<![CDATA[At the Roots: Natural Healing for Cystic Fibrosis - Blog]]>Wed, 10 Apr 2019 18:44:15 -0400Weebly<![CDATA[Not All Plastics Are Safe]]>Thu, 14 Mar 2019 03:15:35 GMThttp://www.cfnaturalhealth.com/blog/not-all-plastics-are-safe
I just wanted to post a quick reminder that not all plastics are safe to use. All plastics are derived from fossil fuels, thus may exude toxic chemicals that may be carcinogenic, neurotoxic, hematological, cytogenetic, or have other negative health impacts. And of course, all plastics are bad for the environment. Therefore, reduce your exposure to plastics whenever possible and instead choose glass, metal, or ceramic reusable containers and utensils. Always recycle. And make sure that no matter what plastic you use, avoid exposing it to high heat, such as in microwaves or in dishwashers. 

More information on what the plastic numbers mean is here: www.babygreenthumb.com/p-122-safe-plastic-numbers-guide.aspx

More specific to CF, many brands of prescription pancreatic enzymes contain phthalates, a class of plasticizers that are known endocrine disruptors and can cause liver damage. I recommend avoiding enzymes containing phthalates, especially those who have liver issues. Pancreaze is a brand that does not contain phthalates. It's an outrage that phthalates are banned for use in toys and baby products, but not in pharmaceuticals! This must change! 
<![CDATA[Bloating, Gas, and Indigestion]]>Fri, 15 Feb 2019 21:22:03 GMThttp://www.cfnaturalhealth.com/blog/bloating-and-indigestionPictureBitters: a classic cure for indigestion (dyspepsia)
When we have CF or any other condition with significant digestive involvement, bloating and indigestion are common nuisances. Fortunately, digestive complaints are nothing new to the human species, therefore the world's many herbal healing traditions have a huge amount of knowledge to contribute to this issue. Interestingly, digestion is one of the things that I feel conventional medicine has the hardest time understanding and helping with, especially for chronic digestive issues. So in this article I'd like to briefly mention a few herbs and techniques to use to address bloating and indigestion. There are so many herbs that help with digestive issues of all sorts and I couldn't possibly discuss all of them in one article, but I'll touch on a few that I use frequently for myself and my clients. 

Indigestion can mean a bunch of things and has a lot of synonyms: dyspepsia, stomach ache, sick stomach, colic, collywobbles (!), and so on. It can be an umbrella term that includes gas, bloating, stomach cramps, intestinal cramps, nausea, burping, constipation, delayed gastric emptying, and so on. If you get indigestion often and the gastroenterologist doesn't know why or how to help you, they will likely give you a label of "IBS" (irritable bowel syndrome) and probably send you hope with proton-pump inhibitors and/or prozac. We herbalists don't really use that term because we have a more complex understanding of indigestion and can differentiate its causes better than conventional docs can. Depending on the specific symptoms, certain herbs are more or less helpful. So I'll break things down by symptom. 

Before I do so, I want to reiterate here the strong connection between the lungs and the guts. In Chinese medicine, the lungs and large intestine are connected through the Metal element. In Ayurveda, eating certain foods that are hard to digest, like dairy, have an impact on our respiratory mucus production. I see this connection over and over again in my clients and in myself. Foods that we have particular sensitivities to (an over-reaction of the immune system as a result of poor digestion of proteins) can cause excessive mucus production in our intestines, and by reflex (connected through the vagus nerve) cause excessive mucus production in the lungs and sinuses. I also experience this when I over eat or when I eat a meal with an incompatible combination of foods that is hard to digest. The body produces mucus to flush irritating things out of it more quickly, and so when foods irritate us, the guts produce mucus. Recognizing the connection between respiratory and gut mucus production helps us make smarter dietary choices for our lung and sinus health. I've found that keep a food journal can help track these connections. 

I will also mention that the first step to having good digestion is eating the right foods. Everyone digests differently and has different dietary needs, so the foods we eat need to be tailored to our particular bodies. There is no "one size fits all" diet. I discuss this much more in depth in the rest of my website, so please browse to learn more. 

Carminatives are a class of herbs that assist with gas, bloating, nausea, delayed gastric emptying, and intestinal spasms, among other things. They contain volatile oils that are usually spicy and aromatic, and these have a counter-irritating effect that causes relaxation of the smooth muscles in our stomach, intestines, and gallbladder and pancreatic ducts. When we have gas and bloating, what often causes pain is the spasming and griping of the muscles of our stomach and intestines as they try to move the gas down and out of our intestines through the rectum (farting). So carminatives can help relax these spasms to help the gas pass more easily. 

Gas is generally caused by the bacteria in our gut when they ferment upon certain types of carbohydrates. Different bacteria prefer different types of carbs for food - some like simple sugars like cane sugar, lactose, simple starches in white potatoes or refined flours, or dried fruit. Bacteria that like simple sugars tend to be less beneficial to our health, but not all of them are bad. If we eat a lot of simple sugars a lot of the time, these bacteria will overgrow and cause chronic digestive issues. Other bacteria, generally the ones that are good for our health, like complex carbohydrates and fibers contained in fibrous plants and whole grains, also called "prebiotics". The more prebiotics we eat, the more we feed these beneficial bacteria, and the more they educate our immune systems to work properly. The not-helpful bacteria are usually the ones that like to produce the most gas, so a first step can be to cut out simple sugars and instead eat more fruits and vegetables. Sometimes eating fiber can cause bloating temporarily as our gut bacteria population shifts to favor the helpful species, so gas is not alway a bad thing. But when it happens, here's some herbs that can help. 
Ginger root is number one on this list because it does almost everything to help the guts. It's anti-inflammatory, it speeds up gastric emptying, improves a weak appetite, and relaxes spasming intestinal muscles. It is amazing for nausea, motion sickness, stomach aches, and almost anything gut-related. It should be taken with caution in people with severe GERD, ulcers, or super sensitive stomachs. A small amount goes a long way - it's very spicy! I take capsules (1-3 capsules of 500mg each) as needed, especially after I've eaten a big meal that I need help digesting. Other methods are ginger tea, ginger candy, ginger tincture, powder, glycerite, vinegar extract, and so on. And of course, you can cook with it, as is most traditional! Remember to start with a low dose and work your way up - it's powerful! It is considered warming or even "hot", so not as good for use when it's very hot out or if there's a fever. 

Peppermint is a carminative almost everyone has used at some point in their lives. It is one of the most warming mints and yet is also anti-inflammatory in its after effect, similar to ginger. Other mints that have a similar effect but slightly different flavor are spearmint, chocolate mint, apple mint, winter mint, and for kids, catnip. Catnip is considered a little gentler and is great for colic in babies, toddlers, and kids of all ages. All mints are great for nausea, intestinal spasms, gas, and bloating. The best form to take is in tea of dried leaves, but you can also take tincture or capsules (capsules are the least effective form because they have already lost a lot of their essential oils due to the powdering/processing). There have been many studies on the use of peppermint essential oil in very small doses taken orally to help with the symptoms of IBS. 

Culinary spices like fennel, cardamom, clove, turmeric, anise, and other spices (including ginger of course) contained in curry care all carminatives. Adding these spices to hard to digest foods can sometimes help prevent or relieve indigestion. Almost every culture has their preferred arsenal of carminatives, so use what is most common, comfortable, and tasty for you!

I've talked about bitters many times on this website, so I recommend reading about them more deeply here. But I will briefly say that they're alcohol (or vinegar) extracts of bitter herbs (usually roots) combined with carminative herbs used as an all-around digestive tonic. They're wonderful when taken 5-15 minutes before meals to stimulate our digestive organs to secrete their juices optimally: stomach acid from the stomach, bile from the liver, pancreatic enzymes and pancreatic bicarbonate from the pancreas, as well as saliva and salivary enzymes. If our digestive secretions are produced at the right time and in the right amounts, this helps us digest our fats, proteins, and carbohydrates most effectively, reducing incomplete digestion that can lead to gas, bloating, and mucus production. Some excellent bitters are artichoke leaf, dandelion root, burdock root, angelica root (which is also carminative), chamomile (also carminative and nervine, making it excellent for colicky babies), horehound (also carminative and expectorant for the lungs), elecampane (carminative and expectorant), and many more. In Europe, some cultures take "aperitifs" before or after meals, and in the US the hippest hipster bars are getting into bitters. But before the turn of the 20th century, doctors, pharmacists and healers of all kinds would suggest bitters for indigestion all over the Western world (as shown in the label at the top of this article). So it's an old remedy that's making a comeback because it just works so well, and there are not drugs that can do what it does. They also can be used to relieve gastric reflux/ heart burn. It's easy to make your own bitters with alcohol or vinegar, but you can also buy it from a few companies. I recommend Urban Moonshine. 

PictureMeadowsweet (Filipendula) leaf and flower.
Sometimes the inflammation in our guts can get really bad and cause diarrhea, pain, and even trigger inflammation in other parts of our bodies. There are some digestive herbs that I consider to be "topical" anti-inflammatories (that is, topical to our gut tissue when drunk). One of the best anti-inflammatory herbs that I know of is meadowsweet leaf and flower. It is somewhat astringent, so it's great for loose stools and diarrhea, and it is aromatic (so a little carminative) and tastes great in tea. It also contains methyl-salicylates which are strongly anti-inflammatory (salicylic acid, that is aspirin, was originally derived from the methyl-salicylates in willow bark and meadowsweet leaf). It's great in tea and tincture.

Other great anti-inflammatory herbs for tea are marshmallow leaf, comfrey leaf, and plantain leaf. Each of these is demulcent (gooey) and soothing, helping to coat the gut tissue and protect it from irritants. These can also help rebuild a deficient mucosal lining that has been degraded by chronic inflammation (which leads to "leaky gut" or increased intestinal permeability). For leaky gut in particular, comfrey root is the best. It's good in tea (steep in warm or cook water, but not hot water) or in tincture. It's the slimiest, gooey-est herb I know of, and contains allantoin which helps speed up healing and tissue proliferation. It also has prebiotic fiber to feed good bacteria. It needs to be used sparingly however, because the root contains pyrrolizidine alkaloids, which are liver-toxic in large doses. Use at moderate doses for only a few weeks at a time, or small doses for up to one or two months, then take a break. Do not use if you have liver disease. Marshmallow root has a similar slimyness to comfrey root, and is a safe alternative for those who are concerned about the pyrrolizidine alkaloids. It's best as a root powder mixed in a little cold water, letting it sit for 15-30 min until the mixture turns into goo. Then drink between meals. In the old days, "slippery elm" (the powdered inner bark of the elm tree) was used the same way marshmallow root powder is used today, but as a result of over harvesting and climate change, elm trees have become endangered so I discourage people from using slippery elm. In general it's best to take slimy herbs away from meals and supplements because the fiber can bind to supplements and make them less easy to absorb. 


If you are interested in setting up a consultation with me that includes personalized herbal and nutritional advice, please click here for more information. 


<![CDATA[Paleo(ish) Biscuits]]>Thu, 27 Dec 2018 18:48:29 GMThttp://www.cfnaturalhealth.com/blog/paleoish-biscuitsPicture
I love biscuits (that is, American biscuits), but since going gluten-free, and then Paleo, I've had to cut them out. Until now! As usual, I've experimented by combining a few recipes together and came up with a successful way to satisfy my love for the biscuit! I also have a variation for the egg-free people (I am one of those). I found that replacing the eggs with ground flax seeds actually makes them taste better

Oh, and I call these Paleo(ish) because I usually make them with a little brown rice flour, but you can replace that with tapioca flour instead if you're being strict about it. This recipe is pretty quick and easy, and makes about 10 biscuits. 

4 eggs (from free range and pastured chicken). 3 eggs if they're from ducks. [Egg-free alternative = 4 tbsp of ground flax seeds + 1/2 cup water]
1 cup of almond flour
1/4 cup coconut flour
1/2 cup tapioca flour or rice flour
1 tbsp of honey
1 tbsp apple cider vinegar
3 tbsp coconut oil 
1 tsp sea salt
1 tsp baking soda
1/2 tsp of fresh or dried herbs of your choice (optional)
1/4 tsp xanthum gum or guar gum
Water or hemp/nut milk until consistency is right
*I bet you could add fancy stuff to these to make them more like scones. Maybe dried cranberries, chocolate chips, blueberries, etc. 

1. Melt the coconut oil and honey together in a little saucepan until liquidy.
2. Mix dry ingredients together in a big bowl.
3. Preheat oven to 375 degrees F.
4. Grind the whole flax seeds in a coffee grinder (I have a coffee grinder for seeds only) and add the water in a little bowl. Let that sit for 5 minutes. 
5. Combine wet ingredients and wet flax together in a separate bowl. 
6. Combine all ingredients together in the big bowl and stir. Add water or hemp/nut milk until you get the constancy of the dough to be like cookie dough. Let this dough sit for a few minutes, because it takes a while for the coconut flour to absorb the liquid. You may need to add a little more water/milk after the dough sits. 
7. Plop them on a cookie sheet (greased or ungreased). Press them into the shape you want, they won't rise much. 
8. Bake for 15-20 minutes until lightly browned at the edges.


Nutrition Facts
I've done a rough calculation of the nutrition facts in one biscuit (if the full recipe makes 10 biscuits)...
Per biscuit (flax version):
15g carbs
5g fiber 
11g fat
5g protein

P.S. If you have constipation issues, don't eat more than 2 flax biscuits at once. Too much insoluble fiber... argh!
<![CDATA[Antiviral Herbs for Cold and Flu Season]]>Tue, 30 Oct 2018 14:34:33 GMThttp://www.cfnaturalhealth.com/blog/antiviral-herbs-for-cold-and-flu-seasonPicture
Now that the colder weather has come upon us in the northern hemisphere, it's time for viruses to make their rounds! Colds and flus can be pretty problematic for people with CF and other respiratory diseases as they can tax our immune systems and cause excessive mucus production, which can then lead to increased vulnerability to bacterial infections and exacerbations.

​Although there are very few tools that conventional technomedicine has for fighting viruses like colds and flus, there are many, many medicinal herbs that have antiviral activity and many more that stimulate the immune system to fight the infections ourselves. In this article, I will discuss medicinal herbs and foods that can help us prevent viral infections and hasten our recovery when they do come. 

Antiviral Herbs
Conventional medicine and the pharmaceutical industry have not yet figured out how to deal effectively with viruses. Science still knows very little about viruses. There are some drugs can inhibit replication of certain viruses such as HIV and herpes (having different levels of effectiveness depending on the virus) and vaccines can stimulate the body to create antibodies to a specific virus so that when you do catch it, the immune system can fight it off much more easily. While humans are still quite ignorant about viruses, plants and fungi have a few hundred million years head start on us in finding solutions to protect themselves from these pathogens! Plants' wisdom is contained in their tissues, which we can learn from and benefit from by consuming them, as all of our ancestors have done for hundreds of thousands of years. Many plants and fungi create antiviral compounds that directly kill viruses. 

In general, there are three types of pathogens that we are concerned about when it comes to respiratory infection: bacteria, viruses, and fungi. Viruses are very different from bacteria. There are several categories of viruses and many millions of species, only several thousand of which have been named and studied. Not all viruses are bad, some are commensal or dormant, and we may depend on some of them to help us function normally. Some viruses can even help us fight bacteria and fungi [1]!

