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Black Cohosh

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1.What are the historical uses of black cohosh? ... Common names: black snakeroot, macrotys, bugbane, bugwort, rattleroot, rattleweed. Root is black in color ... – PowerPoint PPT presentation

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Title: Black Cohosh


1
Black Cohosh
By Stephanie Russell
2
Overview
  • Background Info.
  • Historical Uses
  • Reported Benefits
  • Phytoestrogens
  • Estrogenic effects
  • Research
  • Harmful effects
  • Conclusion

3
Learning Objectives
  • 1.What are the historical uses of black cohosh?
  • 2. Name the common symptoms associated with
    menopause.
  • 3. What are the physiological changes that occur
    during menopause?
  • 4. What are phytoestrogens? What specific foods
    are they found in?

4
Learning Objectives
  • 5. What does current research say about the
    possibility that the isoflavone formononetin is
    found in black cohosh?
  • 6. What are some of the potential side
    effects/warnings that should be considered before
    using black cohosh?

5
Background Information
  • Belongs to the buttercup family
  • Latin names Actaea racemosa, Cimicifuga
    racemosa
  • Common names black snakeroot, macrotys, bugbane,
    bugwort, rattleroot, rattleweed
  • Root is black in color when harvested from the
    wild
  • Cohosh Algonquin Indian word meaning rough -
    refers to the plants gnarly root structure

6
Background Information
  • Shrub-like Plant
  • Native to eastern deciduous forests of North
    America
  • Flowers of plant have a strong odor, which acts
    as an insect repellant (bugbane)

7
Background Info.
  • Underground Root/rhizome
  • Used to make tea
  • Liquid Extracts
  • Pills/Capsules
  • Sold as a dietary supplement in U.S.

8
Notable Ingredients
  • Triterpene Glycosides
  • actein related compounds, cimigoside
  • Other ingredients
  • tannins, fatty acids, phytoesterols
  • Isoflavones
  • formononetin
  • very controversial

9
Historical Uses
  • Native Americans
  • Ceremonial treatment of snakebites
  • Rheumatism
  • Kidney Disease
  • Respiratory Illnesses
  • Skin Problems
  • Used root to make a tonic
  • Poultices were made by pounding leaves

10
Historical Uses
  • 19th Century American Physicians
  • Fever
  • Menstrual Cramps
  • Arthritis
  • Insomnia

11
Reported Benefits
  • Treat menopause symptoms
  • Hot Flashes
  • Night Sweats
  • Vaginal Dryness
  • Bone Loss
  • Mood Swings
  • Rheumatoid Arthritis
  • Premenstrual Syndrome

12
Other Reported Benefits...
  • Asthma
  • Back Pain
  • Muscle Spasms
  • Sleep Disorders
  • Depression
  • Induce labor
  • Diarrhea
  • Dizziness
  • Edema
  • Fever
  • High Blood Pressure

13
Menopause
  • Natural process that occurs in women
  • Marked by cessation of menstrual cycle
  • Physiological changes occur
  • Decreased production of estrogen/progesterone
  • Higher levels of luteinizing hormone/follicle-stim
    ulating hormone
  • In some women, these hormonal imbalances cause
    undesirable symptoms (climacteric)
  • LH/FSH oppose the action of estrogen
  • If high levels of LH/FSH low levels of estrogen

14
Hormone Therapy
  • Until recent years, was the gold standard
    treatment for symptoms associated with menopause
  • Uses estrogen, progesterone, or combination of
    both to increase hormone levels
  • Due to recent safety concerns, many women are
    seeking alternative remedies
  • Increases risk for stroke, breast cancer, heart
    attack, blood clots, gall bladder disease

15
Alternative remedies forsymptoms of menopuse
  • Phytoestrogens
  • Plant-derived compounds w/ weak estrogenic
    activity - similar in structure to estrogen
  • isoflavones, lignans, coumestans
  • found in legumes, soybeans, vegetables, cereals
  • Isoflavones (found in soy)
  • genistein, daidzein (most studies)
  • can bind to estrogen receptors
  • may enhance estrogens beneficial effects, or
    block negative effects

16
Structures
Estradiol (major estrogen in humans)
Genistein
17
(No Transcript)
18
Estrogenic effects ofBlack Cohosh
  • Is black cohosh estrogenic?
  • Evidence is conflicting
  • formononetin - estrogenic isoflavone
  • mainly found in red clover - some in soy
  • some research suggests it is a constituent of
    Black Cohosh
  • recent studies say it is not
  • older studies may have been compromised by
    adulteration of plant materials, or
    misidentification of formononetin
  • has not been found in commercial extracts

