1. Introduction to Molecular Implications on Health Caused by Herbal and Traditional Medicine

Reading Time: 5 minutes

Oxygen can be a tricky and deceptive ally to have. There is a plethora of medical evidence that points towards the fact that oxidative stress can cause damage to your cells and tissues. Despite this, the free radicals that are created as a result of oxidative stress also occur during a normal metabolism and as a result contribute to variations in a human being’s health as well as to the inception of disease. Free radicals can be thought of as molecules with an odd number of electrons. The odd or unpaired electron is very reactive because it proactive searches to pair with another free electron. Free radicals are created when a human being’s metabolism is in an oxidative state and is producing energy. Free radicals contribute to things such as:

  • Enzyme-catalyzed reactions
  • Electron transport in mitochondria
  • Signal transduction and gene expression
  • Activation of nuclear transcription factors
  • Oxidative injury to molecules, cells and tissues
  • Antimicrobial action of neutrophils and macrophages
  • Aging and disease

Normal metabolisms need oxygen to function, which is a free radical itself. Scientists assume that due to evolution, oxygen was chosen as the terminal electron acceptor for respiration. Oxygen is biradical as two unpaired electrons of oxygen spin in the same direction, and therefore not as dangerous as some other free radicals. Other varieties of oxygen-derived free radicals including superoxide and hydroxyl radicals, that are generated during metabolism or via ionizing radiation are more powerful oxidants and as a result can be more dangerous.

On top of the studies conducted on the biological effects of these particular reactive oxygen variants, studies on reactive nitrogen variants has been gradually increasing over the years. NO, or nitrogen monoxide (nitric oxide), is a free radical created by NO synthase (NOS). This enzyme modulates physiological reactions such as vasodilation or producing signals in the brain. When the body is experiencing inflammation, on the other hand, NOS or iNOS synthesis is induced. The iNOS contributes to an overproduction in NO, which results in injury. Even of more concern is that excessive amounts of NO can react with superoxide to generate the highly toxic product peroxynitrite. Oxidation of lipids, proteins and DNA can happen, which contributes to a higher risk in tissue damage.

Reactive oxygen as well as nitrogen variants are contributors to the process of normal cell regulation where it’s imperative for signal transduction to function properly using oxidants and redox status. The signaling cascade contributing to inflammatory reactions are derived from oxidative stress being a critical upstream factor, through their stimulation of adhesion molecules and chemoattractant production. When hydrogen peroxide is broken down to generate hydroxyl radicals, the transcription factor for the simulation of inflammatory reactions, NF-kB, might also be mobilized. The excessive production of these responsive variants is poisonous, secreting cytostatic effects, resulting in membrane injuries, and mobilizing the pathways of cell death, which includes apoptosis and necrosis.

Research has shown that all diseases include the presence of some form of free radicals. The majority of these diseases have free radicals as a secondary cause in addition to the primary disease process, but for some diseases free radicals seem to be the primary cause. From this we can extrapolate the existence of a thin red line that divides the usefulness and impact on health and disease of oxidants and antioxidants. In order to guarantee some degree of a healthy aging experience, the balance between these must be maintained.

Oxidative stress as a medical terminology implies the antioxidant status of cells and tissues is changed by their contact with oxidants. As a result, the redox status is impacted by how much a cell’s components are in an oxidized state of being. Generally speaking, there is a reducing environment inside cells that act as a shield against the startup of the process of oxidative damage. Protein misfolding or aggregation is not allowed as the reducing environment contains disulfide bonds (S-S) that do not spontaneously generate as sulfhydryl groups are kept in a reduced state (SH). The reducing environment is sustained by the process of oxidative metabolism and by the activities of antioxidant enzymes and substances, among them glutathione, thioredoxin, vitamins E and C, and enzymes such as superoxide dismutase (SOD), catalase and the selenium-dependent glutathione and thierodoxin hydroperoxidases, whose purpose is to clear away reactive oxygen variants.

Alterations in the redox status and the decrease of antioxidants happen throughout oxidative stress. The thiol redox status can be an effective index to go by as it pertains to oxidative stress mostly due to the fact that metabolism and NADPH-dependent enzymes sustain cell glutathione (GSH) almost entirely in its reduced state of being. Oxidized glutathione, also known as glutathione disulfide or GSSG, collects under conditions of having been in contact with oxidants, and this alters the ratio of oxidized to reduced glutathione. An increase in this ratio points towards the presence of oxidative stress. A lot of tissues are comprised of hefty amounts of glutathione, 2-4 mM in erythrocytes or neural tissues and up to mM in hepatic tissues. Reactive variants of oxygen and nitrogen can be directly impacted by glutathione to decrease the levels of this substance, the cell’s foremost preventative antioxidant.