There are a few tricky things about viruses that make them hard to kill. Firstly, viruses are extremely tiny compared to other pathogens and structurally very simple - consisting of just DNA or RNA and an outer protein layer called a capsid. Some viruses, like the flu (influenza) have an additional outside lipid bilayer membrane called an envelope, which is similar to what animal cells have (like us). Rhinoviruses, which cause the majority of "colds" (rhino- being Greek for "of the nose"), do not have envelopes. Secondly, science is not really sure if viruses are "alive" or not, since they can't live or replicate outside of a living host, so they have fewer ways to be destroyed or made inert compared to other  pathogenic cells that live on their own, like bacteria and fungi. Thirdly, they have incredible structural diversity. And forth, they mutate very rapidly, especially cold viruses, so that our immune systems have to constantly try to figure out how to kill the latest version of the pathogen. You may have caught a cold and successfully fought it off two weeks ago, but by the time it infects 10 more people and comes back to you, its genetic mutations have changed it so much that the body now no longer recognizes it and has to start developing antibodies to it all over again as if it was new! Flu's mutate a little less rapidly, which allows scientists to develop flu vaccines. But flu vaccines have varying levels of efficacy, since multiple strains of influenza cause "the flu". Some years' vaccines have higher accuracy and efficacy than others. Drug developers just choose the most common strains of the flu worldwide the previous year and make a vaccine with it, hoping that the strains haven't mutated much while the vaccine was in development. Then next year, they start all over again with the newly mutated influenza strains. If you want to know more about how viruses replicate and infect us, here's some fun little videos here and here

The good news is that many herbs have ways to help us fight viruses, either by lending us their own antiviral powers, or by stimulating our immune systems to attack viruses more effectively. Plants are also targeted by viruses, so they've learned how to fight them off by creating different types of "secondary metabolites", a fancy term meaning chemical constituents that have a specific biological purpose and that stimulate a physical reaction in the human body. Plants and humans (and our pre-human ancestors) have been co-evolving for a few million years. We have always had medicinal plants as part of our daily lives all throughout our evolutionary history, that is, up until modernity wiped all of them away and replaced them with chemical drugs. I think of medicinal plants as part of the human immune system, just a part that lives outside of our body instead of inside of it. I mean, why go through the trouble of developing your own internal human-version of antiviral compounds when you've got plants all around you to help you out? Well, that is, until modernity reduced our cohabitation with wild plants. (Sigh.) All animals use herbal medicine - there is documentation of cats, dogs, bears, primates, and many other mammals knowing specific plants to take in specific health situations. Even caterpillars do it [2]!

Acute Care
First I will talk about the herbs that are helpful when you feel the virus coming on or when you're in the midst of an infection. These herbs are for short term use and generally need to be taken in high doses frequently, every few hours (to inhibit viral replication, which can take only a few hours). It is especially important to start these herbs as early as possible and continue them until the symptoms are completely gone (and sometimes for a day or two afterward just to be safe). Antiviral herbs work best when taken as soon as you feel the first "tickle". With colds, people who catch the virus may not develop symptoms until 1-2 days later (this is called the incubation period), but they are still contagious during this time as well as for 1-2 days after developing symptoms. This contagious period can be even longer if the person's immune system is weak. Flu's are contagious for longer than colds, sometimes for 7-10 days after catching it. That's why social isolation is very important during the contagious stage, to make sure you don't spread it to other people, especially people with respiratory diseases and compromised immune systems. 

​Below are a few herbs for acute viral care...

The elder bush or tree (Sambucus canadensis - North American, and Sambucus nigra - European) is used to stimulate the immune system and also as a direct antiviral treatment. It is a very sacred plant that has been used in indigenous European medicine for millennia. The elder berries contain vitamin C and many bioflavonoids, as well as anthocyanidins which are its purple-black pigment. Several clinical trials have shown that elderberry extracts significantly speed up recover from colds and flus, and reduce the need for rescue interventions [3, 4, 5]. Elderberries and flowers also contain anti-inflammatory compounds that reduce the negative consequences of inflammation from innate immune reactions, such as fever, muscle aches, swollen throat and eyes, digestive upset, and so on. Elder flower is used as a diaphoretic, which is an old word that means a plant action that helps the body move and release heat to the periphery of the body, helping a fever break earlier. Elder flowers contain flavonoids such as kaempferol, quercetin, and rutin, which reduce genetic expression of pro-inflammatory interleukins and cytokines. Quercetin in particular is used to reduce the production of histamine, which causes the production of clear, runny mucus that is common in viral infections (and also in allergies). 

When in the midst of a viral infection, the adult dose is 1-5 teaspoons of elderberry syrup every 3 hours until the symptoms are gone. This is very easy to do, since elderberry syrup is delicious! Make sure to get syrup made with honey or glycerine, not with sugar or other processed sweeteners. Also, make sure that the elderberries are organic (all herbal medicine should be organic whenever possible, since pesticides are very harmful to the human body and to the environment). You can also make elderberry syrup yourself with dry or fresh berries, though fresh is always better. Elderberries are usually harvested in the late summer or early fall here in Vermont. I get mine from my neighbor who has a bunch of bushes in her backyard, but if you don't have access to local elderberry syrup, I really like the taste of this brand, which is carried in many health food stores in the US. And remember, never buy anything from Amazon.com (they have sketchy business practices, horrible political affiliations, and destroy local, small businesses).  

Elder flower is great to be used as a tea during a viral infection, especially if there are fevers and chills. It can help the fever peak and break quick. It's also great for people who can't mount a proper fever, that is, if the fever doesn't get high enough. The ideal temperature for a fever is 101-103° F (38.3 - 39.4° C) for adults, for only a few days at a time. If the temperature gets above that, or if it lasts for more than several days, seek medical attention. Remember, fevers are really important mechanisms that our body uses to fight pathogens! Viruses are destroyed when our body temperature rises and our innate immune system works most efficiently at a higher temperature, so suppressing a fever with tylenol or ibuprofen shuts down this helpful mechanism. That said, if the fever gets too high or lasts too long, we may not want to raise the fever higher, so elder berries and flowers may not want to be used in those situations. Andrographis may be more appropriate (see below). 

Fire Cider
Fire cider is a traditional European and North American recipe used to fight off acute infections, especially colds and flus. It is an apple cider vinegar infusion of pungent herbs and spices that stimulate the immune system and have direct antiviral effects. The most common herbs used are garlic, ginger, horseradish, turmeric, onion, and a variety of peppers and chilis. It's very easy to make at home as the chopped herbs only need to steep in (organic) apple cider vinegar for 2-4 weeks before being strained and then sweetened to taste with local raw honey.

​Pungent and spicy herbs stimulate diaphoresis, as mentioned above, and also thin mucus by encouraging more water secretion from the cells in the mucous membranes of our respiratory tract, sinuses, and gastrointestinal tract. This mucus-thinning effect allows the mucus to be coughed up and cleared out more easily, and it is why pungent herbs are called "expectorants". Garlic is particularly antiviral, as I will mention below, and all of these herbs are anti-inflammatory and can help reduce the achey symptoms of colds and flus. The quercetin contained in onions has been shown to be more effective at killing the flu virus than Tamiflu, the only pharmaceutical treatment for influenza [6]. By stimulating the immune system with expectorants that protect the respiratory tract, recovery from colds and flus can be sped up. A typical dose of fire cider is a 1/2 - 1 ounce (15-30 mL) shot every several hours while symptoms persist. I love to mix fire cider with elderberry syrup to get a sweet and sour flavor! It is usually not available in stores, which is just fine since it's so easy to make yourself and is shelf-stable. There is a nasty company called "Shire City" which unethically trade marked the term "fire cider" (even though it is a term used by folk medicine) and has been suing other companies and organizations using the term. So make sure not to buy fire cider from them. 

Garlic is an culinary herb, a food, and a medicine. It is truly a powerful plant that can be used in a hundred applications, all of which I cannot cover here. In particular, this pungent herb is antibacterial, antiviral, antifungal, anticancer, and is anti-inflammatory and protective to the cardiovascular system and the liver. It is one of the strongest antiviral substances known [6,7], and its antiviral compounds (primarily allicin) are readily available in the blood after absorption through the digestive tract. To me, this makes garlic one of the most powerful tools for fighting viral colds and flus.

Multiple constituents in garlic are effective against drug-resistant bacteria such as MRSA [8,9] and make antifungal and antibiotic drugs work better [10]. Studies show that “each clove has from seven to thirteen milligrams of allicin, so three cloves contains the same antibacterial activity as a standard dose of penicillin” [11]. The spiciness of garlic is created by the sulfur-based nutrients called thiosulfinates, which kill cancer cells and reduce the risk of arterial blood clots [11]. Garlic is very high in antioxidants, and will neutralize free radicals quickly and effectively [12]. 

During a cold, flu, or respiratory infection of any kind, the optimal dose is 1 clove (raw) every 3 hours. It is very important to crush and chop the clove and then let it sit for 5-10 minutes to let the enzymes activate the antimicrobial constituents (i.e. allicin) that are released from the plant cells when they are broken. Raw garlic can go down easier if you take it with a little honey or a slice of tomato. For people with sensitive stomachs or issues with heartburn, it may be a good idea to take garlic with other food to prevent upset stomach. Once crushed and let sit, garlic can be heated briefly (as you would in a vegetable sauté) without damaging its antimicrobial power too much. But if garlic is "aged" or chopped and then let sit for too long, like 30 min, it will lose most of its antimicrobial effects (but it will still have cardioprotective and anticancer effects). That's why garlic capsules are not antiviral, but they can be helpful in other ways. There is a new supplement called Allimax that claims to have found a way to preserve allicin's effectiveness by protecting it from oxidation (allicin oxidizes very quickly when exposed to air, which neutralizes its effectiveness). To be safe, I just use fresh raw garlic (that my sister grows on her farm). Garlic can also be eaten daily as a tonic and for infection prevention, which may be a really good idea for CFers in general. Make sure your garlic is organic and locally grown if possible. Make sure you do not buy garlic grown in China, as it is often bleached to make it look white!

Allicin and other pungent constituents in garlic are very small, small enough to pass from the blood into the alveolar space in the lungs, where you then breath them out upon exhalation (giving you "garlic breath"). But this is a good thing, because we want those antimicrobial compounds to be working directly on the lung tissue. So if you get garlic breath, that's a good sign that you've taken the right dose! You can also eat fresh parsley or drink wheat grass or barley grass juice to reduce “garlic breath”. 

Andrographis paniculata is an herb that comes to us from Ayurvedic medicine, the traditional healing system of India. This extraordinary plant is a powerful antiviral and clinical studies have shown it to be effective in speeding up recovery from colds and flus [13,14]. It is directly antiviral and an excellent stimulant of innate immunity. Andrographis one of my favorite antiviral herbs because it is cooling, unlike most other antiviral and immune-stimulating herbs, which tend to be warming. It is considered a febrifuge, which means that it can directly cool a fever in a way that is different than diaphoretics like elderflower, garlic, ginger, yarrow, etc. I would choose andrographis over elderberry when there is fear that the fever is already too high and should not be increased. It is a very bitter herb, and while tincture is certainly useful it can be too bitter for some adults and most children. Therefore, capsules are usually the easiest way to take them. The typical dose is 1-3 mL of tincture three times per day, or 300-500mg powder (in capsules or tablets with at least 5% standardized andrographolides) three times per day. 

Echinacea (E. purpurea, E. angustifolia, or E. pallida) is a well-known herb used to enhance the immune system and fight viruses. It is an immune stimulant, and it is also an excellent lymphatic. A lymphatic is an herb that stimulates the movement of fluid in the lymphatic vessels and the processing of bodily wastes in the lymph nodes. When we are sick, white blood cells that have captured and have begun digesting pathogens move through the lymphatic vessels of the body and collect in the lymph nodes (those lumps under your ears, on your neck, in your arm pits, behind the knees, in the groin, and several other places), the tonsils, and the spleen for processing and break down. Sometimes the body gets overwhelmed by the amount of viral garbage that is being processed, and the lymph nodes can swell and become painful. Echinacea can be helpful for helping the lymph nodes get less backed up and help the lymph flow more smoothly. For this reason, in traditional Native American and European-American medicine, echinacea is used for blood and lymph infections (particularly when there is "streaking" visible on the skin... it's signature is that there is streaking on its flower stem) and venemous snake bites. Lymph movement can be very important in the recovery from flus, as was demonstrated in the 1918 flu pandemic where patients of osteopathic and Eclectic physicians had the highest survival rates because of their manual lymph movement techniques and herbal lymphatic treatments, respectively. 

Echinacea contains alkyl-amides and immune active polysaccharides, which are responsible for its immune-stimulating effects. When taken in high doses, several times per day, it is shown to significantly shorten the duration of a cold, and reduce the inflammation and severity of symptoms [15,16]. At lower doses it may not be as effective in acute situations, though it can be helpful for increasing immune vigilance for people with poor immunity on a long-term basis. It is not suitable for people with autoimmune disorders, as it may exacerbate symptoms. The most potent form of echinacea is a tincture of the fresh root. Tincture of fresh flowering tops or dry root is slightly less effective, though still good. Some people like to combine tinctures of fresh tops and fresh roots half and half. A typical dose for colds or acute immune stimulation is 5 mL (1 tsp) every 2 hours as long as the symptoms persist. This can get a little expensive, so I personally prefer to use other herbs instead. But echinacea can be the best choice if the viral infection causes inflamed lymph nodes. Capsules will be less effective since they are made from dry herb (and not all supplements claiming to have echinacea in them actually do, so make sure you choose a good company). It is also traditional to make tea from the dry root. 

IMPORTANT: This a very important note on the sustainable use of echinacea. All three echinacea species are native to North America, and Echinacea angustifolia is on the United Plant Savers "At Risk" list (i.e. endangered species) because of overharvesting in the wild. Therefore, do not buy E. angustifolia preparations, especially not if it's wild harvested! Instead, make sure that you only buy E. purpurea (a.k.a. purple cone flower) preparations, and make sure they are organic (as always). 

Other Herbs
There are many other herbs that are used for acute viral infections, but I don't have space to talk about all of them here. If you want to know a whole bunch more about antiviral herbs, check out Stephen Buhner's book Herbal Antivirals. One other I will mention is goldenseal, Hydrastis canadensis. Goldenseal is a small woodland understory plant native to North America that contains berberine and hydrastine, the latter being very potently antiviral. However, this plant should not be used for colds or flus unless there is no other choice. Goldenseal is also on the UPS "At Risk" list due to over-harvesting and habitat destruction. Like echinacea, it is one of the few medicinal herbs that modern Americans have heard about and its reputation has unfortunately caused it to be misused and endangered. Therefore, I do not recommend goldenseal be used for colds and flus. It may be more appropriate for other clinical applications when used very judiciously, but I will not discuss that here. 

Some additional options for diaphoresis to break a fever include hot teas of ginger root, yarrow leaf and flower, garden sage, thyme, oregano, rosemary, peppermint, horehound, hyssop, and many more. Drinking hot diaphoretic teas can help relieve symptoms related to fevers and help colds resolve more quickly. It is common to all traditional medical systems to wrap the feverish person in blankets, drink hot tea, sit by the fire, and sweat it out. Do so with caution with high fevers, as mentioned above.

Preventative Care
Some herbs are great for taking daily during cold and flu season or over the long term to build a stronger immune system and prevent infections from taking hold in the first place. My favorite immune-boosting herb for long term daily use is astragalus root (Astragalus propinquus). It comes to us from Traditional Chinese Medicine where it is used as a tonic and a blood-builder. Studies have shown it to enhance innate immune and balance acquired immunity, specifically by enhancing the activity of white blood cells [17]. It is also used as adjunctive therapy for cancer, as it increases white blood cell count and prevents neutropenia from chemotherapy, protecting cancer patients from chemo-related infections. It is mild tasting and very safe for all ages. Caution may be warranted for use during autoimmune flares. It can be taken in powder, tincture, decoction (a tea of the root simmer for at least two hours), bone broths, and soup stocks. It is excellent when combined with reishi mushroom and eleutherococcus (a.k.a. Siberian ginseng), all of which are immune stimulating and safe for long term tonic use. For more info on astragalus, read my materia medica monograph on it. 

