The Role of Herbs in Fertility
This article was originally published in the August 2019 issue of AromaCulture Magazine (www.aromaculture.com) and has been adapted for use here with permission from the publisher.
Fertility has long been thought of as only a “woman’s issue”. Even now, a lot of people don’t realise that the partner providing the xy chromosomes in a potential pregnancy contributes to up to half of all infertility cases. Approximately 15% of couples trying to conceive experience infertility. 20-30% of those are due to infertility on the side of the partner with testes*, 25-30% being on the side of the partner with ovaries, and another 20-30% of cases are due to an issue with both partners. The rest being of an unknown cause. Worldwide, there is a lack of data on infertility rates in people with testes, largely because of the patriarchal belief - still very strong in some parts of the world - that it always falls on the shoulders of the ovary-having partner whether pregnancy can be achieved, and many teste-having people in an infertile couple are never tested or treated for fertility at all. (Ashok Agarwal, et al, 2015)
Causes of Infertility
Usually, infertility in people with testes is due to a problem with spermatogenesis. That is, the creation of sperm (Alessandro Ilacqua et al 2018). This is because sperm needs a very specific environment to grow in (Alessandro Ilacqua et al 2018). The right temperature, the right nutrients, and the right hormone levels are all factors in creating a that environment (Alessandro Ilacqua et al 2018). A diet rich in Omega-3 fatty acids, antioxidants such as vitamins E, C, A, D, selenium, zinc, and folate is beneficial (Salas-Huetos A et al, 2017),(González-Rodríguez LG et al, 2018). In real life, this looks like large amounts of a variety of vegetables, some fruit, fish and seafood, poultry, and whole grains (Salas-Huetos A et al, 2017).
A recent study has found strong ties between the mediterranean diet and healthy semen quality and motility (Albert Salas-Huetos, et al, 2019). while diets high in processed meats, dairy products, alcohol, coffee and sugar have a negative impact on sperm quality (Salas-Huetos A et al, 2017). The mediterranean diet generally consists of high amounts of olive oil, fruit, nuts, legumes, vegetables and whole grains; some fish, lean meats such as poultry, and low amounts of red and processed meats, dairy products, and sugar (Albert Salas-Huetos, et al, 2019). This is a great guideline for consuming many, if not all the nutrients listed above.
There are many environmental factors that can lead to infertility: age, caffeine intake, temperature, pollution, and stress, are just a few (Alessandro Ilacqua et al 2018). Heat stress in the testes is maybe a surprising one, though simple. Sperm cannot properly grow in high temperatures and end up with high oxidative stress, poor motility and DNA damage; that’s why it is recommended to avoid too much cycling, wearing tight underwear, and sedentary work and lifestyle while trying to conceive. - or at least get up from the desk once per hour (Mahsa Darbandi, Sara Darbandi et al, 2018),(Gill K et al, 2019),(Simon Mills and Kerry Bone, 2013).
Stress and hormones
As important as diet and nutrition are to sperm quality, stress is just as important to consider. To get to the nitty gritty of why this is, we have to understand a little bit about the endocrine system. Testosterone is produced throughout the day by the leydig cells in the testes (Mahsa Darbandi, Sara Darbandi et al, 2018). They make testosterone in response to luteinizing hormone (LH) from the pituitary gland, which is stimulated by gonadotropin-releasing hormone (GnRH) from the hypothalamus, pulse-released every 1-2 hours (Mahsa Darbandi, Sara Darbandi et al, 2018). This is called the “HP axis” or sometimes “HPG axis” (Hypothalamic-Pituitary-Gonad),(Mahsa Darbandi, Sara Darbandi et al, 2018). Both acute and chronic stress directly affect this pathway and resulting testosterone pulsing (Salam Ranabir and K. Reetu, 2011). Chronic stress leads to suppression of gonadotropins and gonadal steroid hormones, the ones responsible for successful spermatogenesis, which leads to decreased sperm count, motility problems, and DNA damage (Mahsa Darbandi, Sara Darbandi et al, 2018),(Alessandro Ilacqua et al 2018),(Daly W. et al, 2005),(Salam Ranabir and K. Reetu, 2011).
