OCD, Ashwagandha and Serotonin Dysregulation


In the latest edition of Galen’s Watch a study of interest came up, Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial. Patients with Obsessive-compulsive disorder (OCD) taking SSRI’s were randomized to 120mg/day of Withania for 6 weeks. It was found to be beneficial as a safe and effective adjunct to SSRIs in the treatment of OCD with a positive change in self-rated compulsions and obsessions. OCD is thought to be a dysregulation of the serotonergic system. Other diseases that have links to this dysregulation are anorexia nervosa, depression, anxiety, PTSD, IBS, autism……

Withania somnifera ( Ashwagandha)  is a trophorestorative specific to the endocrine system.  In The Medicine Woman’s Roots they describe this common herbal term as

A trophorestorative is an herb, food or other substance that acts as a nutritive restorative for the body, usually with a strong affinity for an organ or organ system and corrects deficiency and weakness not simply through temporary stimulation but through the vital nourishment of that organ or organ system.

Trophorestoratives sometimes called tonics fall into another commonly used term and heading of Nervine but more specifically Withania is an adaptogen.  The word adaptogen was coined by Soviet scientist, Dr. Nikolai Lazarev.

Adaptogens modulate our response to stress (physical, environmental, or emotional) and help regulate the interconnected endocrine, immune, and nervous systems. This re-regulation of a disordered or highly stressed system is achieved by metabolic regulators such as cytokines, catecholamines, glucocorticoids, cortisol, serotonin, nitric oxide (NO), cholecystokinin, corticotrophin-releasing factor (CRF), and sex hormones.

Harmony Remedies: An Overview of Adaptogens by David Winston

Other interesting resources on Withania:

HERBAL ADAPTOGENS Fitting into the Modern Age Christopher Hobbs L.Ac., A.H.G.

The Winter Cherry: Restoring Vitality The Medicine Woman’s Roots

Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review Alternative Medicine Review

Ashwagandha  by Gayle Engels, Josef Brinckmann  HerbalGram. 2013; American  Botanical Council

Complementary Therapies in Medicine Volume 27, August 2016, Pages 25–29 Evaluation of the efficacy of Withania somnifera (Ashwagandha) root extract in patients with obsessive-compulsive disorder: A randomized double-blind placebo-controlled trial

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Do You Have Bitter Deficiency Syndrome?

Hops Humulus lupus
James Green once said our society has bitter deficiency syndrome. Bitters have always been part of traditional diets. It’s only modern day diets that we see less and less bitter foods being a normal part of what we eat. Looking at the bitter components of beer a group of scientists studied the effect of matured hop bitter acids (MHBA) on weight loss. Imagine the delirious happiness of beer lovers if it worked! In conclusion the study did show a weight reduction in the MHBA group, so good news for all. The bitterness of beer is measured in International Bitterness Units (IBU’s). Two of the most popular beers, Coors and Bud, have a IBU of 10 supporting James Green’s idea that we are not choosing bitter foods to be part of our diet and therefore have bitter deficiency. To compare, a Guinness has a IBU of 40 and Dogfish Head 90 Minute IPA is a 90! To learn the how reintroducing bitters into our lives can have a far reaching effect please read Jim McDonald’s,  Blessed Bitters.
“It is my opinion that the nearly complete lack of bitter flavored foods in the overall U.S. and Canadian diet is a major contributing factor to common cultural health imbalances such as PMS, other female and male sexual organ dysfunctions, hormonal imbalances, migraine headache, indigestion, liver and gall bladder dysfunction, abnormal metabolism, hypoglycemia, diabetes, etc. ” -James Green, The Male Herbal

German Kava Ban Lifted by Court – Court Ruling Details


Kava (Piper methysticum)

Kava (Piper methysticum)

Excerpts taken from the article: German Kava Ban Lifted by Court: The Alleged Hepatotoxicity of Kava (Piper methysticum) as a Case of Ill-Defined Herbal Drug Identity, Lacking Quality Control, and Misguided Regulatory Politics

Until the year 2002, extracts of the rhizome and roots of the Melanesian plant kava [Piper methys- ticum G. Forst. (Piperaceae)] were marketed in Germany and other countries in the form of me- dicinal products licensed for the treatment of situational anxiety. After receiving a series of case reports concerning alleged liver toxicity, the German regulatory authority BfArM (Bundesinstitut für Arzneimittel und Medizinprodukte; Federal Institute for Drugs and Medical Devices) decided in the summer of 2002 to cancel all drug registrations for all medicinal products containing kava by a simple administration decision, with the exception of homeopathic dilutions of 4D (1 : 10 000) or higher. Formally, the benefit-risk ratio was declared negative. Other regulators outside Germany soon followed this decision. The consequences of this ban were felt worldwide and led to an economic disaster in many South Pacific states. Within Europe, the kava ban deprived physicians of an effective and comparatively safe medication, creating a “therapeutic gap nobody wished for” [1].

