Herbal Cascara Sagrada (Rhamnus purshiana) and Metabolic syndrome or type 2 diabetes

Cascara sagrada is a species of buckthorn, genus Rhamnus, belonging to the family Rhamnaceae, native to western North America, it's bark has been used in traditional medicine for gastrointestinal support. and it is thought to have a laxative and natural cleansing, etc., effect.
Metabolic syndrome
According to the American Academy of Family Physicians, insulin resistance often goes along with other health problems, such as diabetes, high cholesterol and high blood pressure. These problems are all risk factors for heart disease. When a person has many of these problems at the same time, doctors commonly call it “metabolic syndrome.” It is sometimes called “insulin resistance syndrome” or “syndrome X.” Many people who have type 2 diabetes also have metabolic syndrome
Other defined it as a disorder of energy utilization and storage, diagnosed by a co-occurrence of 3 out of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density cholesterol (HDL) levels. The metabolic syndrome increases the risk of developing cardiovascular disease, particularly heart failure, and diabetes.
Diabetes is defined as a condition caused by insufficient insulin entering the bloodstream to regulate the glucose. It is either caused by cells in pancreas dying off or receptor sites clogged up by fat and cholesterol. In some cases, diabetes is also caused by allergic reactions of cells in the immune system.

The ingredients
Beside the main compound of anthraquinones, other compounds include anthraquinone glycosides, (emodin, frangulin, iso-emodin, aloe-emodin, and chrysophanol), rhein, aloin, malic acid, tannic acid, cascarosides A, B, C, and D, hydroxy anthracene derivatives (HAD), etc.

The Benefits
Emodin, a chemical compound found in Cascara Sagrada may pocess the potential to treat matabolic syndrome by inhibiting 11beta-HSD1 activity of liver and fat significantly and reversing prednisone-induced insulin resistance in mice. Scientific evidence to support the above, including Dr. Wang and the research team in the study in ob/ob mice indicated that emodin (30 μmol/L) suppressed 11-dehydrocorticosterone-induced adipogenesis without affecting corticosterone-induced adipogenesis; emodin (3 μmol/L) reduced 11-dehydrocorticosterone-stimulated lipolysis, but had no effect on corticosterone-induced lipolysis. Moreover, emodin (3 μmol/L) partly reversed the impaired insulin-stimulated glucose uptake and adiponectin secretion induced by 11-dehydrocorticosterone but not those induced by corticosterone. In ob/ob mice, long-term emodin administration decreased 11β-HSD1 activity in mesenteric adipose tissues, lowered non-fasting and fasting blood glucose levels, and improved glucose tolerance. Other in the study of  Glucocorticoid excess (Cushing's syndrome)  causes metabolic syndrome showed that a selective 11β-HSD1 inhibitor, KR-67183, may provide a new therapeutic window in the prevention and treatment without toxicity in type 2 diabetes with obesity as KR-67183 concentration-dependently inhibited 11β-HSD1 activity in human and mouse 11β-HSD1 over-expressed cells and in the ex vivo assay of C57BL/6 mice and he administration of KR-67183 (20 and 50mg/kg/day, orally for 28 days) improved the glucose tolerance and insulin sensitivity with suppressed 11β-HSD1 activity in the liver and fat.

The Side effects
1. Cascara Sagrada can be liver toxic.
2. Postal hypertension
Cascara sagrada (CS) has been associated with the development of cholestatic hepatitis, complicated by portal hypertension.
3. Fresh cut, dried bark may cause vomiting and diarrhea.
4. It may cause allergic effect.
5. Etc.

