Many women experience sleep disturbance and insomnia during the menopause transition and beyond. The symptoms associated with declining oestrogen levels include hot flushes and night sweats, increased anxiety and depression, joint aches and pains, and bladder problems. These may lead to non-restorative sleep and early morning wakening which can further increase symptoms of anxiety and depression.

The value of a Medical Herbalist’s approach to treatment of insomnia around the menopause is that herbs can be selected and combined to treat both the symptoms and cause of poor sleep. There are a wide range of herbs that are relaxing and sedating acting via the neurotransmitter GABA. Increasing the levels and action of GABA in the brain promotes sleep onset and maintenance. Herbs that have this action include Valerian, Passionflower, California poppy, Ziziphus, Lemon Balm, Hops, Skullcap and Nutmeg.

To address the cause of insomnia herbs are selected with phytoestrogen action to help reduce the decline in oestrogen levels and include Black cohosh, Wild yam, Red Clover, and Shatavari. The adrenal glands become a source of oestrogen during the menopause, so it is very important to support adrenal function with herbs such as Ashwagandha, Korean ginseng, Eleuthero, Rhodiola and Liquorice. The herbs selected will depend on each individual and treatment may include others to reduce depression, improve cognition and support bladder function.

Advice on how to manage sleep and sleep hygiene is widely available. Behavioural changes can be very helpful in tackling menopause associated insomnia. Of particular importance are regular times for going to bed and getting up to synchronise the internal circadian clock. The internal clock is maintained by the pineal hormone melatonin which conveys information about the light/dark cycle to the body and controls the sleep/wake cycle. During the menopause melatonin levels gradually decrease in association with declining oestrogen levels and as part of the ageing process. Changes in melatonin release may therefore contribute to poor sleep patterns. The herb Vitex or Chaste berry helps regulate ovarian hormonal changes during the perimenopause but has also been shown to directly increase melatonin secretion. This direct action of vitex can used to increase night-time melatonin levels as part of treatment for insomnia.

Diet can be important in preventing insomnia. The evening meal should be eaten several hours before bed to ensure digestion does not disrupt sleep. Some foods contain tryptophan and can be beneficial for sleep such as pumpkin seeds, walnuts, chickpeas, almonds, turkey, chicken, and eggs. Any food intolerances may disrupt sleep and it is useful to keep a food sleep diary.

If you have taken a sleep medication such as Zopiclone for severe insomnia this should ideally only be for a short period to minimise any side effects and addiction. Herbal sedatives can be very helpful in the withdrawal from sleep medication. Medication dosage should be reduced very slowly and combined with herbal treatment such as nutmeg which can be slowly increased over the same period to prevent withdrawal symptoms such as rebound insomnia.
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Treatment with herbal medicine in combination with diet, exercise, reducing stress levels, sleep hygiene and regular bedtimes can be very effective in combating insomnia and reducing the symptoms associated with the menopause transition.

Reference sources

Menopause and Insomnia https://www.womens-health-concern.org/wp-content/uploads/2022/12/17-WHC-FACTSHEET-Menopause-and-insomnia-NOV2022-B.pdf
Sleep, Melatonin, and the Menopausal Transition: What are the links?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611767/#:~:text=As%20a%20woman%20approaches%20menopause,in%20a%20more%20gradual%20course.
The Seven-Day Sleep Prescription (2022) Aric Prather, Penguin Random House UK
Why We Sleep (2017) Matthew Walker Penguin Random House UK
Sleep The Elixir of Life (2021) Christine Herbert Aeon UK

Insomnia is the deeply irritating difficulty in falling or staying asleep or disturbed sleep patterns that fail to refresh you.

​Life events can result in short term insomnia whereas chronic insomnia is defined as occurring on more than three nights a week over three months.