19
Estrogenic effects ofBlack Cohosh
  • Suppresses secretion of luteinizing hormone
  • Studies are conflicting
  • No single chemical component has been identified
    for this action
  • Possibly through synergetic effect of several
    chemical fractions

20
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric SymptomsOsmers, Ruediger
MD, PhD Friede, Michael PhD Liske, Eckehard
PhD Schnitker, Joerg PhD Freudenstein, Johannes
PhD Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
  • Objective To compare the efficacy and
    tolerability of the isopropanolic black cohosh
    extract in the treatment of climacteric
    complaints compared with placebo.
  • Methods Randomized, double-blind clinical trial.
    304 patients randomly allocated to receive
    tablets of 40mg drug, or matching placebo daily
    for 12 weeks.
  • Drug contained 2.5mg isopropanolic extract
    corresponding to 20mg root stock
  • Placebo corresponded to the active medication
    w/out isopropanolic extract

21
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric SymptomsOsmers, Ruediger
MD, PhD Friede, Michael PhD Liske, Eckehard
PhD Schnitker, Joerg PhD Freudenstein, Johannes
PhD Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
  • Inclusion criteria
  • Postmenopausal women (12 months since last
    regular menstruation), or 6 months since the
    last regular menstruation plus FSH 50 U/L
  • 45 years and older
  • Climacteric complaints as defined by menopause
    rating scale (MRS) - 0.4 in at least 3 items
  • MRS is used to measure intensity of menopausal
    symptoms Includes 10 items, each ranging from 0
    (no complaints), to 1 (severe symptoms), in
    increments of 0.1

22
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric SymptomsOsmers, Ruediger
MD, PhD Friede, Michael PhD Liske, Eckehard
PhD Schnitker, Joerg PhD Freudenstein, Johannes
PhD Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
  • Exclusion Criteria
  • Cancer - diseases that could interfere w/ the
    assessment of climacteric symptoms
  • Drug abuse
  • Women taking hormone replacement therapy
  • Women taking supplements such as soy/red clover

23
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric SymptomsOsmers, Ruediger
MD, PhD Friede, Michael PhD Liske, Eckehard
PhD Schnitker, Joerg PhD Freudenstein, Johannes
PhD Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
  • Clinical examinations and interviews were
    performed before treatment began, and 4, 12 weeks
    after
  • Intensity of symptoms were assessed according to
    MRS ratings

24
Efficacy and Safety of Isopropanolic Black Cohosh
Extract for Climacteric SymptomsOsmers, Ruediger
MD, PhD Friede, Michael PhD Liske, Eckehard
PhD Schnitker, Joerg PhD Freudenstein, Johannes
PhD Henneicke-von Zepelin, Hans-Heinrich PhD
Volume 105(5, part1) May 2005, pp1074-1083
  • Findings
  • The isopropanolic black cohosh extract was more
    effective than placebo
  • Difference was 0.03-0.05 on MRS units
  • Hot flashes, atrophy, and psyche decreased
    statistically significantly in the Black Cohosh
    extract compared w/ placebo
  • Most effective in relieving symptoms in early
    climacteric women

25
Effects of black cohosh on bone turnover,
vaginal mucosa, and various blood parameters in
postmenopausal womenWuttke, Wolfgang MD Gorkow,
Christoph DVM Seidlova-Wuttke, Dana MD The
North American Menopause Society 13(2) April
2006 pp 185-196
  • Objective To analyze the effects of Cimicifuga
    racemosa (CR) preparation on markers of bone
    metabolism, hormones, sex hormone-binding
    globulin, lipometabolism, and vaginal maturity
  • Design Double blind, placebo-controlled, and
    conjugated estrogens (CE) controlled study.
    Included 62 postmenopausal women given a daily
    dose of 40mg herbal drug(CR), 0.6mg CE, or
    placebo for 12 weeks.

