56 | Is Vitex Contraindicated in PCOS with Jillian Bar-Av

Camille Freeman (00:00)
Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman. I am a licensed nutritionist and registered herbalist. In this podcast, I share little tips and tidbits that may be helpful for other practitioners. Today, I'm delighted to welcome Jillian Bar-Av to the podcast. Jillian is also a registered herbalist and licensed nutritionist. I invited Jillian to come on and speak to us about Vitex and PCOS because there is a misconception. If you poke around online, you will find that a number of people are saying folks who have Vitex should not be taking... Or folks who have PCOS should not be taking Vitex. Jillian got curious about that and thought, Well, wait a minute, that doesn't really make sense. Did some digging, found out why people think that, and why it's probably not true. I'm really excited to share this with you. Just to give you a little bit of background about Jillian, like I said, she's a registered herbalist with the American Herbalist Guild, a licensed nutritionist in the state of Maryland. She has a clinical practice focused on interstitial cystitis and PCOS. She also serves on the clinical faculty at the Maryland University of Integrative Health.

Camille Freeman (01:04)
Jillian began studying medicinal herbs at the California School of Herbal Studies in the year 2000 and received a Master of Science in Herbal Medicine from Maryland University of Integrative Health in 2005. She enjoys gardening, taking looks in the woods, and getting to the bottom of herbal mysteries. I can't wait to dive in and share a little bit more about this mystery. Okay, I am so happy to bring Jillian Barr up onto the show today. I've known Jillian for, I think, 20 years or more now. It's been a long time. And last year, Jillian presented at the Monday mentoring conference and shared some really fascinating information about Vitex. I thought other practitioners might really appreciate some of what she shared. So, Jillian, welcome to In the clinic. So happy to have you here. Thank you. I was wondering if we could just start off and you could tell us some of the highlights from your conference presentation, what got you interested in Vitex and what you learned when you went poking around a little bit.

Jillian Bar-Av (02:13)
Sure. Thank you so much for having me, Camille.

Camille Freeman (02:15)
I.

Jillian Bar-Av (02:17)
Got interested in learning a little bit more about what Vitex is doing in the body because I've always used it for polycystic ovarian syndrome. I have PCOS, I have clients with PCOS, I teach about PCOS cases, and it's always part of the protocol. And then I started to read and hear about in the popular podcasts and websites that it's contraindicated with PCOS because it raises LH. And PCOS, part of that condition is chronically elevated LH or luteinizing hormone. So if you have an herb that also is raising it, it makes sense that it would be contraindicated related. So what I thought would be really easy is to just go look for a study that showed me that Vitex raises LH. And I was just looking for the reference. But what I instead found was literature saying that it lowers LH. So then I was like, Okay. And I could not find the piece of literature that showed that it raises LH. And I eventually reached out to a naturopath who had written and spoken about it on a podcast and asked her what her reference was. And she pointed me to a study. And then the reference in that study actually led me to the source of it.

Jillian Bar-Av (03:37)
And it's not the original source, but it is a source that promoted it, which is Principles and Practice of Phytotherapy, the first edition from 2000, which is a really reputable source. And I think the issue around this is that their second edition in 2013 clears up what they wrote in the 2000, but it got out into the world.

Camille Freeman (04:05)
So can you talk to us more about the confusion and what was in the first edition that was cleared up in the second? And how have you come to understand this now?

Jillian Bar-Av (04:16)
Yeah, definitely. So in the first edition, it said that Vitex raises LH, and it was just part of what Vitex does. There wasn't a huge explanation about it. It's just this is what we know how Vitex works. And this was the popular understanding from the 1960s through the 90s. Then the second edition, what it clears up is that that original assumption came from a 1961 study done on guinea pigs, where they fed the guinea pigs Vitex and saw changes that happened. And then they interpreted those changes as having raised LH and lowered FH. But there wasn't any actual study of those hormonal levels in the guinea pigs. So it was an interpretation. Then that information also was distributed with a lot of German Vitex products. And so it just became part of the common understanding of what Vitex does.

Camille Freeman (05:20)
Got it. And so the newer edition clears this up a little bit and shares that actually some of our newer studies and understanding points to, in fact, the opposite.

Jillian Bar-Av (05:32)
Yeah. And what we know now, Vitex does, one of the things it does is that it stimulates dopamine production. And when you stimulate dopamine, there is actually a direct LH lowering effect on that alone. So that's cleared up in the second edition as well.

Camille Freeman (05:49)
Got it. So it sounds like from your perspective, you are using it all along. And then you heard this rumble of, oh, some people are saying that it's contraindicated, that got you curious. You went digging and then you went on this, I don't want to call it a wild goose chase because you did... Is it catch the goose? I'm not sure what the metaphor is here, but anyway, you got to the bottom of it. One of the things I think is so important here is just that if you had only gone to one place or just gone back a few steps, you might have come away from this thinking, Oh, Vitex might be contraindicated in PCOS.

Jillian Bar-Av (06:30)
Yes.

