition to genetics, the development of allergies may to due to multi-factorial causes, which includes overexposure to particular substances that initiates an ‘overreaction’ response by the allergic individual’s immune system. Some theories of the increased rate of allergies is that it is due to a decrease in breastfeeding along with early introduction of potentially allergenic foods to an infant’s diet, (4) and high levels of air and water pollution. (5)

The term ‘allergy’ refers to a grouping of symptoms that affects different body systems. The allergic patient may experience symptoms in only one, or several body systems. People may experience allergies that are due to a wide array of antigens (triggering substances), such as foods, pollen, environmental particles, animal dander, dust mites, cigarette smoke, ingredients in soaps, newsprint, latex and almost anything else that a person may come into contact with. Although many of the antigens that provoke allergic reactions are proteins, many non-protein components can illicit allergic reactions, such as toluene diisocyanate found in dry cleaning fluid.(6) The following is a grouping of symptoms that are commonly associated with different body systems.

Respiratory symptoms: stuffy/runny nose, sneezing, coughing, watery eyes, wheezing, recurring ear infections, tickling or sore throat, asthma.

Integumentary symptoms: swelling of hands and feet, itchy, dry, red scaling skin patches, dark circles under the eyes, swollen tongue. Digestive symptoms: bloating, flatulence, diarrhea, constipation, weight loss or gain, burning anal and underarm rash, abdominal discomfort.

Allergic reactions are initiated by the immune system’s over- response to substances it deems as distinct from itself. Although well tolerated by most people, in the allergic person contact with the offending substance (antigen), is the basis of the hypersensitivity reaction. (7) Immunoglobulins are specific antibodies that have the responsibility of tracking down and destroying antigens that are recognized by the body. There are five different classes of antibodies, IgE, IgA, IgG, IgM, and IgD.  Each of these specifically attack different categories of antigens. Every antibody is ‘antigen specific’, and is programmed to react to a specific kind of invader. In the case of allergies, these antibodies become overzealous, and begin to recognize substances that are usually benign, as if they were dangerous invaders. Once an antibody recognizes a suspected antigen, it attaches to it and forms an ‘antigen-antibody’ complex. This complex initiates the release of histamines and other chemicals that lead to inflammation, the common theme to all hypersensitivity reactions (allergies). The inflammatory response causes the release of chemical mediators, vasodilation, increased vascular permeability, edema and tissue damage. (8) Allergic reactions can range from a trivial annoyance such as an itchy rash and runny nose, to a fatal incident.

There are four different classes of allergic reactions: Type I (Immediate Hypersensitivity Reactions), Type II (Cytotoxic Reactions), Type III(Immune Complex Mediated Reactions) and Type IV(Cell Dependent Reactions). (9) Type I reactions occur almost immediately after exposure to an antigen, and range from a temporary outbreak of hives, skin rash, headache, GI symptoms, rhinitis, and asthma-like symptoms, to fatal Anaphylactic shock characterized by difficulty breathing, closing of the throat, decreased blood pressure, tachycardia, seizures and loss of consciousness. The symptoms can be local or systemic, depending on the port of entry of the antigen. (10) IgE immunoglobulins are widely believed to be responsible for Type I reactions. However, recent studies report that IgG, previously thought to only be involved with DELAYED reactions, may also be involved in the initiation of Type I reactions. (11) (12) (13)(14)  This evidence supports complementary health care practitioners, who have been regularly testing  patients for both IgE AND IgG mediated reactions  for decades, although most conventional physicians still disregard IgG testing.

Type II- Type IV reactions are referred to as DELAYED reactions, since they can occur 24- 72 hours after encountering the offending substance. They involve IgG, and to some degree IgM, although many allergic reactions do not involve any antigen-antibody complex, but are due to the direct release of histamines and other inflammatory compounds by mast cells and other white blood cells.

