Chasteberry: Women's Best Friend (and Men, too!)

Vitex agnus-castus, also known as the chaste tree, is a shrub whose berries, leaves, and seeds are used primarily for reproductive system conditions. Among women, Vitex agnus-castus is commonly utilized for premenstrual syndrome (PMS) symptoms, including painful breasts, menstrual disorders, fibrocystic breast disease, infertility, preventing miscarriage, and increasing breast milk production.

Men use the herb to help alleviate the symptoms of benign prostatic hyperplasia and to improve libido. It has non-reproductive system uses as well.

Vitex agnus-castus is a source of the flavone apigenin — and the apigenin flavone glucoside vitexin — which has antioxidant, anticancer, anti-inflammatory, antihyperalgesic, and neuroprotective effects.1-3 Another compound, casticin, has a significant ability to inhibit lipid peroxidation.4

In female rats with normal and induced aging, an extract of Vitex agnus-castus helped normalize aging-related effects that included follicle-stimulating-hormone (FSH) and luteinizing-hormone (LH) elevations as well as decreased estrogen and antioxidant enzyme levels.5

Chasteberry and Prolactin

Research in rat pituitary cells revealed an inhibitory effect for Vitex agnus-castus extract against excess secretion of prolactin — a hormone that enables milk production in women — suggesting its use as an alternative therapy for individuals with hyperprolactinemia (elevated blood levels of prolactin).6 High prolactin levels are associated with infertility, low libido, and bone loss in women and erectile dysfunction in men. In a randomized, double-blind, placebo-controlled trial involving women with a condition known as latent hyperprolactinemia, the administration of a 20-milligram capsule of chaste tree fruit for three months was associated with a reduction in prolactin release, normalization of shortened menstrual cycle luteal phase (which occurs following ovulation), and improvement in luteal phase progesterone synthesis.7 Women who received chasteberry also experienced an increase in beta-estradiol during this phase.

Investigation of the prolactin-suppressive mechanisms of Vitex agnus-castus has revealed compounds with an ability to bind to receptors for the neurotransmitter dopamine, which aids in the control of the brain’s pleasure and reward centers, among other functions.8 Pharmacologic research has confirmedthe dopaminergic effect of extracts of chasteberry and suggests actions via opioid receptors.9,10

Chasteberry and PMS

A trial that investigated the effects of daily chasteberry extract supplementation, during three menstrual cycles among 43 women with premenstrual syndrome, resulted in a significant reduction in symptoms that gradually returned after the supplement was discontinued.11 Another trial that compared the effects of chasteberry extract to a placebo, among 170 women with PMS, determined that improvement in irritability, mood alteration, anger, headache, breast fullness, and other premenstrual symptoms was greater among those who received the extract — and that the treatment was well tolerated.12 In a trial involving Japanese women with PMS, daily administration of Vitex agnus-castus extract for three cycles revealed decreases in irritability, depressed mood, anger, headache, bloating, breast fullness, skin disorder, fatigue, drowsiness, and sleeplessness.13 The rate of response to the extract increased over time, with 91% of the participants showing a response at the third menstrual cycle. A double-blind, placebo-controlled trial that included 217 Chinese women with PMS also resulted in improvement in association with treatment with Vitex agnus-castus extract for up to three cycles.14

Yet another trial, which evaluated the effects Vitex agnus-castus administered for six days prior to the menses for six cycles among 128 women who suffered from PMS, resulted in significant improvement among those who received the herb in comparison with a placebo.15 The authors noted two important differences between their study and others: increased duration of treatment (six months instead of three) and cyclic use instead of daily usage (six days instead of 30 days).

A randomized, controlled trial that compared the effects of chasteberry to pyridoxine (vitamin B6), among women with premenstrual tension syndrome, found that chasteberry was associated with greater alleviation of typical complaints: breast tenderness, edema, inner tension, headache, constipation, and depression.16 In a trial that compared the effects of Vitex agnus-castus to fluoxetine (Prozac) in women with premenstrual dysphoric disorder (PMDD, a more severe form of premenstrual syndrome), a similar number of participants responded to both treatments; however, fluoxetine was more effective for psychological symptoms and chasteberry for physical symptoms.17

A systematic review of eight randomized trials that involved women with PMS or PMDD found positive effects for Vitex agnus-castus in all trials, as well as safety.18 Another review, which included 43 studies reported between 2009 and 2016, concluded that Vitex agnus-castus helped treat premenstrual syndrome, alleviated postmenstrual pain, and was beneficial for women experiencing infertility.19