Eleuthero (Eleutherococcus sinensus) is another immune-stimulating root from Chinese Medicine and is used pretty similarly to astragalus, though is best for shorter term use (several months at a time for those with weak immune systems). It can be a little more stimulating to the immune system in the short term compared to astragalus. 

In children, breastfeeding is very important for transferring immunity to many diseases from mother to child. Antibodies to many diseases, including bacteria and viruses, are transferred in the milk to the nursing infant. Breastfeeding can ensure that the child's immune system is as robust as possible as they grow older, and can help colonize them with healthy bacteria and important nutrients and fatty acids that you cannot get from factory-made formula. Nursing for at least one year is good, but nursing for 2-4 years is optimal, especially for CFers and immune-compromised children. For parents that cannot nurse their children, there are human milk banks available in most countries. These are organizations that provides human milk to infants that need it, given by nursing parents who have excess milk production. Human milk is way, WAY healthier than infant formula for many reasons that I can't go into here. And the good thing about getting milk from a milk bank is that this will increase exposure to multiple nursing people's antibodies and expand the diversity of antibodies the infant receives, therefore increasing the breadth of immunity. So... maybe everyone should do this?!

In addition, many studies have shown how taking probiotics, either in food or supplements, can help improve immunity and prevent respiratory infections infections in adults and children [18,19, 20]. For more information on how to choose a good probiotic, read this article

Lastly, hygiene is very important to think about during cold and flu season. Washing hands frequently when in public places (especially hospitals and doctor's offices!) with soap and water or alcohol-based hand sanitizers is important. Avoid triclosan-based soaps and hand-sanitizers, not only because triclosan is carcinogenic and gets into the public water system, but also because bacteria are now becoming resistant to it. Soap and water still works, as does alcohol. Also, colonize yourself with good bacteria from natural places and healthy soils. These good bacteria educate your immune system and compete with pathogens to protect you. Always cough or sneeze into your elbows or inside your shirt, not into your hands, and wash your hands after blowing your nose or touching your face if you have a virus. Hands are the most common tools of cross-contamination. So be conscious of public door knobs and handles. When I'm in the hospital I always touch elevator buttons with my elbows, knees, or my fist-knuckles (not my finger tips). Little things like that can sometimes make a difference. 

Eating nutritious, anti-inflammatory foods during a cold or flu is very important for hastening recovery and reducing symptoms. Garlic and onions, as mentioned above, are excellent choices, as well as spicy soups and broths. One of my favorite things to eat when I have a cold is spicy tom-kha soup (a Thai coconut soup). Drinking plenty of fluids is important, especially in the form of hot herbal teas, soups, and broths. Bone broth is a very nutritious and healing food for illness. Generally it is important to avoid inflammatory and hard to digest foods when we are sick, such as sugar, rancid oxidized oils, gluten, dairy, sodas, fried foods, and junk food. Simple, warm, well-cooked foods are best. Vitamin C in food form is helpful, such as from cabbage and sauerkraut, whole citrus, kiwi, blueberries, and other organic berries. Vitamin C in supplement form is not as helpful, and sometimes can be inflammatory (as with ascorbic acid). 



[1] Golkar, Zhabiz, Omar Bagasra, and Donald Gene Pace. "Bacteriophage therapy: a potential solution for the antibiotic resistance crisis." The Journal of Infection in Developing Countries 8.02 (2014): 129-136. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5547374/>
[2] ​https://www.urbanmoonshine.com/blogs/blog/adaptive-plasticity-guido-mase
[3] Zakay-Rones, Z., et al. "Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections." Journal of International Medical Research 32.2 (2004): 132-140.
[4] Barak, Vivian, Tal Halperin, and Inna Kalickman. "The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines." 
Eur Cytokine Netw 12.2 (2001): 290-296.
​[5] Zakay-Rones, Zichria, et al. "Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama." 
The Journal of Alternative and Complementary Medicine 1.4 (1995): 361-369.
[6] Weber, Norbert D., et al. "In vitro virucidaleffects of Alliumsativum(garlic) extract and compounds." Plantamedica 58.05 (1992): 417-423.
[7] Josling, Peter. "Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey." Advances in therapy 18.4 (2001): 189-193.
[8] Tsao, Shyh-ming, Cheng-chin Hsu, and Mei-chin Yin. "Garlic extract and two diallyl sulphides inhibit methicillin-resistant Staphylococcus aureus infection in BALB/cA mice." Journal of Antimicrobial Chemotherapy 52.6 (2003): 974-980.
[9] Cutler, R. R., and P. Wilson. "Antibacterial activity of a new, stable, aqueous extract of allicin against methicillin-resistant Staphylococcus aureus." 
British journal of biomedical science61.2 (2004): 71-74.
[10] Li, Guoliang, et al. "Fresh garlic extract enhances the antimicrobial activities of antibiotics on resistant strains in vitro." 
Jundishapur journal of microbiology 8.5 (2015).
[11] Robinson, Jo. Eating on the Wild Side. Little, Brown, and co. 2013. 
] Wei, Zhihua, and Benjamin HS Lau. "Garlic inhibits free radical generation and augments antioxidant enzyme activity in vascular endothelial cells." Nutrition research 18.1 (1998): 61-70.
[13] Puri, Anju, et al. "Immunostimulant agents from Andrographis paniculata." Journal of Natural products 56.7 (1993): 995-999.
[14] Coon, Joanna Thompson, and EdzardErnst. "Andrographis paniculatain the treatment of upper respiratory tract infections: a systematic review of safety and efficacy." Plantamedica 70.04 (2004): 293-298.

[15] Sharma, Manju, et al. "Induction of multiple pro-inflammatory cytokines by respiratory viruses and reversal by standardized Echinacea, a potent antiviral herbal extract." Antiviral Research 83.2 (2009): 165-170.
[16] JawadMoutaz, et al. "Safety and efficacy profile of Echinacea purpureato prevent common cold episodes: a randomized, double-blind, placebo-controlled trial." Evidence-Based Complementary and Alternative Medicine2012 (2012).
ShaoBao-Mei, et al. "A study on the immune receptors for polysaccharides from the roots of Astragalus membranaceus, a Chinese medicinal herb." Biochemical and biophysical research communications 320.4 (2004): 1103-1111.
[18] Hao, Qiukui, et al. "Probiotics for preventing acute upper respiratory tract infections." Cochrane Database of Systematic Reviews 9 (2011).
[19] Vouloumanou, Evridiki K., et al. "Probiotics for the prevention of respiratory tract infections: a systematic review." 
International journal of antimicrobial agents 34.3 (2009): 197-e1.
[20] Weizman, Zvi, Ghaleb Asli, and Ahmed Alsheikh. "Effect of a probiotic infant formula on infections in child care centers: comparison of two probiotic agents." 
Pediatrics 115.1 (2005): 5-9.
<![CDATA[Herbal Monograph: Reishi Mushroom]]>Wed, 17 Oct 2018 04:00:00 GMThttp://www.cfnaturalhealth.com/blog/herbal-monograph-reishi-mushroomPicture
This post is a continuation of my series focusing on individual herbs. In herbalism, we call in-depth documentation of individual herbs "monographs", and we call a compendium of monographs a "materia medica". My personal materia medica is over 300 pages long by now, so I'd like to provide some of the information I've gleaned about specific herbs that I think the CF community will greatly benefit from. So far we've covered astragalus and elecampane. Today I'd like to discuss one of the most revered medicinal herbs in Chinese Medicine: reishi mushroom. 

Reishi mushroom (Ganoderma lucidum or G. tsugae) grows wild in northern conifer forests in most of the Northern Hemisphere, including in East Asia, Europe, and North America. It is used traditionally to improve vitality, lengthen life, and boost immunity. Modern herbalists have found it to be one of the most powerful tools for re-reglating the immune system by both improving weak immune responses and also down-regulating hyper-reactive immune systems (e.g. allergies and autoimmunity).

Botanical/Latin Name 
Ganoderma tsugae (in northern forests), G. lucidum (in southern forests), G. lingzhi (China), and other Ganoderma species native to North America. Most research is done on G. lucidum, however there is some evidence that G. tsugae may be even more medicinal. 
Family: Ganodermataceae.

Common Names
Reishi (Japanese), Ling-zhi (Mandarin Chinese). A rough translation of lingzhi is "spirit mushroom" or "divine fungus". 

Parts Used
Mature fruiting body (mushroom). 

Glossy red-brown tree mushroom with a red neck that sticks out of the log (other red tree mushrooms generally don't have a neck). When it's younger it has yellow and white rings on the outer edges. Reishi is a polypore mushroom, meaning that it has tiny holes on the pale underside where its spores come out. In the northeastern U.S., G. tsugae grows only on dead hemlock logs. Other ganoderma species may grow on other tree species, such as maple. 

Growing and Harvesting
In the northeast of North America, harvest the mushroom just before the fruiting body gets completely ripe, before all the white/yellow disappears. Once the fruiting body has completely matured (has no more yellow or white left on its rim) it begins to breakdown and become more susceptible to fungal, bacterial, and insect infection. In Vermont, the first harvest is in July, and sometimes there is a second growth in September or October. Make sure to tap the fruit on dead hemlocks to spread the spores. Always cut it off the tree with a knife so as not to damage the mycelial network underneath the bark. A reishi log will last 3-4 years. Slice the mushrooms into thin strips before they dry out and leave the slices out in the sun to cause vitamin D2 production. Fungi are very similar to humans in a several ways, and one of those ways is that we each can create our own supply of vitamin D through sun exposure (though we produce vitamin D3 and they produce vitamin D2, which are not equivalent but are similar). One can also inoculate logs directly or grow reishi indoors on grain substrates (usually done in a commercial setting).
These are a little young but I had to harvest them early because they were getting bug-eaten.
Sliced reishi drying in the sun room.
Strips of dried mushroom are widely available commercially from international organic herbal distributors like Mountain Rose Herbs or from Chinese herb stores. As with all herbs sourced internationally, it's very important to know where the herb comes from, how it was grown, and if it is certified organic or some equivalent. Most reishi is grown in China, and herbal contamination with pollutants or non-medicinal plants is a serious issue. So make sure you are buying it from a legitimate source. The best way to ensure quality is to harvest or grow your own! Unlike some other wild medicinal mushrooms such as chaga, reishi is not threatened and grows quickly and easily under the right conditions, so overharvesting and sustainability is not as much of an issue. But the mushroom is not plentiful, so if you find it, make sure not to harvest all of it and also make sure to protect its habitat since they only grow on dead hemlock trees in the wild. It is always important to be conscious of sustainability and so it is a good idea to leave some mushrooms to allow them to spore and spread their spores in the forest to ensure future propagation. I was taught that after harvesting a mushroom you can knock the mushroom against other fallen hemlock logs in the forest to inoculate them. 

You can also buy powdered mushrooms, ideally steamed or autoclaved to break down the chitin, improving bioavailability. In our apothecary we buy our steamed powder from Mushroom Harvest. Reishi is also available in capsules from Paul Stamets' company Host Defense.  
Dried strips of Ganoderma lucidum from a commercial source.
Bitter and slightly chocolatey. 

Neutral and slightly cool. Moderately drying. 

Physological Actions
Immunomodulant*, anti-allergy*, tonic*, adaptogen, hepatic, anticancer, hypotensive, hypoglycemic, styptic topically (stops bleeding).
​[*indicates primary uses]

Clinical Uses
  • Immunodeficiency, autoimmunity, allergies - turns up Th1 (innate immunity) and turns down Th2 (acquired immunity)
  • Allergies - seasonal, food, chemical sensitivities
  • Asthma and lung weakness - has an affinity for strengthening the respiratory system
  • Reduces high cholesterol, balances blood sugar dysregulation, reduces high blood pressure
  • Cancer - turns up the activity of natural killer cells responsible for hunting for and killing cancer cells
  • As an adaptogen, helpful for chronic stress that leads to burnout, immunodeficiency, or disturbed Shen (emotional upheaval, mania, psychosis)
  • Autoimmunity - rheumatoid arthritis, Hashimoto’s (hypothyroidism), lupus, etc.
  • Traditionally used to increase longevity (immortality), especially in the Taoist tradition

Key Constituents
  • Polysaccharides (long-chain carbohydrates): beta-glucans and glucoronoglucans, proteoglycans
    • These polysaccharides are immunomodulating, stimulating the activity of natural killer cells and white blood cells to kill pathogens and potential cancer cells. 
  • Steroidal triterpenes: ganoderic acids
    • May interact with stress hormone production in the adrenal glands, given the steroidal backbone giving reishi its adaptogenic qualities. Studies have shown is also has anticancer effects.
  • Simple phenolic acids - cinnamate
    • Anti-inflammatory
  • Polyphenols - catechins
    • Anti-inflammatory, immunomodulating - shifts Th2 responses to Th1
  • Vitamin D2 (if exposed to sunlight)
Modulating Immunity
In a clinical setting, I use reishi primarily when the client has disturbed immune responses, either with low immunity, autoimmunity, or allergies. Reishi helps shift an allergic or hyper-reactive response that harms the body towards a response that is less inflammatory and focuses more on pathogens (microbes). The short hand for this transition is called shifting the Th2 immune system (also called acquired immunity, which is antibody-based) towards Th1 immunity (or innate immunity, which does not involve antibodies). When the gut microbiome is disrupted or when the person is exposed to certain viruses or pollutants, the body can develop antibodies to things that are not harmful to its health, such as pollens, animal dander, and even its own tissues. Part of the solution to this problem is to calm down this antibody-mediated side of the immune system with herbs that shift Th2 to Th1. Reishi is one of the most powerful of these herbs. 

Here is a diagram showing the two sides of the immune response:
The immune response in the bottom half of the diagram, Th2, produces histamine and pro-inflammatory cytokines which lead to tissue inflammation and thin, clear, runny secretions. This response also leads to increased IgE production, which you can test for in the blood to measure the level of hyper-reactive inflammation. People with severe allergic responses have very high IgE levels in the blood. 

Clinical and Pharmacological Studies
  • Triterpenes have a direct cytotoxic and cytostatic effects in cancers, sensitize cancer cells to chemotherapy, inhibit metastasis. Enhances oxidative stress and apoptosis in cancer cells but not healthy cells. Also enhances T-cell recognition of cancer cells (Cheng, 2015).
    • Leukemia, lymphoma, cervical, colon, breast, melanoma, etc. (in vitro)
  • Polysaccharides inhibit tumor growth, induce apoptosis (Cheng, 2015).
    • Stimulates WBC (lymphocyte) activity against cancer cells
  • Ethanol extracts (tincture) and polysaccharides reduce acute and chronic inflammation (NF-kB mediated), which leads to cancer, in animal and in vitro models → potential for cancer prevention (Cheng, 2015).
  • Reduces TNF-a mediated inflammation in steroid-resistant asthma models (specifically ganoderic acid) (Liu, et al., 2015). Triterpenoid extracts of G. tsugae were anti-inflammatory and reduced Th2 immune responses in asthmatic mice without suppressing the immune system (Chen, 2007). Reishi polysaccharides shifted immune responses from Th2 to Th1 in the blood of asthmatic children allergic to dust mites (Jan, et al. 2011).
  • Protects the liver from oxidative stress and reverses mild fatty liver disease in placebo-controlled clinical trial (Chiu, 2017); antiviral against hepatitis B virus and protective against viral liver injury in mice (Li, 2006)
  • Reishi has a hypoglycemic effect in diabetic mice, reduces HA1c, and normalizes WBC levels in type 1 models (Vitak, et al., 2017)
  • Reishi spore powder reduced blood sugar and blood lipid profiles in type 2 diabetic rats (Wang, et al., 2015)
  • Reishi plus San Miao San in a DB-PC trial of rheumatoid arthritis showed significant pain improvement in treatment group, but no improvement in markers of inflammation (Li, 2007).
  • Reishi polysaccharides significantly improved symptoms of neurasthenia over placebo (Tang, 2005).