Food allergies are widespread, and remain an under-diagnosed phenomena. Delayed food allergies are often the culprit behind eczema, difficulty concentrating, recurrent ear infections, chronic rhinitis and immunodeficiency in both children and adults.(15)  Severe reactions to common allergens such as milk, egg, peanut and sesame are on the rise. The threshold needed to trigger a severe reaction can be as low as a molecular amount.(16)  Pharmacists can advocate for patients by suggesting that they see a physician who regularly performs both IgG and IgE testing to search for food sensitivities. In addition, pharmacists can instruct clients in keeping a food diary, and practicing avoidance and re-introduction of specific foods, in an attempt to track down offending substances.

Conventional medical treatment of allergies involves the use of a variety of pharmaceutical agents that are mainly focused on the reduction of symptoms. These include antihistamines that stop histamine release, decongestants to constrict the mucous membranes and decrease secretions, cromolyn sodium that interferes with the mast cell release of inflammatory chemicals, and steroidal inhalants. Drug therapies can be useful for acute symptom relief, but do not address the underlying cause of allergies, and often have a variety of adverse effects including insomnia, nervousness, irritability, dry mouth, constipation, urinary retention, rapid heartbeat, blurred vision, drowsiness and dependency.

Naturally oriented practitioners take a different approach. The first line of defense for the allergic individual is to address diet and lifestyle issues. HEPA air filters reduce exposure to mold, pollen, dust mites and dander. Neti pots, small ‘tea-pot’ like devices, are excellent to use as saline irrigators. This removes particle allergens from sensitive mucous membranes, and has been shown to decrease the inflammatory mediators histamine and leukotriene C-4.(17) Pharmacists can recommend the use of air filters and Neti Pots to their clients. The allergic person must avoid foods discovered to initiate an allergic response, while increasing the consumption of anti-inflammatory foods, such as cold water fish, Omega 3 oils, and dark green leafy vegetables. One study examined how the consumption of ALA (alpha-linolenic acid), effects the level of C- reactive protein(CRP), a known marker for inflammation, and found that dietary supplementation with ALA for 3 months significantly decreased CRP.(18)  Eliminating food allergens ALSO tends to decrease sensitivity to inhalant allergens. The authors have had numerous clinical reports from patients with seasonal inhalant allergies, who were able to get through their previous ‘allergy season’ without the use of any medications, after removing common foods such as wheat and dairy from their diet. This makes sense, because many grains are in the grass family and cross react with other grass species. Several studies have documented cases of cross reactivity between food and pollen antigens.(19) Stress reduction, through techniques such as meditation and yoga, can help to decrease the frequency and intensity of allergic reactions. Endogenous serum cortisol acts as a natural anti-inflammatory mediator. Stress reduces serum cortisol, which leads to increased inflammation(20).

Nutritional supplements such as vitamin C (500- 1000 mg) and magnesium (400 mg) have shown promise in clinical studies involving asthma patients, and may also be useful for allergies.(21) Other herbs and natural remedies can also be helpful.

Quercetin

Quercetin is an active bioflavonoid found abundantly in plants, including evening primrose leaf, onion and green tea. It is a strong inhibitor of basophil and mast cell degranulation.(22)  Degranulation of mast cells is an active process that requires the influx of calcium, along with an increase in cAMP(adenosine monophospate). This activity leads to phosphorylation of the membrane around mast cell granules, which renders them permeable to water and calcium. The mast cell uses calcium-activated enzymes to assemble contractile microtubules, which pulls the granules towards the cell membrane, where the inflammatory contents are spilled outside the cell, unleashing an allergic reaction.(23)  Quercetin prevents calcium from influxing into the cell.(24)  Secondary mediators of inflammation, such as arachidonic acid metabolites, are released outside the cell via the action of the enzyme phospholipase A2. (Steroids act as anti-inflammatory agents due to their ability to inhibit phospholipase A-2.) Quercitin inhibits many steps along the eicosanoid membrane pathway, including phospholipase A2 and    lipoxygenase.(25) Quercetin taken along with vitamin C has been reported to reduce hay fever symptoms.(26)  The authors have used quercetin clinically for a number of pathological processes, including inhalant allergies, food allergies, atopic dermatitis, chronic sinusitis, bronchitis, asthma, serous otitis media reoccurrences, and ITP.

Recommended dosage: 500 -1000 mg three times a day on an empty stomach as a capsule, tablet or nasal spray.