Among women with cyclical mastalgia (breast pain), Vitex agnus-castus extract given daily for three menstrual cycles was associated with a greater reduction of pain intensity in comparison with a placebo.20 A review published in Evidence-Based Complementary and Alternative Medicine concluded that, “Data from randomized and non-randomized well-conducted studies provides convincing evidence to suggest that A. castus is safe, effective, and well tolerated in a majority of patients suffering from mastalgia.”21

Women who suffer from migraine headaches often experience worsening of the condition in the premenstrual phase. A study that included 100 women with migraines and PMS who were given Vitex agnus-castus daily for three months resulted in two-thirds of the participants reporting a dramatic reduction in PMS symptoms; 42% of the subjects experienced a reduction in frequency of monthly migraine attacks that was greater than 50%.22 Fifty-seven percent of the women had a reduction of over 50% in the number of monthly days with headache.

PCOS, Menopause, and Beyond

A review of preclinical and clinical studies that investigated the effects of alternative therapies for polycystic ovary syndrome (PCOS) and related decreased or absent menstruation, as well as elevated male hormone levels, revealed evidence for equivalent effects for Vitex agnus-castus and the drug bromocriptine.23

Difficulty in the ability to remember or concentrate is a common complaint among postmenopausal women. In a study involving female rats that had their ovaries removed to mimic human menopause, Vitex agnus-castus extract, as well as the hormone estradiol, improved learning and memory in comparison with a control group.24

“Fruits of Vitex agnus-castus have been used in the treatment of many female conditions”, wrote A. Rani and A. Sharma in a recent review. These conditions include: menstrual disorders such as amenorrhea and dysmenorrhea, premenstrual dysphoric disorder (PMDD), insufficiency of the corpus luteum, hyperprolactinemia, disrupted lactation, infertility, acne, menopause, cyclic breast pain, and cyclical mastalgia. Diarrhea, flatulence, and inflammatory conditions are also included.

Vitex agnus-castus seems to hold great potential for an in-depth investigation for various biological activities,” the authors wrote.25

References


  1. He M et al. Fitoterapia. 2016 Dec;115:74-85.
  2. Chen S-N et al. Fitoterapia. 2011;82(4):528-533.
  3. Rafieian-Kopaei M et al. Electronic Physician. 2017;9(1):3685-3689.
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  10. Webster DE et al. J Ethnopharmacol. 2006 Jun 30;106(2):216-21.
  11. Berger D et al. Arch Gynecol Obstet. 2000 Nov;264(3):150-3.
  12. Schellenberg R et al. BMJ. 2001 Jan 20;322(7279):134-7.
  13. Momoeda M et al. Adv Ther. 2014 Mar;31(3):362-73.
  14. He Z et al. Maturitas. 2009 May 20;63(1):99-103.
  15. Zamani M et al. Acta Med Iran. 2012;50(2):101-6.
  16. Lauritzen C et al. Phytomedicine. 1997 Sep;4(3):183-9.
  17. Atmaca M et al. Hum Psychopharmacol. 2003 Apr;18(3):191-5.
  18. Cerqueira RO et al. Arch Womens Ment Health. 2017 Dec;20(6):713-719.
  19. Rafieian-Kopaei M et al. Electron Physician. 2017 Jan 25;9(1):3685-3689.
  20. Halaska M et al. Breast. 1999 Aug;8(4):175-81.
  21. Carmichael AR et al. Evid Based Complement Alternat Med. 2008 Sep;5(3):247-50.
  22. Ambrosini A et al. Acta Neurol Belg. 2013 Mar;113(1):25-9.
  23. Arentz S et al. BMC Complement Altern Med. 2014 Dec 18;14:511.
  24. Allahtavakoli M et al. Basic Clin Neurosci. 2015 Jul;6(3):185-92.
  25. Rani A et al. Pharmacogn Rev. 2013 Jul;7(14):188-98.

What Every Woman Needs to Know About Hormone Replacement

Lorraine Maita, MD

Hormone Replacement Therapy: Safe Solutions for Healthy Aging

Many women fear the onset of menopause. They find the changes in their minds and bodies to be
depressing. Most women gain weight and lose bone, hair, and memory, and their risk for cardiovascular disease increases. They suffer from hot flashes, night sweats, sleep disruption, mood swings, irritability, dry and sagging skin, loss of interest in life, low libido, anxiety, and depression.

