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HRB 705 Materia Medica II

FinalPresentation

Upon completion of this course students will be able to:

1. Create a narrative story about the medicinal use of a plant describing the qualities
(actions, taste energetics, organoleptics etc.) based on personal experience of the medicinal herbs covered in this course.
2. Explain and recall the botanical classification, botanical names, common names, parts used, properties, uses, dosage, and safety issues for the medicinal herbs covered in this course.
3. Differentiate herbs of similar therapeutic use and apply to case study examples.
4. Research and evaluate herbal products and the range of scientific evidence available on the use of medicinal plants.
5. Compare and evaluate traditional and modern research in monograph categories (parts used, indications, dosage, extraction) of a core group of herbs .

 

The attached presentation was the culmination of learning throughout the course, as well as in other courses.  The students chose a body system, a particular illness or issue, and then explained the medicinal herbs that could be used. I tried the herbs in the formulation and tested it throughout the course to develop personal experience with the plants. The presentation included the rationale for the selected herbs, therapeutic actions, safety, dosage, etc.

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Microbial Testing Internship Part III

     The final internship of my program involved working with the Quality Control Manager to conduct microbial testing of MUIH manufactured botanicals.  The purpose of this internship was to create a repeatable and cost-effective method for aseptic botanical testing outside of a formal laboratory.  This method would provide a low-cost testing option that would allow small scale herbal businesses and manufacturers to meet part of the requirements for GMP compliance without significant financial hardship.

     The internship work involved several different components. First, was reviewing and updating the documentation from previous internships to ensure completeness and applicability.  This process began at home where I modified material to make it relevant to the tinctures being tested. During the time at the Dispensary doing the actual testing, the SOPs and documents had to be examined and re-examined, with feedback and lessons learned incorporated into the final product.    

     The next component of the internship was the specimen inoculation in the MUIH Dispensary. The inoculation required following the steps outlined in the revised SOP with careful attention to detail to ensure an aseptic environment.  Carrying out the botanical testing according to the procedures required a degree of skill, training, and competency that I was able to leverage from previous trimesters’ work in botanical testing.  I found myself prepared for the procedures involved, particularly with the measuring of ingredients and using the pipettes according to aseptic techniques.

     The inoculation itself required measuring out exact dilutions of the tinctures, keeping all the materials well organized, and ensuring exact and accurate application of the inoculation solution. The materials were then taken home and observed over several days before they were analyzed for microbial growth.  

 

     The final part of the internship involved working with other interns to determine the costs of all materials and man hours in order to carry out the botanical testing. These estimates needed to be clear and accurate to provide a picture of long-term requirements.  

 

HRB 620b Herbal Therapeutics II

The course description for this course:

In this course, students will apply skills, principles, and knowledge to generate a body of scholarly material to demonstrate their proficiencies in herbal medicine as a professional. Students will engage in multiple, advanced medicine making experiences and discover effective methods of documentation, principles of manufacturing and problem-solving techniques applicable both in the industry and clinical practice. Additionally, students will explore a variety of viable career paths. By reflecting on these potential career paths, they will be encouraged to apply their own personal concepts and ideas to building career opportunities.

The artifact that I chose for this class is a paper that I wrote on hypoglycemic herbs. We were given the freedom to choose an area or specialty of interest to write about. I wanted to develop my knowledge while deepening my experience with scholarly research and documentation.  As research and teaching are goals of mine, I found it important to hone my research and writing skills.

HRB 620b Module 2

MUIH Microbial Analysis Experiment Internship Part III

 

At last, we have reached the end of this series on the “internship” that is no longer an internship. If you didn’t read the series, you should start at Part I.  The point of this blog series is to illustrate some of the work that I have done and things that I have learned. Since this is a real, ongoing, study involving accredited universities (University of Maryland and Maryland University of Integrative Health), I am not disclosing all materials and methods, analysis, or results.

This last portion of the experiment I have been participated in involved testing botanical extracts against various bacteria, yeast, and mold.  Specifically, I got to test hydro-alcoholic extracts of Echinacea purpurea (commonly known as Purple Coneflower or Echinacea), of varying strengths to see if it inhibited growth of the bacterias, yeast, and mold.  To do this, I created dilutions using 3 different Echinacea tinctures to inoculate, incubate, and interpret results from 3M Petrifilms.