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References
1. Metabolic syndrome (Wikipedia)
2.  Metabolic syndrome, (American Academy of Family Physicians)
3. Cascara sagrada (Rhamnus purshiana)(Sigma Aldrich)
4. "Emodin, a natural product, selectively inhibits 11beta-hydroxysteroid dehydrogenase type 1 and ameliorates metabolic disorder in diet-induced obese mice" by Feng Y, Huang SL, Dou W, Zhang S, Chen JH, Shen Y, Shen JH, Leng Y.(PubMed)
5. Emodin, an 11β-hydroxysteroid dehydrogenase type 1 inhibitor, regulates adipocyte function in vitro and exerts anti-diabetic effect in ob/ob mice. by Wang YJ, Huang SL, Feng Y, Ning MM, Leng Y.(PubMed)
6. Anti-diabetic and anti-adipogenic effects of a novel selective 11β-hydroxysteroid dehydrogenase type 1 inhibitor in the diet-induced obese mice. by Park JS, Rhee SD, Jung WH, Kang NS, Kim HY, Kang SK, Ahn JH, Kim KY.(PubMed)
7. [Toxic hepatitis following consumption of the herbal medicinal product Cascara Sagrada].[Article in Danish]" by Jacobsen C, Semb S, Kromann-Andersen H(PubMed)
8. "Cascara sagrada-induced intrahepatic cholestasis causing portal hypertension: case report and review of herbal hepatotoxicity" by Nadir A, Reddy D, Van Thiel DH.(PubMed)
9. "Occupational respiratory allergic disease induced by Passiflora alata and Rhamnus purshiana" by Giavina-Bianchi PF Jr, Castro FF, Machado ML, Duarte AJ.(PubMed)

Herbal Butterbur and Migraine

Butterbur, found in wet, marshy, damp land, including wetland, riverside, forest, etc., is a creeping underground plant, genus Petasites of 15 -20 species, belonging to the family Asteraceae, native to Northern Hemisphere. It has been used in herbal medicne used as an pain reliever in digestive system, including stomach, bile ducts, and duodenum, etc.
Migraine headache is one most common headaches defined as condition of chronic neurological disorder of moderate to severe headaches, and nausea that usually develop gradually over 5–20 minutes and last for less than 60 minutes and affected over 15% of the population in US alone, as a result of the change in the brain and its surrounding blood vessels.

The Ingredients
The chemical constituents of Butterbur include Petioles, petasitene and pethybrene,  quercetin 3-O-beta-D-glucoside, quercetin 3-O-beta-D-6''-O-acetylglucoside, and rutin, caffeic acid, alkaloids, S-petasin and iso-S-petasin, etc.

The Benefits
Although the herb is used as nutritional supplement in US, scientific studies suggested that it may be used as the prevention of allergic rhinitis and treatment of migraine. In a three-arm, parallel-group, randomized trial comparing Petasites extract 75 mg bid, Petasites extract 50 mg bid, or placebo bid in 245 patients with migraine, Butterbur Petasites extract 75 mg bid is more effective than placebo and is well tolerated as a preventive therapy for migraine, with mild symptoms of gastrointestinal events, predominantly burping. Other study of extract of Petasites hybridus suggest that migraine patients can benefit from prophylactic treatment with this special extract. The combination of high efficacy and excellent tolerance emphasizes the particular value that Petasites hybridus has for the prophylactic treatment of migraine. But in a systematic review, the herbs is showed to have a Moderate evidence of effectiveness, thus, available for a higher than the recommended dose of the proprietary Petasites root extract Petadolex in the prophylaxis of migraine and suggested that rigorous studies are required to confirm effectiveness and safety in long-term use before treatment with Petasites root extract can be recommended the herb as an alternative option in the treatment to patient with the prophylaxis of migraine.

Side effects
1. Butterbur may be toxic to liver and cause cancer due to the presence of pyrrolizidine alkaloids
2. If you are pregnant please do not use Butterbur with out the permission of the related special field specialist
3. Allergic effect to certain people who are allergic to ragweed, marigold, daisy, etc.
4. Overdoses may cause indigestion, headache, nausea, vomiting, diarrhea, etc.
5. Etc.




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 References
(1) Petasites hybridus root (butterbur) is an effective preventive treatment for migraine.

Lipton RB, Göbel H, Einhäupl KM, Wilks K, Mauskop A.(PubMed)

(2) An extract of Petasites hybridus is effective in the prophylaxis of migraine.

Grossman W, Schmidramsl H.(PubMed)

(3) Effectiveness of Petasites hybridus preparations in the prophylaxis of migraine: a systematic review.

Agosti R, Duke RK, Chrubasik JE, Chrubasik S.(PubMed)

(4) Simultaneous investigation of sesquiterpenes, pyrrolizidine alkaloids and N-oxides in Butterbur (Petasites hybridus) with an offline 2D-combination of HPLC-UV and LC-MMI-ToF-MS.