26
Effects of black cohosh on bone turnover, vaginal
mucosa, and various blood parameters in
postmenopausal womenWuttke, Wolfgang MD Gorkow,
Christoph DVM Seidlova-Wuttke, Dana MD The
North American Menopause Society 13(2) April
2006 pp 185-196
  • Inclusion Criteria
  • Postmenopausal, aged 40-60 years
  • Last menstrual bleeding 6 months ago
  • Postmenopausal hormone values (E2 25mU/mL) baseline and wk 2
  • at least 3 hot flashes/day
  • Sum score of MRS 1.7 at wk 2 and baseline, sum
    scores of MRS item 1 (hot flashes) 0.3 at wk 2
    and baseline

27
Effects of black cohosh on bone turnover, vaginal
mucosa, and various blood parameters in
postmenopausal womenWuttke, Wolfgang MD Gorkow,
Christoph DVM Seidlova-Wuttke, Dana MD The
North American Menopause Society 13(2) April
2006 pp 185-196
  • Exclusion criteria
  • Hysterectomy
  • Endometriosis
  • Current treatment w/ estrogenic substances
  • Alcohol/drug abuse
  • hypertriglyceridemia or hypercholesterolemia

28
Effects of black cohosh on bone turnover, vaginal
mucosa, and various blood parameters in
postmenopausal womenWuttke, Wolfgang MD Gorkow,
Christoph DVM Seidlova-Wuttke, Dana MD The
North American Menopause Society 13(2) April
2006 pp 185-196
  • Methods of assessment
  • Markers of bone turnover, estradiol, FSH, LH,
    SHBG, triglycerides, total cholesterol, high
    density cholesterol, low-density cholesterol, and
    routine clinical chemistry parameters were
    determined from blood samples.
  • Vaginal maturity index was determined from
    vaginal smears
  • Configured by counting 500 cells and calculating
    the of parabasal, intermediary, and superficial
    cells

29
Effects of black cohosh on bone turnover, vaginal
mucosa, and various blood parameters in
postmenopausal womenWuttke, Wolfgang MD Gorkow,
Christoph DVM Seidlova-Wuttke, Dana MD The
North American Menopause Society 13(2) April
2006 pp 185-196
  • Results CR has estrogen-like effects on vaginal
    mucosa (increased number of superficial cells)
  • Not as strong of an effect as CE, but
    significantly higher than placebo
  • CR has beneficial bone-remodeling effects
  • At wk 12, markers for bone formation
    significantly increased in CR group, compared w/
    placebo
  • Conclusion CR has beneficial effects on
    climacteric symptoms - beneficial bone remodeling
    and weak estrogenic-like effects on the vaginal
    mucosa

30
Harmful Effects
  • Liver Toxicity
  • 1 case of acute liver failure
  • 2 cases of hepatitis
  • Other cases reported in people using multiple
    herbal remedies
  • No scientific research to support these claims
  • General side effects
  • Nausea, vomiting, dizziness, stomach discomfort
  • Not recommended for use during pregnancy or
    breastfeeding
  • Do not take with ER therapy
  • No noted drug interactions

31
Conclusion
  • Black Cohosh may be a relatively safe/effective
    alternative to HR therapy, but dosage/duration
    should be monitored by physician to avoid
    potential harmful effects
  • However, more studies are needed to understand
    the active components, and mechanisms of action
    responsible for the beneficial effects on
    menopausal symptoms.

32
References
  • The American College of Obstetricians and
    Gynecologists Volume 1.5 (5, part 1), May 2005,
    pp 1074-1083
  • The North American Menopause Society Volume 11
    (5), September/October 2004, pp 575-577
  • The Medical Journal of Australia Volume 177 (8)
    2002 pp 440-443
  • http//www.womenshealth.gov
  • U.S. Department of Health and Human Services
  • http//www.nccam.nih.gov/health/blackcohosh/
  • The North American Menopause Society volume 13
    (2), March/April 2006 pp 185-196
  • http//www.health-care-beauty.com/Amerifit-Estrove
    n-Extra-Strength-60-Caplets-B00014FUTQ.htm
  • http//www.bodyandfitness.com/Information/Herbal/R
    esearch/black.htm
  • http//www.holisticonline.com/Herbal-Med/_Herbs/h3
    2.htm
  • http//www.allnatural.net/herbpages/black-cohosh.s
    html
  • http//www.drugdigest.org/DD/PrintablePages/herbMo
    nograph/0,11475,4079,00.html
  • http//www.healthcentral.com/peoplepharmacy/408/20
    554.html
  • http//ods.od.nih.gov/factsheets/BlackCohosh.asp

33
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