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