  • Reishi can be too drying for people with already dried out mucous membranes, so it's best to formulate it with something moistening, like licorice or marshmallow root.
  • Beware in people with mushroom spore allergies. In this case it's either best to avoid using it altogether or use mycelium extracts instead (Host Defense reishi capsules source from mycelium only).

Preparations and Dosing
Because reishi is a mushroom, it has a thick skin-like outer layer called chitin that needs to be broken down with long exposure to heat in order to be absorbable. That's why eating raw mushrooms of any kind is completely useless. Traditionally, reishi is boiled or simmered for many hours (at least 4 hours, but 24 hours is best) to break down the chitin and extract the constituents. This long-simmered tea is called a decoction. It's great to add to immune-boosting broths with bones and herbs like astragalus. The typical dose for reishi in decoction is 7-10 grams per day in water. 

Another excellent way to take reishi is in a double-phase extracted tincture. This means that the reishi is both boiled to extract the polysaccharides and triterpenoids, and also tinctured in alcohol to extract the phenolic compounds, then the two extractions are combined. The typical dose of a double-extracted tincture is 1-2mL twice er day. 

You can also take the pre-steamed or autoclaved powders mixed in liquids or foods without having to process them. The typical dose for powders is 1-2 tsp per day, or about 3-8 grams. 

Combinations/Similar Herbs
  • My formulations for seasonal allergies often include reishi, nettles, and goldenrod (tea or tincture)
  • Enhancing respiratory immunity: reishi, astragalus, licorice (decoction or tincture)
  • ​Autoimmunity or severe inflammation: with baikal skullcap and licorice
  • Anticancer: with astragalus, turkey tail, and other medicinal mushrooms
  • Cancer adjunct/ recovery from chemo: astragalus, reishi, tulsi, etc.

I find reishi to be an excellent addition to any protocol attempting to alleviate symptoms of allergies, autoimmunity, low immunity, and overall lung weakness. It can help strengthen overall vitality and immunity so that we CFers or people with chronic lung disease get less infections or recover more quickly when they do occur. Reishi is a safe herb to take daily for a very long time, as it is done in traditional medicine. If you've taken reishi, let me know how it has worked for you!


  • Chen, Miaw-Ling, and Bi-Fong Lin. "Effects of triterpenoid-rich extracts of Ganoderma tsugae on airway hyperreactivity and Th2 responses in vivo." International Archives of Allergy and Immunology 143.1 (2007): 21-30.
  • Cheng, Shujie, and Daniel Sliva. "Ganoderma lucidum for cancer treatment: we are close but still not there." Integrative cancer therapies 14.3 (2015): 249-257.
  • Chiu, Hui-Fang, et al. "Triterpenoids and polysaccharide peptides-enriched Ganoderma lucidum: a randomized, double-blind placebo-controlled crossover study of its antioxidation and hepatoprotective efficacy in healthy volunteers." Pharmaceutical biology 55.1 (2017): 1041-1046.
  • Jan, Rong-Hwa et al. “Immuno-Modulatory Activity of Ganoderma Lucidum-Derived Polysacharide on Human Monocytoid Dendritic Cells Pulsed with Der P 1 Allergen.” BMC Immunology 12 (2011): 31. PMC. Web. 24 June 2017.
  • Li, Edmund K., et al. "Safety and efficacy of Ganoderma lucidum (lingzhi) and San Miao San supplementation in patients with rheumatoid arthritis: A double‐blind, randomized, placebo‐controlled pilot trial." Arthritis Care & Research 57.7 (2007): 1143-1150.
  • Li, Yan-Qun, and Shun-Fa Wang. "Anti-hepatitis B activities of ganoderic acid from Ganoderma lucidum." Biotechnology letters 28.11 (2006): 837-841.
  • Liu, Changda, et al. "Ganoderic acid C 1 isolated from the anti-asthma formula, ASHMI™ suppresses TNF-α production by mouse macrophages and peripheral blood mononuclear cells from asthma patients." International immunopharmacology 27.2 (2015): 224-231.
  • Tang, Wenbo, et al. "A randomized, double-blind and placebo-controlled study of a Ganoderma lucidum polysaccharide extract in neurasthenia." Journal of medicinal food 8.1 (2005): 53-58.
  • Vitak, Taras et al. “Effect of Medicinal Mushrooms on Blood Cells under Conditions of Diabetes Mellitus.” World Journal of Diabetes 8.5 (2017): 187–201. PMC. Web. 24 June 2017.
  • Wang, Fang et al. “Effect of Ganoderma Lucidum Spores Intervention on Glucose and Lipid Metabolism Gene Expression Profiles in Type 2 Diabetic Rats.” Lipids in Health and Disease 14 (2015): 49. PMC. Web. 24 June 2017.

<![CDATA[Herbal and Dietary Support for CF Children and Adults]]>Tue, 02 Oct 2018 13:54:13 GMThttp://www.cfnaturalhealth.com/blog/herbal-and-dietary-support-for-cf-children-and-adultsPicture
In this article, originally published in AromaCulture Magazine in July, I discuss herbal and dietary support for CF children and adults. I discuss digestion, respiratory disease, liver support, and modulation of CFTR sodium chloride channels by natural means. 

Cystic fibrosis is an autosomal recessive genetic disease that leads to the malfunctioning of several organ systems but most especially impacts the lungs, sinuses, and digestion. It is the most common autosomal recessive genetic disorder (meaning that each parent must be a carrier of the genetic mutation) in people of Western European decent. There are approximately 30,000 people living with cystic fibrosis (CF) in the United States, and more than 70,000 people worldwide.

