The Herbal Mini-Series: Case 2, Gingko!

Disclosure:  We do not approve or disapprove the use of Ginkgo in anyone without speaking to his/her health care practitioner.  We are merely providing information to the public.

Gingko Biloba is an extract made from leaves of the Ginkgo biloba tree and containing a variety of phytochemicals. Ginkgo leaves contain two types of chemicals (flavonoids and terpenoids) believed to have potent antioxidant properties. Antioxidants are substances that scavenge free radicals -- compounds in the body that damage cell membranes, tamper with DNA, and even cause cell death. Free radicals are believed to contribute to health problems including heart disease and cancer as well as Alzheimer's disease and other forms of dementia. Antioxidants such as those found in ginkgo can help neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Similarly to Ginseng, Ginkgo has been used in traditional medicine to treat blood disorders and enhance memory. It is also used for reducing pain while walking in intermittant claudication, decreasing vertigo symptoms, and reducing painful attacks of Reynaud's syndrome, as well as treating tension glaucoma and symptoms of premenstrual syndrome (PMS).

Dosing and Standarization (from UpToDate, an accepted physician’s reference): 120-240mg/day (for example, Oral: 40-80 mg 3 times/day, standardized to contain 24% to 27% ginkgo flavone glycosides and 6% to 7% triterpenes per dose)

Potential Interactions and Contraindications:

Do not take without consulting with your doctor!

o   If at risk of bleeding, have active bleeding, or have a history of a bleeding disease

o   if you are taking blood thinners on medication that affect bleeding such as warfarin/Coumadin, aspirin, Plavix, etc.

o   If you have a seizure disorder or are on seizure medications (anti-convulsants)

o   Certain medications metabolized by the liver (calcium channel blockers (nifedipine), certain benzodiazepines, cyclosporine, non-nucleoside reverse transcriptase inhibitors, protease inhibitors, trazodone, and other medications influenced by the P450 CYP3A4 isoenzyme)

o   Drink excessive amounts of grapefruit juice

o   Taking medications for a psychiatric disorder (anti-psychotics and anti-depressives)

o   Medications for high blood pressure (anti-hypertensives)

o   Thiazide (water pills)

Approved Gingko Biloba Products:

• Freeda Gingko Biloba (60mg GBE/capsule)
• Gingko-Go! Gingko Biloba Extract (120mg GBE/caplet)
• Ginkoba Memory (40mg GBE/tablet)
• GNC Herbal Plus Standardized Ginkgo Biloba (60mg GBE/vegetarian capsule)
• GNC Preventative Nutrition Memorall (60mg GBE/softgel capsule)
• Mountain Home Nutritionals Brain Advantage (30mg GBE/capsule)
• Nature Made Ginkgo Biloba (30mg GBE/capsule)
• Nature’s Valley Ginkgo Biloba with Vinpocetine (60mg GBE/softgel)
• Olympian Labs Incorporated 24% / 6% Standardized Ginkgo Biloba (60mg GBE/capsule)
• Total Nutrition Ginkgo Biloba (100mg/softgel)
• Vitamin Shoppe Standardized Herbs Ginkgo Biloba Extract (120mg GBE/capsule)

References:

1.  Ginkgo biloba: Natural drug information.  UpToDate Online.  <http://www.uptodate.com/contents/ginkgo-biloba-natural-drug-information?source=search_result&search=gingko&selectedTitle=1~150>.  Copyright 2012.  Accessed February 14, 2012.

I Am What I Eat and I Eat What I Think: Mindful Eating

I couldn't say it better if I tried...check out the NY Times for an article on the new trend (and helpful practice) of mindful eating!  

http://www.nytimes.com/2012/02/08/dining/mindful-eating-as-food-for-thought.html?pagewanted=1&_r=1&sq=mindless%20eating&st=cse&scp=1

Some of our tips as well:

1.  Start mindful eating with simple foods and a few ingredients - It will help you focus and keep you from being too overwhelmed, especially at the start!

2.  If you like mixing foods on your plate, first try to eat each ingredient separately.  Notice the flavors and textures in each individual food.  Then mix the foods together and see how the flavors meld.

3.  Try a fun guessing game:  First, use a blindfold and cover a friend's eyes.  Have them smell different types of food and try to identify each one.  Then, use a clothespin to block the sense of smell of your friend while keeping the blindfold on.  See if they can recognize the foods now!  Finally, let them taste the foods with the blindfold and clothespin on - it may be harder than you think.  These exercises will tune you into how much of eating and taste is actually the senses of smell and sight.  

Good luck!

The Herbal Mini-Series: Case 1, Ginseng!