The current consensus among medical researchers is that the decrease of oxidative stress can contribute to improvements on a clinical level. Free radicals can be produced in excessive amounts, or the natural antioxidant system defenses can falter, initially commencing the process of oxidative status, and then eventually metamorphing into oxidative damage and illness. Two diseases that result from this oxidative stress are cancer and heart disease. Oxidation of low density lipoproteins in human beings is regarded as the first phase towards the progression and gradual development of atherosclerosis, which is the precursor to cardiovascular disease. Injury to the DNA as a result from oxidation jump starts the process of carcinogenesis.

Convincing support for the contribution of free radicals to the development of diseases is derived from epidemiological research that presents a strengthened antioxidant status is connected to a reduced risk of a number of diseases. Vitamin E leading to the stalling of the development of cardiovascular disease is one that comes to mind. An enhanced antioxidant status is also connected to a smaller risk of cataracts and cancer, and some recent studies indicate an inverse correlation between antioxidant status and the manifestation of rheumatoid arthritis and diabetes mellatus. Alas, the number of implications where antioxidants can be effective in the prevention and treatment of an illness is on the rise.

Oxidative stress nonetheless remains a secondary cause for most diseases instead of a primary cause. Some diseases that are primarily caused by oxidative stress include inflammatory bowel disease, retinal ischemia, cardiovascular disease and restenosis, AIDS, ARDS and neurodegenerative diseases such as a stroke, Parkinson’s disease and Alzheimer’s disease. These implications might provide evidence sufficient enough to suggest antioxidant treatment is feasible as there is a clear contribution of oxidative stress to oxidative damage in these diseases.

In these series of articles we will explore oxidative stress and it’s impact on the many illness that can be harmful to our organ systems by highlighting empirical evidence and medical benefits of applying this knowledge. These series of articles will also concentrate on crucial natural antioxidant enzymes and antioxidant substances that encompass vitamins A, E and C, flavonoids, polyphenols, carotenoids, lipoic acid, among other nutrients that can be found in various foods and drinks. Oxidative stress can be detrimental to the maintenance of human health. There is an increasing body of literature that presents evidence pointing in the direction of the conclusion that a balance between oxidants and antioxidants is required for the long term sustainability of human health and the prevention of pathological responses that lead to the development of illnesses. These series of articles is available for all to read but is primarily focused on informing researchers in biomedical sciences and clinicians. The fact that we can undoubtedly provide ourselves and our patients with the ability to age in a healthy and sustainable manner requires knowledge regarding how oxidants and antioxidants can positively or adversely affect biological systems.

3. Abnormal Behavior Throughout the Ages

Reading Time: 2 minutes

GRAY AREAS OF ABNORMALITY

For this thought experiment, we will need to determine whether or not these two students show signs of abnormality.

In the year between her 19th and 20th birthday, Donna, who is 5’8, dropped from 160 to 125 pounds.

The weight loss commenced when she had gotten sick with the flu and lost 15 pounds.

Her friends complimented her on her new physique and she gained the motivation to further decrease her weight. This included cutting her daily caloric intake to 1100, avoiding sugars and carbohydrates, and jogging several miles per day for exercise. There are times when she is so hungry that it takes a toll on her academic performance, as she could think about nothing else but eating. Despite this, she is extremely satisfied with her new physique and wants to keep it for as long as possible, so she is determined to eat as little as possible despite the overwhelming feeling of hunger. She feels also wouldn’t hurt to lose a few more pounds so she can fit into a smaller, cuter skirt she saw at the mall the other day.

Her twin brother Donald is what most people might consider to be an alcoholic. He drinks anywhere between 4-7 beers a day, and despite his excessive consumption of alcohol, does not feel drunk after it. Due to this, he might top off the night with a few shots of alcohol, especially on Saturday nights going out at a bar or nightclub.

He has received several citations for underage drinking, and proudly displays them on the wall in his dorm room as trophies. Donald’s grades are not up to their fullest potential and he does not take much interest in his classes. He also finds it difficult to complete assignments.

Are Donna and Donald’s behaviors abnormal to you? How would you assess their level of dysfunction, distress, deviance and danger for either of the twins?

QUESTIONS TO ASK ONESELF

  1. What do you think is the mental health continuum model?
  2. What is cultural relativism in your mind? What do you think are some advantages and disadvantages of using this approach to determining abnormality?
  3. How do you use the criteria of unusualness to determine levels of abnormality? What do you think are some advantages and disadvantages for this criterion?
  4. What do you think is the distress criteria for determining abnormality? What issues arise from it’s use, and how can it be effective in identifying and determining abnormal behaviors?
  5. What do you think is the mental illness criteria for determining abnormality? What issues arise from it’s use, and how can it be effective in identifying and determining abnormal behaviors?
  6. What are the four words that start with the letter D for determining abnormal behaviors?