The landmark 2002 study Women’s Health Initiative (WHI) initially scared many doctors from prescribing hormone replacement therapy, and women feared taking it. After years of researching the subgroups in this study and analyzing new trials of bioidentical hormone replacement therapy, there is new evidence that hormone replacement therapy can be beneficial.

Menopause Could Speed Up Aging

A research study found that cellular aging increases by an average of 6% in menopause. This seemingly small amount can add up over a lifetime.1,2Sleep disruption can age women faster. Postmenopausal women with five insomnia symptoms were, in another study, almost two years older biologically than women the same chronological age with no insomnia symptoms."3,4

Doubts About Conclusions from the Women’s Health Initiative

The Women’s Health Initiative (WHI) emphasized the risks of hormone replacement therapy. One of the principal investigators in the study describes how the findings were misinterpreted. He discusses that there was no statistically significant harm for either breast cancer or heart attacks for women who began replacement therapy before age 60; therefore, women who abandoned hormone replacement therapy suffered needlessly. They were denied the benefits of relief from hot flashes, night sweats, sleepless nights, dry vagina, and painful intercourse, as well as the decreased risk of bone loss and cardiovascular disease.5 Even long-term use may be safe since other studies did not show an increased overall mortality in an 18-year follow-up of postmenopausal women who received conjugated equine estrogens with medroxyprogesterone acetate for an average of 5.6 years, or conjugated equine estrogens for an average of 7.2 years.6

Problems with the WHI Study

Part of the challenge with the WHI study has been that it only showed increased risk in cases in which estrogens were combined with progestins but the use of unopposed estrogen was not linked to an increased risk of breast cancer. As compared with the WHI hormone formulations, the use of bioidentical estrogen and progesterone was associated with much better protection against breast cancer. The equine estrogens and synthetic progestins used in the WHI study are different in their chemical structures from the natural hormones that are produced in a woman’s body.7 Many studies have revealed that synthetic progestins and bioidentical progesterone have very different effects on tissues; while synthetic progestins may increase estrogen-stimulated breast cell proliferation, progesterone inhibits this activity.8

Also, while progesterone has anti-estrogenic activity in breast tissue, synthetic progestins bind estrogen receptors in breast tissue and show estrogenic properties.8 Finally, synthetic progestins convert weaker estrogens into more potent estrogens, while progesterone has the opposite effect.8 Moreover, transdermal (through the skin) estradiol, a route that avoids the ”first-pass” effect, was as effective as oral formulations, but it was associated with a better safety profile.9 The adverse effects of the synthetic progestin medroxyprogesterone acetate, including its increased risk for breast cancer, stroke, and cognitive dysfunction, have been documented in several studies.10

Further Evidence of the Benefits of Bioidentical Hormone Replacement Therapy

A 2009 Postgraduate Medicine review analyzed whether or not bioidentical hormones are safer or more efficacious than commonly used synthetic versions. Based on physiological data and clinical outcomes, the study concluded that bioidentical hormones are associated with lower risks of breast cancer and cardiovascular disease, and are more efficacious than their synthetic or animal-derived counterparts.8 Many other subsequent studies support these findings.8,11,12,13,14,15,16

The Route of Administration of Hormone Therapy Affects the Risk

Studies in Climacteric found that giving estrogen transdermally decreases the risk of clots, embolisms, strokes, and gallbladder disease. Bioidentical progesterone had positive effects on decreasing blood pressure, clots, and embolisms and even breast cancer – contrary to the synthetic form medroxyprogesterone acetate (MPA). 11 The authors concluded that transdermal estrogen and oral progesterone are better hormone replacement options.12

Estrogen Has Many Health Benefits

The health benefits of hormone replacement therapy are many. Studies showed the benefits of estrogen on memory and executive function.17,18,19 While the greatest benefits occur at a younger age, even women over 65 had improvements.20,21 Bioidentical hormone replacement was also more effective than placebo in preventing depression.13 Coronary artery calcium scores were lower in the group taking hormones and hormone therapy, and mortality rates and the incidence of cardiovascular diseases were reduced.22 One proposed mechanism by which estrogen decreases the risk of cardiovascular disease may be by controlling the outflow of sympathetic and parasympathetic activity.23