I learned aseptic lab techniques while carrying out the study discussed in Part II of this series. This time around, it was even more important because I was handling petrifilm loaded with yeast and mold spores, and one with E.Coli (yuck!).   Having the experience gained from the first round made it much easier to confidently carry out the steps while limiting exposure.  Some of the additional daily tasks involved taking ambient temperatures, monitoring samples, counting colonies, and reporting results.

I won’t go into all the nerdy details since more will be written (and it’s really the school’s place to properly publish the study and get credit for it).  For now here are some pics of what I’ve been learning and doing.

 

U.S. National Arboretum Internship

 

I had the opportunity to do my Spring 2018 internship at the U.S. National Arboretum in Washington, D.C.  The Arboretum is run by the U.S.D.A.’s Agricultural Research Service and hosts many different types of gardens and exhibits.  I had three different tasks: spend four Saturdays working in the National Herb Garden, create herbal monographs for several herbs that I worked with, and finally, to assist in the design, planning, and execution of a workshop on herbal bitters that would be held on the Arboretum grounds in August.

The work in the gardens provided a new appreciation for the hard work horticulturists put in.  My internship started with hours of carrying and planting herbs, and digging up tulip bulbs from the Spring entrance display.  The next Saturday, I planted enough corn and sugarcane to fill in the entire display we had dug up the week before. I pulled weeds, planted lemon balm, and pruned other herbs.  Dozens of people stopped to ask questions, providing an opportunity to share knowledge about the plants. During my two remaining days of work, I pulled weeds and helped shape plants in the Medicinal, Native American, and Culinary Herb Gardens.  The hard work in the garden paid off because I learned new gardening skills such as the right planting depth, proper pruning, and all about several garden pests. These skills will be very useful for cultivating my own herbs.

Creating the herbal monographs required a lot of research, my own organoleptic experience, and taking photos of properly identified plants.  The monographs can be viewed here. The final task, preparing for the Bitters Workshop, required extensive soft skills. I worked with the Arboretum staff via email, telephone, and through live collaboration sessions where we edited documents as we exchanged ideas.  

Each of the three tasks was very different from the others. I was able to do some manual labor, research, and event planning all surrounding herbs.  In the end, I walked away with some cultivation skills, experience creating monographs, and an appreciation for the amount of coordination that goes into planning events.  

Disclaimer:  Due to the beauty of Arboretum, I took an obscene amount of photos from May – July so I captured both Spring and Summer in the Herb Garden.

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HRB 620a Herbal Therapeutics I

The Learning Objectives for Herbal Therapeutics were as follows:

  1. Utilize principles of modern herbal medicine in order to determine how to best support wellness.
  2. Effectively apply herbs in a wellness model.
  3. Evaluate various herbal actions in order to choose those best suited for wellness.
  4. Apply experiences and concepts to effectively formulate herbal medicines.

This artifact is not a finished product, but rather reflects the learning and thought process occurring during the development of an herbal formulation to address a specific problem.  Notes in the document show reasons that a particular herb was omitted or the dosage changed.  The formulation was designed for a specific wellness problem and demonstrated each of the learning objectives.

 

HRB 620a Mod 9 Product Development Activity

 

 

Medicinal Herbs to Support Blood Sugar Management in Non-Insulin-Dependent Diabetes

This past week I had an assignment for school that challenged me to write a professional white paper on a topic of my choosing within the scope of herbal medicine.  I immediately knew I wanted to focus my energy on diabetes due to a recent diagnosis of a close family member.  I wanted to look at the symptoms of diabetes and the research available on medicinal herbs that could potentially serve as adjunctive, complimentary, or alternative treatment for symptom management so that I could suggest this family member discuss these herbs with his primary care provider.

I have attempted to take a large amount of information and present it in a way that is easily digestible.  If you are interested in the research but find this a bit too technical or dry, you are welcome to scroll all the way to the bottom to the conclusion.

Background

Diabetes Mellitus is a chronic metabolic disorder characterized by elevated blood sugar levels (hyperglycemia) and glucose present in the urine (glycosuria).  Insulin, a hormone produced in the pancreas, regulates blood sugar by removing glucose (sugar) from the blood, allowing it to enter cells throughout the body. It is important for other metabolic processes, as well. When there is insufficient insulin, or the body is not reacting to the insulin that is present, the levels of glucose in the blood begin to rise.  Sufficiently high levels of blood glucose result in the body burning alternative sources of energy, like fats, leaving their metabolites, ketones, in the blood. Metabolic changes can result, impairing the body’s ability to handle fats, leading to a buildup of fat throughout their arteries. Ultimately this can contribute to serious health problems such as: blindness, kidney failure, heart attack, and stroke.  

