1. Botanicals for Common Infections in Women
Tori Hudson, N.D.
Clinical Professor, NCNM/Bastyr/SCNM
Medical Director, A Woman’s Time
Program Director, IWHIM
Research/Education Director, Vitanica
Sponsored by:

2. Disclosures Vitanica: Director Education/Research; Co-owner
Scientific Advisory Boards
Gaia Herbs
Nordic Naturals
Integrative Therapeutics Inc
Natural Health International

3. To Be Discussed Yeast vaginitis Bacterial vaginosis Cystitis HPV
Genital herpes

4. Garlic/thyme cream for YVV
N= 64; ages 30-37
32 women = vaginal cream containing garlic and thyme or 32 women = vaginal cream with clotrimazole cream for 7 nights.
The therapeutic response was considered successful if there was an absence of Candida hyphae microscopically and a negative culture for Candida.
The authors report significant improvement in clinical symptoms in both groups after treatment (P<0.05). The garlic/thyme group reported a greater decrease in vulva erythema compared with the clotrimazole group (P=0.02). No worsening of symptoms was reported in either group.
Of the adverse side effects reported, "other side effects" were seen in 9.4% of the clotrimazole group and in 34.4% of the garlic/thyme group.
Iran J Nurs Midwifery Res. December 2010;15(suppl 1):
Thirty-two women were assigned to each treatment group: vaginal cream containing garlic and thyme or vaginal cream with clotrimazole. No detalis about the garlic/thme cream were provided.They were instructed to use the cream for 7 nights. After that, the activities of the first visit were repeated, and patients were asked about adverse side effects. The therapeutic response was considered successful if there was an absence of Candida hyphae microscopically and a negative culture for Candida.
The authors report significant improvement in clinical symptoms in both groups after treatment (P<0.05). The garlic/thyme group reported a greater decrease in vulva erythema compared with the clotrimazole group (P=0.02). No worsening of symptoms was reported in either group.
Of the advere side effects reported, "other side effects" were seen in 9.4% of the clotrimazole group and in 34.4% of the garlic/thyme group.

5. Yeast Vaginitis - Additional vaginal agents
Berberine (goldenseal,oregon grape) - in vitro antifungal; candida albicans.
Calendula - historical use as a local/topical remedy for local infections, wounds, injuries.
Garlic - in vitro inhibitor of candida albicans.
Tea tree - in vitro; inhibitor of candida albicans.
Homeopathics (OTC criteria) – Borax, Hydrastis, Berberis, Kreosotum,others.
Povidine iodine - paint cervix and vagina with solution on day one. Applicator gel (5gm) bedtime, douche next morning using 2T/1qt water bid x 6.
Calif Med 1969;110
Berberine-
Calendula-
Garlic-garlic has been shown in vitro to have antifungal properties that led some to investigate is usefulness to treat YVV. 24/26 strains of C. albicans have proved to be sensitive to garlic. Typical dosing of garlic is one clove wrapped in unbleached gause, then crushed just before insertion. Every night for up to 6 nights.
Tea tree- in vitro studies showed action of tea tree against multiple candidal species, including candida albicans, C. glabrata and C parapsilosis. Intravaginal preparations were tested including pessaries, intravaginal gel, and douces. Typically, one to two drops of tea tree oil are placed into a gelatin capsule and the remainder of the capsule is filed with calendula oil, vegetable oi, or water. 2 capsules are inserted into the vagina at night for up to 6 nights. ( toxicity= allergic contact dermatitis. ) no clinical trials have been done.
Povidine; n=74. All cases cleard in 1-3 weeks.

