Saw palmetto is the most abundant native palm endemic to the southeastern coast of North America, growing from the coastal plains of Louisiana, across the Florida peninsula and up to South Carolina. It is characterised by evergreen, fan-shaped leaves, about one metre wide, lined with saw-like teeth along the margins of the petioles (the petiole is a stalk that attaches the leaf to the plant stem). These sharp spines give saw palmetto its common name. The gruelling harvest, therefore, is best done with heavy gloves to avoid getting cut. The fruit of this impressive palm is the premier herbal treatment for benign prostatic hyperplasia (BPH) and has been lauded as ‘the old man’s friend’. BPH is one of the most common diseases in lower urinary tract symptoms, which can cause urinary dysfunction in middle-aged and elderly men and may affect the normal life of patients.

Saw palmetto is one of the most important North American medicinal plants of modern times. At first touted as a possible remedy for the treatment of coughs, colds and debility, it soon gained a reputation for treatment of various prostate conditions. It was an official drug, listed in two editions of the United States (US) Pharmacopoeia from 1906 to 1916. Multiple effects were reported, both digestive (stimulating appetite and providing nutrition) and reproductive (including increasing the size and secreting ability of the mammary glands, decreasing ovarian and uterine irritability, relieving dysmenorrhoea, improving ovarian dysfunction and decreasing prostate enlargement). In Europe, particularly in France, Germany and Italy, saw palmetto products were a mainstay of homeopathic practice from the 1930s to the 1960s, after which saw palmetto-based phytomedicine products emerged as standard treatments for BPH. As more scientific evidence of safety and efficacy of saw palmetto products was published, interest increased in the early 1990s, particularly in Germany. Demand is still on the rise to this day.

Regarding the growing interest in sustainability and our responsibility to protect our herbal medicines, the increased demand for saw palmetto prompted the Florida Department of Agriculture and Consumer Services to officially put saw palmetto on the “Commercially Exploited Plant List” as of July 17, 2018. From this time a permit is required from the state of Florida to harvest, possess and transport saw palmetto fruit. Written permission from the landowner is required prior to harvest.  From the point of view of sustainability, overall, there is enough fruit grown and harvested in an average year that can supply the dietary supplement market. This herb is valuable not just because of its medicinal properties but also because of the labour and risks to human health involved in collecting it. Please see the Herbal Extract Company saw palmetto monograph for a detailed explanation on the harvesting of this plant. 

References

HEC Saw Palmetto monograph. Available from https://ypi.bmw.mybluehost.me/sites/default/files/2022-11/extract_sawpalmetto_monograph.pdf

Also known as bearberry (referring to its habitat in mountainous parts of the northern hemisphere), uva ursi is the prime remedy for urinary tract inflammation and infections (UTIs), particularly cystitis, urethritis and prostatitis. 

UTIs are the most frequent occurring infections in women and one of the major reasons for antibiotic prescriptions. Escherichia coli is the most frequent pathogen and first-line drugs include the antibiotic fosfomycin. Bacterial resistance is one of the major limiting factors of antibiotic use and despite fosfomycin’s activity against resistant strains (e.g. multidrug resistant E. coli), fosfomycin-resistance is an increasing problem. The antimicrobial activity of uva ursi extracts, and some of its individual constituents, has been observed in vitro however its efficacy compared with standard antimicrobial therapy has not been assessed yet. The first randomised controlled trial assessing the clinical efficacy and safety of uva ursi in comparison with fosfomycin is ongoing and the results have not yet been published. 

To the late herbalist extraordinaire Dorothy Hall, uva ursi combines the rare blend of astringent and demulcent constituents making it both a tonic and a stimulant, but also soothing and calming. She says “most herbal writers mention its effectiveness against kidney-stone pain, its cleansing and toning of the bladder with swift return to comfortable urination, and its... soothing [of] irritable genito-urinary tract inflammation. I have, in common with many other herbalists, found it equally soothing and tonic when gallstones are the problem to be treated.” When using uva ursi Hall adds dandelion (Taraxacum officinale) and buchu (Agathosma betulina) to mixtures where both liver and kidneys show impeded function due to gall or kidney blockage. 