There are two types of diabetes: Insulin-Dependent Diabetes Mellitus (IDDM) and Non-Insulin-Dependent Diabetes Mellitus (NIDDM).  IDDM, often referred to as Type I, is usually characterized by significant lack of insulin production. There are many theories about the cause of the disease, however it is not entirely understood. Type I diabetes must be treated with dietary modifications and exogenous insulin supplementation.

NIDDM, Type II, also involves a deficiency of insulin, however it is much less severe. Sometimes the insulin is being produced, but no longer effective.  Treatment for this type of diabetes does not require insulin since the body is still producing it. Common treatment involves the use of hypoglycemic agents, glucosidase inhibitors, dietary modifications, and preparations designed to delay absorption of glucose.   

Present Case

Herbal medicine has been used to treat diabetes for thousands of years.  There are over one thousand plants that have been used historically for treating symptoms of diabetes.  Plants and plant extracts act in a variety of specific and non-specific ways, with the secondary metabolites from the plants either directly lowering glucose levels in the blood while others impact glucose metabolism.  Metformin, the first drug created for the treatment of Type II diabetes, was developed after the discovery that goat’s rue, Galega officinalis, contained a guanidine alkaloid that potentiated the activity of insulin. That alkaloid, galegine, is structurally similar to the synthetic metformin (Bone, 2003).

Testing of plants for hypoglycemic activity is primarily focused on the bioactivity of compounds related to glucose homeostasis  The mechanisms of actions vary widely, with some effects appearing immediately, and others requiring longer periods of time. Many plants have demonstrated beneficial actions related to symptoms of diabetes other than just blood glucose regulation, however they are beyond the scope of this paper.

Clinical studies have demonstrated that certain medicinal plants can stimulate insulin secretion, augment various receptors involved in the process, prevent insulin resistance before it develops, up-regulate or promote translocation of glucose transporter type 4 (GLUT-4), inhibit glucagon-like peptide-1 (GLP-1) secretion and advanced glycation end product (AGE) formation. The number of herbs that lower blood sugar levels is extensive and prohibitively long.  

A widely used Ayurvedic herb, “gurmar”, or gymnema, (Gymnema sylvestre) was described in ancient texts as useful when urine is sweet and has been documented as an antidiabetic medication for over 2000 years. The name gurmar means “sugar destroyer” in Hindi.  Controlled trials utilizing Gymnema sylvestre found that a preparation of 400 mg/day of Gymnema extract significantly lowered blood glucose and glycosylated haemoglobin over the course of 18 to 20 minutes, resulting in levels unparalleled by the group receiving conventional treatment. The authors concluded that the herb may promote insulin production and act as a regenerative agent, to include in damaged pancreatic tissue. It is suggested that these actions are due to the gymnemic acids (El-Houri, et al., 2014). A recent randomized, double-blind controlled trial was unable to demonstrate antidiabetic effects, but did have statistically significant reductions in body weight (Martínez-Abundis, 2016).

Another traditional remedy with thousands of years of use in Ayurvedic medicine is Coleus forskohlii.  The traditional use was for cardiovascular and digestive disorders, however it is a powerful herb for endocrine function because it has the unique ability to increase production of cyclic AMP (cAMP, adenylate cyclase), an important messenger used by many hormones and neurotransmitters (Bone & Mills, 2013).  While it does not cross into the cell, it is used for intracellular signal transduction, triggering changes in the cell’s function.  There are numerous physiological and biological effects from elevated levels of cAMP, however relative to the metabolic system, cAMP can trigger increased insulin production, stimulates the release of glucagon, stimulates the breakdown fat and inhibits glucose uptake.  Since obesity and adipose tissue play a role in insulin resistance, this herb could play a powerful role as both a hypoglycemic and a fat loss aid at a dosage of at least 50mg/day of forskolin, a diterpene extracted from the plant. This dosage was found to be effective in several clinical trials and studies. The results of another study found that an oral dose of 250mg/day for 12 weeks lowered body fat content in obese men, raised their testosterone levels, and increased their bone mass (Godard, Johnson, & Richmond, 2005).  Another herb that has been found to have similar impact in promoting fat loss is licorice Glycyrrhiza glabra.