6. Lactobacillus species/strains antipathogen properties
L rhamnosus GG
L acidophilus NCFM
L casei Shirota
L. reuteri MM 53
L. casei CRL-431
L. rhamnosus GR-1
L fermentum RC-14
Others to consider:
L plantarum 299V
L salivarius

7. Candida Vaginitis Sample Treatment Plan
Acute
- Boric acid suppositories bid X 3-7 days
- Yogurt 8oz daily and/or Lactobacillus species/strains combinations for 2 weeks
Chronic
- Boric acid suppositories bid x 2-4 wks; then prophylactic plan
- Yogurt 8oz daily and/or Lactobacillus species/strains combinations for 2-6 mo.
- Consider systemic: Garlic, Oregon grape, Goldenseal

8. Bacterial Vaginosis Allium sativum (Garlic)
- Effective against some antibiotic resistant organisms
- Allicin: growth – inhibitory constituent
Garlic,which is antibacterial, antiviral and antifungal has been shown to be effective even against some antibiotic resistant organisms. The major growth-inhibitory component in garlic extract is allicin; garlic with high allicin content is preferable. Garlic cloves can even be carefully peeled and inserted into the vagina

9. Bacterial Vaginosis – Additional Botanicals
Contain berberine: antibacterial; specific for mucosal surfaces
Goldenseal (Hydrastic canadensis)
Oregon grape (Berberis vulgaris)
Tea tree (Malaleuca alternifolia)
antibacterial and antifungal
daily douching effective in candidiasis, trichomoniasis and cervicitis

10. BV and Vitamin C 250 mg vitamin C vaginally for six days Vit C placebo
No clue cells % 53%
No bacteria 77% 54%
L. reappeared % 53.3%
pH > % 38.6%
BV persisted 14% 35.7%
Eur J Ob/GYN 2004

11. Bacterial Vaginosis Other agents: Topical 5% aqueous propolis solution
Topical Povidone-iodine
Ascorbic acid suppositories
Additional agents - Homeopathics:
Borax, Hydrastis Canadensis, Kreosotum, Sepia, Calcarea Carbonicum, Nitric acidum, Carbolic acidum 

12. Lactobacillus species/strains antipathogen properties
L rhamnosus GG
L acidophilus NCFM
L casei Shirota
L. reuteri MM 53
L. casei CRL-431
L. rhamnosus GR-1
L fermentum RC-14
Others to consider:
L plantarum 299V
L salivarius

13. Bacterial Vaginosis Sample Treatment Plan
Option A
Vitamin C tablet x 6 days then
Boric acid supp 1/day x 1 week
Lactobacillus species/strains x 4 weeks
Systemic immune support:
Oregon grape, Goldenseal; 1 tsp bid

14. Bacterial Vaginosis Sample Treatment Plan
Option B
Metronidazole gel - 1 gm bid x 5-10 days
Concurrent oral lactobacillus species/strains 8+billion or more daily for 2-4 weeks
Follow metronidazole with lactobacillus suppositories 1x/day for 7-14 days plus boric acid supp 1/day for 7-14 days
Systemic immune support = Oregon grape, garlic, goldenseal
Immune supportive diet

15. UTI: Cranberry
20 adults who did not have an active urinary tract infection, and were not taking antibiotics.
In phase 1: 3 caps that contained 275 mg of a mixture of dried whole cranberry extract and 25 mg of a concentrate of cranberry extract.
In phase 2: no cranberry on day 1 and 900 mg of cranberry preparation on day two.
Results: In phase 1, 7 of 20 (35%) individuals had anti-microbial activity against Escherichia coli,13 of 20 (65%) had anti-microbial activity against Klebsiella pneumoniae, and 9 of 20 (45%) against Candida albicans.
In phase 2, 23% showed antimicrobial activity against E. coli, 33% against C. albicans, and 67% against K. pneumoniae.
eCAM 2010;7(2): doi: /ecam/nem183
Cranberry and urinary antimicrobial effects
Here is another recent study on the urinary antimicrobial effects of cranberry. This study evaluated 20 adults who did not have an active urinary tract infection, and were not taking antibiotics. In phase 1 of the study, individuals collected first morning urine prior to ingesting 3 caps that contained 275 mg of a mixture of dried whole cranberry extract and 25 mg of a concentrate of cranberry extract. Urine was then collected at 2, 4 and 6 hours. In phase 2, individuals collected urine on 2 consecutive days with no cranberry on day 1 and 900 mg of cranberry preparation on day two.
Results: In phase 1, 7 of 20 (35%) individuals had anti-microbial activity against Escherichia coli, 13 of 20 (65%) had anti-microbial activity against Klebsiella pneumoniae and 9 of 20 (45%) against Candida albicans. In phase 2, 23% showed antimicrobial activity against E. coli, 33% against C. albicans and 67% against K. pneumoniae.
Commentary: This study suggests that the anti-microbial activity of this cranberry extract was not significant for E. coli and that the most frequent anti-microbial activity occurred in both phases for only K. pneumoniae.
While not all studies of cranberry have shown significant antimicrobial effects, other studies of cranberry and urinary tract infections have been more positive. The current study did not study individuals with an active infection but their urine was inoculated with the three organisms and then the anti-microbial effects of the cranberry ingestion was measured as effective is there was a 50% or greater reduction in colony forming units.
It may be that a true anti-microbial effect and colony reduction of cranberry is not the main mechanism of action, but rather the ability of the cranberry to inhibit the adherence of the bacteria to the cells lining the bladder and the urethra and thus being flushed out of the urinary tract system. In addition, I would always recommend other key bladder infection ingredients in an acute treatment plan as well as a prevention of recurrence plan that would include Oregon grape root, pipsissewa, buchu, uva ursi, marshmallow root and Lactobacillus species that dominate the urogenital tract.
Lee Y, Najm W, Owens J, et al. Anti-microbial activitiy of urine after ingestion of cranberry: a pilot study. Epublication prior to print publication: eCAM 2010;7(2): doi: /ecam/nem183