Reanalysis of data from clinical trials using age stratification found decreased coronary disease and all-cause mortality in women aged 50-59, without the risk of breast cancer. More risks of some complications, such as osteoporotic fractures, were seen in women who abruptly stopped HRT.14 HRT also significantly decreases the incidence of various symptoms of menopause and the risk of osteoporotic fractures −and it improves quality of life. In younger healthy women (aged 50-60 years), several meta-analyses now consistently show reductions in coronary heart disease (CHD). In addition, the reanalysis of data from the WHI, and additional studies conducted since then, confirm that there is a decrease in cardiovascular diseases and mortality when HRT is initiated soon after menopause.15 The International Menopause Society published its governing principles based on a review of the literature from 2013 onward. In general, they supported individualized treatment, as it is effective for vasomotor symptoms, urogenital atrophy, and improved quality of life.24

Conclusions

It is time to take the fear out of using hormone replacement therapy and to take a look beyond the myths propagated by the flawed conclusions in the Women’s Health Initiative. Subsequent studies have shown a multitude of benefits and less risk when hormones are given to the appropriate population.

About: Lorraine Maita, MD

Lorraine is a recognized and award-winning holistic, functional, and anti-aging physician and author. She transforms people’s lives by getting to the root cause of illness using the best of science and nature. Her approach is personalized— you are treated as the unique individual you are. Her areas of expertise include: bioidentical hormone therapy, weight loss, treating chronic illness, and executive health. Dr. Maita served as Chief Medical Officer and Medical Director for three Fortune 100 companies and is an Advisory Team Member for WOR radio, the #1 news/talk radio station in the New York metropolitan area. She has a private practice in New Jersey, and her website is www.howtoliveyounger.com. She is the author of Vibrance for Life: How to Live Younger and Healthier.

References:

  1. Levine, M et al. 2016 July 25, (113) no. 33 9327–9332 in the PNAS http://www.pnas.org/content/113/33/9327.long
  2. https://www.livescience.com/55536-menopause-aging.html
  3. Carroll, et al. Biological Psychiatry 2016, July 25
  4. http://newsroom.ucla.edu/releases/menopause-sleepless-nights-may-make-women-age-faster
  5. Langer, R et al. Climacteric. 2017 Apr;20(2):91-96.
  6. Manson, J et al. JAMA. 2017;318(10):927-938
  7. Mueck AO Climacteric. 2012 Apr;15 Suppl 1:11-7.
  8. Holtorf, K. Postgrad Med. 2009 Jan;121(1):73-85
  9. Samaras N. Clin Interv Aging. 2014 Jul 23;9:1175-86.
  10. Stanczyk FZ et al. J Steroid Biochem Mol Biol. 2015 Sep;153:151-9.
  11. L'Hermite M Climacteric. 2013 Aug;16 Suppl 1:44-53.
  12. Simon, JA Climacteric. 2012 Apr;15 Suppl 1:3-10
  13. Gordon, JL JAMA Psychiatry. 2018 Jan 10
  14. Lobo, RA et al. Atherosclerosis. 2016 Nov;254:282-290.
  15. Lobo, RA Nat Rev Endocrinol. 2017 Apr;13(4):220-231.
  16. L'Hermite M Maturitas. 2008 Jul-Aug;60(3-4):185-201.
  17. Baskaran C. et al. J Clin Psychiatry. 2017 May;78(5):e490-e497
  18. Maki, PM Maturitas. 2015 Nov;82(3):288-90
  19. Maki, PM et al. Hum Reprod Update. 2009 Nov-Dec;15(6):667-81
  20. Gass, ML Menopause. 2015 Jul;22(7):685-6
  21. Duka, T et al. Psychopharmacology (Berl). 2000 Apr;149(2):129-39.
  22. Arnson Y, Abstract 1176M-05 presented at 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.
  23. Lagranha, C. et al. Life Sci. 2018 Jan 1;192:190-198
  24. Baber, RJ et al. Climacteric. 2016 Apr;19(2):109-50.

Recognizing and Correcting Mitochondrial Dysfunction with Thiamine (B1)

Chandler Marrs, MS, MA, Ph.D.

Mitochondrial damage and dysfunction sit at the nexus of a range of disease processes across the lifespan. Evidence suggests that everything from the metabolic disturbances observed with obesity, cardiovascular disease, and diabetes through the neurodegeneration observed in many of the aged, like Alzheimer’s and dementia, involve distressed mitochondria. The origins of mitochondrial distress are multiple. Genetics plays a role, but so too do a myriad of environmental factors, from poor diet to chemical exposures. Mitochondria, it appears, are uniquely susceptible to epigenetic and environmentally induced damage. Many types of physiological stressors, lifestyle variables, and environmental and pharmaceutical exposures, can trigger symptoms in formerly asymptomatic carriers of mitochondrial DNA (mtDNA) mutations and/or evoke entirely new disease processes in which the primary disease had not been recognized previously.

