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From The April 2001 Issue of Nutrition Science News
At The Counter with Dan Lukaczer, N.D.
The Truth About Kava
Is kava really as effective as advertised for anxiety?
A recent meta-analysis appears to support what a variety of independent studies have suggested—that standardized extracts of kava (Piper methysticum) are useful for individuals experiencing anxiety disorders. A meta-analysis is a study in which researchers review and combine all of the well-done clinical trials on a particular subject. Oftentimes many small trials are criticized because they lack numbers to be convincing. By combining these trials and analyzing them, researchers feel more confident in reaching conclusions.
In this analysis, kava came out very well. The authors conclude that "kava extract is superior to placebo as a symptomatic treatment for anxiety. Therefore, kava extract is an herbal treatment option for anxiety that is worthy of consideration."1
In the United States, an estimated 20 percent of the population experiences anxiety disorders in any given year. Conventional drug treatment can result in dependence, as well as serious side effects such as drowsiness and memory impairment. Side effects with kava are rare, with the most common including skin reactions and photosensitivity.2
A word of caution: Trials studied in this analysis looked at kava containing a standardized extract of kavalactones (approximately 210 mg in divided dosages). Although I believe it's important to use the whole herb, clearly it is also important to have an herb standardized to a specific ingredient so that you can minimize the differences seen from one supplement to the next.
Yam Cream Redux
In the February issue of NSN, this column stated that, according to FDA guidelines, progesterone creams containing more than 5 mg/oz. progesterone need to be sold as prescription only. Yet many reliable brands contain 450500 mg/oz. Please clarify this apparent contradiction.
It is true that some companies put more progesterone in their creams—hundreds of milligrams more. Whether that is legal to sell over the counter is a question I didn't want to comment on, but it's obviously out there. Certainly women are finding benefit with the greater amounts of progesterone in creams.
A little more complexity: Diosgenin, which is extracted from wild yam (Dioscorea spp.) and chemically converted to bioidentical human progesterone in products, does have biological activity. Diosgenin appears to act as a weak estrogen, possibly similar to soy isoflavones. Additionally, herbalists have been using wild yam for centuries in tincture and tea forms as an antispasmodic and anti-inflammatory, particularly to treat women's conditions such as dysmenorrhea and ovarian or uterine pain. Although there are no controlled trials I am aware of, a good quality yam cream, standardized to diosgenin as well as containing the many other substances found in that plant, probably has some health benefits, even though there is no progesterone in it. The bottom line: Be clear on what you want, and check to see what's in the bottle.
Folic Acid Improves Prozac Outcomes
There is quite a bit of negative news recently regarding interactions between nutrients and drugs. Is the news all bad?
One positive report involves folic acid and the antidepressant Prozac (fluoxetine). In a recent study in Great Britain, 127 patients with major depression received a standard 20 mg/day dose of fluoxetine with or without 500 mcg folic acid in a randomized, placebo-controlled study for 10 weeks.3 The group taking the drug with folic acid experienced a substantial and statistically significant improvement. Folic acid is important as a cofactor in the synthesis of neurotransmitters in the brain and probably works with fluoxetine to improve this brain biochemistry.
Interestingly, when the researchers looked at the data closely, they found that this improvement occurred only in females and not males in the folic acid group. The results were striking. Only 6.1 percent of the women in the folic acid group failed to respond (response meaning a greater than 50 percent symptom improvement), whereas 38.9 percent failed to respond when given fluoxetine alone.
The authors suggest that men did not show this response because they probably were not given enough folic acid. This is supported by the fact that in men, the marker for folic acid sufficiency, serum homocysteine, did not go down (indicating improvement in folic acid status), whereas in women it did.
The U.S. Agency for Health Care Policy and Research in Rockville, Md., recently released a comprehensive report on depression treatments. They found the response rate has not changed significantly in the past 20 years—even with the inclusion of newer drugs such as fluoxetine—and that drug therapy achieves a response rate of only 50 percent.4 If this trial is any indication, significant improvements can be attained by adding folic acid. I would also suggest that supplementing with folic acid long-term include coadministration of vitamin B12 so as to avoid the unlikely occurrence of folic acid masking a vitamin B12 deficiency.
Dan Lukaczer, N.D., is director of clinical research at the Functional Medicine Research Center, a division of Metagenics Inc., in Gig Harbor, Wash.
References
1. Pittler M, Ernst E. Efficacy of kava extract for treating anxiety: systematic review and meta-analysis. J Clin Psychopharmacol 2000 Feb;20(1):84-9.
2. Bolz H, Kieser M. Kava-kava extract WSI490 versus placebo in anxiety disorders: a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry 1997;30:1-5.
3. Coppen A, Bailey J. Enhancement of the antidepressant action of fluoxetine by folic acid: a randomized, placebo-controlled trial. J Affect Disord 2000;60:121-30.
4. Agency for Health Care Policy and Research. Treatment of depression—newer pharmacotherapies. Summary, evidence report/technology assessment: No. 7, March 1999. www.ahcpr.gov/clinic/deprsumm.htm.
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