A systematic review: Vitex agnus castus for premenstrual conditions

A recent systematic review has investigated the effectiveness of Vitex agnus castus (VAC) in the treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). [1]

PMS is estimated to effect 20-30% of women, whilst 2-8% of all women suffer from a more severe form of PMS, called premenstrual dysphoric disorder (PMDD). [2,3,4] Whilst symptoms are similar, severity is the defining factor in PMDD, which manifests as marked emotional distress, impacting patient functioning in some individuals. [2,5]

Researchers analysed eight randomised clinical trials that used VAC in the treatment of PMS or PMDD.  All eight studies demonstrated positive therapeutic outcomes for VAC supplementation in PMS or PMDD. [1]  Furthermore, VAC was well-tolerated with only mild or transient side-effects. [1]

VAC was shown to be superior to placebo in randomised controlled trials. When comparing VAC to active treatment, VAC was more effective than pyridoxine (B6) in treating PMS symptoms but not as efficacious as fluoxetine in alleviating the psychological symptoms of PMS. [1]

In evaluating the dosage and administration of VAC extract, 20mg of VAC was found to be the optimum dosage whilst the use of VAC in the six days before menses only was found to be most efficacious. [6,7]

VAC extract was found to be a safe and valid alternative in the treatment of PMS and PMDD symptoms, however longer studies are warranted to investigate the long-term safety and efficacy of VAC. [1]

1.     Cerqueira, R., Frey, B., Leclerc, E. et al. (2017).  Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health, (20), 713-719.

2.     Vigod, S., Frey, B., Soares, C., Steiner, M. (2010). Approach to premenstrual dysphoria for the mental health practitioner. Psychiatr Clin North Am, (33), 257-272.

3.     Dueñas, J., Lete, I., Bermejo, R. et al (2011). Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a representative cohort of Spanish women of fertile age. European Journal of Obstetrics and Gynecology and Reproductive Biology, 156 (1), 72 – 77.

4.     Yonkers, K., O’Brien, P., Eriksson, E. (2008). Premenstrual syndrome. Lancet, (371), 1200-1210.

5.     Delara, M., Ghofranipour, F., Azadfallah, P., Tavafian, S. S., Kazemnejad, A., & Montazeri, A. (2012). Health related quality of life among adolescents with premenstrual disorders: a cross sectional study. Health and Quality of Life Outcomes10 (1).

6.     Schellenberg, R., Zimmermann, C., Drewe, J., Hoexter, G., Zahner, C. (2012). Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome. Phytomedicine, 19 (14), 1325-1331.

7.     Zamani, M., Neghab, N., Torabian, S. (2012). Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome. Acta Med Iran, 50 (2), 101-106. 

Photo via Leon Biss on Unsplash

Microbial enzymes: could your clients benefit?

There are many contributing factors leading to poor digestion – ageing, stress, genetics, excess alcohol consumption and malnutrition. Poor nutrition may result in low fibre intake and bowel flora imbalance. Inefficient enzyme production may also lead to detrimental health outcomes. As health practitioners, we know addressing dietary and lifestyle issues is a priority. Inclusion of raw foods (where appropriate) and enzyme supplementation where depletion is present may be warranted.

The gastrointestinal system produces and releases digestive enzymes to help catabolise fats, proteins, and carbohydrates, which in turn assists with healthy digestion and nutrient absorption. [1] 

Digestive enzymes derived from microbial species may provide comprehensive support to aid digestive function.[2] Microbe-derived enzymes are normally synthesised from fungal sources via a fermentation process. Some of these enzymes are also used in traditional food preparation. For example, Aspergillus oryzae is used in the fermentation process of soybeans to produce soy sauce, tamari and miso. [2]

Microbial enzymes:
Aspergillus oryzae is a filamentous (thread-like) fungi known to have prominent potential for the secretory production of several enzymes including amylase, protease and tilactase. [2] This strain shows high amylase activity for starch degradation. [3] Lipase is also synthesised from A.oryzae. [1]
Trichoderma longibrachiatum: A known cellulolytic fungi.[4,5] The cellulase activity of T. longibrachiatum may be linked with induction of xylanase activity. Parallels have been drawn between the relationship of hemicellulose and cellulose in plant biomass. [5]
Rhizopus oryzae: Research has highlighted that Rhizopus species family are important and versatile enzymes. [6]

In contrast to animal derived enzymes, microbial enzyme preparations may be more resistant to inactivation by stomach acid and possess broader activity throughout a wide range of pH conditions inherent to the digestive tract. [7] Microbial enzymes are also more active and stable than plant and animal enzymes and require a lower dosage to be effective. [8,9]

1.    Ianiro, G., Pecere, S., Giorgio, V., Gasbarrini, A., & Cammarota, G. (2016). Digestive Enzyme Supplementation in Gastrointestinal Diseases. Current Drug Metabolism, 17(2), 187–193.
2.    Machida, M., Yamada, O., Gomi, K. (2008). Genomics of Aspergillus oryzae: Learning from the History of Koji Mold and Exploration of Its Future. DNA Research, (15), 173–183.
3.    Kim, H., Kim, J., Bai, D., Ah, B-H. (2011). Identification and Characterization of Useful Fungi with α-Amylase Activity from the Korean Traditional Nuruk. Mycobiology, 39(4): 278–282.
4.    Omojasola, P., Jilani, O. (2008). Cellulase Production by Trichoderma longi, Aspergillus niger and Saccharomyces cerevisae Cultured on Waste Materials from Orange. Pakistan Journal of Biological Sciences, 11: 2382-2388.
5.    Royer, J. C., & Nakas, J. P. (1990). Interrelationship of Xylanase Induction and Cellulase Induction of Trichoderma longibrachiatum. Applied and Environmental Microbiology, 56(8), 2535–2539.
6.    Serrano, A., Ferrer, P., Sola, C., Schmid, R., Valero, F. (2001). Optimization of the high-level production of Rhizopus oryzae lipase in Pichia pastori. Journal of Biotechnology, 86, 59–70.
7.    Spiegel, K., Tasali, E., Penev, P., Van Cauter, E. (2004). Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Annals of Internal Medicine, 141(11), 846-850.
8.    Anbu, P., Gopinath, S., Cihan, A., Chaulagain, B. (2013). Microbial Enzymes and Their Applications in Industries and Medicine. BioMed Research International, (2013), doi:10.1155/2013/204014
9.    Griffin, S. M., Alderson, D., & Farndon, J. R. (1989). Acid resistant lipase as replacement therapy in chronic pancreatic exocrine insufficiency: a study in dogs. Gut, 30(7), 1012–1015.

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