The Impact of Mitochondrial Dysfunction

Though they were once believed to be rare, we now know that mitochondrial damage and dysfunction are common. By some estimates, as many as 1 in 200 of us carry mutations in the mtDNA. Whether any of those mutations induces illness, however, seems to come down to a number of factors, not just genetics. Nutrition is key among those variables. Nutrients form the backbone of the mitochondrial machinery, determining not just how much cellular energy (ATP) can be derived from diet — perhaps the most critical function of mitochondria — but also how effectively the mitochondria can respond to and clear toxins and manage all of the processes central to these organelles. Among the processes mitochondria control are cell excitability (Ca2+ homeostasis), cell death, steroidogenesis, inflammation and immune function, and reactive oxygen species–caused cellular damage. Quite simply, healthy mitochondria are requisite for a healthy cellular function.

Fatigue: A Hallmark of Mitochondrial Distress

The cardinal symptom of distressed mitochondria is fatigue. Considering the mitochondria’s role in energy production, it makes sense that the physiological response would be reduced energy capacity. As benign as fatigue sounds, however, at the molecular level, fatigue represents something far more damaging, particularly when chronic and unremitting. It suggests that the mitochondria are struggling to maintain basic functions. As one might expect, organ systems that require the most energy, like the central nervous system and the cardiovascular system, take the largest hits, but inasmuch as mitochondria provide energy for every cell, tissue, and organ, no system is left unchallenged.

Recognizing Mitochondrial Distress

The autonomic nervous system is particularly hard hit when the mitochondria are struggling. This results in a sort of autonomic chaos clinically deemed dysautonomia. To the extent that the autonomic system controls all automatic survival functions like heart rate and rhythm, digestion, temperature regulation, electrolyte regulation, sleep-wake cycles, gait and balance, and even mood regulation, disturbances can be quite perplexing. More often than not, the sheer diversity and inconsistency of symptoms lead many physicians to attribute the conditions to psychogenetic origins. They are not. In fact, if someone presents with unremitting fatigue, along with a host of seemingly disparate symptoms, ones that defy diagnostic categories, I would argue that mitochondrial dysfunction ought to be considered. And once one arrives at the mitochondria, diet and nutrients become key drivers.

Mitochondrial Nutrients: What about Thiamine?

One of the more interesting aspects of mitochondrial therapeutics is that successful treatment protocols involve nutrition: supplying the mitochondria with nutrients that facilitate the conversion of food to cellular energy or ATP. In order to get from macronutrients — ingested carbohydrates, proteins, and fats — to ATP, the mitochondria require no less than 22 separate micronutrients: nutrients that are not always available with the modern western diet, may be blocked by medications, and/or are unabsorbable due to faulty genetic machinery.

A growing body of research shows just how important these nutrients are to the mitochondria and to your health. The most researched nutrients include many of the B vitamins, Coenzyme Q10, and magnesium. Among these, thiamine (thiamin, vitamin B1) may be the most important. Thiamine sits atop the pyruvate pathway and is critical for the multiple enzymes involved in the conversion of dietary carbohydrates into ATP. It is also involved in fatty acid oxidation (alpha oxidation in the peroxisomes), linking thiamine to myelination and other critical lipid dependent processes. Diminished thiamine, thus, results not only in diminished cellular fuel and fatigue, but also a myriad of other reactions that ultimately result in ill health.

Thiamine insufficiency and frank deficiency has become increasingly common in western countries where high-calorie, low-nutrient diets and chronic medication use pervade. Dietary insufficiency effectively starves the mitochondria of critical nutrients, while medications further tax the already distressed organelles and increase the need for additional nutrients. The endless feed-forward loop of deleterious compensatory reactions forms the backbone of modern disease: increased inflammation, altered immune response, and disturbed metabolism. That these disease processes emanate from distressed mitochondria suggests that if we were to heal or at least support the mitochondria, many of these symptoms would dissipate. Research bears this out. Dietary and lifestyle changes, along with the therapeutic use of nutrient supplements, particularly thiamine, can unwind a wide variety of complex — and, often seemingly intractable — health issues. It would seem prudent, then, that health ought to begin with the mitochondria.

About: Chandler Marrs, MS, MA, Ph.D., is an accomplished researcher and writer with hundreds of articles on a diverse range of topics to her credit. Her company, Lucine Health Sciences, conducts direct-to-patient research on adverse reactions to medications and publishes an online health journal called Hormones Matter. Most recently, Dr. Marrs, along with renowned thiamine expert, Derrick Lonsdale, co-authored the seminal textbook on thiamine deficiency: Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition.