This is the start of a small series on common supplements that are often asked about or used in our patients.  The inspiration, and most of the information, comes from our wonderful nutrition intern Allison Vogel!  Since the winter often comes with fatigue, difficulty concentrating, and times of physical or emotional stress, I thought I'd start with Ginseng.

Disclosure:  We do not approve or disapprove the use of Ginseng in anyone without speaking to his/her health care practitioner.  We are merely providing information to the public.

Ginseng (Panax ginseng and Panax quinquefolius) is the dried root of one of several species of the Araliaceae family of herbs. Ginseng is widely used in the United States with the belief that it will improve overall energy and vitality, particularly during times of fatigue or stress. It is used for improving thinking, concentration, memory and work efficiency, physical stamina, and athletic endurance.

The most commonly used type is Asian ginseng. Closely related to Asian ginseng is American ginseng, which interestingly, is more widely used in China than in America and is sometimes preferred for its milder effects. 

When ginseng root is left mostly unprocessed it is called "white ginseng." "Red ginseng" refers to Asian ginseng root when it has been steamed and dried. Ginseng-containing foods and dietary supplements are typically made from a powder or extract of "white" or "red" ginseng root.

Dosage and Standardization (from UpToDate, an accepted physician’s reference)

Oral: 100-600 mg/day in divided doses, standardized to contain a minimum of 5% ginsenosides per dose. A regimen of 4 weeks on, followed by 2 weeks off, is recommended for maximum benefit. Up to 900 mg three times daily has been used.

Approved Ginseng Products

• Good Neighbor Pharmacy Ginseng (100mg root extract/softgel)
• Imperial Elixir Korean White Ginseng (500mg root powder/softgel)
• Nature Made Ginseng (250mg root extract/capsule)
• Paradise Herbs Panax Red Ginseng (200mg root extract/vegetable capsule)
• Solgar Korean Ginseng (250mg root extract/vegetable capsule)
• Bluebonnet Herbals American Ginseng (500mg root extract/vegetarian capsule)
• Nature’s Plus Herbal Actives American Ginseng (250mg root extract/vegetarian capsule)
• NSI American Ginseng 80% (250mg root extract/capsule)
• GNC Herbal Plus Standardized Triple Ginsa (400mg Asian Ginseng root extract, 200mg American Ginseng root extract/capsule)
• TruNature Triple Energy Ginsengs with Eleuthero (100 mg Asian Ginseng root extract, 100mg American Ginseng root extract/softgel)
• Vitamin Shoppe Ginseng Complex (400mg Asian Ginseng root, 20mg American Ginseng root/capsule)
• Whole Foods Triple Ginseng (100mg root extract Asian Ginseng, 50mg root extract American Ginseng/vegetarian capsule)

Potential Interactions and Contraindications:

Due to the lack of research, there are a lot of possible interactions with ginseng but few are confirmed. Some of them include:

·         Renal failure

·         Pregnancy or breastfeeding

·         Acute infection

·          Phenelzine, a MAO inhibitor (case reports and theoretical)

·         Warfarin (case reports and theoretical)

·         stimulant medications, including decongestants, caffeine, and caffeine-containing beverages (theoretical)

·         blood pressure medication or in anyone who has danger of low blood pressure (theoretical)

·         diabetics or people on glucose medication (theoretical)

·         anyone with active bleeding, bleeding disorders, or is on any anti-coagulant or medication that affects bleeding (warfarin, heparin, aspirin, clopidogrel, etc.) (theoretical)

References:

Izzo AA, Ernst E.  Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777-98. doi: 10.2165/11317010-000000000-00000.

Janetzky K, Morreale AP. Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 1997; 54:  692-3

Jones BD, Runikis AM. Interaction of ginseng with phenelzine. J Clin Psychopharmacol 1987; 7: 201-2

Kiefer D, Pantuso T. Panax ginseng. Am Fam Physician  2003; 68: 1539-42

Panax ginseng: Natural drug information.  http://www.uptodate.com/contents/panax-ginseng-natural-drug information?source=search_result&search=ginseng&selectedTitle=1~150 Copyright 1978-2012 Lexicomp, Inc. © 2012 UpToDate, Inc

Shader RI, Greenblatt DJ. Bees, ginseng and MAOIs revisited [letter]. J Clin Psychopharmacol 1988; 8: 235

Shader RI, Greenblatt DJ. Phenelzine and the dream machine:  ramblings and reflections [letter]. J Clin Psychopharmacol  1985; 5: 65

Yuan CS, Wei G, Dey L, et al. Brief communication:  American ginseng reduces warfarin’s effect in healthypatients – a randomized, controlled trial. Ann Intern Med 2004; 141: 23-7