Tag Archives: Archives of Internal Medicine

Scrophularia nodosa

Botanical Name : Scrophularia nodosa
Family: Scrophulariaceae
Genus: Scrophularia
Species: S. nodosa
Kingdom: Plantae
Order: Lamiales

Common Names: Figwort, Woodland figwort, and Common figwort, Knotted Figwort.

Habitat : Scrophularia nodosa is native to Europe, incl Britain, south and east from Norway to Spain and temperate Asia to the Yensei region. It grows on damp ground in woods, hedgebanks, by streams etc. An occasional garden weed.

Description:
Scrophularia nodosa is a perennial herbaceous plant. It grows upright, with thick, sharply square, succulent stems up to 150 cm tall from a horizontal rootstock. Its leaves are opposite, ovate at the base and lanceolate at the tip, all having toothed margins. It is in flower from Jun to September, and the seeds ripen from Jul to September. The flowers are in loose cymes in oblong or pyramidal panicles. The individual flowers are globular, with five green sepals encircling green or purple petals, giving way to an egg-shaped seed capsule.

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Cultivation :
Succeeds in most moist to wet soils in full sun or partial shade. Plants are hardy to at least -15°c

Propagation :
Seed – sow spring or autumn in a cold frame. When they are large enough to handle, prick the seedlings out into individual pots and plant them out in the summer. If you have sufficient seed then it can be sown outdoors in situ in the autumn or the spring. Division in spring. Larger divisions can be planted out direct into their permanent positions. We have found it best to pot up the smaller divisions and grow them on in a lightly shaded position in a cold frame, planting them out once they are well established in the summer.

Edible Uses: Root – cooked. It smells and tastes unpleasant, but has been used in times of famine. There must be some doubts about the edibility of this root.

Medicinal Uses:
Scrophularia nodosa is a plant that supports detoxification of the body and it may be used as a treatment for various kinds of skin disorders. The whole plant is alterative, anodyne, anti-inflammatory, diuretic, mildly purgative and stimulant. It is harvested as the plant comes into flower in the summer and can be dried for later use. A decoction is applied externally to sprains, swellings, burns, inflammations etc, and is said to be useful in treating chronic skin diseases, scrofulous sores and gangrene. The leaves can also be applied fresh or be made into an ointment. Internally, the plant is used in the treatment of chronic skin diseases (such as eczema, psoriasis and pruritis), mastitis, swollen lymph nodes and poor circulation. It should not be prescribed for patients with heart conditions. The root is anthelmintic

Powerful medicines whenever enlarged glands are present including nodosities in the breasts. Figwort is used to cleanse and purify the body. Figwort is used to treat skin diseases such as eczema, acne and psoriasis. It has been called the Scrofula Plant, on account of its value in all cutaneous eruptions, abscesses, wounds, etc., the name of the genus being derived from that of the disease for which it was formerly considered a specific (tuberculosis of the lymph glands in the neck). It has diuretic and anodyne properties. A decoction is made of it for external use and the fresh leaves are also made into an ointment. Of the different kinds of Figwort used, this species is most employed, principally as a fomentation for sprains, swellings, inflammations, wounds and diseased parts, especially in scrofulous sores and gangrene. The leaves simply bruised are employed as an application to burns and swellings. Figwort is used for lingering and congenital illnesses of the lymphatic system and the skin. It has a stimulating and strengthening effect on the bladder and kidneys. The glycosides it contains make it suitable for treating mild heart conditions that call for stimulating the metabolism and eliminating water retention in the body. For this purpose, use figwort as a tea or tincture.

The herb and root have been used to treat cancer of the fleshy parts. The powdered root in water has been used as a tea to treat condyloma. The juice of the root and leaf are applied externally to tumors and cancers. The ointment treats painful tumors, and the fresh poultice may be used for inflamed tumors and glandular indurations. When figwort is used externally, the tea is also given internally as further therapeutic support. In traditional Chinese medicine, Figwort (S. ningpoensis) is a standard remedy. Because of its ability to stimulate the pancreas, it is used in the treatment of diabetes Known as huyen sam or xuan shen, it is also a remedy for fever and sadness, swellings and pain of the throat, furuncles, and to aid digestion.

A decoction of the herb has been successfully used as a cure for the scab in swine. Cattle, as a rule, will refuse to eat the leaves, as they are bitter, acrid and nauseating, producing purging and vomiting if chewed.

Folklore:
The plant was thought, by the doctrine of signatures to be able to cure the throat disease scrofula because of the throat-like shape of its flowers.

Known Hazards: Avoid in patients with ventricular tachycardia (increased heart rate). Lack of toxicological data excludes use during pregnancy .