This disruption of the HPG axis is thought to be due to increased cortisol and other stress hormones (Mahsa Darbandi, Sara Darbandi et al, 2018),(Alessandro Ilacqua et al 2018). A simplistic understanding of why excess production of stress hormones leads to suppression of sex hormones has to do with the fact that they are both steroid hormones made from cholesterol. In acute and chronic stress the body prioritizes stress hormones over reproduction (Mahsa Darbandi, Sara Darbandi et al, 2018),(Kaye K. Brownlee et al, 2005). This is of particular importance because understandably, experiencing infertility and going through tests and treatment is very stressful in itself, often putting strain on relationships involved (Alessandro Ilacqua et al 2018). Using therapy, meditation, exercise, or other stress relieving activities can be invaluable while exploring fertility and trying to conceive. Later on, we’ll look at some herbs that can help regulate hormone levels and manage stress.
One of the most common causes of infertility in those with testes is varicocele, which is a weakening and widening of the veins along the cord that holds up the testicles. This causes inflammation and decreased blood flow, resulting in adverse effects such as increased scrotal temperature, increased intratesticular pressure, and even a buildup of toxic metabolites and hormonal abnormalities. A large number of people with varicocele have reduced levels of testosterone, though it is unclear whether low testosterone is caused by the varicocele and resulting leydig cell damage, or if the low hormone levels is from testicular failure that is more likely to lead to venous insufficiency and varicocele. Either way, this can be a contributing factor to infertility. (P D Kantartzi, et al, 2007)
One of the conventional treatments for varicocele is surgery (P D Kantartzi, et al, 2007). If this route is taken, we can employ herbs to help the wound-healing process and protect against recurrence. There are a number of herbs used traditionally for varicocele and similar conditions of the testes, such as inflammation and heat.
Key herbs used for increasing fertility
The health of someone’s sperm can be said to be a reflection of their overall health, so when facing fertility problems, we should look at all aspects of the person’s life and health. Allergies, food intolerances and sensitivities, autoimmunity, and gut health are common potential weak spots to look out for. There are a number of herbs used traditionally to “increase vitality”, and boost fertility. Some of these are adaptogens, which increase the vitality of the body as a whole, some are hormone modulators, and some specific to the prostate. Herbs are used to strengthen the veins in those with varicocele, thereby improving semen quality. Circulatory herbs are used for improving microcirculation, which is important for moving toxins out, and nutrients into the peripheries and pelvis. (Simon Mills and Kerry Bone, 2013)
Serenoa repens (Saw palmetto)
Traditionally known as a “male reproductive tonic”, saw palmetto is used to strengthen the reproductive system in all humans, especially if there is a history of prostatitis or BPH (benign prostatic hypertrophy). It is anxiolytic, anti-andronergic (inhibits or decreases androgens), anti-inflammatory - especially to the reproductive system and organs, and an aphrodisiac. It is used for BPH and prostatitis, erectile dysfunction, decreased libido, and testosterone deficiency. Though it may sound contradictory, studies have shown that taking serenoa over a period of time can increase testosterone levels, while decreasing other androgens, like 5-alpha-dihydrotestosterone (DHT) which is far stronger than testosterone and a large factor in BPH. Most hormones in the body have complicated pathways they follow including feedback loops which help decide whether there should be more of a specific one in the body, which is why many herbs (though not all) that affect the endocrine system have a balancing effect rather than a straightforward increase or decrease relationship with hormones. (Simon Mills and Kerry Bone, 2013)
Tribulus terrestris (Tribulus)
Tribulus has a long history of use as a urinary herb in ayurvedic tradition, but less documented use historically in western herbalism. It does however, have a strong presence in more recent herbalism in the west, along with a significant amount of research for its effects on the reproductive system.