– A ban that has been contested because of the poor evidence of risks related to kava. Only recently, two German administrative courts decided that the decision of the regulatory authority to ban kava as a measure to ensure consumer safety was inappropriate and even associated with an increased risk due to the higher risk inherent to the therapeutic alternatives. This ruling can be considered as final for at least the German market, as no further appeal has been pursued by the regulatory authorities. However, in order to prevent further misunderstandings, especially in other markets, the current situation calls for a comprehensive presentation of the cardinal facts and misconceptions concerning kava and related drug quality issues.

Possible Theories Concerning the Perceived Liver Damage
The analysis of the case reports by Teschke had revealed only very few case reports with a relatively high probability of having been caused by kava, among them one report with a proven allergic reaction to the product [29], and thus a type of reaction which must be assessed apart from the issue of typically dose-de- pendent toxic reactions. Although the number of cases seems in- significant when compared with the known exposure data (450 million daily doses in ten years according to IMS data), the ob- served cases still demand a pharmacological explanation. Thus, over the past twelve years, several theories have been published, which, all in all, can be summed up in five major lines of thought:

” The “human genetic variability theory”: According to this school of thought, kava preparations are completely harmless to the general population. However, there is a small subgroup of the European Caucasian population lacking the metabolizing liver enzyme cytochrome P450 subtype 2D6 (CYP 2D6), as ob- served in one case report [30]. This mutation might lead to an unusual metabolic pattern in these patients, resulting in the transformation of the normally harmless constituents of kava into toxic metabolites in the liver. This theory suffers from the fact that this would be a typical dose-dependent toxicity. With approximately 7–9% of Caucasians being CYP 2D6-deficient, a much higher number of case reports would be expected not only in Germany, but in all Caucasian populations. This was quite obviously not the case; the observations were almost exclusively restricted to Germany and Switzerland, with the latter country using kava products of German origin.

The “metabolic toxification theory” assumes a toxification of kava constituents through the formation of electrophilic qui- noid metabolites, as demonstrated in vitro in hepatic microsomes [31, 32]. Whereas both hypotheses could provide an ex- planation for liver toxicity in the presence of other drugs (inter- actions at the metabolic level), this type of reaction would, according to the authors, only occur with elevated exposures to kavalactones. With traditional kava drinking in the South Pacific, the kavalactone exposure by far exceeds the exposure with the German kava extract products. The maximum daily dose of German medicinal kava products was 120 mg kavalactones, whereas a single coconut shell of kava would provide > 210 mg [33], calculated with a method for which the results would have to be multiplied by 1.7 to be comparable to the lev- el of modern HPLC methods [34]. Accordingly, Olsen et al. (2011) admit that “there remains no undisputable reason for the increased prevalence of kava-induced hepatotoxicity in Western countries” [32], the fact notwithstanding that such an increased prevalence has not been demonstrated.
The “organic solvent theory”: In traditional kava use of the Pacific Islands, kava is always extracted with water. In contrast, the German medicinal products contained kava extracts pre- pared with ethanol-water mixtures, and one product contained an acetone extract. Organic solvents are used to achieve a better extractability of the kavalactones as the major active constituent fraction of kava rhizomes and roots. The “organic solvent theory” holds that kava may contain non-water-soluble hepatotoxic compounds that are not contained in the traditional aqueous extract, but enriched in the European preparations. This difference might explain why the traditional aqueous kava preparations are considered a safer option than the European organic extracts [35]. However, one must bear in mind that ethanol extracts of kava roots and rhizomes have been in use in Germany for more than 100 years, and were al- ready mentioned for the first time by Lewin in 1886 [36], with no reports on relevant safety issues until the year 1999, when the first case reports of liver toxicity were published in Switzerland with a German-produced product. A recent focus of the debate is flavokavin B, which has been shown to be liver toxic in mice in relatively high doses [37], although others could not confirm this finding [38]. The organic solvent hypothesis has been largely ignored [26,27], but there may still be a relationship between the phytochemical composition of kava preparations and the quality of the herbal material.
The “wrong plant part theory” assumes that European extract manufacturers used wrong plant parts such as leaves or stems. These plant parts may contain the alkaloid pipermethystine with liver-toxic properties [39,40]. However, an analysis of the European kava extracts clearly showed the absence of pi- permethysticine in the German kava extract preparations [41]. The hypothesis of using inappropriate plant parts and/or inappropriate protection against secondary contamination by mould toxins can still not be fully excluded, as it partly mirrors the current trading habits [42–45].
The “adulteration theory”: Again, one should not ignore that kava rhizome and root extracts prepared with ethanol/water mixtures have a history of safe use in Germany dating back to at least 1886. Prior to the mid-1990 s, there was not a single re- port of liver toxicity from anywhere in the world. The question imposes itself: Might there have been a change of kava raw ma- terial quality with a potential impact on kava safety – a change, which might be considered an adulteration? There is increasing evidence that this was, in fact, the case [43, 44, 46]. The “adulteration theory” combines aspects from the aforemen- tioned hypotheses, especially the “wrong plant part theory”. It also requires an additional introduction into the ethnobotani- cal background of kava.