Disclaimer : The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplement, it is always advisable to consult with your own health care provider.

Resources:
https://en.wikipedia.org/wiki/Scrophularia_nodosa
http://www.herbnet.com/Herb%20Uses_FGH.htm
http://www.pfaf.org/user/Plant.aspx?LatinName=Scrophularia+nodosa

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Want to live longer? Try Vitamin D

Writing in the journal Clinical Endocrinology, scientists from the Netherlands, Austria, and the U.S. report that low blood levels of the sunshine vitamin are associated with increased risk of all-cause mortality, and mortality from heart disease, in the elderly. The research follows hot on the heels of similar findings published in Nutrition Research and in the Archives of Internal Medicine.
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The new study used data from 614 people participating in the Hoorn Study, a prospective population-based study with men and women with an average age of 69.8. Blood levels of 25(OH)D were measured at the start of the study. After an average of six years of follow-up, 51 deaths had been documented, 20 of which were due to cardiovascular health.

People with the lowest average vitamin D levels were found to be at a 124 and 378 percent increased risk of all-cause mortality and cardiovascular mortality, respectively.

Commenting on the potential mechanism, the researchers note:
“Apart from the maintenance of muscular and skeletal health, vitamin D may also protect against cancer, infections, autoimmune and vascular diseases, suggesting that vitamin D deficiency might contribute to a reduced life expectancy.”

Adults with lower blood levels of vitamin D may also be more likely to die from heart disease or stroke. Scientists in Finland compared blood levels of vitamin D, and deaths from heart disease or stroke over time in more than 6,000 people. Those with the lowest vitamin D levels had a 25 percent higher risk of dying from heart disease or stroke.

In addition, in a study of 166 women undergoing treatment for breast cancer, nearly 70 percent had low levels of vitamin D in their blood, according to a study presented at the American Society of Clinical Oncology’s Breast Cancer Symposium. The analysis showed women with late-stage disease and non-Caucasian women had even lower levels.

Said Luke Peppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester’s James P. Wilmot Cancer Center:

“Vitamin D is essential to maintaining bone health and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It’s important for women and their doctors to work together to boost their vitamin D intake.”

Resources:
NUTRAIngredients.com November 3, 2009
Reuters October 29, 2009
University Rochester Medical Center October 9, 2009
Clinical Endocrinology November 2009, Volume 71, Issue 5, Pages: 666-672
American Society of Clinical Oncology’s Breast Cancer Symposium, San Francisco, CA October 8, 2009

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Better to Be Fat and Fit Than Skinny and Unfit

Silhouettes representing healthy, overweight, ...Image via Wikipedia

Is a person’s weight really a reliable indicator of overall health?

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Some medical research is showing that it isn’t. Last week a report in The Archives of Internal Medicine compared weight and cardiovascular risk factors among a representative sample of more than 5,400 adults. Half of the overweight people and one-third of obese people in the study were “metabolically healthy.” That means that many overweight and obese adults may have healthy levels of “good” cholesterol, blood pressure, and blood glucose.

At the same time, about one out of four slim people in the study actually had at least two cardiovascular risk factors typically associated with obesity.

Being overweight or obese is definitely linked with numerous health problems. Nonetheless, researchers found the proportion of overweight and obese people who are metabolically healthy surprising.

Several studies have shown that fitness, as determined by how a person performs on a treadmill, is a far better indicator of health than body mass index. Some research has indicated that people who are fat but can still keep up on treadmill tests have much lower heart risk than people who are slim and unfit.

Sources:
New York Times August 18, 2008
Archives of Internal Medicine August, 2008; 168(15):1617-1624.

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Glucosamine

GlucosamineImage viaOther names: glucosamine sulfate, glucosamine sulphate, glucosamine hydrochloride, N-acetyl glucosamine, chitosamine

Definition:
Glucosamine (C6H13NO5) is an amino sugar and a prominent precursor in the biochemical synthesis of glycosylated proteins and lipids. A type of glucosamine forms chitin, which composes the exoskeletons of crustaceans and other arthropods, cell walls in fungi and many higher organisms. Glucosamine is one of the most abundant monosaccharides. It is produced commercially by the hydrolysis of crustacean exoskeletons or, less commonly and more expensive to the consumer, by fermentation of a grain such as corn or wheat. Glucosamine is commonly used as a treatment for osteoarthritis, although its acceptance as a medical therapy varies.

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Glucosamine is a compound found naturally in the body, made from glucose and the amino acid glutamine. Glucosamine is needed to produce glycosaminoglycan, a molecule used in the formation and repair of cartilage and other body tissues. Production of glucosamine slows with age.