Sleep deprivation can harm health. Effects on mental health include a decrease in thinking ability and memory, and an increase in low mood and anxiety. Poor sleep quality increases the likelihood of being overweight or obese. Sleep increases the production of leptin, an appetite suppressing hormone, so decreased levels of leptin with less sleep result in increased appetite. Reduced hours of sleep increase the risk of diabetes, hypertension and reduced immune function.

Treatment of insomnia with sedative drugs is no longer the first choice of treatment. These drugs have serious side effects such as daytime sleepiness and the risk of addiction.

A much more attractive option is to take herbal medicine as part of an integrated approach with lifestyle changes to improve sleep hygiene, diet, and exercise. These can be combined with other nonpharmacological methods such as talking therapies.

Herbal medicines are one of the most popular and frequently used therapies for treating insomnia. They can be readily bought over the counter and allow self-management of short-term periods of insomnia.

There are a wide range of sedative herbs which have a similar mechanism of action to sedative drugs, but they have far fewer side effects, and they are not addictive. Sedative herbs include:

• Valerian (Valeriana officinalis)
• Passionflower (Passiflora incarnata)
• California poppy (Eschscholzia californica)
• Hops (Humulus lupulus)
• Lemon balm (Melissa officinalis)
• Skullcap (Scutellaria lateriflora)
• Nutmeg (Myristica fragans)
• Chamomile (Matricaria recutita)
• Lavender (Lavendula angustifolia)
• Ashwagandha (Withania somnifera)

There are several possible causes of insomnia, and these need to be identified if treatment is to be effective long-term. The aim of a Medical Herbalist is to identify the underlying cause and to select a combination of herbs which will provide both sedative actions to treat the symptom of insomnia and other herbal actions to treat the underlying cause. The possible causes of insomnia include:

• Stress, anxiety or depression
• Gastrointestinal disorders
• Menopausal or other hormonal imbalances
• Musculoskeletal restlessness or pain
• Glucose imbalance

So, diagnosis of the cause of insomnia determines the selection herbs for treatment. The selection of herbs can be modified for each individual and combined with advice on sleep hygiene, diet, and exercise to improve both the duration and quality of sleep. 

 In a recent study over a third of people infected with coronavirus had at least one symptom of long covid three to six months after infection. The most common symptoms were fatigue, breathing problems, muscle pains, abdominal symptoms, headaches, brain fog and anxiety or depression.

There was no clear link between the severity of the acute covid infection and the occurrence of long covid. Many people with long covid had a mild form of the infection and did not need to be hospitalized. Women are more likely to suffer and people between 35 and 49 years of age.

The cause of long covid is unclear. It is a multisystem disorder which may result from a disruption in the body’s immune system. Altered levels of cytokines, molecules that help to regulate immune response, have been found in people who have had Covid 19. An autoimmune response in which the immune system attacks the body’s own cells could be a cause. Variation in the disruption of the immune response may explain the variability in symptoms (1).

There are similarities between long covid and chronic fatigue syndrome (CFS/ME) which often follows a viral infection. The symptoms of CFS/ME have been associated with dysfunction of the mitochondria, the energy producing structures in the cell, resulting in poor energy delivery and the associated physical and mental fatigue. Recent evidence shows patients with covid 19 have cells with compromised mitochondrial function and an energy deficit (2). This is compensated by a metabolic shift which triggers an enhanced inflammatory response and many of the resulting symptoms.

The NHS has set up some long covid clinics but the options for treatment are limited and the availability of these clinics very variable. Rest is key to recovery from long covid but support with herbal medicines, supplements and diet can aid that recovery.

How a Medical Herbalist can provide you with treatment to aid recovery:

Long covid is a multisystem disorder affecting several different tissues in the body. Medical Herbalists use a wide range of herbs each containing many active ingredients which target different sites in the body. Several herbs are mixed together to maximally target affected tissue.

Each person will have experienced a different response to the Covid 19 infection and will be experiencing different symptoms of long covid. Following a consultation, a Medical Herbalist can select the optimal mix of herbs to help reduce the particular symptoms experienced by each individual.