16. UTI: Cranberry
10 Greek postmenopausal women who had at least 3 documented urinary tract infections (UTIs) in the previous year or at least 2 UTIs in the last 6 months prior to the start of the study.
400 mg of cranberry extract twice per day over 6 months.
While taking the cranberry extract, none of the women had a UTI over the course of the 6 months and almost all of the urine cultures were sterile (normal). Three women reported mild gastrointestinal problems and their dose was reduced to 2 capsules per day and as a result, their gastrointestinal problems subsided.
J Altern Complement Med 2009;15(11):1155.
Cranberry and bladder infections
November #2, 2010
A small study was conducted in 10 Greek postmenopausal women who had at least 3 documented urinary tract infections (UTIs) in the previous year or at least 2 UTIs in the last 6 months prior to the start of the study. Women were given 400 mg of cranberry extract twice per day (2 caps in the morning and 2 in the evening) over 6 months. Urine cultures were taken and proven normal before the start of the study and then every month during the study.
While taking the cranberry extract, none of the women had a UTI over the course of the 6 months and almost all of the urine cultures were sterile (normal). Three women reported mild gastrointestinal problems and their dose was reduced to 2 capsules per day and as a result, their gastrointestinal problems subsided.
Commentary: Cranberries, in the form of juice and capsules have been shown to be effective in previous prevention and treatment of bladder infections. Both cranberries and blueberries belong to the Vaccinium species which are rich sources of dietary flavonoids, including anthocyanins and proanthocyanidins. While the exact mechanism of the benefits of cranberries has not been clearly established, it is thought that the inhibition of adherence of the main bacteria causing infection, Escherichia coli, to the uroepithelial cells that line the wall of the bladder is the main action.
Karefilakis C, Mazokopakis E. Efficacy of cranberry capsules in prevention of urinary tract infections in postmenopausal women. J Altern Complement Med 2009;15(11):1155.

17. UTI: Uva ursi Arctostaphylos uva ursi Constituents: Action: Dose:
Arbutin
Action:
Antiseptic; most effective in alkaline environment
Dose:
Freeze-dried leaves = mg per day
Tincture = tsp tid
CI during pregnancy
Uva ursi is considered an antimicrobial urinary tonic that is both astringing due to tannin content, and diuretic.
Contains arbutin, a phenolic glycoside-found in up to 10% of the leaf. It degrades into the antiseptic component hydroquinone in an alkaline environment. Hydroquinone is most effective in an alkaline environment. Antimicrobial especiallly against E.coli.