It is known as a reproductive tonic, hormone regulator, aphrodisiac, and fertility agent. Tribulus increases sex hormone production in humans, probably by interacting with the hypothalamus and increasing gonadotropins thereby stimulating the release of either testosterone from the testes, or estrogen from the ovaries. There are several studies showing enhanced spermatogenesis, in both production and quality, increased libido, and increased overall fertility with oral doses of tribulus. (Simon Mills and Kerry Bone, 2013)
Centella asiatica (Gotu kola)
Gotu kola was long ago adopted by western herbalists, but has been celebrated in Ayurvedic tradition for probably as long as there has been Ayurvedic tradition. This important herb is fairly unique in its ability to promote tissue regeneration. According to some pharmacological studies these properties are seen also in vein walls, improving microcirculation. It is for these properties that centella is an invaluable herb for venous conditions - including varicocele. It is also an adaptogen and anti-inflammatory. (Simon Mills and Kerry Bone, 2013)
Vaccinium myrtillus (Bilberry)
Bilberry belongs to the same plant family as blueberry and cranberry; those with the dark colours that are indicative of a high antioxidant content. Bilberry is astringent, vasoprotective, anti-inflammatory, and antioxidant. A high anthocyanin content helps to protect and strengthen blood vessels. Therefore, this is another herb that supports microcirculation, used for venous insufficiency and varicocele. (Simon Mills and Kerry Bone, 2013)
Aesculus hippocastanum (Horsechesnut)
Horsechesnut is an herb that has been well studied for its positive effects on varicocele and sperm quality (Asian J Androl., 2016). In mild and moderate cases, it is able to shrink the size of the varicocele (Asian J Androl., 2016). This is due to its astringent qualities, anti-inflammatory, and venous tonic actions (Simon Mills and Kerry Bone, 2013). Horsechesnut is used in a number conditions involving venous insufficiency or venous tone problems, including hemorrhoids and varicose veins (Simon Mills and Kerry Bone, 2013). These conditions all result from weakened vein walls that eventually bulge (Ashok Agarwal, et al, 2015).
Turnera diffusa (Damiana)
Damiana grows in the warm, dry, tropical parts of North America. This is a key herb for dealing with the stress and anxiety around sex and fertility. It is a nervine tonic, aphrodisiac, and mood-lifting. It is used largely for erectile dysfunction and nervousness around sex. (Simon Mills and Kerry Bone, 2013)
There are many herbs that can be used for those experiencing problems with fertility. The herbs outlined above have specific reproductive use, though it is important to also employ nervines, herbs for digestive health, and person-specific herbs. The herbs used for stress should be based on what is right for each person. Chamomile (Matricaria), oat straw (Avena sativa), or skullcap (Scutellaria lateriflora), are all well tolerated, relaxing nervines. It is always a good idea to talk to your herbalist or health professional to get the most out of your herbal formula.
Despite reaching authoritative hights of over six feet, mullein, as a pervasive biennial, does a pretty good job of evading consciousness. That is, until one is captivated by her soft yellow flowers and even softer patterned leaves, she reveals herself as dominating dry and dusty hillsides throughout North America.
From a symbolic, or energetic standpoint, Mullen embodies, to me, resilience and an unapologetic exsistence. Her roots dig deep to allow her stock to reach skyward, purposefully, boldly. She is a reminder to stand tall.
Her medicine clears the lungs and allows one to breathe deeply and fully, an important piece of moving through grief and insecurities that constrict the chest and cause one to shrink into theirself. By expanding the lungs and straightening the spine, she is a gentle nudge to stand tall, unapologetically, boldly.
This article was originally published in the September 2018 issue of AromaCulture Magazine (www.aromaculture.com) and has been adapted for use here with permission from the publisher.
Nutrition is well known to be an important factor for immune system function. In fact, malnutrition is the leading cause of immunodeficiency worldwide (Chandra, RK, 2007). Although developing a deficiency in a single nutrient is uncommon, clinical studies show that even mild deficiencies can negatively affect immune system function (Chandra, RK, 2007). This may manifest as an increased frequency of colds and flus, genital, and urinary tract infections (Chandra, RK, 2002).
