Karen R. Hurd Nutritional Practice
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Black Cohosh
Black cohosh has become a frequent over-the-counter treatment for the symptoms of menopause. As common thinking goes the assumption is made that because black cohosh is a natural herb, that its safety is unquestionable. I have never recommended black cohosh in my practice because of the endocrine response that comes from the use of this herb. I view black cohosh as being in the same category as other stimulants of the endocrine system such as caffeine and nicotine.

Black cohosh is a member of the buttercup family. It is a perennial plant that is native to North America. It is also known by the names black snakeroot, bugbane, bugwort, rattleroot, rattletop, and rattleweed. It received the name of bugbane and bugwort because insects avoid it.

Black cohosh supplements are made from the roots and rhizomes (underground stems). As black cohosh is considered a dietary supplement and not a medication, there is no standardized preparation of black cohosh supplements from manufacturer to manufacturer. Even with the same company producing the black cohosh supplements, variation in concentration can occur from batch to batch. However, the preparation known as Remifemin has been the most standardized and used in many of the studies of black cohosh; although even the manufacturer of this preparation changed the formulation from a solution (root extracted with ethanol, 60% by volume) to tablets (root extracted with isopropyl alcohol, 40% by volume) which complicated the comparison of research results.

Historically, black cohosh was used by the North American Indians to treat malaise, gynecological disorders, kidney disorders, malaria, rheumatism, sore throats, colds, cough, constipation, hives, and backache. It was (and still is) used to bring on menstruation and to induce lactation. The primary use of black cohosh is for alleviation of menopausal symptoms.

As the studies that have been conducted indicate that black cohosh has a similar effect to that of estrogen in treating menopausal symptoms, it is not recommended during pregnancy as it may stimulate uterine contractions. Additionally, there is controversy regarding the safety of black cohosh in women with a personal history or strong family history of breast cancer.

Most of the studies that have been conducted thus far are open trials and lack blinding and long-term follow-up, making it difficult to draw definitive conclusions either on the efficacy of black cohosh or its danger. We do know that in larger doses black cohosh can cause dizziness, headaches, giddiness, nausea, and vomiting. Additionally, the studies that have been done report a frequent occurrence of gastrointestinal discomfort.

Despite the lack of clinical studies that resoundingly support or discourage the use of black cohosh, it cannot be denied that there is a noted difference in menopausal symptoms with the use of this herb. It is clear that black cohosh acts in a way similar to estrogen. Therefore, the question becomes: Is it wise to use a substance that either is a hormone or acts like a hormone in treating menopause? Is this use of hormonal replacement therapy using estrogen or an herb a safe thing to do?

A woman must understand when the ovaries cease to produce estrogen because of the natural aging process; there is another gland that will take over the production of estrogen. The estrogen produced by this gland is not as potent as the estrogen produced by the ovaries, but it is more than sufficient to maintain a woman's health at the level that it was prior to the ovaries cessation of production, however, not strong enough to cause the ripening of an egg and thus the continuation of a menstrual cycle. In plain English, we will still make enough estrogen to maintain our womanhood; we just won't have a menstrual cycle anymore.


The gland that takes over the function of providing estrogen is actually a set of glands. They are called the adrenals. Sitting on top of the kidneys, these little glands are powerful factories of not only estrogen, but adrenalin as well as several other hormones.


The adrenals were responsible for making adequate amounts of estrogen for the female body prior to the onset of menses. At menarche the ovaries began for the first time to produce estrogen and the adrenals gladly gave up the job of making this hormone. The adrenals have a significant amount of work to do; they do not do work that another gland can handle.


Thus, through the menstruating years of a woman, the ovaries are the estrogen factory. At menopause, the adrenals must again pick up the function of producing estrogen. If, in those ensuing years, a woman has not taken care of her adrenal glands, if she has put them under such stress that they are fatigued, then the adrenals are reluctant to take on the responsibility of producing adequate amounts of estrogen once the ovaries are defunct.


Imagine if you were the office manager for a small business. Part of your responsibilities are doing the accounting. As the business matured, an accountant was hired and you are relieved of that part of your responsibilities. But after three or four decades, the company decides that an accountant is no longer necessary. The demand for the company services has declined. It is still a very viable business, but there is no need to produce at the level that the business once did.


Based on this situation, the boss lets the accountant go. He turns to you and says,  "It is now your responsibility, once again, to be the accountant."


You are not happy about this situation at all. During these three to four decades you have run yourself ragged trying to get all the office manager's responsibilities fulfilled. Additionally, you have been so busy that you haven't done a good job of taking care of yourself physically, so you are in a worse health condition than you were thirty to forty years ago. The additional burden of being the accountant is overwhelming.


You do not respond to the task well. You do shoddy work in your accounting. Everyone in the company is disappointed with your performance. The boss decides to "encourage" you by beating you once a day. It is effective in that you do work harder and faster when he is beating you. However, as time goes by, you become so tired and beat that you finally fail altogether.


If we put this back into the prospective of the adrenal glands, it becomes clear. The adrenals are fatigued from years of overwork and lack of care. In this precarious position, they are given more work. They are unable to accomplish the additional tasking in an acceptable manner, so we use what I call "adrenal whips" to force the production of the desired response. Adrenal whips are caffeine, nicotine, artificial sweeteners, sugary products, and black cohosh (to name just a few). The whips are effective, but they accomplish only the speeding of the adrenals into complete exhaustion which results in a myriad of health problems, not the least of which is to accelerate the aging process.


The best solution is to adequately care for the adrenal glands so that when it becomes necessary for them to again become the estrogen-producer for the body, they are easily able to take over the function. It is also possible to recover a fatigued adrenal system even after several years of abuse. This is done through diet and lifestyle.


Here is a condensed list of the things necessary to nourish the adrenals: Cease consumption of sweets, caffeine, alcohol, decaffeinated products, artificial sweeteners, endocrine-stimulating herbs such as black cohosh, licorice root, dong quai, ephedra, and ma huang. Do not wear perfumes or use scented products. Eat efficient proteins such as eggs, meat, poultry, fish, and seafood at each meal. Consume at least one serving of legumes daily. Limit fruit intake to one piece daily (at the maximum). Drink one-half gallon of water daily. Sleep a full eight to ten hours daily.


It takes a minimum of three months to see changes. It will take eighteen to twenty-four months to see a complete change. The adrenals heal slowly. Also expect noticeable withdrawal symptoms when removing the whips.


Going through menopause without being miserable is most definitely possible. Taking care of yourself as far as diet and lifestyle is the best way to accomplish this. Avoid the whip of black cohosh. Eat right. Live right. Then you will feel right.
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