18. UTI: Uva ursi Also contains: methylarbutin tannins
ursolic acid (diuretic)
phenolic acid
resins
flavonoids(quercitin and Isoquercitin)
Tannins- 15% tannin content but can increase to 40% when gathered late in the season. Gallic and Egallic acids are the primary tannins found in Uva Ursi.
Quercitin-diuretic and anti-inflammatory
Indications; acute cystiti, pyelonephritis, urethritis, lithiasis, blader irritation, pain tenesmus, dragging sensation

19. UTI: Goldenseal Hydrastis canadensis Constituent: Berberine Action:
Antibacterial
Inhibits bacteria from adhering
Dose:
Freeze-dried = mg tid
Tincture = 1-1/2 tsp tid
Chief antibiotic sunstance, berberine; works better in alkaline environment. Berberine is antibacterial against E. coli and Proteus species; inhibits the bacteria from adhering.

20. UTI: Oregon Grape Berberis aquifolium Constituent: Action: Berberine
Antibacterial
Inhibits bacteria from adhering

21. UTI: Pipsissewa Chimaphila umbellata Constituents: Action: Arbutin
Antiseptic
Antibacterial
Astringent
Alterative
Diuretic
Argutin degrades to hydroquinone
Indications: cystitis acute or chronic; dysuria or pyuria, pyelonephritis, hematuria

22. UTI: Marshmallow Althaea officinalis Constituents: Action: Mucilage
Protective layer
Contains mucilage that forms a protective layer on the lining of the bladder, minimizing the inflammation and irritation.

23. UTI: Buchu Barosma betulina Constituents: Action: Dose: Flavonoids
Mucilageous constituents
Action:
Diuretic; protective layer
Dose:
mg tid
tincture 1 ½ tsp tid

24. Cystitis: Sample Treatment Plan - Acute
Increase water (8 or more glasses daily)
Increase cranberry juice (16 oz daily)
Vitamin C (2,000 mg every 2 hours for 2 days, then 2 grams tid for one week)
Botanicals: cranberry, goldenseal, Oregon grape root, buchu, uva ursi, pipsissewa (every 2 hours for 2 days, then 2 doses tid for one week)
Formula, singles or similar formula
Cranstat Extra=cranberry concentrate, buchu leaf, pipsissewa, uva ursi leaf, oregon grape root, marshmallow root

25. Cystitis: Sample Treatment Plan Chronic recurring
Void upon urge, after intercourse
Condoms if intercourse
Staphysagria after intercourse
Increase fluids
Cranberry extract 400 mg bid
Mannose powder 1 tsp/day
Probiotics–8+ billion daily; urogenital specific species (consider intravaginal lactobacillus spp)
Consider “Cranstat extra” 2 caps daily

26. HPV Treatment
Treating HPV-infected cells may help boost immunity by destroying the cells within which the HPV resides, thereby releasing HPV to disease-fighting dendritic cells and macrophages.

27. Naturopathic Treatment
Smoking cessation
Safe sex practice education
Support the immune system
Treat HPV
Treat the dysplasia

28. Three Month Oral Protocol
Botanical Protocol 1
Red clover
Dandelion root
Licorice root
Goldenseal root
Botanical Protocol 2
Thuja
Echinacea
Ligusticum