With exception to people in at risk groups, such as the elderly and those in clinical immunocompromised states, eating a varied, whole foods diet is usually simpler and more effective than supplementing to ensure you are getting a rounded variety of nutrients to take care of your immune system (Chandra S, Chandra RK).
Understanding the Immune System
The immune system is generally divided into two categories: innate, and acquired - sometimes called humoral. The innate immune system is the first line of defence, and consists of the skin, mucosal barriers, enzymes such as those in saliva and stomach acid, and generalized immune cells such as macrophages, leukocytes, natural killer cells (NK cells), and dendritic cells. These are cells that directly kill any foreign pathogens and material that they don’t recognize as part of the body. (Wintergerst ES et al)
If the innate immune system fails to prevent infection, the adaptive immune system steps up (Wintergerst ES et al). These are specialized T and B lymphocytes, named for whether they mature in the thymus gland or the bone marrow (Wintergerst ES et al). These cells make up antibodies, memory cells that recognize past infection and can quickly react to subsequent exposure (Wintergerst ES et al). The adaptive immune system has a more complex system. It uses signalling molecules called cytokines and interleukins which act like hormones to trigger an inflammatory response, reactive oxygen species (ROS) to weaken pathogens, and inflammation (Wintergerst ES et al). All components of the immune system are vulnerable to deficiencies, from barrier integrity, to phagocytosis and antibody production, to the ability to deal with excessive ROS (L.C. Carmen).
In addition to circulating in the lymph and bloodstream, immune cells are also present in the skin and epithelial lining of the gut, lungs, and reproductive tract (Wintergerst ES et al). The gut is in fact considered the largest immune organ in the body, referred to as GALT (gut-associated lymphoid tissue) (Wintergerst ES et al). The health of the gastrointestinal tract itself will affect absorption of nutrients and therefore immune function, but of equal importance is the health of the microbiome (Forchielli ML, Walker WA). The composition of gut bacteria has been shown to influence not only gastric immune cells, but mucosal immune cells at distal sites as well (AJ McDermont, GB Huffnagle) One of the ways a healthy microbiome interacts with the immune system is by producing short-chain fatty acids and other metabolites that induce inflammatory mediators, and help to produce a balanced T-helper response (Forchielli ML, Walker WA).
Nutrients and their effects on the Immune System
It is difficult to study the effects of diet overall on immune health, so most studies are carried out on single nutrients. The nutrients that are known to directly affect the immune system are essential amino acids, folic acid, vitamins A, C, E, B6, B12, zinc, copper, iron, and selenium. (Calder PC, Kew S),(Wintergerst ES),(Maggini S et al)
Innate immunity - barrier integrity
Vitamins A, C, D, E, and zinc are all directly related to skin barrier and epithelial mucous membrane integrity and function (Maggini S et al). For example, vitamin A is involved in gene expression and differentiation of epithelial tissue, therefore regeneration of the tissue is impaired with deficiency, as is its ability to fight extracellular infections. (Wintergerst ES),(Maggini S et al). When there is a deficiency in any of these nutrients, as shown in studies of vitamins A, and D, there will be a higher frequency of infections in the eyes, respiratory tract, and gastrointestinal tract (Maggini S et al). Increasing vitamin A levels in children in developing countries has resulted in fewer deaths from measles, diarrheal disease, acute respiratory infections, malaria, and tuberculosis (Maggini S et al).
Vitamin D in particular is protective to the respiratory tract; we notice this in the winter months when a lack of sunlight causes increased lung infections (Maggini S et al). Alternatively, using cod liver oil or UV exposure during the winter decreases susceptibility to respiratory infections (Maggini S et al). This happens because vitamin D stimulates production of generalized immune cells that are present in the mucous lining of the lungs and respiratory tract (Maggini S et al). It is vital to every part of the immune system, as there are vitamin D receptors on most immune cells (Maggini S et al).