Cautions: Quercitin may raise levels of estradiol and should  be used with caution with hormone intervention.(27) Quercetin may inhibit the activity of enzymes that break down Felodipine into an inactive form, thereby raising blood levels of Felodipine.(28)

Baikal Skullcap Root (Scutellaria baicalensis)

The root of the Chinese Skullcap, Radix Scutellaria baicalensis, called Huang Qin in traditional Chinese Medicine, has been used for thousands of years, especially for inflammation and high fevers. It contains the flavonoids baicalin and wogonin, well researched for their anti-allergy and free radical scavenging properties.(29) (30) These components are similar in structure and mechanism of action to Quercetin.(31)  Another component of Scutellaria, baicalein, has even a stronger anti-inflammatory and anti-allergic effect, specifically reducing leukotriene B4 and C4 production by inhibiting lipoxygenase.(32)

The dose is typically 2-6g/day of the dried root or 4 to 12 ml per day of a 1:2 fluid extract.

Cautions: No specific adverse reactions have been reported. However, due to structural similarity to quercetin  similar cautions may apply.

Nettles (Urtica dioica)

Stinging Nettles is a common plant found in damp waste areas around the United States and Europe. Touching the stingers on the nettle plant, causes an allergic reaction, probably due to the formic acid found in the stingers which initiates a localized histamine release. Traditional herbalists have historically recommended the juice of the nettle as an antidote to the rash caused by the nettle stinger, as well as the prophylactic use of nettle tea for spring allergies. In addition, the homeopathic remedy made from nettle,Urtica, is successfully used for hives and other allergic skin irritations. One preliminary study found that freeze dried nettles were helpful for symptoms of allergic rhinitis.(33) The authors have also encouraged the use of nettle herb for allergic patients, with favorable results.

Typical dosage is 600 mg dried herb or 2-4 ml per day of fluid extract in divided doses.

Cautions: may occasionally cause mild gastrointestinal irritation when used internally.

Mimosa (Albizzia lebbeck, Albizzia kalkora)

Albizzia is a member of the mimosa family that has been used in Ayurvedic practice for asthma and dermatitis, and as a sedative in Traditional Chinese Medicine. Several studies were performed on a bark extract of this plant, which showed advantageous actions against allergic symptoms, including anaphylaxis,(34) atopic allergy(35) and gastrointestinal allergic symptoms such as diarrhea.(36) Albizzia has been shown to stabilize mast cell degranulation , depress levels of anti-allergy antibodies, and decrease the overaggressive action of T and B lymphocytes.

A therapeutic dose of Albezzia is 3-6 ml/day of the 1:2 extract. (37)

Cautions: No adverse reactions have been reported.

Coleus (Coleus forskohlii )

Coleus is a member of the mint family, and grows wild in Thailand , India and other areas. It has been used in traditional Ayurvedic medicine for allergic symptoms such as bronchitis and breathing difficulties.(38) In 1974 Hoechst Pharmaceuticals, along with the Indian Central Drug Research Institute, conducted studies on Coleus extract and found that it had muscle relaxant and antihypertensive effects.  The active constituent forskolin, extracted from the root of Coleus forskohlii , has been  found to increase Cyclic AMP(39)(40), which causes bronchial relaxation. Forskolin has the added advantage of being receptor independent, which avoids the desensitization caused by the repeated use of B-adrenergic agonist pharmaceuticals.(41) Forskolin also inhibits the release of histamine from basophils, which decreases the allergic response.(42)

The  recommended dosage of Coleus is  50 mg 2 times a day of an extract standardized to contain 18% forskolin.

Cautions: Coleus may lower blood pressure.

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Ellen Kamhi , The Natural Nurse®, (www.naturalnurse.com) and Eugene Zampieron (www.drznaturally.com) are the authors ofThe Natural Medicine Chest and Arthritis, The Alternative Medicine Guide. Dr. Zampieron is a Professor of Botanical Medicine at Bridgeport College of Naturopathic Medicine and Ellen Kamhi is a Professional Herbalist with Nature’s Answer in Hauppauge, NY.