Acne and Diet: Does Carb Intake Play a Role?

Acne is often a concern among adolescents, teenagers and, increasingly, adults — particularly women. While this chronic inflammatory condition associated with oily skin may not last a lifetime, acne pustules and cysts can leave red marks and mild to deep pitting that, unless treated, can be carried into old age.

A Historical Look

While acne sufferers in the past were advised they’d “grow out of it,” modern dermatology has several effective therapies, ranging from topical medications that target sebum or the bacteria that colonize or infect the skin, to hormonal therapies such as oral contraceptives. For stubborn cases, isotretinoin (Accutane), an orally administered vitamin A derivative, is very effective at reducing the production of sebum that leads to acne but has side effects that can be severe, including an elevated risk of birth defects if used by pregnant women.

During the 1960s and 1970s, the consumption of chocolate and greasy foods was believed to contribute to acne. It was subsequently determined that acne has a genetic cause and the possibility of any relationship of diet to the disease was prematurely discarded.

“The prevalence of adult acne in the US appears to be increasing over the last few decades,” Shereen. N. Mahmood, MD, and Whitney. P. Bowe, MD, observe in a recent review. “We are well aware that genetics can strongly influence a patient's risk of developing acne. However, significant changes in germline genetic variants are unlikely to have occurred over the last 20 years.”1

Although acne in one’s teens is usually at its worst among males as opposed to females (which is blamed on the onset of high levels of androgenic hormones that play a strong role in the disease), acne often continues into adulthood in women, or can make its first appearance then.2

Acne and Carbohydrate Metabolism

While a condition characterized by polycystic ovaries and infertility in women was described in 1935 by Irving F. Stein, Sr. and Michael L. Leventhal, formal diagnostic criteria for the condition now known as polycystic ovary syndrome (PCOS) were not proposed until the 1990s at a National Institute of Health sponsored conference. “It is now accepted that it is multifactorial, partly genetic; however, a number of candidate genes have been postulated,” write Dorota Szydlarska and colleagues in 2017. “Insulin resistance has been noted consistently among many women with PCOS, especially in those with hyperandrogenism, but it is not included in any of the diagnostic criteria. Now there is strong evidence that cardiovascular disease risk factors and disturbances in carbohydrate metabolism are all increased in patients with PCOS compared to the healthy population.”3

Polycystic ovary syndrome is characterized by multiple ovarian cysts, irregular menstrual periods, infertility, obesity, insulin resistance, hirsutism, scalp hair loss, acanthosis nigricans, and acne. However, PCOS may be a misnomer. A significant percentage of women who appear to have the condition have normal-looking ovaries. And while obesity has been hypothesized as a driver of the condition, lean women also have PCOS. Nevertheless, obesity and/or insulin resistance are closely involved with the condition, although researchers aren’t sure whether they are a cause or an effect.

In an article titled, “Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle,” B. C. Melnik notes that acne vulgaris is primarily a disease of wealthy countries and is more prevalent in developed than in developing countries. The article states that “No acne has been found in non-Westernized populations still living under Paleolithic dietary conditions constraining hyperglycemic carbohydrates, milk, and dairy products”. It further explains that Western diets over-activate mTORC1, “the key conductor of metabolism”, and that increased mTORC1 signaling is a “characteristic feature of insulin resistance, obesity, type 2 diabetes mellitus, cancer, and neurodegenerative diseases”.4

In 2007, a trial reported in the American Journal of Clinical Nutrition reported a reduction in total acne lesion counts and improved insulin sensitivity among male acne sufferers assigned to low glycemic load diets for 12 weeks days in comparison with participants who were assigned to consume carbohydrate-dense foods.5 And in a study involving 64 New York residents among whom half had moderate to severe acne, it was found that acne patients had a greater total carbohydrate, available carbohydrate, percent energy from carbohydrate and glycemic load intake compared to those without the disease.6 The acne group also had higher insulin and insulin-like growth factor-1 levels, and increased insulin resistance.

The increase in glucose and consequent rise in insulin among individuals who consume high amounts of carbohydrates can increase the production of testosterone in the ovaries, which causes acne and other PCOS symptoms. In addition to avoiding the consumption of excessive carbohydrates by following a low glycemic index diet, acne sufferers may also wish to avoid foods that contain significant amounts of testosterone or its metabolite dihydrotestosterone. According to dermatologist Norman Orentreich, MD, these include wheat germ, peanut and corn oils.