Innate immunity - generalized immune cells
As with the previous section, vitamins A, C, D, E, and zinc, with the inclusion of copper and iron have important roles in the function and production of the various generalized immune cells and phagocytosis (Wintergerst ES),(Maggini S et al). There are a significant number of vitamin D receptors on monocytes, macrophages, and thymus tissue, suggesting a vital role of vitamin D in immune system function and immune cell production and maturation (Maggini S et al)(Barbara Prieti et al). Although vitamin D stimulates production of monocytes, antimicrobial peptides, NK cells, and neutrophils in the lungs (Maggini S et al), it appears to have an immunomodulatory role on the innate immune system - particularly on monocytes and antigen-presenting cells (Barbara Prieti et al). This has important implications in autoimmune diseases, which are vulnerable to an overactive immune system (Barbara Prieti et al).
Iron influences cell differentiation and growth, including immune cells, however, an overabundance of iron can actually feed the pathogen, so supplementation should only be used in iron-deficient states. (Maggini S et al)
All nutrients mentioned in this article except for vitamin C and iron are used in antibody production, while B6, selenium, copper, and zinc have a direct impact on it (Wintergerst ES),(Maggini S et al). The latter nutrients also have a direct impact in particular on B-cell proliferation; these particularly good with extracellular pathogens (Maggini S et al).
Vitamin D again is an important nutrient in adaptive immune system function. Vitamin D enhances calcium and phosphate absorption and promotes mineralisation of bone. Because immune cells originate in the bone marrow, healthy bones will produce healthy immune cells. During active infections, both T and B lymphocytes upregulate vitamin D receptors, and there is evidence that calcitriol acts in a suppressive way on B cells in the same way that T-suppressor cells work, which can again have important implications in autoimmunity. (Barbara Prieti et al)
Vitamins B6, B12, and Folate work together in protein synthesis. A deficiency in any of these three vitamins results in decreased T-lymphocyte maturation and proliferation, as well as antibody and cytokine production. Selenium activates the expression of genes that code for cytokines and various other proteins involved in the immune response. (Maggini S et al)
ROS are a normal byproduct of immune system function. They are created during inflammation and are used to kill bacteria and pathogens, but every cell in the body is vulnerable to oxidative stress. Vitamin C is an effective antioxidant that scavenges free radicals therefore controlling oxidative stress, and regulating inflammation. Vitamin C is rapidly used up during infection, as high concentrations of ROS can impair immune response even though they are used in immune response. Studies show that increased vitamin C intake can significantly reduce the duration and severity of cold and flu symptoms, though will not prevent infection in the first place. (Maggini S et al)
Healthy Dietary Sources
Now that we know which specific nutrients are important for the immune system and why, if you are noticing in yourself or in your clients a potential immune deficiency, through looking at their diet we can find what they may be missing. We often hear about the importance of eating a “varied, whole foods diet”. But what does eating whole foods mean? Unprocessed whole grains are grains with the outer shell, or hull, included. Whole grains have substantially more minerals, vitamins, and other nutrients compared to refined, hulled grains (Pritchford). When comparing vegetables, some studies have found that organically grown plants contain up to 90% more minerals than conventionally grown (Pritchford).
Similarly to conventionally grown plants, farmed fish contain less healthy fats and are more susceptible to infection, even when organically fed, than wild fish do (Pritchford). The same can be said for grass-fed beef over grain fed, the former having a higher fatty-acid content, and a higher content of omega 3 precursors (Cynthia A. Daley et al).
It appears that by simply changing to organic whole foods, with grass-fed beef or wild fish, you can already start to increase your nutrient profile, though this is not always possible for every demographic. Here, we can generally stick to locally sourced food, and think about which foods contain the highest levels of the immune-specific nutrients. This information is easily found online, but as a general rule, there are high levels of minerals and B vitamins in dark green, leafy vegetables, while orange and red pigments are rich in Vitamin A (Dieticians of Canada, 2018). Of course, in all cases it is important to remember to take care of your gut health.
There are a few overlaps, and many differences between Herbalists and Naturopaths. It can sometimes be difficult and confusing to choose the right health care provider when faced with a growing number of alternative and integrative practitioners available. The following is a brief(ish) overview of the differences between these two common health care modalities.