Glucosamine is available as a nutritional supplement in health food stores and many drug stores. Glucosamine supplements are manufactured in a laboratory from chitin, a substance found in the shells of shrimp, crab, lobster, and other sea creatures. In additional to nutritional supplements, glucosamine is also used in sports drinks and in cosmetics.

Glucosamine is often combined with chondroitin sulfate, a molecule naturally present in cartilage. Chondroitin gives cartilage elasticity and is believed to prevent the destruction of cartilage by enzymes. Glucosamine is sometimes combined with methylsulfonylmethane, or MSM, in nutritional supplements.

Biochemistry:
Glucosamine was first identified in 1876 by Dr. Georg Ledderhose, but the stereochemistry was not fully defined until 1939 by the work of Walter Haworth.[1] D-Glucosamine is made naturally in the form of glucosamine-6-phosphate, and is the biochemical precursor of all nitrogen-containing sugars.   Specifically, glucosamine-6-phosphate is synthesized from fructose-6-phosphate and glutamine[3] as the first step of the hexosamine biosynthesis pathway.[4] The end-product of this pathway is UDP-N-acetylglucosamine (UDP-GlcNAc), which is then used for making glycosaminoglycans, proteoglycans, and glycolipids.

As the formation of glucosamine-6-phosphate is the first step for the synthesis of these products, glucosamine may be important in regulating their production. However, the way that the hexosamine biosynthesis pathway is actually regulated, and whether this could be involved in contributing to human disease, remains unclear.

Health effects:
Oral glucosamine is commonly used for the treatment of osteoarthritis. Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to rebuild cartilage and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness. A randomized, double-blind, placebo-controlled trial found glucosamine sulfate is no better than placebo in reducing the symptoms or progression of hip osteoarthritis.

There is promising evidence that glucosamine may reduce pain symptoms of knee osteoarthritis and possibly slow the progression of osteoarthritis. For example, a study published in the journal Archives of Internal Medicine examined people with osteoarthritis over three years. Researchers assessed pain and structural improvements seen on x-ray. They gave 202 people with mild to moderate osteoarthritis 1,500 mg of glucosamine sulfate a day or a placebo.

At the end of the study, researchers found that glucosamine slowed the progression of knee osteoarthritis compared to the placebo. People in the glucosamine group had a significant reduction in pain and stiffness. On x-ray, there was no average change or narrowing of joint spaces in the knees (a sign of deterioration) of the glucosamine group. In contrast, joint spaces of participants taking the placebo narrowed over the three years.

One of the largest studies on glucosamine for osteoarthritis was a 6-month study sponsored by the National Institutes of Health. Called GAIT, the study compared the effectiveness of glucosamine hydrochloride (HCL), chondroitin sulfate, a combination of glucosamine and chondroitin sulfate, the drug celecoxib (Celebrex), or a placebo in people with knee osteoarthritis.

Glucosamine or chondroitin alone or in combination didn’t reduce pain in the overall group, although people in the study with moderate-to-severe knee pain were more likely to respond to glucosamine.

One major drawback of the GAIT Trial was that glucosamine hydrochloride was used rather than the more widely used and researched glucosamine sulfate. A recent analysis of previous studies, including the GAIT Trial, concluded that glucosamine hydrochloride was not effective. The analysis also found that studies on glucosamine sulfate were too different from one another and were not as well-designed as they should be, so they could not properly draw a conclusion. More research is needed.

Still, health care providers often suggest a three month trial of glucosamine and discontinuing it if there is no improvement after three months. A typical dose for osteoarthritis is 1,500 mg of glucosamine sulfate each day.

Other Conditions
Other conditions for which glucosamine is used include rheumatoid arthritis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), chronic venous insufficiency, and skin conditions, although further evidence is needed.

Use:
A typical dosage of glucosamine salt is 1,500 mg per day. Glucosamine contains an amino group that is positively charged at physiological pH. The anion included in the salt may vary. Commonly sold forms of glucosamine are glucosamine sulphate and glucosamine hydrochloride. The amount of glucosamine present in 1500 mg of glucosamine salt will depend on which anion is present and whether additional salts are included in the manufacturer’s calculation. Glucosamine is often sold in combination with other supplements such as chondroitin sulfate and methylsulfonylmethane.

Glucosamine is a popular alternative medicine used by consumers for the treatment of osteoarthritis. Glucosamine is also extensively used in veterinary medicine as an unregulated but widely accepted supplement.