In 137 women with PCOS who had menstrual abnormalities and/or acne and/or mild hirsutism and insulin resistance, supplementation with myo-inositol or D-chiro-inositol helped regulate their menstrual cycles and improved acne, endocrine and metabolic parameters, and insulin resistance.7 Another trial, which investigated the effects of daily chromium supplementation in women with PCOS, found a significant decrease in the prevalence of acne and other PCOS characteristics in women who received the mineral compared with a placebo group.8 And in a 10-week randomized trial involving 45 participants with mild to moderate acne, there was a reduction in inflammatory and noninflammatory acne lesions in association with supplementation with the omega 3 fatty acids EPA and DHA, as well as the omega 6 fatty acid GLA, in comparison with a control group.9

Although iodine is an essential mineral, prolonged intake of high doses can result in acne in those who are predisposed. Acne sufferers are advised to stick to the current recommended daily allowance of iodine if they find that higher amounts aggravate their condition.

Diet and Acne

“Does diet really affect acne?” H. R. Ferdowsian and S. Levin ask in a recent view. “Prospective studies, including randomized controlled trials, demonstrated a positive association between a high-glycemic-load diet, hormonal mediators, and acne risk. Based on these findings, there exists convincing data supporting the role of dairy products and high-glycemic-index foods in influencing hormonal and inflammatory factors, which can increase acne prevalence and severity.”10

While we can’t do anything (yet) about genetic predispositions, following a low glycemic index diet designed to minimize spikes in glucose and insulin could go a long way toward reducing acne as well as overweight and obesity, hypoglycemia and diabetes, and other conditions associated with insulin resistance.

References

  1. Mahmood SN et al. J Drugs Dermatol. 2014 Apr;13(4):428-35.
  2. Dréno B et al. J Eur Acad Dermatol Venereol. 2015 Jun;29(6):1096-106.
  3. Szydlarska D et al. Adv Clin Exp Med. 2017 May-Jun;26(3):555-558.
  4. Melnik BC. Clin Dermatol. 2018 Jan - Feb;36(1):29-40.
  5. Smith R et al. Am J Clin Nutr. 2007 Jul;86(1):107-15.
  6. Burris J et al. J Acad Nutr Diet. 2017 Sep;117(9):1375-1383.
  7. Formuso C et al. Minerva Ginecol. 2015 Aug;67(4):321-5.
  8. Jamilian M et al. Biol Trace Elem Res. 2016 Jul;172(1):72-8.
  9. Jung JY et al. Acta Derm Venereol. 2014 Sep;94(5):521-5.
  10. Ferdowsian HR et al. Skin Therapy Lett. 2010 Mar;15(3):1-2, 5.

Snacking 101: What Should We Snack on, and When?

Jill Weisenberger, MS, RDN, CDE, CHWC, FAND

Is it a good time for a snack? Patients often ask what time they should snack and what makes a good snack. The short answer to these questions: Snack when you’re hungry if a meal is some time away, and choose the foods lacking in your diet.

Why Snack?

If your calorie needs are high, you’ll probably need to snack at least a couple of times each day to fit in enough food. Otherwise, maybe just once, or perhaps not at all. Healthy adults rarely need to eat between meals for good health or weight loss, but there may still be good reasons to do so.

If you’re snacking to boost your metabolic rate, it’s time to rethink that strategy. While it is true that you burn a bit more calories to digest, absorb, and assimilate food and nutrients, eating frequently does not keep your metabolic rate humming, as many diet books suggest. The jump in metabolic rate with eating — called the thermic effect of food — is influenced by what you eat, not by how often you eat. In other words, over 24 hours, the extra calories burned from eating are similar if you eat a day’s worth of food in three meals or if you eat those same foods over three meals and multiple snacks.[i]

When it comes to appetite, the results are a bit murky. One review of several studies found a slight benefit to managing hunger when people ate six meals per day instead of just three. It was also found that eating less than three times daily is more likely to leave you hungry.[ii] You, however, should expect your experience to be unique, and it will probably vary from day-to-day depending on your activity level, food choices, and more.

Even though researchers have hunted for the ideal pattern of eating frequency, they haven’t found one[iii] because there probably isn’t one (no “one size fits all”).