Camille Freeman (06:31)
So it really did take you going back and back and back, continuing to say, Well, where did you get that information? Where did you get that information? To find out, Oh, wait a minute. This doesn't really make any sense. And in fact, the opposite of what people are saying is actually what seems to be indicated in literature at this point.

Jillian Bar-Av (06:48)
Yeah. And the funny thing is that I have both these books. So if I had just started there, pulling them off my shelf, it might have been faster.

Camille Freeman (06:57)
I think it's a valuable exercise anyway, though, because I've come across this a number of times in researching for my webinars where you do that, you reference hop back and back and back, and ultimately you find out actually, no, somebody misinterpreted along the way, and it just gets perpetuated. So I really appreciate this story about how you came across it. I also appreciate that you're open to hearing that you might be wrong because I think that is something when people have been in practice, for you, I think it has been like 15 or 20 years that you've been doing this work. And sometimes it's easy to think, oh, well, that person is newer or that person is trained in a different way or whatever. But of course, I know what I'm doing. So I do appreciate that even this many years down the road, You're still open to, I could be wrong about this. Let me see if I get there's some new information to update my understanding.

Jillian Bar-Av (07:52)
Yeah, that happens all the time.

Camille Freeman (07:55)
So true. I think it's the hallmark of a great practitioner. In fact.

Jillian Bar-Av (07:57)
I've already tried... I've already revised things that I put out in that lecture that you referenced in my own mind. I'm like, oh, now I would say that differently.

Camille Freeman (08:08)
Yeah. I think we live and learn. Another question that I have for you is around the dosing of Vitex, because I know this is something that trips people up, practitioners, especially folks who might be newer to herbs or newer to Vitex. Do you have any words of wisdom for us about dosing or how you've used Vitex in your own practice?

Jillian Bar-Av (08:30)
Yeah. In fact, that's what I was referring to. And what I would correct from the conference challenge is around some things I said around dosage, because it wasn't really clear to me until I dove into the dosage again to understand that when low doses of extracts are used in clinical studies and they say that they're using between 4 and 40 milligrams, what that actually is equivalent to in terms of crude herb because it's not always that easy to find. So I actually found that I had to research looking up the actual pharmaceutical names of these extracts to see what their strength is.

Camille Freeman (09:18)
Yes. I have had a hard time with this, too, that sometimes there's a trade name, but the exact formula isn't there or it's not clear. It does take some digging. So what did you find in terms of how to think about dosing?

Jillian Bar-Av (09:34)
Yeah. So what I found is that there are two main products used in the clinical studies. One's out of Germany and one is a Swiss product. But they're almost identical. The German product, they say is a 7 to 11 to 1 ratio. So 7-11:1.

Camille Freeman (09:59)
Okay? yes. Somewhere between 7 and 11 to 1.

Jillian Bar-Av (10:03)
Yes. Exactly. And that one's called BNO 1095 or Agnecastan. Okay, that's the German one. The Swiss one is a range of 6 to 12 to 1. So they're very similar. And that one's called ZE 440 and is made by Zeller. So when you see a clinical trial that says 20 milligrams is what was used, what that actually equates to is like... What is the range here? I have it written down. It's like 120 to 200 40. Yeah, 20 milligrams is 120 to 240 milligrams of crude herb. Yeah. So I think the really important thing, especially because when we look at herbal, a lot of the time the dosage are given in milliliter s is to make sure that you know what the dosage of that tincture is or really the strength of that tincture. And how does that equate to the tincture that you personally are going to be using. And so what I have found is that in the herbals, the strategy will be listed as 1 to 5 mls per day. And generally that's based off a 1 to 5 strength tincture. But personally, what I have access to, usually through my dispensary is a 1 to 2 extract tincture.

Jillian Bar-Av (11:39)
So that's very different.

Camille Freeman (11:40)
Yeah. And so even when you look at, okay, well, here's the products that have been used in some of these studies, and here's the crude weight equivalent, which is that 200... It's still pretty low dose that's being used in that study. So if you're using a 1 to 2 extract, extract to get the equivalence, would you say that's going to be something in the range of a mil or two of that 1 to 2 extract, or how do you apply that with your own client?

Jillian Bar-Av (12:11)
If you're using a 1 to 5 extract to get in that range, it would be half to one mil per day. So to equivalent 120 to 200.

Camille Freeman (12:24)
Oh, 120. Yeah. Okay. I'm going for the high end, but yes.

Jillian Bar-Av (12:27)
So if it was the 240, then it's 1 mil per day. If you went to two mils of a 1 to five, you'd be actually giving more around 500 milligrams per day. Which is you started off asking me, how do I dose it? Ever since I first started using Vitex, that is my go to dose, 500 milligrams per day. And I look at whatever extract I have and I calculated out just do 500 milligrams per day. Because in the 90s, there's a study that was a questionnaire across herbalists across Europe that asked them, what's your dosage of Vitax? And across the board, that was like the median dose was somewhere between 450 and 500 milligrams per day. So just based on that, I tend to use that dose. Through some other reading, I now may want to actually play with higher doses.