Using a modern prescribing system, Functional Herbal Therapy by Kerry Bone (3), which combines functional medicine with the unique properties of medicinal plants, the treatment goals for treating long covid can be identified. These are:
To support immune function, boost mitochondrial function to reduce fatigue, manage non-resolving inflammation, support adrenal function, target any remaining infection, restore lung tissue, boost cognition, improve sleep and boost circulatory and blood vessel health.

The herbs selected may each meet several of these target goals so the combination of herbs for each individual will be a unique selection at optimal concentrations. Herbal medicines selected by a Medical Herbalist can be combined with any orthodox treatment and have few side effects.

Using the pioneering work of Dr Sarah Myhill4 in the treatment of mitochondrial malfunction in people with CF/ME advice will be given on the supplements which have been shown to improve mitochondrial function. These include magnesium, vitamin B3, acetyl L-carnitine, Coenzyme Q10, and Vitamin B12. Other supplements which can aid recovery will also be identified.

Diet is a very important part of recovery. Advice will be given on how changes in diet can be used to maximise energy production of mitochondria, support immune function, and improve the gut microbiome. Particular emphasis will be given to the use of phytonutrient-rich plants foods as part of the therapy.

Medical Herbalists provide a unique combination of treatment with herbs, supplements, and diet to give a multi targeted approach to address the imbalance in the body’s physiology that has resulted from infection with Covid 19 and aid recovery.
 
References

1.  Nature News Feature (2021) ‘The four most urgent questions about long covid’ Nature 594, 168-170 (2021) doi: https://doi.org/10.1038/d41586-021-01511-z
2. Ajaz, S., McPhail, M. J., Singh, K. K., Mujib, S., Trovato, F. M., Napoli, S., & Agarwal, K. (2021). Mitochondrial metabolic manipulation by SARS-CoV-2 in peripheral blood mononuclear cells of patients with COVID-19. American journal of physiology. Cell physiology, 320(1), C57–C65.
3. Bone, K. (2021) Functional Herbal Therapy: A Modern Paradigm for Clinicians. Aeon Books Ltd, London.
4. Myhill, S. (2017) Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis: it’s mitochondria, not hypochondria. 2nd Ed, Hammersmith Books Ltd, London

 
 

It’s becoming sadly clear that for some people Covid-19 is not merely a short-term acute respiratory infection but a much longer-lasting illness that can scar and harm several systems in the body.

While most people recover from Covid-19 within two to four weeks, 10-20% experience one or more ongoing symptoms. The list is long: severe fatigue, recurrent sore throats, breathlessness, poor sleep, muscle pain, brain fog, and depression. It’s called Long Covid and we’re learning more about it each day.

A recent report by the National Institute of Health Research (NIHR) suggests that Long Covid is not a single syndrome but four different ones that can occur simultaneously. They identify patients experiencing after-effects of intensive care, those with post-viral fatigue, people with lasting organ damage, and those whose symptoms move around the body.

It is well known that viral infections can act as catalysts for fatigue, gut issues, and other health problems such as poor memory and sleep disturbances that persist long after the infection has gone. The long-term effects of Covid 19 are similar to the symptoms experienced by those with Chronic Fatigue Syndrome (CFS) that develops after a viral infection in up to 80% of cases.

While a virus might be the trigger, the cause of post-viral fatigue syndrome is unclear.  One theory is that it may result from an overreaction of the body’s immune system that induces widespread inflammation. This is indicated by elevated levels of immune messengers called cytokines, which can cross the blood-brain barrier and potentially cause long-term changes in the brain. Others are looking into why mitochondria, the structures that generate energy within cells, are affected and how this results in fatigue.

Convalescence is the gradual recovery of health and strength after illness and vital for recovery from Covid-19. A recuperative regime should consist of total rest, help with sleep and relaxation, limited exercise, and a simple diet of easily digested nutritious food.