29. Cervical Dysplasia Research
Green tea
Coriolus versicolor
I3C/DIM

30. Cervical Dysplasia - Green Tea Vaginal and Oral
51 patients with cervicitis to CIN 2 divided into 4 groups and compared to 39 controls.
20/27 using poly E ointment vaginally 2x/week
6/8 poly E plus poly E capsule
3/6 poly E capsule
6/10 EGCG capsule
Overall: 69% response rate 35/51 with green tea extract vs 10 % response rate 4/39 in controls (P<0.05).
Eur j cancer prev 2003;12(5):
51 patients with cervical lesions (chronic cervicitis, mild dysplasia, moderate dysplasia and severe dysplasia), were divided into four groups, as compared with 39 untreated patients as a control. Poly E ointment was applied locally to 27 patients twice a week. Poly E is a high polyphenol content, decaffeinated, proprietary green tea extract. For oral delivery, a 200 mg of poly E or EGCG capsule was taken orally every day for 8-12 weeks. In the study, 20/ 27 (74%) under poly E ointment therapy showed a resonse. 6 out of 8 patients under poly E ointment plus poly E capsule therapy (75%) showed a response, and 3/6 patients (50%) under poly E capsule therapy showed a response. 6/10 patients (60%) under EGCG capsule therapy showed a response. Overally, a 69% response rate (35/51) was noted for treatment with green tea extracts, as compared with a 10% response rate (4/39) in untreated controls. This data suggests that green tea extracts in a form of ointment and capsule are effective for treating HPV infected cervical lesions.
??? “showed a response”= results were eval by f/u pap, bx of lesion, HPV testing and response was determiend by their change in degree of atypia or dysplasia. The main limitation in this study was the complexity of the design, which did not allow for a sufficient number of subjects in any arm of the study to demonstrate differences among therapy or for any given decree of dysplasia. Although ointment was helpful, oral therapy in this study appeared to be as effective. RECOMMENDATIONS: we should consider an 8-12 week trial of a high polyphenol content green tea extract at a dose of 200 mg/day for patients presenting with especially ASCUS and LGSIL.
Epidemiological studies have shown an inverse relationship between amount of tea consumed and rates of a number of cancers. The evidence for the protective effects of tea are strongest in Asian populations who mainly drink green tea. For women, there has been relatively little evidence that tea decreases cancer risk. The Iowa Women’s Health Study showed that tea consumption decreased the rate of rectal cancer, but did not decrease the incidence of any gyn cancers. The tea consumed in this study was mainly black tea which may account for the lack of effect. There was a case control study in China that showed a decreased risk in the incidence of developing ovarian CA with increased consumption of green tea. A Japanese observational study showed that a high rate of green tea (5 or more cups/day) was assoc with an improved prognosis in patients with stage I and II breast cancer.

31. Green Tea
ECGC in green tea was evaluated on cervical epithelial; cells and cervical cancer cells and HPV.
Both ECGC and polyphenols E inhibited immortalized cervical epithelial and cancer cell growth.
Green tea induced apoptosis, decreased gene expression, and cell cycle changes.
Int J Gynecol Cancer ;20(4):

32. Green tea ointment and anogenital warts
RCT
Sinecatechins ointment 15% or 10% or placebo three times daily for a maximum of 16 weeks or until complete clearance of all warts, followed by a 12 week tx free f/u to assess recurrence.
Tatti S, et al. Ob and Gyn2008;111(6):1371
This was a randomized, double-blind placebo controlled trial involving 502 men and women aged 18 and older with 2-30 anogenital warts. Patients applied sinecatechins ointment 15% or 10% or placebo three times daily for a maximum of 16 weeks or until complete clearance of all warts, followed by a a12 week tx free f/u to assess recurrence.
Complete clearance of all baseline and newly occurring warts was obtained in 57.2% and 56.4% of patients treated with sinecatechins ointment 15% and 10% respecitively compared with 33.7% for placebo. Significance was observed at weeks 4 and 6 and all subsequent visits. Partial clearance rates of at least 50% were reported for 78.4% and 74.0% of those using the 15% and 10% ointments compared with 51.5% with placebo. Recurrence rates were 6.5% vs 8.3% vs 8.8%.

33. Green tea and warts
Two phase III trials evaluated treatment of EGWs with ointment containing a mixture of green tea catechins (Polyphenon E), U.S. adopted name: sinecatechins.
Men and women aged > 18 years with two to 30 EGWs applied vehicle Polyphenon E ointment 10% or Polyphenon E ointment 15% three times daily until complete clearance of all EGWs (baseline + new EGWs) or for a maximum of 16 weeks.
838 completed treatment after 16 weeks.