Bioavailability and pharmacokinetics:
Two recent studies confirm that glucosamine is bioavailable both systemically and at the site of action (the joint) after oral administration of crystalline glucosamine sulfate in osteoarthritis patients. Steady state glucosamine concentrations in plasma and synovial fluid were correlated and in line with those effective in selected in vitro studies

Clinical studies:
There have been multiple clinical trials of glucosamine as a medical therapy for osteoarthritis, but results have been conflicting. The evidence both for and against glucosamine’s efficacy has led to debate among physicians about whether to recommend glucosamine treatment to their patients.

Multiple clinical trials in the 1980s and 1990s, all sponsored by the European patent-holder, Rottapharm, demonstrated a benefit for glucosamine. However, these studies were of poor quality due to shortcomings in their methods, including small size, short duration, poor analysis of drop-outs, and unclear procedures for blinding. Rottapharm then sponsored two large (at least 100 patients per group), three-year-long, placebo-controlled clinical trials of the Rottapharm brand of glucosamine sulfate. These studies both demonstrated a clear benefit for glucosamine treatment. There was not only an improvement in symptoms but also an improvement in joint space narrowing on radiographs. This suggested that glucosamine, unlike pain relievers such as NSAIDs, can actually help prevent the destruction of cartilage that is the hallmark of osteoarthritis. On the other hand, several subsequent studies, independent of Rottapharm, but smaller and shorter, did not detect any benefit of glucosamine.

Due to these controversial results, some reviews and meta-analyses have evaluated the efficacy of glucosamine. Richy et al. performed a meta-analysis of randomized clinical trials in 2003 and found efficacy for glucosamine on VAS and WOMAC pain, Lequesne index and VAS mobility and good tolerability.

Recently, a review by Bruyere et al. about glucosamine and chondroitin sulfate for the treatment of knee and hip osteoarthritis concludes that both products act as valuable symptomatic therapies for osteoarthritis disease with some potential structure-modifying effects.

This situation led the National Institutes of Health to fund a large, multicenter clinical trial (the GAIT trial) studying reported pain in osteoarthritis of the knee, comparing groups treated with chondroitin sulfate, glucosamine, and the combination, as well as both placebo and celecoxib. The results of this 6-month trial found that patients taking glucosamine HCl, chondroitin sulfate, or a combination of the two had no statistically significant improvement in their symptoms compared to patients taking a placebo. The group of patients who took celecoxib did have a statistically significant improvement in their symptoms. These results suggest that glucosamine and chondroitin did not effectively relieve pain in the overall group of osteoarthritis patients, but it should be interpreted with caution because most patients presented only mild pain (thus a narrow margin to appraise pain improvement) and because of an unusual response to placebo in the trial (60%). However, exploratory analysis of a subgroup of patients suggested that the supplements taken together (glucosamine and chondroitin sulfate) may be significantly more effective than placebo (79.2% versus 54%; p = 0.002) and a 10% higher than the positive control, in patients with pain classified as moderate to severe (see testing hypotheses suggested by the data).

In an accompanying editorial, Dr. Marc Hochberg also noted that “It is disappointing that the GAIT investigators did not use glucosamine sulfate … since the results would then have provided important information that might have explained in part the heterogeneity in the studies reviewed by Towheed and colleagues” But this concern is not shared by pharmacologists at the PDR who state, “The counter anion of the glucosamine salt (i.e. chloride or sulfate) is unlikely to play any role in the action or pharmacokinetics of glucosamine”. Thus the question of glucosamine’s efficacy will not be resolved without further updates or trials.

In this respect, a 6-month double-blind, multicenter trial has been recently performed to assess the efficacy of glucosamine sulfate 1500 mg once daily compared to placebo and acetaminophen in patients with osteoarthritis of the knee (GUIDE study). The results showed that glucosamine sulfate improved the Lequesne algofunctional index significantly compared to placebo and the positive control. Secondary analyses, including the OARSI responder indices, were also significantly favorable for glucosamine sulfate.

A subsequent meta-analysis of randomized controlled trials, including the NIH trial by Clegg, concluded that hydrochloride is not effective and that there was too much heterogeneity among trials of glucosamine sulfate to draw a conclusion.[46] In response to these conclusions, Dr. J-Y Reginster in an accompanying editorial suggests that the authors failed to apply the principles of a sound systematic review to the meta-analysis, but instead put together different efficacy outcomes and trial designs by mixing 4-week studies with 3-year trials, intramuscular/intraarticular administrations with oral ones, and low-quality small studies reported in the early 1980s with high-quality studies reported in 2007.

However, currently OARSI (OsteoArthritis Research Society International) is recommending glucosamine as the second most effective treatment for moderate cases of osteoarthritis. Likewise, recent European League Against Rheumatism practice guidelines for knee osteoarthritis grants to glucosamine sulfate the highest level of evidence, 1A, and strength of the recommendation, A.