Herbal medicine can provide valuable support as part of this recovery regime and is used effectively by Medical Herbalists to support the recovery from CFS.  The herbs selected for treatment will include tonic herbs to help revitalize and reduce fatigue, adrenal support to improve the response to stress, and anti-inflammatory herbs to help regulate cytokine production.

The herbs selected for each person depend on the symptoms experienced. The treatment may include circulatory support to improve blood flow, particularly to reduce brain fog. Help to improve sleep and reduce depression, support for the digestive system and relief of muscle pains. In some the symptoms are cyclical and move around the body so herbal treatment can be varied in response to these changes.

More help is needed for those with Long Covid. A Medical Herbalist can provide treatment to support recovery and help reduce the severity and duration of the symptoms.
 
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Many of us are struggling to cope in the pandemic and trying to prevent our periods of anxiety turning into depression. People who have previously suffered from depression are particularly susceptible but we all may be vulnerable during the present crisis. There are many different causes of depression, but we need to address those over which we have some control.

Depression has been linked to anxiety resulting from chronic stress, poor sleep disrupting circadian rhythms, general bodily inflammation, disruption in the gut bacteria caused by poor diet, and hormone imbalances. The causes and responses will be different for each person.

The two most common treatments are antidepressant drugs and talking therapies. Both are effective for some people but not others. Many people experience problems with taking antidepressant drugs because of side effects and withdrawal symptoms. This has led to the search for other forms of treatment.

Herbal medicine has been used to treat depression for hundreds of years. Recent evidence demonstrates the effective antidepressant action of individual herbs such as St John’s Wort, Saffron, and Rhodiola. These herbs are effective, well tolerated, with few side effects, and do not cause dependence and withdrawal symptoms.

Since depression is a complex condition resulting from a range of contributing factors, regulating a single target may not reduce depression as effectively as targeting multiple systems. The advantage of herbal medicine is that different herbs can be selected with different sites of action and combined in a single formula. The selection of herbs with a range of different actions increases the potential effectiveness of treatment. The herbs selected will vary with each individual depending on the causes of depression.

For example, you may be given a herbal formula to treat depression which contains herbs to reduce anxiety, balance the stress hormone cortisol, promote healthy bacteria in the gut, and reduce inflammation.

Many people turn to herbal medicine in search of a treatment that is effective, long lasting and with few side effects. Combining different herbs in a formulation for each individual provides a multitargeted approach and sustainable form of treatment.

It’s that time of the year again. Many of us are spluttering with coughs and colds. Cold winter weather makes us much more susceptible to infections such as cold and flu viruses.

We often rush to buy remedies over the counter at the chemist that relieve symptoms such as sneezing, blocked noses, sore throats, headaches and coughs. However, these remedies do not address the problems of persistent colds, the ones that keep returning, or coughs that linger. Once you have had one infection it can make you more susceptible to further infections particularly after the festive season.

The main benefit of treatment with herbal medicines is that it can address both the causes and the symptoms. The reasons we catch colds are because we are exposed to the virus and our immune system is unable to fight the infection.

Herbal medicines offer a two-pronged approach. First, herbal medicines can boost our immune system so strengthening the body's ability to fight infection. Second, herbs can be very effective antimicrobial agents killing pathogenic viruses and bacteria.

This second action has a further benefit of not only killing cold or flu viruses but also preventing secondary bacterial infections. This avoids asking GPs to prescribe antibiotics. With the wider increase in antibiotic resistance, we should reduce our use of antibiotics and preserve the body's ability to fight more serious bacterial infections.

A Medical Herbalist has access to a wide range of different herbs with both immune-enhancing and antimicrobial actions. They can prepare a unique mix of herbs for you to strengthen your whole body in fighting infections and getting fit again.
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Irritable bowel syndrome (IBS) is a common digestive problem affecting nearly a third of the population. Symptoms include unpredictable bowel movements - diarrhoea, constipation or both - stomach pain, and bloating. There are also several non-digestive symptoms such as muscle pain, tiredness, mood disturbance, and headaches. IBS can take a major toll on the quality of everyday life.