More than 75% of people with CF are diagnosed by the age of two[i]. It is a degenerative disease and the median life expectancy in the United States is 37 years old[ii]. In the last several decades, extensive research and new drug interventions have allowed what used to be considered a childhood disease to transition into a manageable illness where individuals may live well into adulthood.
The primary pathophysiological feature of CF is the mutation and malfunction of the sodium-chloride channels on the cell membranes of epithelial tissues, which leads to a thick, sticky mucus in the lumina of the bronchi, bronchioles, intestines, pancreatic ducts, as well as the sinuses and other epithelial tissues. Depending on the genetic mutations or phenotype of the individual, other organs may be involved leading to chronic liver disease, CF-related diabetes (CFRD, a combination of both insulin-insufficiency and insulin resistance), immunodeficiency, osteoporosis, and other complications. Thick mucus in the respiratory system leads to plugged airways, bronchiole scarification, and vulnerability to bacterial and fungal infections. The targets of most conventional therapies developed for CF are to thin the mucus in the lungs, help the individual cough it out, supplementation with pancreatic enzymes to aid with digestion, and frequent use of antibiotics to treat recurring bacterial lung and sinus infections.
Although almost all CF people develop both digestive and respiratory disease, individuals tend towards having difficulty with one system more than the other, especially as children. Like most chronic diseases, CF’s presentation is unique to every individual, thus personalized medicine is the most effective way to treat this disease. Western herbalism and other traditional healing systems such as Traditional Chinese Medicine and Ayurveda are inherently personalized, therefore integration of these modalities can be very beneficial to the clinical outcomes of the intervention. Complementary medicine can help address symptoms and root causes of disease where conventional medicine fails to do so, and also can help reduce the negative side effects of some conventional medical treatments. As a clinical herbalist and person with CF, I have helped myself and other CFers improve overall health quality and reduce symptomatology with use of herbs, diet, and lifestyle changes, some of which I will describe below.
Improving Health Outcomes During Childhood: Diet and Digestion
Once the diagnosis has been made, the primary focus of conventional treatment for children with CF is digestive: getting in enough calories to maintain weight gain and growth, provide supplemental pancreatic enzymes when the pancreas cannot produce its own (90% of people with CF have pancreatic insufficiency[iii]) and address nutrient deficiencies with supplementation. A secondary focus is on prevention and treatment of bacterial lung infections.
The early childhood years after weaning can be some of the most challenging in terms of finding the right brand and dose of pancreatic enzymes to ensure proper fat digestion (steatorrhea is common in CF) and also finding solutions to the numerous digestive symptoms that can arise including gastric reflux, stomach aches, cramping, diarrhea, constipation, and gas. Herbal and dietary interventions can significantly help a child’s digestion and help improve weight gain, growth, immunity, and overall vitality.
Considering Conventional Medications for Digestion
Most CFers will need take supplemental pancreatic enzymes, and finding the right brand is an important first step. Many pancreatic enzymes brands on the market contain phthalates and contain sodium bicarbonate, both of which can have negative side effects. Two enzyme brands without phthalates or sodium bicarbonate are Pancreaze (which I use) or Viokace. Phthalates are known to cause liver damage in animal studies, and I have spoken with several parents of CF children whose elevated liver enzymes (AST and ALT) dropped back down to normal after switching to a brand of enzymes not containing phthalates. I will discuss this issue in greater detail further on. There are some over-the-counter supplemental pancreatic enzymes available, but they are generally not enteric-coated (which is required) and they do not contain high enough levels of lipase per capsule for the needs of a CF person.
Secondly, it is now unfortunately standard protocol in many CF specialty clinics to prescribe proton-pump inhibitors (PPIs) or other antacids to CFers to address generalized digestive complaints or to make their pancreatic enzymes work better to reduce steatorrhea. PPIs are overused and inappropriately used even in the general American population to address gastric reflux by reducing the stomach’s ability to produce hydrochloric acid, thus lowering gastric acidity. In most cases reflux is caused by low, not high stomach acid because adequate acidity in the stomach is what triggers the lower esophageal sphincter (LES) between the stomach and esophagus to close, preventing acid reflux[iv] [v] [vi] [vii]. Although PPIs are not FDA approved for long term use, they are frequently prescribed that way and unfortunately this makes reflux worse in most cases, leading to dependence on higher and higher doses. There is also the issue that inadequate sodium bicarbonate production in the pancreases of some people with CF caused increased acidity in the duodenum[viii], leading to the inactivation of supplemental pancreatic enzymes that need alkaline environments in order to activate.
Herbal Digestive Support
Fortunately, there are herbal solutions to digestive problems like reflux as well as to the possible problem of inadequate bicarbonate production that may allow CFers to avoid PPIs and their negative side effects (including nutrient deficiency, bone loss, enteric infection, asthma, etc.[ix]). The use of bitter herbs before meals is an effective tool for improving overall digestion. Bitter tastants cause the release of the hormone cholecystokinin, which stimulates gastric secretions, bile release from the liver and gallbladder, insulin production, pancreatic enzyme secretion, and eventually leads to bicarbonate release from the pancreas[x]. Tinctures, teas, or honey-pastilles of bitter herbs have been traditionally used in Europe for centuries to stimulate the digestion before meals, to settle upset stomachs, and as overall digestive tonics. The use of bitter tinctures (both alcohol based and apple cider vinegar based) before meals in people with CF, adults and children, often results in improved fat absorption, decreased digestive discomfort after meals, and improved transit times. Improving transit time both increases appetite and allows for more frequent meals, thus increasing daily calorie intake. Some bitter herbs commonly used are dandelion root, gentian root, artichoke leaf, and burdock root formulated with small amounts of ginger and something to sweeten it, such as licorice or stevia (for picky eaters, honey may be used to sweeten the tinctures). It is important to remember that the effect that bitters have on the body is triggered by a taste reflex, so the person must be able to taste the bitterness in order for the benefits of these herbs to be conferred. A typical dose of a bitters tincture is 1-3mL (depending on the weight of the individual) on the tongue or in a little water, about 5-10 minutes before meals. Bitters can also be used as needed during bouts of reflux, and can do well paired with soothing, mucilaginous herbs such as licorice or marshmallow root. Reflux can also be improved by drinking a tablespoon of apple cider vinegar in a cup of water when symptoms arise or taken before meals as prevention.
Stomach aches, cramping, bloating, diarrhea, and intestinal pain are all common symptoms that children and adults with CF experience on a regular basis. Significant digestive complaints, especially diarrhea, can reduce absorption of nutrition and calories from food, therefore a primary focus of herbal intervention should be on calming digestive symptoms to improve nutrient absorption and weight gain. Teas or tinctures of peppermint leaf, ginger root, meadowsweet leaf and flower, chamomile flower, plantain leaf, licorice root, ginger root, and others can be very soothing to the gastrointestinal tract by helping to reduce inflammation and relax digestive muscles to dispel gas. Meadowsweet (Filipendula ulmaria) in particular is an excellent herb for reducing pain and inflammation in the intestinal tract and tastes great in tea. It is slightly demulcent and contains methylsalicylates[xi], which are strongly antioxidant and inhibit inflammatory prostaglandin formation. Meadowsweet and the above herbs are food-like and safe to drink several times per day.
Gastroparesis (delayed gastric emptying) is another common ailment in CF children and often has to do with overall poor digestive secretions partly due to a diet without bitter plants, as is common in the West. Adding regular use of bitter herbs or foods can help, as well as capsules or teas of ginger root. Ginger (Zingiber officiale) is used as a warming digestive and circulatory stimulant, excellent for nausea, gas, bloating, as well as arthritis and many other uses. Because ginger is so spicy, small doses are best. I have found that 1-3g of encapsulated ginger taken after a meal can help speed up sluggish digestion and hasten gastric emptying, especially when meals have been too large or too complex. In older children and adults, small doses of kava tincture (Piper methysticum) can be used in a similar way to hasten gastric emptying.
A very important part of the protocol for people with CF is obtaining enough high-fat, high-calorie foods that help maintain weight and energy levels. Weight loss and nutritional deficiencies, especially of fat-soluble vitamins, are very common and the conventional solution is often to allow the child or adult to eat freely with no dietary restrictions, including junk food, sodas, and sugar-laden “nutritional supplements” like Ensure. Children with CF are often picky eaters and have poor appetites, so parents are sometimes desperate to find anything that the child will eat, making junk food a common default. However, people with CF are not exempt from the laws of human nutrition – in fact, our bodies are more sensitive to poor food choices than people without CF because our background levels of inflammation are many times the norm[xii]. Avoiding inflammatory foods while optimizing calories and nutrient density should be the goal of a healthy CF diet. Furthermore, there is a very strong connection between the level of irritation and mucus-production in the digestive tract and the amount of mucus produced in the respiratory system. The lungs, sinuses, and gastrointestinal tract are connected via vagal enervation, and irritation in one system can lead to reflexive irritation in the other. Thus, avoiding irritating and inflammatory foods can make a big difference in reducing baseline mucus production in the lungs.
To this end, people with CF often do best when removing sugar and refined sweeteners, gluten and refined carbohydrates, dairy (with some exceptions), and industrial seed oils (such as from canola, sunflower, corn, refined/toasted sesame, low-quality non-organic olive oil, or generally “vegetable oil”). The focus of the diet should be on nutrient-dense, antioxidant-rich foods including organic darkly colored vegetables (especially leafy greens), grass-fed and pasture-raised beef and pork, wild-caught fish, pasture-raised eggs, fibrous root vegetables, fruits (especially berries, apples, and avocados), nuts and seeds, probiotic fermented foods (sauerkraut, miso, kombucha, etc.), and animal fats. Grass-fed dairy or gluten-free whole grains may be included if they are well tolerated. Often an Ancestral or Paleolithic diet serves as a good template, which can be modified to meet the individual’s needs and to avoid specific food intolerances. Poor digestion in CF is often the result of a combination of functional disregulation and improper food choices that lead to further exacerbation of baseline digestive inflammation. People with CF (myself included) can experience significant personal improvement of digestive (and respiratory) symptoms by cleaning up the diet.
Nutrition Supplements
Parents of children with CF will often have to resist pressure from their doctors who abhor dietary restrictions and like to push sugar-laden “nutrition shakes” on their patients. However, there are now excellent high-nutrient, whole food, sugar-free nutritional powders and shakes available at most grocery and health food stores that are much healthier and just as effective. Some good products include Garden of Life’s meal replacement powders and Vega’s all-in-one plant protein powders, however these are generally low in fat so it’s a good idea to add fat to these shakes from canned coconut milk, flax seed oil, avocado oil, or other high-quality oil. Since fat digestion is a concern with CFers, children and adults who are experiencing steatorrhea or are having trouble gaining weight  should consider adding lecithin powder or liquid to fatty foods or shakes/smoothies to improve fat emulsification for better absorption in the small intestine. Lecithin can be sourced from eggs, soy, or sunflower seeds.
Respiratory Support
For the majority of people with CF, frequent use of antibiotics for sinus and lung infections is an unavoidable necessity. Improving the diet and digestion may significantly improve the vitality and immune status so that the individual is more resilient in fighting off infections. However, when infections do take hold, herbs can play a complementary role to conventional therapy.
A major part of respiratory support is maximizing immune resilience and encouraging mucus thinning and expectoration. Astragalus propinquus, a popular root from Chinese Medicine, is an excellent immune-stimulating and immune-modulating herb. Astragalus has been shown to modulate immunity by activating regulatory T-cells[xiii] and stimulates overall innate immunity[xiv]. In Chinese Medicine it is used to disperse phlegm and as a respiratory tonic for weak lungs[xv]. I think of astragalus as one of the primary herbal allies of any person with CF, as it is very safe for all ages and has no known drug interactions. It can be taken as a tincture, in powder or capsules, or as a long-simmered tea called a decoction. Fortunately, it tastes sweet and mild, making it palatable even for children. Another excellent expectorant, adaptogen, and mucous-membrane tonic is licorice (Glycyrrhiza glabra). It can be taken in tincture, tea, powder, or capsule. It is contraindicated in people with high blood pressure. For expectoration, elecampane (Inula helenium) is an herb from Western herbalism, use traditionally as an expectorant, warming bitter, and antimicrobial for the respiratory and digestive systems. Used in small doses as a tonic or in larger doses to combat acute infections, it is a broad spectrum antimicrobial and is used to thin and encourage the clearance of mucus from the lungs[xvi].
The most common infections and colonizations in the lungs of CFers are by Pseudomonas aeruginosa and Staphylococcus aureus (including its common drug-resistant strain, Methicillin-resistance S. aureus, MRSA). Because whole-herb preparations contain hundreds of different phytochemical compounds, the risk of bacterial resistance to herbs is much lower than for pharmaceutical antibiotics, so herbs can play a helpful role in combating drug-resistant bacteria. In addition, many herbs can make antibiotics work better by inhibiting bacterial efflux pumps[xvii], and breaking through bacterial biofilms (e.g. thyme, rosemary, berberine containing plants like barberry root or Oregon grape root, etc.). Fresh garlic is one of the most powerful herbs for the respiratory tract and is strongly antibacterial, antifungal, and antiviral[xviii] [xix]. Freshly-chopped raw garlic provides the most antimicrobial activity. Tinctures of thyme (Thymus vulgaris), elecampane, osha (Ligusticum porteri), Cryptolepis sanguinolenta, and others are some of our strongest antibacterial herbs and can be helpful against both gram-positive and gram-negative bacteria, including drug-resistant ones[xx].
An area that I have a good amount of personal experience with is the use of antimicrobial essential oils both for inhalation and rectal suppositories. Certain essential oils have antibacterial activities equal to or stronger than some of the most potent antibiotics currently in existence, especially against bacterial biofilms. These include cinnamon, clove, thyme (chemotype thymol), and lemongrass (Cymbopogon spp.)[xxi] [xxii] [xxiii] [xxiv] [xxv], however these oils can be very harsh and irritating to the mucous membranes so they need to be used with caution or with the advice of an herbalist or certified aromatherapist. For small children, a good place to start is with inhalation of gentler oils such as lavender, tea tree, and peppermint essential oils via aromatherapy diffuser kept close to the head, either when sitting down resting or when sleeping. Lavender and eucalyptus species are anti-inflammatory[xxvi] [xxvii], and both tea tree and peppermint essential oils have shown activity against gram-negative bacteria including Pseudomonas aeruginosa and their biofilms[xxviii] [xxix]. Children ages 8 and older may begin to experiment with small amounts (1-3 drops) of simples or combinations of these three oils diluted in about 5mL sterile saline and inhaled through a nebulizer. Nebulizing essential oils can be done during acute infections or for several weeks at a time on an ongoing basis, taking 2-week breaks in between, in attempts to clear a long-term bacterial colonization. In a 10-year-old CF client, regular nebulization of this kind made the Pseudomonas in his sputum cultures more sensitive to a wider range of antibiotics, and after two years he had his first bacteria-free culture. As a reminder, it is very important to source undiluted, pure essential oils for inhalation from a reputable company that sources exclusively from organic or un-sprayed plants. The company should be able to provide detailed batch records, GC/MS test results, and information on sources and chemotyping.
Adolescents and adults can begin to experiment with nebulizing stronger essential oils that combat a larger range of bacteria. I have personally had good results in shifting the bacterial load and antibiotic sensitivity of my sputum cultures through nebulizing essential oils such as tea tree, thyme (Benchmark Thyme, chemotype linalool), frankincense, lemongrass (in very small amounts and well-diluted), Eucalyptus globulus, and Eucalyptus citriodora[xxx] [xxxi]. Rectal suppositories may be an even more effective way to use essential oils for respiratory infections because the oils are quickly and easily absorbed into the blood stream via the highly vascularized tissue in the rectum, circulating the compounds throughout the body first before being metabolized by the liver and kidneys[xxxii]. It is also more tolerable to take in larger doses of stronger herbs via the rectum than via inhalation, including thyme (ct. thymol), lemongrass, rosemary (ct. camphor), oregano, and cinnamon. Cinnamon, thyme, and lemongrass are oils showing some of the strongest activity against MRSA[xxxiii] [xxxiv]. When inhaling essential oils by nebulizer or using oils via rectal suppository it is best to have guidance from an aromatherapist or herbalist, as there is risk of improper use causing mucosal irritation or damage. If there is significant airway irritation (other than coughing, which is a normal reaction) or bronchospasm, burning or severe discomfort of the throat or mouth (or rectum, in the case of suppositories), symptoms of allergic reaction, kidney pain, or difficulty with urination, stop using essential oils immediately and seek medical attention.
Liver Support
Children and adults with CF can develop chronic liver disease with elevated liver enzymes indicating liver inflammation or steatohepatitis. Liver disease in CF children has been linked to increased intestinal permeability and intestinal dysbiosis[xxxv], meaning that the diet and gut inflammation may be important points of intervention. In addition, there are several brands of enteric-coated pancreatic enzymes that are available in the U.S., and most of them contain phthalates[xxxvi], a class of chemical plasticizers known to induce liver oxidation and damage, reduce hepatic glutathione, and disrupt liver metabolism[xxxvii]. These are symptoms that do occur in some children that take phthalate-containing enzymes. Phthalates are also endocrine disruptors, and have been shown to disregulate serum insulin, blood glucose, liver glycogen, thyroid hormones, and cortisol[xxxviii]. The most commonly prescribed enzyme brand in the U.S. is Creon, which contains hypromellose phthalate. The two enzyme brands that do not contain phthalates are Pancreaze and Viokace. I personally use Pancreaze.
If liver inflammation is present, indicated by elevated liver enzymes (i.e. AST, ALT), high serum bilirubin and/or albumin, common conventional treatment is prescription of ursodiol (ox bile). There are several herbs that have been shown to reduce liver inflammation, most especially milk thistle. Several studies have shown 80% silymarin extracts from milk thistle to be effective at reducing liver inflammation in humans[xxxix]. Studies and clinical experience have shown that effective doses are between 400mg and 1000mg per day, depending on weight and level of liver inflammation, taken in divided doses with meals. Curcuminoid extracts from turmeric root have also been shown to decrease liver inflammation as well as systemic inflammation[xl] [xli]. Turmeric and curcuminoid extracts must be formulated with black pepper and taken with fatty meals in order to optimize bioavailability.
Sodium-Chloride Channel Modulation
A new line of research in the several years has been on both herbal and pharmaceutical agents that correct malfunctioning of the CFTR protein, which is responsible for the thick mucus that leads to many of the problems associated with CF. Several studies have pointed to the additive effects of pairing curcuminoids (from turmeric) with the isoflavone genistein (from soy) for correcting CFTR gating in certain mutations[xlii], and clinical trials in Europe are studying the pairing’s effects on CF patients[xliii]. In the last year, research has led to the development of an herbal supplement now available on the market, called Indeptra, which is designed specifically to help correct CFTR function[xliv]. It has several formulations, each targeting specific CF mutation classes. For example, the Indeptra B formula is suggested for class II mutations including deltaF508 (the most common CF mutation) and contains the following herbal extracts: curcuminoids from turmeric, trans-resveratrol from Japanese knotweed, amentoflavone, quercetin dihydrate, Bioperine from black pepper, silymarin from milk thistle, EGCG from green tea, hawthorn berry and leaf, and forskolin from Coleus forskolii. I take Indeptra B myself (I am homozygous for deltaF508) and two of my CF clients (ages 7 and 10) have experienced improvement in their digestion from this formula.
There are many herbs that can be very effective in helping to reduce symptomatology and target the underlying dysfunctions in CF. I have mentioned a few herbal and dietary interventions that I have used, but there are many more. People with CF often have to take many expensive prescription drugs, often with significant side effects, so minimizing the need for these drugs while optimizing qualitative and quantitative metrics of health through natural supportive therapies is the goal of holistic CF care.



[i] Cystic Fibrosis Foundation. “About cystic fibrosis”. <https://www.cff.org/What-is-CF/About-Cystic-Fibrosis/>

[ii] National Institute of Health. “Cystic fibrosis fact sheet”. <https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=36>

[iii] Wilschanski, Michael, and Ivana Novak. "The cystic fibrosis of exocrine pancreas." Cold Spring Harbor perspectives in medicine 3.5 (2013): a009746.

[iv] Iwai, Wataru, et al. "Gastric hypochlorhydria is associated with an exacerbation of dyspeptic symptoms in female patients." Journal of gastroenterology 48.2 (2013): 214-221.

[v] Gowen, George F. "Spontaneous enterogastric reflux gastritis and esophagitis." Annals of surgery 201.2 (1985): 170.

[vi] Dixon, M. F., et al. "Reflux gastritis: distinct histopathological entity?." Journal of clinical pathology 39.5 (1986): 524-530.

[vii] Fisher, Robert S., William Lipshutz, and Sidney Cohen. "The hormonal regulation of pyloric sphincter function." Journal of Clinical Investigation 52.5 (1973): 1289.

[viii] Robinson, P. J., A. L. Smith, and P. D. Sly. "Duodenal pH in cystic fibrosis and its relationship to fat malabsorption." Digestive diseases and sciences 35.10 (1990): 1299-1304.

[ix] Sheen, Edward, and George Triadafilopoulos. "Adverse effects of long-term proton pump inhibitor therapy." Digestive diseases and sciences 56.4 (2011): 931-950.

[x] Valussi, Marco. "Functional foods with digestion-enhancing properties." International journal of food sciences and nutrition 63.sup1 (2012): 82-89.

[xi] Papp, Ildikó, et al. "Monitoring volatile and non-volatile salicylates in Filipendula ulmaria by different chromatographic techniques." Chromatographia 68.1 (2008): 125-129.

[xii] Høiby, N. "Inflammation and infection in cystic fibrosis-hen or egg?." European Respiratory Journal. (2001): 4-5.

[xiii] Liu, Qing-yang, et al. "Astragalus polysaccharides regulate T cell-mediated immunity via CD11chighCD45RBlow DCs in vitro." Journal of ethnopharmacology 136.3 (2011): 457-464.

[xiv] Yuan, S. L., et al. "Effects of dietary Astragalus polysaccharide on growth performance and immune function in weaned pigs." Animal Science 82.4 (2006): 501-507.

[xv] TCM Wiki. “Radix Astragali”. <https://tcmwiki.com/wiki/radix-astragali>

[xvi] Kenny, C. R., A. Furey, and B. Lucey. "A post-antibiotic era looms: can plant natural product research fill the void?." British journal of biomedical science 72.4 (2015): 191-200.

[xvii] Stavri, Michael, Laura JV Piddock, and Simon Gibbons. "Bacterial efflux pump inhibitors from natural sources." Journal of antimicrobial chemotherapy 59.6 (2006): 1247-1260.

[xviii] Hughes, Bronwyn G., and Larry D. Lawson. "Antimicrobial effects of Allium sativum L.(garlic), Allium ampeloprasum L.(elephant garlic), and Allium cepa L.(onion), garlic compounds and commercial garlic supplement products." Phytotherapy Research 5.4 (1991): 154-158.

[xix] Weber, Norbert D., et al. "In vitro virucidal effects of Allium sativum (garlic) extract and compounds." Planta medica 58.05 (1992): 417-423.

[xx] Buhner, Stephen Harrod. Herbal antibiotics: natural alternatives for treating drug-Resistant bacteria. Storey Pub., 2012.

[xxi] Warnke, Patrick H., et al. "The ongoing battle against multi-resistant strains: in-vitro inhibition of hospital-acquired MRSA, VRE, Pseudomonas, ESBL E. coli and Klebsiella species in the presence of plant-derived antiseptic oils." Journal of Cranio-Maxillo-Facial Surgery 41.4 (2013): 321-326.

[xxii] Tohidpour, A., et al. "Antibacterial effect of essential oils from two medicinal plants against Methicillin-resistant Staphylococcus aureus (MRSA)." Phytomedicine 17.2 (2010): 142-145.

[xxiii] Aiemsaard, Jareerat, et al. "The effect of lemongrass oil and its major components on clinical isolate mastitis pathogens and their mechanisms of action on Staphylococcus aureus DMST 4745." Research in veterinary science 91.3 (2011): e31-e37.

[xxiv] Naveed, Rasheeha, et al. "Antimicrobial activity of the bioactive components of essential oils from Pakistani spices against Salmonella and other multi-drug resistant bacteria." BMC complementary and alternative medicine 13.1 (2013): 265.

[xxv] Kavanaugh, Nicole L., and Katharina Ribbeck. "Selected antimicrobial essential oils eradicate Pseudomonas spp. and Staphylococcus aureus biofilms." Applied and environmental microbiology 78.11 (2012): 4057-4061.

[xxvi] Hajhashemi, Valiollah, Alireza Ghannadi, and Badie Sharif. "Anti-inflammatory and analgesic properties of the leaf extracts and essential oil of Lavandula angustifolia Mill." Journal of ethnopharmacology 89.1 (2003): 67-71.

[xxvii] Sadlon, Angela E., and Davis W. Lamson. "Immune-modifying and antimicrobial effects of Eucalyptus oil and simple inhalation devices." Alternative medicine review 15.1 (2010): 33-43.

[xxviii] İşcan, Gökalp, et al. "Antimicrobial screening of Mentha piperita essential oils." Journal of agricultural and food chemistry 50.14 (2002): 3943-3946.