The most extensively trained of the alternative health professions tend to be Naturopaths, as they receive a similar degree of training as Medical Doctors and hold the title of “Dr.” or “ND”. They are able to diagnose, prescribe pharmaceuticals, and order blood tests, x-rays, and other scans. Because of this, they are required to write a licensing exam and in BC are covered by many medical benefits plans.
Naturopaths are trained in a variety of modalities including acupuncture, homeopathy, and botanicals, though, aren't specialists in these areas. Their training will spend a few months on each subject rather than the years covered by specialists in any of those modalities,
While naturopaths dabble in herbal arts, Herbalists are the specialists in botanicals. They are extensively trained in Herbalism, which includes modern science of medicine and herbs, as well as herbal traditional use and philosophy. There is an emphasis on holistic care, not absent in naturopathy, which means that diet and lifestyle habits are of just as much (if not more) importance as the herbs that are used.
Why See an Herbalist Over a Naturopath?
Naturopaths are very good at diagnosis, though unless they seek training outside of their naturopathic training, generally have a minimal or very basic understanding of herbal medicine. This is because although they are trained in it, they get merely a few months of training whereas herbalists will have years.
Although every Naturopath practices in their own unique way, many will have an emphasis on supplement use and ‘nutraceuticals’ (that is, concentrated extracts of herbs). This is different than how herbalists practice, as herbalists tend to use whole herb preparations and (many) feel the whole herb extract is preferable for a variety of reasons both scientific and philosophical.
Many people will see a Naturopath initially for a diagnosis, and to explore treatment options, and after switch to an herbalist to pursue long (or shorter) term herbal treatment. They may also choose to see both a Naturopath and an Herbalist as they can work together very effectively.
Herbalists are really good at choosing the herbs that are right for the individual, as they are versed in a far wider variety of herbs then most Naturopaths and have a far deeper understanding of the breadth of activity in each herb. They also have a good understanding of the way that herbs interact with each other, and with pharmaceuticals, and supplements. This is important as herb/drug/nutrient interactions can alter desired effects or even be dangerous. When pursuing herbal treatment for any reason, it can be far more beneficial to work with an Herbalist than with a Naturopath.
Why Use Herbs at all?
Many are safe to use long term and work wonderfully alongside conventional (or otherwise) treatments.
Conventional medicine (pharmaceuticals) really excel at dealing with acute conditions and symptom management - despite what various blogs and articles tell you, you aren’t going to find an herb that takes a headache away as quickly as Tylenol does. Though If you suffer from chronic pain for example, daily use of Tylenol can quickly deteriorate the health of your liver. There are many herbs that taken daily over the course of weeks or months will manage your pain, often to the point of not having to take harsh pharmaceuticals at all. (That being said, stronger herbs are available to deal with severe pain when necessary and appropriate). If you feel most comfortable using conventional medicine, herbs work really well alongside pharmaceuticals to negate the damaging effects they can have on your liver and kidneys and protect against other side effects.
They give us tools that conventional medicine simply doesn't have
Unlike conventional medicine, herbs truly shine when it comes to treating chronic conditions. Herbs are slower acting and have a cumulative effect, meaning they work best when taken daily over time, but they give us many options for resolving long standing issues over simply treating the symptoms. Although they take time to produce an effect, when used properly herbs usually aren’t a life sentence; as they work to restore balance in the system where the problem is stemming from.
Aside from treating chronic conditions, there are many safe (and delicious) options for treating more acute conditions such as helping to resolve a flu more quickly, or using sedative herbs to get to sleep. Herbal medicine has a lot of tools for things that conventional medicine simply doesn’t. You can’t go to your doctor with the complaint of “I just don’t feel that great” and expect to get much help aside from eating better and getting more sleep (and that’s if your doctor is especially progressive). There are herbs that are able to help your body to better deal with stress, heal more quickly after surgery, or lift your spirits.
It’s impossible to list the variety of conditions that herbal medicine is used for - so if you’re wondering if you can benefit, the answer is yes - even if it’s not curable, your quality of life can certainly be effected (for the better).
Thoughts, discussions, learnings, about various aspects of herbs and healing.