References

Hoffman D. The New Holistic Herbal. Melbourne:Element. 1990.p. 179

Tóth B, Jávorházy A, Nyirády P, Csupor-Löffler B, Birinyi P, Zhanel G, Naber K, Länger R, Vörhendi N, Gede N, Váncsa S, Hegyi P, Csupor D. Bearberry in the treatment of acute uncomplicated cystitis (BRUMI): protocol of a multicentre, randomised double-blind clinical trial. BMJ Open. 2022 Jun 24;12(6):e057982. doi: 10.1136/bmjopen-2021-057982. PMID: 35750460; PMCID: PMC9234905.

Hall D. Dorothy Hall’s Herbal Medicine. Lothian Publishing Company:Sydney 1988. p291-3

While used for centuries in the traditional medicine of many cultures, functional mushrooms are having a moment in Western herbal medicine with exotic varieties capturing the popular imagination. This is because, being rich in nutrients and bioactive compounds, they can assist people to feel and perform better. The trailblazing mycologist, author, entrepreneur and perhaps, most famously, the protagonist of the 2019 documentary Fantastic Fungi, Paul Stamets, touts the benefits of mushrooms saying: “Mushrooms are food for the body and medicine for the soul.” The colloquial term “mushroom stacking” refers to the enhanced benefits from combining medicinal mushrooms to increase overall health outcomes. Stacking adaptogenic mushrooms can create a synergistic effect, amplifying the benefits of each mushroom. 

The growing interest in microdosing psychedelics was the genesis for the practice of stacking, which involves combining microdoses of psychedelics, primarily psilocybin-containing mushrooms, with other substances that are purported to accentuate the beneficial effects. In fact, the Stamets Stack is named after Paul Stamets who has been credited with introducing the concept of stacking. The eponymous Stamets Stack includes lion's mane, niacin (vitamin B3) and the active ingredient psilocybin (which in Australia is Schedule 9 (prohibited drug) except for prescription for authorised prescribers). Stamets claims that the combination of psilocybin and lion's mane has the ability to support the development of new neural pathways (neuroplasticity) and also repair existing neurological damage. 

The use of such admixtures appears to have a long history. Aztecs combined cacao with psilocybin mushrooms in a practice referred to as cacahua-xochitl, which literally means chocolate-mushrooms, and psilocybin admixtures composed of honey, flowers and herbs have been noted in historical records among both Indigenous and non-indigenous peoples. Mushrooms, henbane (also known as nightshade, Hyoscyamus niger), stinging nettles (Urtica dioica) and other active substances were commonly added to enhance the effects of beer during the Middle Ages. Chocolate and cacao remain popular additions to psilocybin, whereas adding Syrian rue (Peganum harmala), lion’s mane (Hericium erinaceus) and/or niacin appear to be a more recent phenomenon. 

The Herbal Extract Company’s mushroom stacking is focused on the practical use of this concept as it applies to functional mushrooms without the hallucinogenic “magic” properties. A popular combination for focus and cognition includes cordyceps (Cordyceps militaris), lion’s mane (Hericium erinaceus) and reishi (Ganoderma lucidum). It offers support for energy, brain health and stress support all at once. The results of a 2019 systematic review of in vivo studies suggest that dietary supplementation with lion's mane, reishi and cordyceps mushrooms may have a beneficial effect on cognitive impairment however further clinical research studies are needed. 

References

Plotkin M. The Mushroom Moment. Herbalgram. The Journal of the American Botanical Council. Winter 2024;139:36-41

Rootman JM, Kryskow P, Harvey K, Stamets P, Santos-Brault E, Kuypers KPC, Polito V, Bourzat F, Walsh Z. Adults who microdose psychedelics report health related motivations and lower levels of anxiety and depression compared to non-microdosers. Sci Rep. 2021 Nov 18;11(1):22479. doi: 10.1038/s41598-021-01811-4. PMID: 34795334; PMCID: PMC8602275.

Nkodo A. A Systematic Review of in-vivo Studies on Dietary Mushroom Supplementation for Cognitive Impairment (P14-021-19). Curr Dev Nutr. 2019 Jun 13;3(Suppl 1):nzz052.P14-021-19. doi: 10.1093/cdn/nzz052.P14-021-19. PMCID: PMC6574952.

Cordyceps appears to be a safe immunological adjuvant for the treatment of patients with mild to moderate COVID-19 according to an August 2023 randomised, double-blind, placebo-controlled study. The study's findings provide intriguing insights into the potential of cordyceps to enhance recovery and alleviate symptoms. Further research with larger groups is essential to validate these findings and uncover the full potential of cordyceps in COVID-19 treatment.