[xxix] Husain, Fohad M., et al. "Sub-MICs of Mentha piperita essential oil and menthol inhibits AHL mediated quorum sensing and biofilm of Gram-negative bacteria." Frontiers in microbiology 6 (2015): 420.

[xxx] At the Roots. “Inhaling Essential Oils”. <http://www.cfnaturalhealth.com/blog/inhaling-essential-oils>

[xxxi] At the Roots. “Benchmark Thyme”. <http://www.cfnaturalhealth.com/blog/benchmark-thyme>

[xxxii] Schnaubelt, Kurt. The healing intelligence of essential oils: the science of advanced aromatherapy. Healing Arts Press, 2011.

[xxxiii] Kon, Kateryna Volodymyrivna, and Mahendra Kumar Rai. "Plant essential oils and their constituents in coping with multidrug-resistant bacteria." Expert review of anti-infective therapy 10.7 (2012): 775-790.

[xxxiv] Tohidpour, A., et al. 2010.

[xxxv] Flass, Thomas, et al. "Intestinal lesions are associated with altered intestinal microbiome and are more frequent in children and young adults with cystic fibrosis and cirrhosis." PLoS One10.2 (2015): e0116967.

[xxxvi] Cystic Fibrosis Foundation. “Inactive ingredients in pancreatic enzymes”. <https://www.cff.org/PDF-Archive/Inactive-Ingredients-in-Pancreatic-Enzymes/>

[xxxvii] Keller, Bernd O., A. George F. Davidson, and Sheila M. Innis. "Phthalate metabolites in urine of CF patients are associated with use of enteric-coated pancreatic enzymes." Environmental toxicology and pharmacology 27.3 (2009): 424-427.

[xxxviii] Casals-Casas, Cristina, and Béatrice Desvergne. "Endocrine disruptors: from endocrine to metabolic disruption." Annual review of physiology 73 (2011): 135-162.

[xxxix] Flora, Kenneth, et al. "Milk thistle (Silybum marianum) for the therapy of liver disease." The American journal of gastroenterology 93.2 (1998): 139.

[xl] Wu, Shu-Ju, et al. "Curcumin and saikosaponin a inhibit chemical-induced liver inflammation and fibrosis in rats." The American journal of Chinese medicine 38.01 (2010): 99-111.

[xli] Lee, Hwa-Young, et al. "Turmeric extract and its active compound, curcumin, protect against chronic CCl 4-induced liver damage by enhancing antioxidation." BMC complementary and alternative medicine 16.1 (2016): 316.

[xlii] Sohma, Yoshiro, Ying-Chun Yu, and Tzyh-Chang Hwang. "Curcumin and genistein: the combined effects on disease-associated CFTR mutants and their clinical implications." Current pharmaceutical design 19.19 (2013): 3521-3528.

[xliii] Netherlands Trial Register. The effect of curcumin and genistein in CF patients with a class III mutation. <http://www.trialregister.nl/Trialreg/admin/rctview.asp?TC=4585>

[xliv] Planetary Biosciences. “What is Indeptra?” <https://planetarybiosciences.com/what-is-indrepta/>
<![CDATA[Lung Collapse & Pleurodesis]]>Sat, 19 May 2018 15:34:23 GMThttp://www.cfnaturalhealth.com/blog/lung-collapse-pleurodesisPictureA pneumothorax of the left lung (very faint).
I've been meaning to write a post about lung collapses for a few years now, and I guess I needed another one (lung collapse, that is) to encourage me to finally get it done. A lung collapse, or pneumothorax, is not uncommon in CFers with advanced lung disease. I've had several over the last four years and two surgeries to correct them. Here I will discuss what a pneumothorax is, what the causes are, what the common interventions are, and describe my experience of those interventions. 

What It Is
Let's start with a bit of physiology. There are several tissue types that make up the lung. The alveoli are air sacks that look like little clusters of grapes. These fill with air and are responsible for the gas exchange of oxygen and carbon dioxide into and out of the blood. The bronchi and bronchioles are the tubes that funnel air from your mouth, through the trachea, down into the alveoli. The pleura is a double-lined sack that encases the alveoli, expanding and contracting as your diaphragm moves up and down. There is an inner pleura (the visceral pleura) and the outer pleura (parietal pleura), and between them is the "pleural space" filled with a thin fluid that allows the two linings to slide against each other smoothly as you breath. A healthy set of lungs is illustrated in the diagram below.
If we get a tear in one or both of the pleural linings, either from trauma (like a stabbing) or inflammation/infection that slowly eats away at or tears the inner pleura, the space between the two pleura can fill with air. In the above diagram, that would be the dark purple space. As the pleural space fills with air, the inner pleura collapses inward and crushes the alveoli, inhibiting their ability to expand and fill with air. This is a pneumothorax, or lung collapse. Depending on the extent of the pneumothorax (pneumo for short), this can cause shortness of breath, pain, reduced blood oxygenation, and if it's severe enough, it can put pressure on the heart which can cause severe circulatory complications.

In general, a pneumothorax is an emergency. However, if you live long enough with a disease like this, you'll come to find that there are different grades of emergency. I've had two big pneumos in the last month or so. The first one I knew was there but I didn't go to the hospital for about three days. I waited because sometimes I get little ones that get better on their own without any intervention; these probably feel a lot like pleurisy. But this one didn't get better - it only got worse. The second one this time around was bigger and I knew that it was serious right away, so I called my doc and went to the ER that day. 

That said, a CF pneumothorax is a bit different than other types of pneumos (yes, we are so very special). Because CFers with advanced lung disease have a very significant amount of scarring, we rarely get complete pneumos like regular people (that is, where the lung completely collapses) because the scarring pins the inner pleura to the outer pleura, kind of like tacking up a tapestry to the ceiling of your room. I guess that's kinda good, right? Might as well look on the bright side of this whole situation. So when I've had my pneumos, they've always been either "small" or "moderate" by radiological standards. Each time my docs felt safe enough to have me wait a few days before making a decision on what intervention I needed (with daily x-rays to make sure it wasn't getting bitter). Often times people with CF get apical pneumos, meaning that the pleura at the tops of the lungs (the apexes) collapse because infection/inflammation causes the most damage to the topmost lobes first. 

The Causes
In CF, pneumos are caused generally by severe infection or inflammation that degrades the integrity of the inner pleural lining so that it tears and allows air to leak out of the lung space. Often times there can be a vulnerable spot, then a big coughing fit can cause the tear. The pleura are highly enervated, meaning that they have a lot of nerves, and when something is wrong, you will feel it! It can be very painful. I don't think I've ever had pleurisy, which is painful  inflammation of the pleura, but pleurisy and pneumos are likely connected. Some people get pleurisy and never get a pneumo, and others (like me) get pneumos but no pleurisy. Some CFers get neither. You tend to be "the type" or not. But if you've had one, you're probably gonna get more.

My Experience
I got my first pneumo in July of 2014. Spring and summer is usually when my biggest lung problems happen. I think it has to do with the warm, humid air and potentially the pollens, although I don't have any allergies. My lungs really like cold, dry air, so they're very happy in the Vermont winters. This first time, there was a bit of pain, enough for me to not be able to sleep well, and I had this weird "floppy" sensation in my left lung when I bent over. With my typical "it's not big deal" attitude I waited a day, then biked to the grocery store and called my doc. They asked me to get an x-ray, so I took the bus to town (about an hour) and they told me I had one. I was admitted to the hospital right there. I think I brought some clothes and stuff, but I can't remember. This was all very new for me. I didn't know how serious a pneumo was. We started IV antibiotics and waited a few days to make a decision. They convinced me that a pleurodesis was the best option. 

Now normally, for non-CFers, if you have a pneumo they'd put in a chest tube immediately to vent the air that is trapped between the pleura. But for CFers, since our pneumos aren't as emergent as complete collapses, sometimes we skip this step. Sometimes it's small enough that we don't need to do anything and the body just reabsorbs the air on its own, and the two pleura going back to normal. For a while. But if you have CF, once you've had one pneumo, you're pretty much guaranteed to get another one. So the "permanent" solution to the problem of recurring pneumos is a pleurodesis. I'll describe that procedure in a little bit. 

So I got the pleurodesis surgery and it was "successful". It was the most painful thing that's ever happened to me, but, "successful". The next July, one year later, I was hiking with my herbal classmates on our annual camp out, on a very hot day, and in the middle of the trail I felt it. It was undeniable this time, and the pain was worse than before. And it was on the same side. I was pretty angry. Not only was this at the most inconvenient time possible, but the docs had all but guaranteed me that the surgery would prevent this from ever happening again on that side. The x-ray showed a small pneumo on the left side and I was admitted to do IV antibiotics. The docs said it was unusual for someone to get a pneumo on the side that was pleuradesed, but obviously, it's possible. However, because I had done a pleurodesis on that side, they said all we had to do was wait for the body to reabsorb the air in that little spot. The procedure I had done the previous year would prevent the collapse from getting any bigger. And it was true. We waited and it healed on its own. But I missed the field trip. 

Since then I've had that characteristic pleural pain several times on both sides, mainly at the tops of my lungs, but I just waited it out and it resolved on its own in a couple days. I haven't had another significant pnemo on the left side since the one in 2015.

This year, at the end of April, I had pleural pain on the right side that started on a Saturday night (after about 5 hours of very intense drumming for a dance class that day, which caused a lot of inflammation, apparently) and it got worse over the weekend until I finally went in for an x-ray on Tuesday and got a diagnosis of a pneumo on the right side. It was small, and so I was admitted to the hospital to get two weeks of IV antibiotics (one week at home). I was put on continuous oxygen because oxygen has an easier time being reabsorbed by the body than other room-air gases like nitrogen, so if you fill the lung space with oxygen the air in the pleural space can get reabsorbed faster, theoretically. I decided to wait and do no intervention other than that. I knew what a pleurodesis felt like and I was desperate to avoid it if I could. A week later the x-ray showed it was completely resolved, so I went home and rested until the pain went away, then I got back to normal life about a week and a half later. But it was too early. After a long weekend of work and hosting a guest in my house for three days, I had pleural pain all night and then that morning I sat up and felt the pain suddenly intensify. I knew immediately that I had made a terrible mistake. I had not allowed myself enough time to heal before becoming active again. I went in for an x-ray and it was confirmed: the pneumo was there and it was bigger than ever. 

I was admitted to the hospital on Monday and we just waited it out and watched the pneumo. It didn't get any bigger, but my worst fears were confirmed: we'd have to do an intervention or this would just keep happening, even if it did heal again. On Tuesday I decided to schedule the pleurodesis. On Wednesday they put in a chest tube with interventional radiology (guided under a CT machine) to vent some of the air, since it was getting harder for me to breath and painful to walk around. Although that hurt a little it was really not a big deal. On Thursday I got the pleurodesis. 

I've had a lot of surgeries in my life. A lot. But I will say that the pleurodeses were the most intense that I've had. I'm not saying this to scare you off or make you decide against them, because basically when it comes down to it there's not much choice. But it's important to know what you're getting into. I didn't know the first time, but I was really glad that I was prepared for the second one. Here's what it is. 

A pleurodesis is a procedure done with laparoscopy where the two pleura are fused together, "permanently" preventing a big pneumo from ever happening again. This is done by abrading the space between the two pleura and spraying it with talc so that the tissue becomes so inflamed that it scarifies and fuses together, removing the pleural space. If this sounds painful, that's because it is. In fact, they'll tell you that if it's painful that means it's working. 

The procedure is short, only takes about an hour. You generally wake up with a chest tube and two or three other incisions. I decided to get an epidural both times, which was a REALLY good choice. The epidural and the chest tube stay in for two to four days. The chest tube drains any excess air and fluid that has been left over in the pleural space after surgery. Once the tube stops draining and the pneumo seems to be resolved, they'll take the tube out, and once the tube is gone you generally don't need the epidural anymore. 

The epidural is essentially a method of injecting an anesthetic or pain killer directly into the space surrounding the spinal cord so that you numb a finite area in the chest without getting the negative side effects of systemic opiate painkillers such as dizziness, nausea, and constipation. Getting it in is not that bad. It's pretty quick and doesn't hurt more than getting an IV put in. The first time I had a hard time accepting the concept of a needle going into my spine - that freaked me out a bit. But once it's in they just put a little catheter in just like a PICC line, and you don't feel it at all (it's numb, that's the point). Without the epidural I don't know how I would have gotten through those first few days post-op. I highly recommend getting one. They often don't work perfectly and their placement can get dislodged pretty easily, but something is better than nothing. Otherwise you'll have to rely on oral/IV opiates and I hate those. They make me really nauseous and dizzy and woozy. I don't personally feel susceptible to opiate addiction, but that is also a risk that I'd rather minimize. If they place the epidural high enough then you won't need a urinary catheter or anything and can go to the bathroom on your own (though for the first couple days I was bed-ridden so I had to go in a commode that they brought to my bed). If they put the epidural too low, that will numb the pelvic nerves and make you incontinent. But that's not usually a problem with pleurodesis because the surgery is done up high. 

This most recent time I got the epidural, once I was transported from the recovery room to my hospital room the tube must have moved around a bit and it was numbing my left side but not my right, exactly the opposite of what I needed. The pain was getting extreme, so I asked the anesthesiologist to come and fiddle with the line until it finally got to a spot where the right side was numbed a little, maybe like 30% (though the left side was 100% numb). Better than nothing! Way better! I also took ibuprofen and tylenol. Yeah, loading up on painkillers is not my favorite thing, but with pain that extreme you need everything you can just to be able to breath. 

Sleep was difficult, but every day the pain diminished a little bit so that I could lower my epidural dose (the opiates in it were making me nauseous). Hey! The anesthesiologist taught me a little trick that I'd like to share. If you're feeling a wave of nausea, put an alcohol pad right under your nose and inhale that for a few minutes. It really works! I think smelling salts or essential oils would also do that trick, but alcohol pads were an easy option at the time. By Sunday the chest tube was no longer producing fluid and the epidural had stopped working altogether. So both were taken out that day, which was very liberating! Every day thereafter the pain improved, and by Tuesday I relied solely on ibuprofen. Ibuprofen works WAY better than tylenol in this situation, likely because of the extent of the inflammation (tylenol is not an anti-inflammatory, only a painkiller). But I didn't take ibuprofen for the first few days after surgery because I thought that if the point of the surgery is to cause inflammation, then why would I take an anti-inflammatory? I'm not sure it would have made much of a difference. For about a week post-op I had a low grade fever, which is normal (caused by surgical trauma). For about four days after the surgery I had a bit of edema in my feet and ankles, which is caused by laying in bed and not moving around. It improved with taking a cleavers tincture and by walking around, even just in my room or down the hall and back. When I got the chest tube out and I could walk around the hospital again, the edema went away.

The pain is worst when inhaling deeply, coughing, and any time that I take those involuntary sharp inhales that we're constantly doing and don't notice. Like when you burp, yawn, sneeze, or just need to inhale deeply once in a while for no apparent reason. You'll notice every single one of those for a few weeks. My back muscles also got all locked up and sore from tensing up as a result of the pain. That's improved a bit with better chair support and sleeping in my own bed at home. 

I was desperate to get home so they let me out on Wednesday, 6 days after the surgery, with home IV antibiotics. I have been trying not to exert myself at all since getting home. I've learned my lesson! I'm just gonna sit around and write and read and watch movies for a while, and maybe work in my garden a little, but not too much. No lifting or twisting or biking, though I have been going on walks again. It still hurts to cough and inhale deeply. I really don't like taking so much tylenol, which is my only choice in terms of strong pain killers that don't mess with my head (I really hate the feeling of not being able to think clearly). But if I don't take the tylenol then I can't breath deeply and coughing is excruciating, and I have to do both those things in order to heal the lung properly. So I take my herbs alongside it to keep my liver healthy. I'll have to wait a very long time before getting back to climbing, which makes me sad.