Topical Infused Oil of Chamomile for Carpel Tunnel Syndrome

Topical Infused Oil of Chamomile for Carpel Tunnel Syndrome

Chamomile Flowers

Some herbs are very humble. They have been around so long and used so commonly that we forget they are medicine. Chamomile is one of those herbs. It can be found in countless herbal pleasure teas at the grocery store and growing wildly all-around. It can be used dried, fresh, infused in oil or water and distilled as a essential oil. Used topically or internally is it generally considered very safe.  A recent study used Chamomile topically, as an infused oil, to treat carpel tunnel syndrome. The researchers, in a similar study, also looked at topical chamomile infused oil for knee osteoarthritis. It was found in both studies to be helpful and improved symptomatic and functional status of the patients and decreased the need for pain medication. The infused oil was prepared in the traditional Persian method by boiling aqueous extract of chamomile in sesame oil and further concentrated by vaporization. The preparation included both essential oils (chamazulene and bisabolol oxide) and polyphenols (a flavonoid such as apigenin and its derivatives). Because they used sesame oil as the vehicle for the active constituents of the chamomile flower, they cannot attribute the results solely to the chamomile.


In Western Herbal Medicine Chamomile is utilized more for stress, anxiety, insomnia and to increase digestion through its bitter principles. It is also used topically in balms and salves primarily for skin irritations, rashes and swellings. Balms would contain the infused oil or essential oil or both. Uncommonly, it is used for arthritis alone and may be part of a larger herbal topical formula but it is not thought of as a strong topical anti-inflammatory for musculo-skeletal issues.

Chamomile resources:


Efficacy and safety of topical Matricaria chamomilla L. (chamomile) oil for knee osteoarthritis: A randomized controlled clinical trial.

A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. (using Traditionally prepared Persian Chamomile oil) 

Rhodiola for Mild to Moderate Depression Equal to Sertraline.

Rhodiola for Mild to Moderate Depression Equal to Sertraline.


The Journal Phytomedicine published the study  Rhodiola rosea versus sertraline for major depressive disorder: A randomized placebo-controlled trial earlier this year. In the trial it was found that for mild to moderate depression Rhodiola was slightly less effective  than sertraline and both were not that different from placebo. In addition, there was a much higher rate of adverse effects with sertraline (63.2%) over Rhodiola (30.0%).  Read a full analysis of the study at Natural Medicine JournalRhodiola Rosea vs Sertraline for Major Depression.

Rhodiola is known to affect several body systems including the cardiovascular, central nervous and reproductive and has adaptogenic, anti-stress, neuroendocrine and antioxidant effects. Read Rhodiola rosea: A Phytomedicinal Overview  by The American Botanical  Council for an in depth look at it. It is an excellent article.

David Winston mentions it is useful in cardiovascular-based depression in his article Differential Treatment of Depression and Anxiety with Botanical and Nutritional Medicines and for deficiency insomnia in his article Botanical/Nutritional Protocols For Insomnia and Other Sleep Disorders.

The Medicine Hunter has an article on harvesting Rhodiola and a cool video.


Galen’s Watch is a Journal Watch for alternative and complementary health practitioners. 