The study meticulously analysed biomarkers associated with inflammation, immune response and infection. A total of 58 patients were considered evaluable for the analysis with 30 in the cordyceps group and 28 in the placebo group. Cordyceps capsules, administered at a dose of 500mg three times a day for 15 days along with supportive treatment, showed effectiveness in patients with mild to moderate COVID-19 infection. This was evidenced by the proportionately higher number of recoveries on day five, the relatively shorter time for improvement of clinical symptoms, and the proportionately higher number of patients showing negative RT-PCR tests on day 10.

Mild symptomatic COVID-19 infection was defined as patients with uncomplicated upper respiratory tract infection. The patient had mild symptoms such as fever, cough, sore throat, nasal congestion, malaise and headache, without evidence of breathlessness or hypoxia. Moderately symptomatic COVID-19 infection was defined as pneumonia with no signs of severe disease (patients in respiratory distress). All mild patients received the standard of care treatment that included vitamin C, zinc supplements and antibiotics such as azithromycin or cefixime as per the institutional protocol in both groups. In both groups patients with moderate disease received antiviral treatment such as injections of remdesivir, anti-inflammatory agents such as prednisolone and anti-coagulants such as low molecular weight heparin, vitamin C and trace elements, as per the institutional protocol. Cordyceps was safe and well tolerated by patients, with no drug interruption or dose reduction due to minor adverse events in any of the patients. 

References

Dubhashi S, Sinha S, Dwivedi S, Ghanekar J, Kadam S, Samant P, Datta V, Singh S, Chaudry IH, Gurmet P, Kelkar H, Mishra R, Galwankar S, Agrawal A. Early Trends to Show the Efficacy of Cordyceps militaris in Mild to Moderate COVID Inflammation. Cureus. 2023 Aug 18;15(8):e43731. doi: 10.7759/cureus.43731. PMID: 37727187; PMCID: PMC10505833

Bupleurum is a traditional Chinese medicine used to protect the liver where it exerts anti-inflammatory and hepatoprotective actions. This suggests it may be beneficial in diseases associated with poor liver function, acute and chronic liver disease including hepatitis, non-alcoholic fatty liver disease and liver cancer. The root was traditionally used as a tonic for influenza and the common cold, to treat the associated fever (because it is cooling), inflammation and pain, as well as prolapse of the uterus and rectum. 

The anti-inflammatory action extends to chronic inflammatory disorders and autoimmune diseases such as asthma, rheumatoid arthritis, osteoarthritis, dementia, pancreatitis, hyperthyroidism and hypothyroidism. Bupleurum also protects the stomach and kidneys from toxic damage making it helpful for people who get frequent urinary tract infections. 

Bupleurum can also improve liver enzyme activity in regard to oestrogen clearance making it effective in endometriosis, irregular menstruation and the symptoms of perimenopause such as hot flushes and depressive mood change. More recently it has been used in the management of miscarriage cases where it plays an important role in immune modulation, and inflammatory management, for autoimmune mediated recurrent miscarriage cases and as an adaptogen to assist in adrenal recovery to overcome debility associated with recurrent pregnancy loss. 

References

van Wyk B, Wink M. Medicinal Plants of the World. Pretoria: Briza Publications; 2004. p. 73

Ren M, McGowan E, Li Y, et al. Saikosaponin-d Suppresses COX2 Through p-STAT3/C/EBPβ Signaling Pathway in Liver Cancer: A Novel Mechanism of Action. Front Pharmacol. 2019;10:623. Published 2019 May 29. doi:10.3389/fphar.2019.00623

HEC condition guides

Hechtman L. Advanced Clinical Naturopathic Medicine. Elsevier Australia:Chatswood. 2020. p. 374.

Sarris J, Wardle J. Clinical Naturopathy, 2nd ed. Chatswood:Elsevier. 2014. p.443.

Yeom M, Kim EY, Kim JH, Jung HS, Sohn Y. High Doses of Bupleurum falcatum Partially Prevents Estrogen Deficiency-Induced Bone Loss With Anti-osteoclastogenic Activity Due to Enhanced iNOS/NO Signaling. Front Pharmacol. 2018;9:1314. Published 2018 Nov 16. doi:10.3389/fphar.2018.01314