Herbal Support
I feel that I am healing much faster than I did last time I had the surgery four years ago. There are a lot of factors to explain that, but the two most important ones are that I am physically stronger and healthier due to climbing, good nutrition, and regular use of medicinal herbal tonics. Plus, I have been using several herbs that are specifically indicated for tissue healing.

I am/was taking herbs during my recovery for five specific reasons: to reduce inflammation (pre-op), to protect my liver and help it metabolize the intense drugs and anesthesia, to protect my kidneys from the drugs (particularly vancomycin), to speed tissue healing, and to reduce pain. 

When I got the second lung collapse this time around, it was clear to me that I was experiencing a very high inflammatory load at the time. When I feel inflamed I usually get a low-grade fever, I feel very tired, and my lungs feel characteristically "inflamed". I had not been able to do chest PT or use the Vest for several weeks after my April pneumo in order to let the lung heal up on its own. This let mucus build up on the bottom of the right lung and that CT I got later showed I had a small pneumonia down there. That's why we started back up on IV antibiotics. Anyway, I felt inflamed and I know that the inflammation is a cause of my lung collapses. I take a daily tincture of baikal skullcap (Scutellaria baicalensis) normally, but I took an extra amount in those days before I got the surgery. I discuss baikal skullcap in this article. I also stopped eating inflammatory foods such as things with sugar in them and refined carbohydrates, and ate a lot more leafy greens and simple foods like broths and soups. I increased my dose of fish oil and continued to take Indeptra, which contains turmeric curcuminoids. However, I stopped taking turmeric and fish oil 24 hours before surgery because both of those things can reduce clotting and thus increase the risk of surgical bleeding. Also, after the CT scan I began drinking tulsi tea (a.k.a. holy basil, Ocimum sanctum) daily because tulsi has been studied as an effective tool for protecting healthy cells from DNA damage due to radiation exposure (DNA mutation from radiation exposure can lead to cancer, by the way). Throughout the month of May I probably had about 30 x-rays, but the CT equals A LOT more radiation than that. 

To protect my liver from the drugs, particularly tylenol (acetominophen) which depletes hepatic gluathione, I took milk thistle capsules (80% standardized silymarin, about 1000-2000mg daily). Milk thistle seed stimulates the liver to produce its own endogenous glutathione, our body's most important self-made antioxidant. I started taking larger doses of this right after surgery to help my body clear the anesthesia as well. Just like turmeric, it has to be taken with fat to be absorbed.

To protect my kidneys from vancomycin I use a tincture formula that contains goldenrod leaf and flower, astragalus root, and dong quai root (Angelica sinensis). My vanco level and creatinine were getting too high, probably as a result of surgical trauma plus co-administration of high doses of ibuprofen (also filtered partially through the kidneys), so I took higher doses of this tincture than usual. 

To speed tissue healing I took two herbs: solomon's seal root and comfrey root. Solomon's seal is great for tissue healing, especially in joints, muscles, tendons, and ligaments. Comfrey is good for all types of healing (one of its common names is "knit-bone"), and is preferably used topically, though can be used orally for internal tissue healing. Both herbs contain allantoin, a constituent that speeds cell proliferation. Comfrey root has the most allantoin and it is the most powerful herb for wound healing. However, comfrey has two drawbacks and needs to be used carefully. 1) it works so well at speeding tissue healing that if applied topically over a wound that is infected, it can cause the skin to grow too fast over wound, sealing in the infection, causing an abscess (essentially causing healing from the outside in, which is the opposite of what you want). So we always recommend that comfrey be used topically several days after the initial wounding, when the wound is growing granulation tissue and is no longer at risk for infection. Taken internally you don't have the same risk for sealing in infection, but you have a higher risk for the second drawback: 2) comfrey root contains pyrrolizidine alkaloids (PAs) which are toxic to the liver. If comfrey is taken internally for long enough and at high enough doses, there can be liver damage. So the solution is to take it for a short amount of time (about two weeks max at high doses), or to only use it topically. People with underlying liver issues, like CF-related liver disease, should not use comfrey internally. Solomon's seal is a better choice in that situation. I needed to take comfrey internally because you can't apply comfrey topically to a lung! Taking milk thistle alongside it made me feel better about my liver though. I took comfrey for this year's first lung collapse, which healed on its own within a week and a half (though not permanently). I think the speed at which the healing happened had something to do with how much comfrey tincture I was taking. Then, after the pleurodesis, I took comfrey tincture for about a week afterwards. Again, my speedy recovery may have something to do with it. My x-ray one week and two weeks after the surgery showed the pneumo is completely gone and the lung is re-inflated and back to normal (though the pain is not gone). 

Though not an herb, another wound aid I use is honey. Honey has been used for thousands of years to help skin wounds heal faster and to kill infection. Honey is strongly antimicrobial, soothing, and anti-inflammatory to help heal skin quickly and cleanly with minimal scarring. Unlike salves or oils, honey can be applied to a wound immediately. I use medical grade manuka honey that I bought years ago, but any local REAL honey will do (but do not buy "honey" from a supermarket unless it's local and organic because some of the cheap stuff on the shelf is not honey at all, it's corn syrup). The best place to get real honey is at a farmer's market or directly from a bee keeper. The nurse told me that my hospital is now using honey in dressings, especially for drug-resistant infections. I love how some traditions are so effective that they're making a come back. 

​In terms of pain management with herbs, I didn't have that much luck. For chronic pain, herbs like Jamaican dogwood, cannabis, corydalis, and others can be really helpful. But this was acute pain, and it's harder to manage with herbs, especially without getting all woozy (which I hate). This is something I will have to do more experimenting with. There are some topical preps that I haven't tried yet, like lobelia oil, and datura or belladonna salve (DO NOT try these last two without an herbalist's supervision). 

I wanted to write this post for those of you who are going to have this happen to you and want to know more about it. Just like I expressed in my post on hemoptysis, I believe that when we're faced with a situation that's potentially life threatening and scary, if we know as much as we can about the situation and our choices, we can feel more in control and less afraid. Meditation can also been helpful for its calming effects but also for encouraging is to take deeper breaths. 

I also want to say that in the past, having a pleurodesis was a factor that could disqualify you from getting a lung transplant. That is not the case anymore. Operating on lungs without pleurodesis is easier, but it's no longer prohibitory. At least that's what my docs told me with regards to the transplant center in Boston that they refer to. 

Ok, last thing. You should also know that once you have recurrent pneumos, it's a bad idea to fly in planes. The change in air pressure in the cabin as the plane ascends can cause a potentially small and unnoticeable pneumo to expand and get really serious. But if you have a habit of flying with a doc or EMT and a chest tube kit, then it's no problem. Joking. I've rationalized this in a really positive way: no one should be flying in planes anyway due to the unacceptable level of greenhouse gases and air pollution that they produce, so now I just don't have the option at all. No more temptation. Hurray! Actually, my dream is to one day take a freight ship across the sea to Ireland. That would be an adventure!
<![CDATA[Shifting Focus: Paradigm Change for Deep Healing]]>Sat, 06 Jan 2018 16:58:04 GMThttp://www.cfnaturalhealth.com/blog/shifting-focus-paradigm-change-for-deep-healingPicture
I'm sorry that I have been absent from activity on my website and blog in the last year or so. I wanted to give a quick update and explanation, and share a few thoughts that I've been having recently.

PictureIt's winter. There is snow.
Fist of all, I want to give a health update. I am happy to report that I am the healthiest that I've been since high school (more than 12 years ago). Over the last two years my health has been unexpectedly stable and even improving little by little. Although my FEV1 remain steady around 45-47%, every other health metric of mine has improved. My energy is always great and my exercise tolerance is better than it's been since I was a kid. I only feel fatigued when I am very, very sick, which happens about twice per year, right before I go in for routine IV antibiotics. I catch a cold about once a year (the lowest frequency in my entire life) and it lasts for only a few days. My mental health is very good and I rarely feel depressed anymore. My last chest x-ray showed mild improvement. That's never happened before. I finally feel like I understand my disease enough to predict what is going to happen and I have developed an efficacious regimen of oral antibiotics and IVs that adheres to a  regular schedule. I no longer operate on the "I'll wait it out until I'm so sick that I can hardly get off the couch" philosophy. That approach probably resulted in permanent, unnecessary damage to my lungs. I now am proactive rather than reactive. But it took many years of trial and error in order to understand my body enough to develop my own style of medical decision making. I basically make all of my own medical decisions, and my doctors trust me enough these days that they go along with it. Thank goodness. To say that I am an empowered patient is an understatement. 

So interestingly, my main excuse for not paying more attention to my website is that I'm too healthy! This website was an invaluable outlet for need to research my disease and for my concerns regarding my own health when I felt lost and confused. Now that I feel that many (though not all) of my big questions have been answered, I have been focusing on other projects, mainly clinical herbalism and running an herbal apothecary. If my health takes a turn, I may return to this blog as a vehicle to record more research. 

What I've Been Doing
Of course, as is the case with successful treatment of big chronic diseases like CF, it's hard to tell what things have been the biggest contributors to my improvement. But there are four factors that I can say with absolute certain have helped enormously. The first is diet, and chronologically this was the first big change that I made in my life that helped turn my health around. Almost all of what I've discovered in this regard is documented in this website. I am at the point now where my digestion is so improved that I can eat random unhealthy things and have little to no negative consequences (though I don't make this a habit because I know that if I did, I'd go right back to where I started from). If I eat a little cheese at a party, if there is some hidden gluten in a restaurant dish, if there's sugar in my chocolate, I no longer have to be hyper-vigilant. Generally my guts don't care unless I do this for several days in a row. What a change from when I first started this website! The second big factor was, of course, exercise, as I've discussed before. 

The third big factor is a radical paradigm shift in regards to my conceptualization of work, economics, spirituality, and time valuation. I can't really go into the details here as it would take a book's worth (or two) of explanation to do it justice. But to summarize, my health crisis made me wake up to the radical (and painful) realization that if I didn't completely re-evaluate my life and my life goals and think extremely critically about how I was participating in this sick society, I would never heal. I had to break down all of my pre-concieved notions about what made life valuable and worth living, and then I had to rebuild my own paradigm based on my own experiences and wisdom. I had to reject most of the beliefs that this Euro-American culture has regarding health and wellbeing, truth and reality, and discover them for myself. There is no way to understand the difficulty of that task unless you've done it yourself. Most people in this culture don't think critically about the status quo, and so even if it makes them sick or locks them to a hopelessly destructive belief system, they don't know that there are other realities available. For me, this total paradigm shift has led to a rejection of most of this culture's beliefs about "shoulds": "I should get a high-paying job", "I should want to be in traditional positions of power", "I should believe everything that people with advanced degrees have to say", "I should want fancy technology", "I should live up to other people's expectations", "I should believe what this person says because they are highly respected by mainstream people", etc. On a practical level, this has led to a redefining of my life goals and a more realistic understanding of what I should expect from myself before I die. In particular, I had to let go of a lot of guilt regarding my non-participation in the Euro-American production-driven capitalist economy, which was killing me. Once I realized that this system is itself pathogenic, not just for me but for everyone participating in it (even people who don't have a chronic disease), I stopped letting my guilt drain my life away and I started feeling empowered to live my life outside of that box. Life is too short to live according to someone else's standards, especially for me. 

The forth factor in my healing has been herbalism. I have graduated from a three-year program in clinical herbalism and I now practice herbalism in a clinic and I help run a non-profit herbal apothecary. Through herbalism I have made deeper connections to my ancestors via exploration of traditional (pre-colonial) Irish medicine. Now I use my own experiences healing myself to help others heal. And even more important, I see herbalism as a tool to heal our broken culture by helping people reconnect to nature, even when they can't take a daily walk in the woods or swim in the ocean. 

Paradigm Shifting for Deep Healing
This brings me to the real reason I have written this post. I know people might be curious as to why I haven't written in a while, so now that I've gotten that out of the way, let's talk about something more important and more interesting. I recently read an article written by my teacher, Guido Masé, on how herbalism is something we have in common with all animals, including insects, and furthermore, without it our species will lose its phenotypic elasticity, lose its ecological fitness, and eventually die off with lots of disease and suffering. I recommend you read the article yourself here

One thing that I've taken away from this article is that the concept he presents - that loss of exposure to ecological pressures leads to a loss in genetic elasticity - has significant implications for the trajectory of modern society. That is, if industrialized society continues on this course of increased dependence on technology, further environmental degradation, reduced exposure to the natural environment and wild ecosystems, and increased exposure to artificial environments (cities and suburbs) and toxic chemicals, it is all but guaranteed that the rapid proliferation of diseases of modernity (e.g. diabetes, heart disease, cancer, autoimmunity, mental illness, allergies, etc.) will lead to global degradation in human health that will at some point be irreversible. Once genetic pathways that promote phenotypic elasticity are trimmed (in the absence of natural ecological pressures) animals become less resilient and less able to adapt to changes in the environment. With the rapid progress of extreme fluctuations in weather as a result of climate change, this is more dangerous than ever before. We need all the help we can get if we are going to survive climate chaos, which is only going to get worse for at least the next century (longer if we continue to do nothing about it). 

In addition, my herbal clients who have complex health issues that are the least responsive to intervention are usually those that have the most modernized lifestyles. That is, people who have little exposure to nature and uncontrolled environments, who live technology-dependent lives, and who have high-stress jobs and complicated social situations are often the most sick. In other words, of the clients that I have seen so far, those whose health problems are the hardest to improve often live in ultra-modernized situations. Interestingly, these people often feel trapped by their modern lifestyles, not liberated by them, as mainstream dogma would have us believe. I have interacted with many people in several different countries, and I would say that some of the most liberated people I have met have been the least modern. When it comes to resilience to the natural disasters inflicted by climate chaos, we've seen recently that those who are the least dependent on modern technology (i.e who don't need grid-dependent electricity to pump or clean their water, who grow their own food, who work at jobs that can function without electricity or complex infrastructure, who still have manual skills like carpentry, welding, gardening/farming, etc.) are the most able to carry on life in the wake of their devastation and the lack of government and/or international aid. I am not saying this to shame or blame people who live modernized lives (I am one of them), and I'm certainly not saying that modernized people are to blame for their own illnesses. I am simply trying to point out a connection between modernity and illness, since mainstream culture refuses to acknowledge any negative consequences of excessive dependence on technology or a lack of nature in our daily lives. 

Modernity has its benefits, to be sure. I wouldn't be alive without techno-medicine, and I wouldn't be writing this blog without my computer. But we should not be blind to modernity's many drawbacks, particularly for physical and mental health. Especially for mental health. There are many excellent articles and books out there now discussing the concept of "evolutionary mismatch". In the context of the human body, since genetic evolution takes tens of thousands of years and our societies change at a much more rapid pace (now dramatically changing by the decade, not by the millennia as in the past), our bodies and minds are still adapted to a paleolithic reality, causing our modern culture to be out of sync with our physical and psychological needs.

I mention this because it makes me very sad to see how deeply this mismatch impacts some of my clients. Our society is deeply flawed and not designed to support healthy human life. Violence, racism, misogyny, classism, economic oppression, and political/religious fundamentalism are now rampant in the Westernized world. A growing feeling of being unsafe, especially in the U.S., weighs heavily on the psyche. This effects everyone's health, whether they realize it or not. So when I try to help clients heal themselves, I can only do so much unless they are willing to think very critically about how they are participating in this modern pathogenic society. I truly believe that without this critical analysis of the status quo and the individual's role in it, there can be no deep healing. As you will have gathered by now, I am most concerned with healing disease at its roots. And when the roots of disease are lodged deep in the soil of social and ecological injustice, we must target the root causes of that injustice. Thus, for deep healing, cultural healing, society-wide healing, we must look beyond the individual towards the whole of society. We must look past the trees for the forest. 