Take what you know and thought about from the previous six questions and attempt to apply it to this scenario:

Chad has several arrests for sexual assault against a minor and had recently been convicted of throwing a bottle of water in the face of an elderly woman in an argument over a parking space. On his medical record are listed a number of diagnosis’s for mental health disorders, including attention deficit and hyperactivity disorder, conduct disorder and substance abuse issues. The judge at Chad’s last trial made the remark that Chad did not seem to care about the consequences of his own behavior nor the idea of going to jail. Which of the following criterion could be used to determine that Chad’s behavior is NOT abnormal?

A. Cultural Relativism

B. Unusualness

C. Distress

D. Mental Illness

1. Clinically Tested Herbal Treatments – History and Regulatory gfInsights in America

Reading Time: 3 minutes

In the United States of America, there are 4 regulatory classifications as it pertains to botanicals and herbs:

  1. Food
  2. Dietary Supplement
  3. Over the Counter Medication (OTC)
  4. Prescription Drug (Rx)

The DSHEA or the Dietary Supplement Health and Education Act of 1994 states that most herbs and botanical ingredients must be regulated as dietary supplements. We will go over how the DSHEA is used to regulate herbs and botanicals in the US, how they were subject to regulation and enforcement historically before the existence of the DSHEA, and how the DSHEA came into being to provide this regulatory framework. The DHSEA also goes on to encompass outlining regulatory requirements for either over the counter or prescription based drugs that contain botanical ingredients.

Food, medicine and clothing has often been derived from plants across all countries on the planet throughout their various life cycles. The estimation for the percentage of plants used in producing medicine ranges from 10 to 15 percent across 300,000 higher species. Yet only 1 percent of plants are used for the purposes of producing food or food related byproducts. In the early 1900’s and prior to that, plants were the primary means of medication in the United States. The majority of them were listed in the United States Pharmacopeia, and were prescribed by the doctors of the time. Concoctions made from herbal ingredients were the primary go to remedies of the times.

The Food and Drug Administration was handed the authority to regulate drug safety standards as well as enforce them in 1938, and this is the year that marked the official start of regulation of medicine in the United States. The Food, Drug and Cosmetic Act had accountability rest with the FDA in screening and enforcing possible unethical, criminal and unsafe practices using drugs, cosmetics and food, as well as the mislabeling of them for fraudulent purposes in addition to chemical modification using ingredients or formulas deemed to be unsafe or not provide the desired effect to a patient.

Botanical based treatments paved the way for the creation of stronger, more chemically synthesized drugs, as a result of demand during World War 2, especially in the area of antibiotics and medication used for treating trauma of all sorts. The federal government gave incentives to pharmaceutical companies traditionally known for their production of botanical ingredient based medications, to shift to more chemistry based drugs. These companies were Merck, Lily and Parke-Davis. Single-entity chemicals had proven themselves to have an increased consistency, were easier to measure and more specifically focused to achieving a certain effect while avoiding others than their herbal forefathers.

In 1951, the Durham-Humphrey Act was passed by Congress to outline a regulation in which any chemical based drug that would be too toxic in certain amounts or have serious adverse effects to the human body in certain quantities must be supervised and administered by an individual screened and licensed by a legal body that vests in him the authority to give out such a drug to the uneducated masses who would take that drug.

Drug manufacturers as a result were also forced to label their drugs as either Rx, which means prescription, or OTC, which means over the counter.

In 1962, the Food, Drug and Cosmetic Act was amended and additional clauses were added to include the testing and screening of drugs, so that advertisers could label them to be “proven safe and effective”. The FDA subsequently followed up with instructions regarding requirements for safety and efficacy testing to have a drug qualify for their approval. Approval became mandatory before marketing of the drug to the public for consumption. Older drugs that were being sold prior to these rules coming into effect were allowed to continue being sold and marketed as long as their ingredients and labels remained the same as before.

In 1972, the FDA commenced a thorough review of all over the counter medications to evaluate their safety and efficacy. Medications that were found to be mostly safe and effective (GRASE) were labeled a Category 1 and given the green light for marketing efforts. Ingredients found in previously issued OTC drugs that were deemed to be unsafe or ineffective were taken off the OTC list and labeled a Category 2 drug, and were no longer allowed to be sold as over the counter medication or forced it’s manufacturer to change the recipe so they did not use those ingredients if they wanted to sell the drug as OTC. If it was difficult to test safety and efficacy due to a lack of data regarding the ingredient to identify it’s effects more well, they were labeled Category 3.

Due to the lack of commercial sponsors willing to spend money on research into botanical ingredients, that were previously found in many over the counter medications, they were either moved into Category 2 as a precaution or in Category 3. Post 1972 the number of botanical ingredients still classified as drugs under the act had significantly diminished, producers of herbs had to market their products as a food supplement as opposed to a medication.