RATINGS

• German Commission E: Approved for the treatment of inflammatory conditions of the urinary tract.

•  Botanical Safety Handbook Class 2b and 2d rating: Not to be used in pregnancy, a caution that is reiterated by most authorities.

PREPARATIONS USED CLINICALLY_

•  Cold water infusion

•  Hot water infusion

•  Tincture

Uva ursi shows greater antibacterial activity in an alkaline environment;some authors suggest giving it along with sodium bicarbonate or substantially increasing fresh fruit and vegetable consumption during treatment to alkalin-ize the urine; others suggest avoiding the use of acidifying agents during treatment. Alkalinization of the urine seems not to be a prerequisite to the antiseptic properties of hydroquinone released from arbutin. Some amount of disagreement can be found in the literature regarding the requirement of an alkaline pH environment for the efficacy of this herb. Some authors postulate that a reduced urinary pH inhibits the efficacy of the herb; others argue that increasing the alkalinity of the urinary environment enhances the efficacy of the herb, while still others state that activity is not depend on urinary pH. Given the reliability of this herb generally, it is prudent to conclude that if uva ursi does not seem to be working, the addition of 2 ''00'' capsules of sodium or potassium bicarbonate may be taken once or twice daily with uva ursi doses, to alkalinize the urine in such situations before making a final determination about efficacy. Some authors recommend discontinuing use of the herb after 7 days; however, the European Scientific Cooperative on Phytotherapy (ESCOP) recommends treatment be continued until complete disappearance of symptoms, up to a maximum of 2 weeks.

DOSAGE_

Doses should provide the equivalent of 400 to 840 mg arbutin daily, divided over two to four doses.

•  Hot or cold infusion: 1.5 to 4 g dried leaves to 150 mL water as a cold infusion steeped for 2 hours or as a hot infusion steeped 30 minutes, and taken up to four times daily.

•  Tincture: 2 to 4 mL three to four times daily of a 1:5 preparation.

USE IN PREGNANCY AND LACTATION

Pregnancy

The Botanical Safety Handbook gives this herb a class 2b and 2d rating: Not to be used in pregnancy, a caution which is reiterated by numerous authorities. However, the reasons for contraindication are variable and not well supported, ranging from alleged uterotonic and oxytocic activity to ‘‘theoretical fetotoxicity.'' The risk of oxytoxic effect is based on a single unreferenced anecdotal report by Brinker in Herb Contraindications and Drug Interactions, and has not been substantiated clinically. Limited evidence suggest that the herb has potentially fetotoxicity owing to its hydroquinone content. Studies using pure hydroquinone (i. e., not the herb in bulk or extract form) have produced microtubulin dysfunction in bone marrow, and exposure of human lymphocytes and cell lines and pure hydroquinone has been shown to cause genetic damage. Low potential for mutagenicity and negative Ames test have also been reported. In animals administered 100 and 400 mg/kg sc per day of arbu-tin, no signs of fetal toxicity were observed. Uva ursi has been used by midwives in the United States as a primary treatment of acute symptomatic cystitis in pregnancy for at least two decades, with no adverse reports associated with its use.

Lactation

The transfer to infants of arbutin/hydroquinone from uva ursi use during lactation has not been researched and therefore is not recommended; however, the risk remains speculative. It is recommended that this herb be used only in the lowest doses during lactation, observing the infant for side effects, and using under the guidance of a qualified health professional.

SAFETY INFORMATION: SIDE EFFECTS, CONTRAINDICATIONS, TOXICITY, AND HERB-DRUG INTERACTIONS_

Used as per directed dose and duration, uva ursi appears to have a good safety profile.

Side Effects

•  Nausea and vomiting have been reported with use, but are not common.

•  Excessive ingestion of arbutin may cause tinnitus, delirium, convulsions, collapse, and death.

Contraindications

•  Kidney disorders

•  Pregnancy and lactation (discussed in the preceding)

•  Children under 12 years old

•  Bowel inflammation

No justification is given for the caution against use in children.

High tannin levels may interfere with iron absorption in the gut and may aggravate highly inflamed or ulcerated GI conditions.

Toxicity

Several authorities claim that arbutin-containing preparations should not be taken for longer than a consecutive week, nor should they be taken more than 5 times annually without medical consultation. No explanation for this recommendation is given though it is likely due to concern regarding hydroquinone consumption. Contrary to this, the European Scientific Cooperative on Phytotherapy (ESCOP) recommends treatment be continued until complete disappearance of symptoms, up to a maximum of 2 weeks. Uva ursi is a known inhibitor of melanin synthesis, and in excessive doses could result in retinal damage. Used acutely according to general dosing recommendations, this herb is expected to have very low carcinogenicity, though carcinogenicity has been observed in mouse and rat models given pure hydroquinone.