It may be unrealistic to expect everyone to disengage with all pathogenic aspects of modernity, especially since most of our livelihoods are now bounded by them. We feed ourselves, shelter ourselves, clothe ourselves, and receive healthcare from this flawed system. Many of us feel that if we tried to disengage from the mainstream, we would be endangering ourselves. But we can take small steps to disengage ourselves from the worst of it, and as a result, improve our resilience. For example, avoiding social media and corporate news to instead read books is a great way to change one's media diet. Engaging in "slow media" can have a really significant impact on mental health and make one much more informed in a way that helps us to avoid manipulation by corporate and other hegemonic powers. Keeping a garden, even in a small community garden plot, can help us keep beneficial soil microbes in our lives. Eating organic food, cooking meals instead of eating out, interacting with wild and domesticated animals (especially farm animals), going on daily or weekly walks in natural places, avoiding toxic cleaning products, minimizing interaction with plastics, sitting or walking quietly with no technological stimulation for at least an hour per day, and so on, can be good ways to start on a path of paradigmatic change and healing. 

I know that if I had not made these deeper changes to my paradigm and my lifestyle that I would not have seen the big improvements in my health as I have. However, this is not an easy thing to suggest to people. Often my clients are already doing a back-breaking amount of work just to get up in the morning and to put food on the table. Often they are in financial situations that make challenging the status quo excessively burdensome. But nothing is impossible. And the goal is to redefine one's reality so that the work one once thought was necessary is actual revealed to be unnecessary; that there is a hidden way around it. Jumping the tracks from one reality to the other is the hardest part. It is not up to me to decide what someone else is capable of. All I can do is lay out the options and let the person choose for themselves. But it is part of my job to point out options that someone else never knew existed.

I would also highly recommend reading the book the Yin and Yang of Climate Crisis: Healing personal, cultural, and ecological imbalance by Brendan Kelly, LAc. Brendan is a local practitioner of Chinese medicine here in Vermont, and his book is an excellent discussion of how the illnesses that modern society, particularly in America, is experiencing are mirror images of the ecological diseases that our world is experiencing, particularly in regards to climate change. He describes how specific aspects of modernized lifestyles and Westernized cultures lead to imbalances in the five elements in both the human body and the global climate, and also how balancing the five elements (wood, fire, earth, metal, water) within us can help us return to a state of balance within humanity and the greater ecology. Just as I have described here, Brendan mentions with clear examples how real healing cannot be successful unless we think about the individual's cultural, social, economic, and ecological context. 

Working on Other Projects
I will be honest, I am not putting a lot of effort into this website these days, as I am working on too many projects in the other aspects of my life. I continue to respond to comments and questions, so keep them coming. I wish you good health!

<![CDATA[Lifestyle Changes to Help Cope with Chronic Pain]]>Tue, 30 May 2017 12:07:18 GMThttp://www.cfnaturalhealth.com/blog/lifestyle-changes-to-help-cope-with-chronic-pain​The following article is a guest post by Jackie Waters, owner of hyper-tidy.com and someone with personal experience overcoming chronic pain. 

Chronic pain is defined as any pain that lasts over 6 months. Over 100 million people worldwide are suffering from chronic pain and if you are one of them, finding relief is your greatest concern. Many people jump to alleviate the symptoms of chronic pain through the use of prescription drugs. However, the repeated use of these pills can lead to an even bigger problem. Here are a few lifestyle changes and tips to help you minimize your chronic pain and restore your quality of life.

When you are in pain, the last thing you want to do is move your body, but developing a habit of exercising can help minimize or prevent pain before it even starts. Exercise has a pain reducing effect on your body that strengthens muscles and helps prevent re-injury and further pain. As you exercise, endorphins are released which not only improve your mood, they also block your pain signals. This means your body’s interpretation of pain will differ and your tolerance threshold for pain will increase. The specific benefits of exercise for chronic pain sufferers are plentiful. It keeps your joints moving well and your muscles strong. Exercising is also good for your mental health, as it is not uncommon for those suffering with chronic pain to be depressed. A routine of exercising can help boost your self esteem and give you a sense of control as you are doing something positive to fight the pain and the effect that it has on your lifestyle. Staying fit also helps you avoid obesity and weight gain, which causes more pain. To find out which forms of exercise will benefit you the most, consult with your doctor and a physical therapist.
Reduce stress in your life
Many studies show that depression, anxiety, and stress can cause pain, and being in pain can cause stress. The relation between stress and pain creates a vicious cycle that promotes both chronic pain and chronic stress. Learning how to cope with stress, or avoiding it altogether, is the best way to minimize pain. Exercising is a great way to reduce stress, as is getting more restful sleep. Sleep impacts healing and a good night’s rest will better help you face the turmoil of the day. Find balance in your day by creating the time to get out of the hustle and bustle, and enjoy a leisure activity. You may also want to pick up a mind-body activity such as yoga or meditation, which are both known to decrease stress levels and increase physical well-being. Chronic pain can definitely take a toll on your life, but as you learn how to manage stress, the impact of pain will lessen.

Avoid long term use of prescription drugs
There are several categories of medicines used to treat chronic pain: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Acetaminophen, antidepressants, anticonvulsants (anti-seizure), muscle relaxants, and opioids. When medicines are prescribed and used properly, the chances of addiction are low, but it can still happen. Although people with a history of substance abuse are more vulnerable to forming an addiction, those who have never had problems with substance abuse are still at risk. The problem occurs because it is easy to exceed the prescribed amount of medication when you are looking for relief. The best way to avoid overuse of your prescribed medication is to find alternate ways to deal with your pain, such as the activities listed earlier. There are also several non-addictive pain relievers on the market. In order to find what would work best for you, consult with your doctor.
In the beginning, living with chronic pain can be very frustrating. You may feel resentment toward your body because you cannot participate in what used to come easy to you. While chronic pain presents change, it does not take away from your quality of life. As long as you make the commitment of staying active and avoiding stress, you can still lead a healthy and progressive life!

About Jackie
​Accepting my diagnosis of rheumatoid arthritis wasn't e
asy. At age 25, the last thing I wanted to hear was how the pain I'd been experiencing was incurable and would be with me for the rest of my life. But with help and support from my parents and close friends, I was able to accept my diagnosis and get on the path to dealing with my arthritis. The result was a life overhaul. I began exercising more regularly, eliminating harmful, chemical-laden products from my life, finding time to relax, and more. My goal was to live a healthy, happy life as free of prescription pain management as possible. The methods covered in my article have worked wonders for me, and I hope they can help many others as well!
<![CDATA[My Changing Views on Antibiotics]]>Fri, 05 May 2017 20:54:42 GMThttp://www.cfnaturalhealth.com/blog/my-changing-views-on-antibioticsPicture
My opinions on the use of antibiotics for chronic lung infections in cystic fibrosis have changed a lot in the last several years. This is predominantly due to my personal experiences, successes, and mistakes. For several years, especially around the time that I started this website, I had a very antagonistic view of antibiotics. I saw them as a necessary evil that had to be avoided as much as possible. I made the personal choice to suffer through many months of infection, fatigue, and heavy mucus loads in order to minimize my exposure to this class of drugs. I did this for two major reasons: minimizing the risk of developing antibiotic resistance, and mitigating the impact that excessive use of antibiotics has on the gut microbiome. For about four years I made the choice to wait as long as possible between hospitalizations, and also to do without oral antibiotics for longer and longer periods of time. Upon reflection, I don't think this was the best choice for me, as I lost lung function during that period and developed some serious and irreversible lung damage. It's not clear whether or not this damage would have developed anyway, even if I was more aggressively using antibiotics. But in the last year or so I have changed tactics and I believe my health has benefitted. Here, I will describe my experiences and review why I made these changes.

I must be absolutely clear: this is not medical advice. I am not advocating for anyone to do what I did or to believe that my experiences are ultimately true and therefore applicable to everyone. This is only a reflection on what I have personally experienced. If others can learn from my mistakes in order to benefit themselves, then that's great. But as I mention in many places on this website, every person's health is very different, and what may be useful for me may not be useful for someone else. 

For several years I would wait as long as possible between hospitalizations and only go in for a clean out if I really felt horrible. At that time, feeling horrible meant that I was so tired that doing daily errands required an incredible exertion of energy and willpower, involved daily fevers with night sweats, significant mucus production with frequent hemoptysis, and weight loss. I usually admitted myself to the hospital only twice a year, usually after catching a virus that resulted in an exacerbation that I couldn't control with other means, like herbs and essential oils. During this time, I experimented with lots of herbal and natural remedies, some of them very successful. I favored experimentation with these new therapies instead of using antibiotics. I discovered a lot about myself during this period, and did lots of research (much of which I have recorded in this website). So it was a very fruitful period. 

But a couple years ago I had my first lung collapse, likely from severe inflammation stemming from chronic, uncontrolled infection in my left upper lung. I had a pleuradesis operation, but a few months later I had a smaller collapse again in the same spot. It became clear to me that I was now at a stage in my disease where the lung damage I was experiencing was accumulating and becoming irreversible, and that I must do everything in my power to preserve the lung capacity that I have left. It caused me to rethink my approach to treating my lung infections. I was beginning to understand that I needed to be more aggressive in my antimicrobial regimen, and that waiting for excessively long periods of time between antibiotics may be doing more harm than good. 

A Change in Tactics
Starting last summer, I began to negotiate a little more with my doctors, who had introduced to me the idea of coming in every 3-4 months for a hospitalization regardless of my lung exacerbation status. Previously, I had resisted this idea as causing overexposure to antibiotics that could disrupt my gut microbiome and make me more susceptible to infections by weakening my immune system, and potentially leading to the development of allergies or fungal overgrowth in the lungs, like Aspergillis. Although these concerns are still forefront in my mind, I now have a better understanding of how to control for them while still using antibiotics strategically and effectively.

I realized that in the years of religious avoidance of antibiotics, there were no significant developments in the two major fears I had (developing antibiotic resistance and degrading my gut microbiome), at least not in a way that was directly attributable to my use of antibiotics. My digestion had improved significantly during that period, but that could also be attributed to many things including a major shift in my diet, better exercise, and the regular use of digestive herbs, prebiotics, and probiotics. There were no major changes to my sputum cultures during that time other than a slight improvement in antibiotic sensitivites, but those also could have been due to the use of herbs that inhibit bacterial resistance to antibiotics (like thyme, goldenseal, or rosemary). So while there were some fairly clear drawbacks to my avoidance of antibiotics in terms of lengthy periods of uncontrolled infection and permanent lung damage (I lost about 5% of lung function during that time), there were not significant benefits, at least none that I could measure. I did, however, learn a lot and in experimenting with antibiotic alternatives I discovered many things that have helped other people in very real ways. 

So now I have developed a new routine of antibiotic use, one that rotates antibiotics to minimize developing resistance, but never going for lengthy periods without having some type of antibiotic on board. This is tailored specifically to my colonizing bacteria and my symptoms. Throughout the years I have gotten to know my bugs very well and their patterns are very predictable. My major bug is MRSA, and if I go too long without antibiotics (more than 2-3 weeks) I get fevers, fatigue, and excessive mucus production. So my new regimen goes like this: I do 4-5 days in the hospital with ceftazidime (covering Pseudomonas) and vancomycin (covering MRSA), then continue for 10 more days of IVs at home. After finishing this course of IVs I usually have about 3-4 weeks with no fevers (this period has lengthened since improving my adrenal resilience with adaptogenic herbs, using testosterone, and supplementing with my herbal antimicrobial tincture formula - osha, thyme, usnea, elecampane - as needed). Then I start a month of inhaled vancomycin, and for the last 2 weeks of that month I use oral minocycline (because I usually start to develop a fever at that point). Then I wait another two weeks (usually using my antimicrobial lung tincture) and then go on two weeks of Sivextro (tedizolid). Sivextro is a newer cousin to Zyvox (linezolid). Zyvox is a very effective anti-MRSA drug with very intense and very serious side effects that I cannot tolerate, but Sivextro is as effective but has far fewer side effects (none for me), although it is extremely expensive. Luckily I have great health insurance (Medicare + Medicaid) that covers it with minimal whining. Then I wait another two weeks until I develop a fever, and start the whole cycle over again. So I end up going into the hospital about every three months. 

Since starting this regimen I have more energy and feel sick and fatigued much less often, which allows me to exercise more, improving my airway clearance and overall strength, as well as my quality of life. I think that's a big point I want to make: my new routine improves my quality of life so that I am happier and more active, which improves my overall health. I am still very focused on maintaining a strong and diverse microbiome, so I supplement daily, always, with probiotics and eat a diet high in prebiotic plant fibers. 

Things to Note
I must admit though that there is a big variable in here that has contributed to the overall improvement in my health in addition to this new antibiotic routine: supplementing with testosterone. Since I am a transgendered person identifying as trans-masculine, I have been supplementing with testosterone for about a year and a half. Alongside top surgery, it has radically improved my life in more ways than I can express. This has to do both with finally getting the treatment that I've needed for my whole life, improving my mental state and reducing my dysphoria, giving me much more energy, and also helping to remediate the negative effects that estrogen has on cystic fibrosis (I've written a really dense scientific paper on estrogen's role in CF if anyone is interested). I could write a separate article on this if anyone is interested. 

You will also notice that I do not inhale any anti-Pseudomonal antibiotics. This is because I noticed that for me personally, they have no effect on either my symptoms or my sputum cultures. Furthermore, I recently listened to an excellent lecture by Dr. Richard Moss from Stanford, put on by CFRI, on the growing problem of Aspergillus colonization and Aspergillosis in CFers. One of the major causes of increased Aspergillus colonization in CF lungs is the constant use of inhaled antibiotics, specifically anti-Pseudomonals like Tobi/tobramycin and Cayston. Using these inhaled antibiotics with no breaks makes overgrowth of fungus in the lungs more likely because it disrupts the lung microbiome; remember that antibiotics are antibacterial but not antifungal. If inhaled anti-Pseudomonal drugs are effective for you, that's excellent. But I worry about constant use for the above reason. That also goes for constant use of antibiotics of any sort - oral or IV. Thus, I think taking breaks in between antibiotic courses and also including regular use of antifungal herbs are good ideas in these situations. Some essential oils are antifungal (such as thyme, lemongrass, or tea tree oil) and can be used in a diffusor, steamed, or nebulized in certain situations. Other herbs can be taken in tincture or tea form like thyme, osha, goldenseal, calendula, and many others. 

I still believe that antibiotics need to used only when absolutely necessary and with very careful planning and study of all potential repercussions. Americans (and most people with access to Western medicine) use antibiotics too frequently and often inappropriately. There are many consequences to the overuse of antibiotics that I have outlined elsewhere in this website including disturbance of the gut microbiome, digestive diseases, allergies, autoimmunity, antibiotic resistance, reduced immunity, and increased risk of fungal infections. However, they are literally lifesaving when properly used, and in CF we need them in many situations. So my views have changed in this regard - I believe that I use them more intelligently now. And it's also possible that my tactics may change again with updated information - that's what a good scientist does! I still use herbal remedies in a complementary way with antibiotics in order to control my infections better. I know for sure that using antibiotics has saved my life many times and their continued use will lengthen my life by decades. But they will only continue to help me if I use them judiciously and in conjunction with other therapies.