34. Green Tea and warts con’t
Complete clearance of all EGWs was obtained in 53.6% (10% ointment) and 54.9% (15% ointment) of patients with Polyphenon E vs. vehicle.
Statistically significant differences in clearance rates appeared after 6 weeks of active treatment.
Only a 55 recurrence rate.
Br J Dermatol Jan;162(1):

35. Additional Anti-viral herbs HPV and CIN
Consider; Mahonia, licorice, thuja, melissa, hypericum, echinacea

36. Coriolus versicolor 39 patients with biopsy confirmed LSIL
21 were controlled
18 took coriolus 3grams/day for 1yr
72.5% of the 18 patients who took coriolus showed normal cervical cytology
90% of patients with HPV+ high risk and took coriolus reverted to HPV negative
Couto. S. Clinical Journal of Mycology. January 2012 Volume 3 36

37. Indole-3-carbinol 30 patients with CIN II-III
17 took I-3-C 400mg for 12 weeks (13 placebo group)
8 of the 17 had complete regression
I-3-C up-regulates tumor suppressor gene PTEN which is MOA for inhibiting development of cervical cancer.
Gynecol Oncol (2)
Another study done on mice that showed I3C reversed cervical dysplasia
Mol Med 2005 Jan-Dec 11(1-12):59-63 37

38. Original research results for treating ASCUS, CIN, CIS
43 cases, including cervical atypia (n=7), cervical dysplasia (n=26), and carcinoma in situ (n=10)
43 patients:
- 38 = normal
- 3 = partial improvements
- 2 = no change
- 0 = no one worse

39. Genital Herpes Natural Treatment Interventions
Considerations
- Host health
- Prevention of recurrences
- Immune support
- Reduce triggers
- Mucosal immunity
- Anti-viral therapies

40. Botanicals - Topical Lemon Balm
Recurrent Oral; n=66
10% S.E. lemon balm vs placebo qid x 5 d
Applied cream no more than 4 hours after onset of prodrome.
Results: day 2 = reduction in severity and number of eruptions with lemon balm.
Total score over 5 days = no difference.
(Koytchev et al)

41. Larrea Tridentata Larrea leaf resin inhibits HSV-2 replication
- NDGA (nordihydroguaiaretic acid)
- mal.4
Acts to inhibit the activity of a gene promotor that is important for viral replication
Use: Leaf resin capsules 1-2 daily; topical Larrea lotion
Ingredients in Larrea leaf resin inhibit HSV-2 replication
- NDGA (nordihydroguaiaretic acid)
- mal.4
act to inhibit the activity of a gene promotor that is important for viral replication
Use: Leaf resin capsules 1-2 daily
Topical Larrea lotion

42. Propolis vs. Acyclovir for Genital Herpes
N=46 men and 44 women, 18–69 y.o.
Recurrent chronic genital HSV type 2
Tx: 3% propolis ointment
5% Acyclovir ointment
Placebo
qid for 10 days
Phytomedicine 2000;7(1)
46 men and 44 women aged years, with recurrent chronic genital HSV type 2, participated in this single-blind, masked investigator randomized and controlled multi-center study.
Upon relapse, the patients were examined and treated with either 3% propolis ointment, 5% acyclovir ointment, or placebo ointment four times daily for 10 days.
The patients were assessed on day 0, day 3, day 7, and day The location, number, size, and stage of lesions were examined. The lesions were classified as vesicular, ulcerated, crusted, or healed.

43. Propolis vs. Acyclovir for Genital Herpes
Day Propolis Acyclovir Placebo
3 (crusts) % 27% 0%
7 (Ulcers/ % % %
Healed)
10 (ulcers/ % 80% %
There was no difference between the groups regarding the stage of the lesions at the initial examination, or the distribution of initial sympotoms. On day 3 of treatment, 50% taking propolis, 27% taking acyclovir and 0% taking placebo had crusted lesions. On day 7 of treatment, of the patients who initially had ulcerations, 10 taking propolis, 4 taking acyclovir, and 3 taking placebo were healed. On day 10 of tretment, of the patients who initially had ulcerations, 100% taking propolis, 805 taking acyclovir, and 70% taking placebo were healed. In the group with vesibular lesions initially, significantly more patients were completely healed in the propolis group than in the other groups.Overall, at the end of treatment, more participants in the propolis group were healed.

44. Dr. Hudson Resources
Women’s Encyclopedia of Natural Medicine; 2nd Edition 2008; Hudson; McGraw-Hill

45. Webinar sponsored by: Webinar sponsored by:
Pictured: Gaia Herbs Farm, Brevard NC
Pictured: Gaia Herbs Farm, Brevard NC