Clinical trials support the use of fenugreek Trigonella foenum-graecum, leaf or seed, at 5g/day for improved blood glucose.  It is also reported to promote pancreatic cell renewal (Kalailingam et al., 2014).  Nopal, or prickly pear cactus Opuntia ficus-indica, has been used as an indigenous remedy for diabetes for hundreds of years. In vivo studies have shown that Opuntia lowers has promise in blended whole plant form, juice extracts, and isolated constituents. It has been found to both lower blood glucose and increase insulin levels (Leem, Kim, Hahm, & Kim, 2016).  The sulfur-containing compounds, allyl propyl disulfide and allicin, found in onions Allium cepa, and garlic Allium sativum, exhibit hypoglycemic effects by competitive interaction with insulin.

Cinnamon has been lauded for its support in blood sugar  management. There are conflicting studies on the efficacy and particular species responsible for the hypoglycemic action.  A meta-analysis found that 1-6 grams of powdered cinnamon (Cinnamomum verum and Cinnamomum cassia) had positive impact on blood sugar levels, however more studies are needed.  There is insufficient quality clinical date to evaluate bitter melon Momordica charantia, however one of its hypoglycemic peptides, Polypeptide-p, also known as “plant insulin” has been clinically demonstrated to be effective for humans when administered subcutaneously.

Other promising medicinal herbs with strong supporting clinical research are Ganoderma lucidum Reishi mushroom and Fucus vesiculosus, a brown algae seaweed known as “bladderwrack” in western herbal medicine. Both are nutritional powerhouses.

Conclusion:

Medicinal plants can effectively serve as an adjunctive treatment or natural alternatives  to commercial oral hypoglycemic medications.  There is insufficient clinical data to support each of the thousands of plants that have been used in traditional medicine systems for blood sugar management.  There is sufficient clinical research to support the use of some of these, such as: Gymnema sylvestre, Coleus forskohlii, licorice Glycyrrhiza glabra, and fenugreek Trigonella foenum-graecum, bladderwrack Fucus vesiculosus, and reishi mushroom Ganoderma lucidum, among others not covered in this paper.

 

References:

Bach, E., Hi, E., Martins, A., Nascimento, P., & Wadt, N. (2018). Hypoglycemic and Hypolipidemic Effects of Ganoderma lucidum in Streptozotocin-Induced Diabetic Rats. Medicines,5(3), 78. doi:10.3390/medicines5030078

Baskaran K., Kizar B, Shanmugasundaram K, et al. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients.  J. Ethnopharmacol. 1990;30(3):295-300.

Bone, K. (2003). A clinical guide to blending liquid herbs: Herbal formulations for the individual patient. St. Louis: Churchill Livingstone.

Bone, K., & Mills, S. (2013). Principles and practices of phytotherapy: Modern herbal medicine (2nd ed.). Edinborough: Churchhill Livingstone Elsevier.

El-Houri, R. B., Kotowska, D., Olsen, L. C., Bhattacharya, S., Christensen, L. P., Grevsen, K.,  Christensen, K. B. (2014). Screening for Bioactive Metabolites in Plant Extracts Modulating Glucose Uptake and Fat Accumulation. Evidence-Based Complementary and Alternative Medicine,2014, 1-8. doi:10.1155/2014/156398

Godard, M. P., Johnson, B. A., & Richmond, S. R. (2005). Body Composition and Hormonal Adaptations Associated with Forskolin Consumption in Overweight and Obese Men. Obesity Research,13(8), 1335-1343. doi:10.1038/oby.2005.162

Hoffmann, D. (2003). Medical herbalism: the science and practice of herbal medicine. Rochester, VT: Healing Arts Press.

Kalailingam P., Kannaian B., Tamilmani E., Kaliaperumal R. (2014). Efficacy of natural diosgenin on cardiovascular risk, insulin secretion, and beta cells in streptozotocin (STZ)-induced diabetic rats. Phytomedicine 21 1154–1161. 10.1016/j.phymed.2014.04.005

Khanna P., Jain S. C., Panagariya A., Dixit V. P. (1981). Hypoglycemic activity of polypeptide-p from a plant source. J. Nat. Prod. 44 648–655. 10.1021/np50018a002

Leem K.-H., Kim M.-G., Hahm Y.-T., Kim H. (2016). Hypoglycemic effect of Opuntia ficus-indicavar. saboten is due to enhanced peripheral glucose uptake through activation of AMPK/p38 MAPK pathway. Nutrients 8 800

Martínez-Abundis, E. (2016, July 13). Effect of Gymnema Sylvestre on Metabolic Syndrome and Insulin[Scholarly project]. In Clinicaltrials.gov. Retrieved from https://clinicaltrials.gov/ct2/show/NCT02370121