Aydın AA, Letzel T.(PubMed)

Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes

Consumption of sugar-sweetened beverages (SSBs), which include soft drinks, fruit drinks, iced tea, and energy and vitamin water drinks has risen across the globe. Regular consumption of SSBs has been associated with weight gain and risk of overweight and obesity, but the role of SSBs in the development of related chronic metabolic diseases. Researchers at the Harvard School of Public Health found that in addition to weight gain, higher consumption of SSBs is associated with development of metabolic syndrome and type 2 diabetes. These data provide empirical evidence that intake of SSBs should be limited to reduce obesity-related risk of chronic metabolic diseases(1).

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(1) "Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis" by Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB.

Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes

Soft drinks and other sweetened beverages may contribute to risk of type 2 diabetes and obesity. researchers at the University of Minnesota in the examination of the association between soft drinks and juice and the risk of type 2 diabetes among Chinese Singaporeans enrolled in a prospective cohort study of 43,580 participants aged 45-74 years and free of diabetes and other chronic diseases at baseline, indicated that after adjustment for potential lifestyle and dietary confounders, participants consuming > or =2 soft drinks per week had a relative risk of type 2 diabetes of 1.42 (95% confidence interval (CI): 1.25, 1.62) compared with those who rarely consumed soft drinks. Similarly, consumption of > or =2 juice beverages per week was associated with an increased risk (relative risk (RR) = 1.29, 95% CI: 1.05, 1.58). The association was modified by 5-year weight gain for > or =2 soft drinks per week among those who gained > or =3 kg (RR = 1.70, 95% CI: 1.34, 2.16) compared with those who gained less weight (RR = 1.20, 95% CI: 1.03, 1.41)(1).

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(1) "Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study" by Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA.

Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes

In the study to  examine the association between consumption of sugar-sweetened beverages and weight change and risk of type 2 diabetes in women, found that those with stable consumption patterns had no difference in weight gain, but weight gain over a 4-year period was highest among women who increased their sugar-sweetened soft drink consumption from 1 or fewer drinks per week to 1 or more drinks per day (multivariate-adjusted means, 4.69 kg for 1991 to 1995 and 4.20 kg for 1995 to 1999) and was smallest among women who decreased their intake (1.34 and 0.15 kg for the 2 periods, respectively) after adjusting for lifestyle and dietary confounders. Increased consumption of fruit punch was also associated with greater weight gain compared with decreased consumption. After adjustment for potential confounders, women consuming 1 or more sugar-sweetened soft drinks per day had a relative risk [RR] of type 2 diabetes of 1.83 (95% confidence interval [CI], 1.42-2.36; P<.001 for trend) compared with those who consumed less than 1 of these beverages per month. Similarly, consumption of fruit punch was associated with increased diabetes risk (RR for > or =1 drink per day compared with <1 drink per month, 2.00; 95% CI, 1.33-3.03; P =.001).(1).
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(1) "Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women" by Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB.

Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults

In the study to evaluate the effect of adding exercise to a hypocaloric diet on changes in appendicular lean mass and strength in frail obese older adults undergoing voluntary weight loss, found that exercise added to diet reduces muscle mass loss during voluntary weight loss and increases muscle strength in frail obese older adults. Regular exercise that incorporates PRT should be used to attenuate muscle mass loss in frail obese older adults on weight-loss therapy(1).

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(1) "Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults" by Frimel TN, Sinacore DR, Villareal DT.

Exercise but not diet-induced weight loss decreases skeletal muscle inflammatory gene expression

In a study to evaluated 12 wk of exercise (aerobic and resistance) or 12 wk of weight loss (approximately 7% reduction) on skeletal muscle mRNAs for toll-like receptor-4 (TLR-4), mechanogrowth factor (MGF), TNF-alpha, and IL-6 in 16 obese (body mass index 38+/-2 kg/m2) older (69+/-1 yr) physically frail individuals, indicated that exercise but not weight loss had a beneficial effect on markers of muscle inflammation and anabolism in frail obese elderly individuals(1).

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(1) "Exercise but not diet-induced weight loss decreases skeletal muscle inflammatory gene expression in frail obese elderly persons" by Lambert CP, Wright NR, Finck BN, Villareal DT.