Safety:
Clinical studies have consistently reported that glucosamine appears safe. Since glucosamine is usually derived from shellfish, those allergic to shellfish may wish to avoid it. However, since glucosamine is derived from the shells of these animals while the allergen is within the flesh of the animals, it is probably safe even for those with shellfish allergy. Alternative sources using fungal fermentation of corn are available. Another concern has been that the extra glucosamine could contribute to diabetes by interfering with the normal regulation of the hexosamine biosynthesis pathway, but several investigations have found no evidence that this occurs. A review conducted by Anderson et al in 2005 summarizes the effects of glucosamine on glucose metabolism in in vitro studies, the effects of oral administration of large doses of glucosamine in animals and the effects of glucosamine supplementation with normal recommended dosages in humans, concluding that glucosamine does not cause glucose intolerance and has no documented effects on glucose metabolism. Other studies conducted in lean or obese subjects concluded that oral glucosamine at standard doses does not cause or significantly worsen insulin resistance or endothelial dysfunction.

The U.S. National Institutes of Health is currently conducting a study of supplemental glucosamine in obese patients, since this population may be particularly sensitive to any effects of glucosamine on insulin resistance.

In the United States, glucosamine is not approved by the Food and Drug Administration for medical use in humans. Since glucosamine is classified as a dietary supplement in the US, safety and formulation are solely the responsibility of the manufacturer; evidence of safety and efficacy is not required as long as it is not advertised as a treatment for a medical condition.

In Europe, glucosamine is approved as a medical drug and is sold in the form of glucosamine sulfate. In this case, evidence of safety and efficacy is required for the medical use of glucosamine and several guidelines have recommended its use as an effective and safe therapy for osteoarthritis. Actually, the Task Force of the European League Against Rheumatism (EULAR) committee recently granted glucosamine sulfate a level of toxicity of 5 in a 0-100 scale, and recent OARSI (OsteoArthritis Research Society International) guidelines for hip and knee osteoarthritis also confirm its excellent safety profile.

Most studies involving humans have found that short-term use of glucosamine is well-tolerated. Side effects may include drowsiness, headache, insomnia, and mild and temporary digestive complaints such as abdominal pain, poor appetite, nausea, heartburn, constipation, diarrhea, and vomiting. In rare human cases, the combination of glucosamine and chondroitin has been linked with temporarily elevated blood pressure and heart rate and palpitations.

Since glucosamine supplements may be made from shellfish, people with allergies to shellfish should avoid glucosamine unless it has been confirmed that it is from a non-shellfish source. The source of glucosamine is not required to be printed on the label, so it may require a phone call to the manufacturer.

There is some evidence suggesting that glucosamine, in doses used to treat osteoarthritis, may worsen blood sugar, insulin, and/or hemoglobin A1c (a test that measures how well blood sugar has been controlled during the previous three months) levels in people with diabetes or insulin resistance.

Theoretically, glucosamine may increase the risk of bleeding. People with bleeding disorders, those taking anti-clotting or anti-platelet medication, such as warfarin, clopidogrel, and Ticlid, or people taking supplements that may increase the risk of bleeding, such as garlic, ginkgo, vitamin E, or red clover, should not take glucosamine unless under the supervision of a healthcare provider.

The safety of glucosamine in pregnant or nursing women isn’t known.

Resources:
http://altmedicine.about.com/cs/herbsvitaminsek/a/Glucosamine.htm
http://en.wikipedia.org/wiki/Glucosamine

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3 Myths About Running and Your Health

Every person who takes up running has been confronted by a “helpful” critic who is more than happy to reel off the reasons running will ruin your life. Here’s a look at three questionable claims about running and health:

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1. Running will give you a heart attack or other heart problems. It is true that exercise temporarily raises the odds of a heart attack while you’re mid-workout, but doing it consistently reduces that risk over the long haul, leading to a net benefit. Going for a run most days of the week is doing far more good than bad for your heart.

2. Running will ruin your bones and joints. A study in the American Journal of Preventive Medicine found no evidence of accelerated rates of osteoarthritis among long-distance runners. Weight-bearing exercise like running helps stave off osteoporosis by maintaining bone mineral density.

3. Running will kill you before your time. According to a study in the Archives of Internal Medicine, running and other vigorous exercise in middle age is associated with a longer life. Not only that, it will make your later years more pleasant by reducing disability.

Sources:
U.S. News & World Report August 13, 2008
American Journal of Preventive Medicine August 2008; 35(2):133-8
Archives of Internal Medicine August 11, 2008; 168(15):1638-46

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