Herb-Drug Interactions

• The only expected drug interaction is possible potentiation of prednisolone and related anti-inflammatory drugs by 50% methanolic extract.

WILD YAM

Botanical name: Dioscorea villosa Family name: Dioscoreacaea Synonyms: Colic root, rheumatism root Part used: Root and rhizome

MAJOR CHEMICAL CONSTITUENTS_

Glycoside and steroidal saponins, including diosgenin and dioscin, alkaloids, tannins, phytosterols, and starch

PRINCIPAL USES_

•  Spasmolytic in the treatment of uterine cramping, dysmenorrhea, and chronic pelvic pain

•  Spasmolytic in cases of urinary tract infection (UTI) and interstitial cystitis

•  Antiemetic in nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum

•  Antispasmodic for irritable uterus or threatened miscarriage with uterine contractions

•  Intrapartum use for painful labor with dysfunctional uterine contractions

•  Postnatally for afterbirth pains

•  Proposed estrogenic effects owing to theoretical ability of steroidal saponins in the plant to bind to estrogen receptors, thus used in the treatment of a variety of perimenopausal and menopausal complaints.

TRADITIONAL AND HISTORICAL USES

Wild yam was used by Native Americans and Eclectic physicians for a wide variety of complaints relating to spasmodic contractions of the hollow viscera ranging from bilious colic to dysmenorrhea. It was included in the National Formulary (NF) from 1916 to 1942 as a diaphoretic and expectorant. In the past decade it has enjoyed a resurgence in popularity based on the erroneous assumption that because it contains steroidal sapo-nins used in the manufacture of progesterone for oral contraceptive pills (OCPs), it could be taken as an herb to increase progesterone levels and thus treat a variety of gynecologic complaints. It is found in topical creams for vaginal dryness. Any increase in progesterone associated with using topical creams, was due to the inclusion of USP grade synthetic progesterone to these products. Its alleged hormonal activity has also led to the inclusion of this herb in breast-enhancing products.

CLINICAL INDICATIONS_

Wild yam is reported by herbal practitioners to be a reliable spasmolytic herb in the treatment uterine cramping, dysmenorrhea, chronic pelvic pain (CPP), urinary tract infection (UTI) and interstitial cystitis, particularly as an adjunct in combination with other herbs specific to those complaints. It is also sometimes used by midwives as an antiemetic in the treatment of troublesome nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum, and as an antispasmodic for irritable uterus or threatened miscarriage with uterine contractions. It is also occasionally used as an adjunct antispasmodic herb painful labor with dysfunctional uterine contractions and in the postpartum period for afterbirth pains.

Wild yam {Dioscorea villosa). (Photo by Martin Wall.)

There is a paucity of studies on the clinical effects of wild yam, and no studies evaluating antispasmodic activity were identified.

IN VITRO, ANIMAL, AND CLINICAL DATA

A 2001 double-blind placebo-controlled crossover study of the effects of a wild yam cream in 23 healthy women suffering from troublesome symptoms of menopause was conducted. After a 4-week baseline period, each woman was given active cream and matching placebo for 3 months in random order. Diaries were completed over the baseline period and for 1 week each month thereafter, and blood and saliva samples were collected at baseline and at 3 and 6 months, for measurement of lipids and hormones. The average age of the subjects was 53.3 ***

1.1 years and average time since last period 4.3 *** 0.9 years. At baseline, the average body mass index was 27.3 *** 0.8, cholesterol level 5.7 *** 0.2 mmol/L and follicle stimulating hormone (FSH) level 74.2 5.1 IU/L; estradiol levels were undetectable in the majority of cases. After 3 months of treatment, no significant side effects were reported with either active treatment or placebo, and there were no changes in weight, systolic or diastolic blood pressure, or levels of total serum cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, FSH, glucose, estradiol, or serum or salivary progesterone. Symptom scores showed a minor effect of both placebo and active treatment on diurnal flushing number and severity and total non-flushing symptom

Is Eating Yams Where the Where the Health Benefits for Women Occur?


Interestingly, in a study by Wu et al, 24 apparently healthy postmenopausal women were recruited to replace their staple food (rice for the most part) with 390 g of yam (Dioscorea alata) in two of three meals per day for 30 days and 22 completed the study.