Camille Freeman (13:27)
So tell me about the higher doses and what makes you think maybe higher doses would be interesting to try?

Jillian Bar-Av (13:36)
So if you look at that second edition of the Principles and Practice of Phytotherapy, they have a really nice chart in the Vitex monograph with showing clinical use and why you would want to use different doses and what you could expect or what conditions you might think about them for. And one of the things with PCOS is if there's elevated prolactin, then Vitex can help by stimulating the dopamine to inhibit prolactin. And so according to Mills and Bone, higher doses, especially if there's true hyperprolactinemia, may actually have better results. Although the question of how it's doing that is actually unknown because it might just be that at a certain dose, then their higher dose would be like 2,500 milligrams per day. So they put high dose between 1,000 and 2,500 milligrams per day, that might be actually, when you get to that dose, exerting estrogenic effects. And that might be overtaking whatever the herb might actually be having its effect through dopamine.

Camille Freeman (14:47)
Right. It's very interesting. And I do know a number of practitioners who use what some of us might think of as more standard dosing where they might be doing a 2 to 5 grams a day type of thing with Vitex. I'm with you. I usually go with much smaller doses in the 250 to 500 milligram range. But it is interesting to think about what circumstances where a higher dose might be indicated and what might that look like for people?

Jillian Bar-Av (15:19)
Yeah. And I think the other thing it brought up for me is having more confidence around asking for testing. So we really don't know what someone's prolactin level is unless we test for it. And so at that point, if it's in range, then I would probably... But I still thought Vitex was indicated, I would probably go with the same dosage I've always used. But if it was actually out of range, I might try higher.

Camille Freeman (15:43)
Yeah, I love that strategy. Very interesting. Is there anything else you wanted to share with us that you discovered about Vitex or any thoughts about this process?

Jillian Bar-Av (15:54)
One study that I came across that excited me was about how it's been discovered that it has an effect on angiogenesis, inhibiting angiogenesis. And so this has applications for cancer as well as a whole host of other conditions. But it's thought that that might be part of what the effect is that's helpful for endometriosis.

Camille Freeman (16:19)
So interesting. Yeah. And for people who might not be as familiar with the term, angiogenesis is just the development of new blood vessels. So anytime you have tissue growth, if it's going to be sustained, you need to have new blood vessels also being formed to feed the tissue and remove waste. So it sounds like a good thing, but in the cases of cancer or other unwanted tissue growth, angiogenesis can actually be fueling the fire, so to speak. So it's really interesting that Vitex might be limiting that at least in some cases.

Jillian Bar-Av (16:50)
Yeah. And then even beneath that, they wondered the researchers, if it was actually due to its effects on nitric oxide and its antioxidant.

Camille Freeman (17:00)
Effects. yes, because that's all tied in to angiogenesis as well. Not to mention PCOS and endometriosis and some of these other traditional reasons that herbalists might think about incorporating Vitex into a formula or recommendation. I love this. This is great. Anything else before you wrap up here? Do you want to throw out there?

Jillian Bar-Av (17:27)
I think I've really said what I had to say. Thank you so.

Camille Freeman (17:29)
Much, Camille. Perfect. I love it. And before we leave, do you want to just say a few words about your herbal observation groups or anything else that you have going on?

Jillian Bar-Av (17:39)
Sure. Thank you. I have started to have herbal observation groups. So this is where we see a free client and there's an observation group that views that consultation and then comes back to discuss and collaborate on the recommendations for that client. And if you have of interest in that as an observer or if you know somebody who would like to be a free client, you can go to my website and there's a tab for observation groups and free client.

Camille Freeman (18:10)
Amazing. And share your website for folks. I'll put it in the show notes.

Jillian Bar-Av (18:15)
But t's Greenspring Herbs. Com. Great.

Camille Freeman (18:18)
I love it. And Jillian has a great newsletter that's really fun for practitioners. She's always sharing stuff that's going on in the garden. Beautiful garden over there and other fun little tidbits. So I encourage you to sign up for Jillian's newsletter.

Jillian Bar-Av (18:32)
Thanks, Camille.

Camille Freeman (18:33)
Amazing. Any other ways that people can stay in touch? There's the newsletter, the website. Do you have any social links that you wanted to share before we wrap up?

Jillian Bar-Av (18:43)
I do have a business Facebook page, but the link is not an easy link to say.

Camille Freeman (18:50)
I'll put it in the show notes. That's great. Sounds good. Jillian's on Facebook. Look in the show notes for the link. Awesome. Well, thank you so much for spending your time with us, Jillian, and sharing this. I think this will be really illuminating for a lot of practitioners.

Jillian Bar-Av (19:03)
Thank you so much for having me, Camille.

Camille Freeman (19:04)
All right. Take care. Thanks for listening to In the Clinic with Camille. Hey, did you know that I write a weekly practitioner note for herbalists and nutritionists? If you would like to get that in your inbox, you can sign up at Camille Freeman. Com newsletter. I'd love to have you join us there.