Considering IBS is so widespread, it is surprising that the orthodox treatment available is so limited. Treatment mainly consists of pain relief, and there is no specific test to diagnose IBS.

IBS is now considered a disorder of the gut-brain axis, a two-way nervous connection between the brain and the nervous system controlling digestion. In those with IBS, the pain receptors in the gut become super-sensitive and generate an exaggerated pain response to the presence of food and drink. What’s called visceral hypersensitivity can also affect other parts of the body causing wider ranging pain.

There are numerous factors that can spark IBS. A well-known cause is that a bad stomach infection initiates an inflammatory response. Other contributing factors are gender (it is more common in women), genetic susceptibility which makes some people more vulnerable, and the levels of stress and anxiety you are experiencing. Changes in gut function such as delayed gastric emptying and increased intestine permeability in leaky gut are other factors.

Gut bacteria play a fundamental role in digestion and changes in the balance of good and bad bacteria are associated with IBS symptoms. Diet is crucial for optimizing gut bacteria and is therefore vital in managing IBS. The two books suggested here* give detailed approaches to controlling IBS through dietary changes.

For the most comprehensive approach to treating both the cause and symptoms of IBS visit a Medical Herbalist. Following a full consultation and assessment of any food intolerances, a mix of herbal medicines will be selected. This will be unique for each individual as people with IBS vary in the symptoms experienced and the possible causes.

A Medical Herbalist will treat IBS by selecting herbs that:

• Promote and balance beneficial bacteria and reduce harmful bacteria
• Ease pain by reducing spasms of the gut wall
• Reduce inflammation and balance the immune response
• Reduce diarrhoea or constipation and promote formation of healthy stools
• Optimise digestive secretions to normalise bowel function
• Promote gastric emptying
• Reduce gut permeability by repairing the gut lining
• Reduce the build up of gas and reduce flatulence
• Improve the ability of the body to cope with stress
• Tone the nervous system to help reduce visceral sensitivity
  

By addressing both the cause and symptoms of IBS with herbal medicines and combining this with changes in diet this offers the most comprehensive treatment and a future free of IBS.
 
*The Digestive Health Solution (2017) Benjamin I Brown, ND
* Eat Yourself Healthy (2019) Dr Megan Rossi
 

 Uncomfortable symptoms experienced by many women during the menopause can  be effectively managed with herbal medicines prescribed by medical herbalists. A recent study ( Link) shows that herbal treatment led to significant improvements for many women.

The menopause affects women in different ways and there is a wide range of symptoms of varying intensity. The study lists sixteen symptoms including hot flushes, mood swings, and joint pain.

Treatment with HRT prescribed by the GP is not a treatment choice for many women, either because it is contraindicated, or they prefer a more natural form of treatment. Many women want an effective alternative and one they feel comfortable taking for a longer duration.

Individual herbs such as black cohosh and red clover bought over the counter can relief menopausal symptoms but not everyone finds them beneficial and the evidence is contradictory. These are standardised formulations which do not meet the individual requirements of each woman.

The variation in women’s experience of the menopause supports the need for both a range of treatment and also the need for this to be tailored to each individual. The study showed how this was provided by a medical herbalist who, following a full consultation, selected several different herbs most beneficial to the patient.

The medical herbalist was able to respond to the needs of the patient and the symptoms experienced, and vary the herbal prescription and protocol accordingly. Selecting an individualised mixture of herbs also allows treatment of other organ systems that may be affected by the menopause and not just those associated with decreasing oestogen levels.

The women in the study reported not just an improvement in menopausal symptoms but improved wellbeing and the ability to carry out a chosen activity thus enhancing their quality of life.

More women need to be aware of the option of visiting a medical herbalist. Participants in the study stated that would have liked their doctor to have told them about visiting a qualified medical herbalist for herbal treatment, an option not currently mentioned in the NICE guidelines.
 