Snacking in the Morning

You’ll benefit from a morning snack if breakfast and lunch are several hours apart. If you’re hungry shortly after breakfast, revamping your morning meal may be more important than planning a snack. Instead of racing out the door with nothing more than a banana or a cup of yogurt, eat a balanced breakfast of at least three food groups. Pair the banana and yogurt together and add some walnuts, for example. Or make an egg sandwich with tomato and avocado on whole grain bread. If you’re the kind who can’t stand much food early in the morning, start with a small snack such as a piece of fruit. Eat your real breakfast later when your stomach is more eager.

Snacking in the Afternoon

I get pretty hungry between my midday lunch and dinner several hours later! So an afternoon snack is more the norm than the exception. I prefer to eat when I get hungry, but sometimes that’s not practical. I might eat earlier to prevent that crazy, painful hunger later on.

Pulling yourself out of an afternoon slump is not a good reason to snack. If you crave a mid-afternoon nap, try to figure out why and think of a few possible solutions. Any of these could be the problem.

· Not enough sleep

· Less caffeine than usual

· Skimpy lunch or poorly balanced lunch

· Boredom

· Inactivity

· Lack of sunlight

Snacking After Dinner

Most of us won’t need an evening snack unless we eat dinner very early. But do snack to replenish a tough evening workout. Moderate exercisers can probably skip a bedtime nosh, but those who train hard should eat, especially if their calorie needs are high. Make yourself a Greek yogurt and frozen fruit smoothie to get the necessary carbohydrates and protein to repair your muscles. One caveat about evening snacking: If you experience heartburn or reflux, finish eating at least three hours before going to bed.

Make a Snack List

Unless you’re very active, your snacks should range from about 100 to 250 calories each. Athletes may need much more. The favorite snacks in North America are chips, chocolate, cheese, and cookies, according to a Nielsen report.[iv] Yet the Dietary Guidelines for Americans identifies fruits, vegetables, and dairy as the most under-consumed food groups.[v] It’s smart to create a list of 5 to 10 snacks to have on hand. This ensures you’ll choose a healthful option when hunger strikes. Your own ideas are probably better, but here are some to get you started.

· Low-fat cottage cheese with whole grain crackers

· Raw vegetables dipped in hummus

· Yogurt and fruit

· Peanut butter and apple slices

· Hard-boiled egg and tomato slices

· Handful of nuts

· Any fresh, frozen, or canned fruit without added sugar

· Whole grain toast with mashed avocado and thinly sliced tomatoes and red onion

Snacking is a popular pastime. Let’s avoid snacking for recreation and stick to snacking to manage hunger and to nourish our bodies. The quality of your food and your total calorie intake are more important than the number of times you eat each day.

About: Jill Weisenberger, MS, RDN, CDE, CHWC, FAND is an internationally recognized nutrition and diabetes expert. Through writing, speaking, one-on-one coaching and working with the media, Jill empowers people to grab control of their health. She is the author of the four books including the best-selling Diabetes Weight Loss – Week by Week and the new Prediabetes: A Complete Guide. Jill has a private practice in Newport News, VA and is a consultant and spokesperson to the food industry, as well as a panelist for the US News & World Report Best Diet Rankings. She is contributing editor to Diabetic Living magazine and a contributor to a variety of magazines and websites, including Kids Eat Right, Environmental Nutrition and Food & Nutrition magazine.

Find out more at jillweisenberger.com and follow her on Twitter and Facebook.

References:

[i] Bellisle F, McDevitt R, Prentice AM. Meal frequency and energy balance. Br J Nutr. 1997; 77(suppl 1):S57-70. http://www.ncbi.nlm.nih.gov/pubmed/9155494.

[ii] Leidy HJ, Campbell WW. The effect of eating frequency on appetite control and food intake: brief synopsis of controlled feeding studies. J Nutr. 2011; 141(1):154-7. doi: 10.3945/jn.109.114389.

[iii] McCrory MA, Campbell WW. Effects of eating frequency, snacking, and breakfast skipping on energy regulation: symposium overview. J Nutr. 2011; 141(1):144-7. doi: 10.3945/jn.109.114918.

[iv] The Nielsen Company. Global consumers nibble, nosh and snack their way to big sales. Nielsen website. http://www.nielsen.com/us/en/insights/news/2014/global-consumers-nibble-nosh-and-snack-their-way-to-big-sales.html. Updated September 30, 2014.

[v] U.S. Department of Agriculture and U.S. Department of Health and Human Services. 2015–2020 Dietary Guidelines for Americans. 8th Edition. Washington, DC: US Government Printing Office; December 2015.

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