Decrease Inflammation with Turmeric


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I think the next trending herb will be turmeric (Curcuma longa) or curcumin the principal curcuminoid derived from the spice turmeric. In fact, I rarely hear about turmeric and more often hear about curcumin. Just look at #curcumin and see how many tweets there are! It seems to be popping up everywhere these days from golden milk recipes to studies looking at a diverse group of diseases. Below there are three studies highlighting curcumin and PMS, cardiovascular disease and depression. The main action of turmeric is anti-inflammatory, and as many diseases have inflammation at their core, it has many possible applications. As seen in this review inflammation is part of all these diseases.

These diseases include Alzheimer’s disease (AD), Parkinson’s disease, multiple sclerosis, epilepsy, cerebral injury, CVDs, cancer, allergy, asthma, bronchitis, colitis, rheumatoid arthritis, renal ischemia, psoriasis, diabetes, obesity, depression, fatigue, and AIDS.

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Lavender: A Perfect Herb for the Modern World?

Being an inhabitant almost in every garden, it is so well known, that it needs no description. –The Complete Herbal 1653 Lavender (Lavendula augustifolia) is a gentle medicinal herb that has been used to treat nervousness, anxiety, depression and tension. In The Earthwise Herbal  it is also listed as being for the persons who are perfectionist, over conscious, depressed and anxious associated with irritable bowel, having insomnia and active in the mind. It seems to me this might be the perfect herb for out times! It is often employed as a essential oil but it can be used as a tincture and in teas. I love the smell but abhor the taste even in the finest fancy desserts so I use the essential oil. Studies regarding lavender regularly come up and I have gathered the ones I have used in Galen’s Watch over the last few years below.
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Inflammation and Depression

Depression has been linked recently in article and studies to inflammation. A recent study Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. looked at the effects of curcumin (500 mg twice daily) or placebo for 8 weeks on individuals with major depressive disorder. There was some positive results in favour of curcumin, enough to warrant further investigation. Another study Curcumin and major depression: a randomised, double-blind, placebo-controlled trial investigating the potential of peripheral biomarkers to predict treatment response and antidepressant mechanisms of change looked at the same dosage of curcumin and found ‘ that curcumin supplementation influences several biomarkers that may be associated with its antidepressant mechanisms of action.’ Could curcumin in conjunction with an anti-inflammatory diet produce a better effect? Dr Weil thinks that is a convincing idea.  It is also intersting to me that St. John’s Wort which has shown some effect on mild depression but is vastly over marketed for it, has always been thought of as a nerve anti-inflammatory, healing to heal nerve injury and reduce pain. Jim McDonald talks about it in treatment of back pain and nerves…

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Nasal Irrigation for Seasonal Allergies

Spring seems to have arrived after a shaky start! The last 2 posts on seasonal allergies covered supplements, herbs, probiotics, and nutraceuticals.

Seasonal Allergies: Astragalus, Pycnogenol and Silymarin

Seasonal Allergies and Probiotics

In addition to trying supplements either herbal or nutraceutical you could also try nasal irrigation for your allergies. Several studies have shown that nasal irrigation can reduce the symptoms of seasonal rhinitis.

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Have a Cold? Try Echinacea, but use it Correctly

Echinacea is an amazing herb and after being touted as THE herb for the common cold was found on every health food store and pharmacy shelf. The problem is the quality of these products is widely variable and the recommended dosages are broad, some of them being ineffectual. The Cochrane Review Echinacea for preventing and treating the common cold says,

Most consumers and physicians are not aware that products available under the term Echinacea differ appreciably in their composition, mainly due to the use of variable plant material, extraction methods and the addition of other components.

 The end result is the miracle cold-herb was tried by many people and failed, too often.
Here are some guidelines for using echinacea properly from Echinacea spp.: A Monograph & What’s New 
  • Use Echinacea purpurea alone or in combination with Echiniacea augustifolia
  • Liquid may be preferable as there is come evidence that actual contact with the oral mucosa is more effective
  • Francis Brinker noted that Echinacea trials that used liquid extracts showed positive outcomes in upper respiratory infections
  • Start the dosing regime at the very -first- signs of sickness
  • Use a loading dose of 5 mL (capsule 1500 mg), followed by 2.5 mL (500-750 mg) every 1-2 hours  for the first day
  • The liquid dose is based on a 1:2 fresh root extract
  • For the next 2 days use 5 mL (1500mg) three times a day
  • For children use Clark’s rule to calculate the dose
Other interesting articles concerning Echinacea, it’s other uses and how to take care of yourself when you have a cold or flu:

Echinacea: From Native American Panacea to Modern Phytopharmaceutical

Echinacea: Reclaiming this powerful plant

An Herbalist’s View: Approaches to Colds and Flus By7Song


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