Abandoning antidepressant drugs can cause unpleasant withdrawal symptoms such as anxiety, confusion, and exhaustion that often force patients back to the drugs they hoped they no longer needed.

The Royal College of Psychiatrists now accepts that it did not sufficiently recognize such withdrawal problems.

The College’s previous advice of slow withdrawal over two to four weeks has been changed to a period of months during which drug doses are reduced more slowly.

Herbal medicines can ease the process of withdrawal and reduce symptoms. They also offer the further possibility of long-term support to boost general health and wellbeing. Crucially, herbal medicines are not addictive so can easily be stopped when good health is achieved.

The approach taken by a Medical Herbalist is to select herbs that address these issues, but the treatment is tailored to each person’s experience.  

Herbs include St John’s wort whose antidepressant action is gentle with few side effects. If interaction with the antidepressant drug could be an issue, other herbs with similar antidepressant action such as skullcap and vervain are available.

To reduce the symptoms of withdrawal such as anxiety and exhaustion, herbs are given to relax and to normalise adrenal function. Treatment may include support for liver function and herbs to improve sleep, address problems with digestion, and increase cerebral blood flow. The choice will depend on the symptoms experienced.

Herbal medicines are an effective way to successfully wean yourself off antidepressant drugs. Please consider visiting a Medical Herbalist to get the full benefits of herbal treatment.

Lyme disease is becoming better known. Three recent events alerted me to the infection: a patient was diagnosed with it, I saw signs in a local wood warning of the dangers of tick bites, and I attended a seminar by the Lyme disease specialist and Australian Naturopath, Amina Eastham-Hiller.

The increasing incidence of Lyme disease may be caused by climate change leading to warmer winters and greater awareness and, therefore, reporting.

Lyme disease is an infection caused by bacteria called Borrelia burgdorferi, which are transmitted to humans following a bite from an infected tick. Only some ticks carry the infection.

The first sign that you may have contracted Lyme disease is the presence of a rash called erythema migrans, which is an expanding area of red from a central tick bite looking like a bulls-eye on a dartboard.  Some people also have flu-like symptoms in the early stages, such as a high temperature, headache, muscle and joint pain, and loss of energy.

If you think that you may have been bitten by a tick, it's vital to visit your GP. Antibiotics are very effective against Lyme disease in the early stages of infection.

Unfortunately, some people do not know they have been bitten by a tick, not everyone gets the bulls-eye rash, and the symptoms of Lyme disease can be misdiagnosed.  The symptoms are like those experienced in other conditions such as chronic fatigue and fibromyalgia and the blood test does not guarantee diagnosis.

If antibiotics are not prescribed in the early stages they can become less effective at eliminating the infection. The Borrelia bacteria are very effective at evading the action of antibiotics. They can penetrate and live inside cells or form dormant cysts gaining protection from the immune system and antibiotics.

Some people develop chronic Lyme disease, which no longer responds to antibiotic treatment. And long term antibiotic use is associated with side effects which further damage health. The symptoms of chronic Lyme disease include severe fatigue, musculature pain, and mental impairment.

Amina Eastham-Hillier argues that herbal medicines are very effective in the treatment of chronic Lyme disease. Herbs are selected for each individual with the following actions:  antimicrobial, support for the immune system, anti-inflammatory, adrenal tonic, nervous system support, improving cognitive function, antioxidant, detoxification, and support for gut micro flora. This wide range of actions of herbal treatment both reduces symptoms and helps restore the body’s natural ability to fight the infection.

Lyme disease is a complex condition and often associated with other secondary infections. NICE has issued advice to help GPs diagnose and treat Lyme disease more quickly to prevent it becoming chronic. The evidence on the benefit of prolonged antibiotic treatment is limited but herbal medicine prescribed by Medical Herbalist provides a way in which this difficult condition can be treated.