Fasting blood and first morning urine samples were collected before and after yam intervention for the analyses of blood lipids, sex hormones, urinary estrogen metabolites and oxidant stress biomarker. The design was a one arm, pre-post study. A similar study of postmenopausal women (n =19) fed 240 g of sweet potato for 41 days was included as a control study. Serum levels of estrone, estradiol, and SHBG were analyzed for this control group. After yam ingestion, there were significant increases in serum concentrations of estrone (26%), sex hormone-binding globulin (SHBG) (9.5%), and near significant increase in estradiol (27%). No significant changes were observed in serum concentrations of dehydroepiandrosterone sulfate, androstenedione, testosterone, follicular stimulating hormone, and luteinizing hormone. Free androgen index estimated from the ratio of serum concentrations of total testosterone to SHBG decreased. Urinary concentrations of the genotoxic metabolite of estrogen, 16-hydroxyestrone decreased significantly by 37%. Plasma cholesterol concentration decreased significantly by 5.9%. The researchers concluded that ingestion of yams as a staple part of the diet might reduce the risk of breast cancer and cardiovascular diseases in postmenopausal women. This is quite different than using wild yam as an herbal supplement, but nonetheless, worthy of further research. And as yams are such a nourishing food, unless one is on a diabetic diet, they are a healthy inclusion in most diets.


Scores, and on nocturnal sweating after placebo, but no statistical difference between placebo and active creams. A randomized, controlled trial of 13 menopausal women given two capsules three times daily for 3 months of an herbal combination containing wild yam root in doses lower than recommended, along with burdock root (Arctium lappa), licorice root (Glycyrrhiza glabra), motherwort (Leonurus cardiaca), and angelica root (Angelica archangelica) demonstrated statistically nonsignificant

Decreases in menopausal symptoms in the active treatment group. Diosgenin, a component of wild yam, has been shown in several studies to reduce total serum cholesterol levels, likely as a result of reduced intestinal cholesterol and an effect potentiated by taking the herb with vitamin C. No hormonal effects, including no changes in DHEA, estrogen, and progesterone levels, or FSH or LH levels, have been observed. In one study of ovariectomized mice receiving 20 to 40 mg/kg of diosgenin injected subcutaneously daily for 15 days, mammary gland epithelial stimulation was observed without progesteronic effects, however, the effects of oral wild yam on breast tissue have not been studied in animal or human trials.

MECHANISMS OF ACTION_

The belief that wild yam acts as a precursor to human sex hormones was widely popularized in the early 1990s based on research John Lee, a proponent of the benefits of progesterone replacement for a variety of menopausal complaints. However, the steroidal saponins found in wild yam are not biologically converted to human sex steroids in the body, nor does the plant itself contain progesterone or estrogen, and claims of it having hormonal activity appear to be erroneous based on clinical research (see the preceding). Mechanisms for the antispasmodic effects of this herb have not been elucidated nor substantiated.

RATINGS_

Botanical Safety Handbook class 1: Herbs that can be safely consumed when used appropriately.

•  No significant adverse events in clinical trials

•  No case reports with significant adverse events and high probability of causality [need to select causality assessment references

•  No identified concerns for use during pregnancy or lactation

•  No innately toxic constituents

•  History of safe traditional use

•  Toxicity associated with excessive use is not a basis for exclusion from this class

•  Idiosyncratic, minor or self-limiting side effects are not bases for exclusion from this class.

PREPARATIONS USED CLINICALLY_

•  Dried root in capsules

•  Tincture

DOSAGE_

•  Dried root in capsules: 250 mg one to three times daily

•  Tincture: 2 to 4 mL three to five times daily

SAFETY INFORMATION: HERB-DRUG INTERACTIONS, TOXICITY, AND CONTRAINDICATIONS_

Wild yam appears to be generally safe when used internally or topically, as recommended Topical application of wild yam extract in women suffering from menopausal symptoms appears to be free of side effects, but appears to have little effect on menopausal symptoms. The herb is sometimes contraindicated for those using hormonal contraception and those with hormone dependent cancers, but this is based on the supposition of hormonal activity of the herb, which is not currently supported by the scientific literature.

Anecdotal reports state that large doses (amounts unspecified) may result in emesis. Positive interactions may be found in association with added benefits of lipid reduction when combined with lipid-lowering medications.

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  • Category: Women's diseases