Gout

Gout is a form of acute arthritis that causes severe pain and swelling in the joints. It most commonly affects the big toe, but may also affect the heel, ankle, hand, wrist, or elbow. It affects the spine often enough to be a factor in lower back pain. Gout is often a recurring condition. An attack usually comes on suddenly and goes away after 5–10 days. Gout occurs when there are high levels of uric acid circulating in the blood, and the acid crystallizes and settles in the body. According to the National Institutes of Health (NIH), gout accounts for about 5% of all cases of arthritis reported in the United States.

Gout appears to be on the increase in the American population. According to a study published in November 2002, there was a twofold increase in the incidence of gout over the 20 years between 1977 and 1997. It is not yet known whether this increase is the result of improved diagnosis or whether it is associated with risk factors that have not yet been identified.

Uric acid is formed in the bloodstream when the body breaks down waste products, mainly those containing purines. Purines can be produced naturally by the body, and they can be ingested from such high-purine foods as meat. Normally, the kidneys filter uric acid particles out of the blood and excrete it into the urine. If the body produces too much uric acid or the kidneys aren’t able to filter enough of it out, there is a buildup of uric acid in the bloodstream. This condition is known as hyperuricemia.


Uric acid does not tend to remain dissolved in the bloodstream. Over the course of years, or even decades, hyperuricemia may cause deposits of crystallized uric acid throughout the body. Joints, tendons, ear tips, and kidneys are favored sites. When the immune system becomes alerted to the urate crystals, it mounts an inflammatory response that includes the pain, redness, swelling, and damage to joint tissue that are the hallmarks of an acute gout attack.

The body’s uric acid production tends to increase in males during puberty. Therefore, it should come as no surprise that nine out of ten of those suffering from gout are men. Since it can take up to 20 years of hyperuricemia to have gout symptoms, men don’t commonly develop gout until reaching their late 30s or early 40s. If a woman does develop gout, typically, it will be later in her life. According to some medical experts, this is because estrogen protects against hyperuricemia. It is not until estrogen levels begin to fall during menopause that urate crystals can begin to accumulate.

Hyperuricemia does not necessarily lead to gout. The tendency to accumulate urate crystals may be due to genetic factors, excess weight, or overindulgence in the wrong kinds of food. In addition, regular use of alcohol to excess, the use of diuretics, and the existence of high levels of cholesterol and triglycerides in the blood can increase the risk of developing the disease. In some cases, an underlying disease such as lymphoma, leukemia, or hemolytic anemia may also lead to gout.

Causes & symptoms

An acute episode of gout often starts without warning. The needle-like urate crystals may be present in the joints for a long time without causing symptoms. Then, there may be a triggering event such as a stubbed toe, an infection, surgery, stress, fatigue, or even a heavy drinking binge. Patients in intensive care units (ICUs) may have an acute flare-up of gout. In addition, it is now known that chronic occupational exposure to lead leads to decreased excretion of urates and an increased risk of developing gout.

In many cases, the gout attack begins in the middle of the night. There is intense pain, which usually involves only one joint. Often it is the first joint of the big toe. The inflamed skin over the joint is warm, shiny, and red or purplish, and the pain is often so excruciating that the sufferer cannot tolerate the pressure of bedcovers. The inflammation may be accompanied by a fever.

Acute symptoms of gout usually resolve in about a week, and then disappear altogether for months or years at a time. Eventually, however, the attacks may occur more frequently, last longer, and do more damage. The urate crystals may eventually settle into hard lumps under the skin around the joints, leading to joint deformity and decreased range of motion.


These hard lumps, called tophi, may also develop in the kidneys and other internal organs, under the skin of the ears, or at the elbow. People with gout also face a heightened risk of kidney disease, and almost 20% of people with gout develop kidney stones. As of 2002, however, the relationship between gout and kidney stone formation is still not completely understood.

Diagnosis

Doctors can diagnose gout based on a physical examination and the patient’s description of symptoms. In order to detect hyperuricemia, doctors can administer a blood test to measure serum urate levels. However, high urate levels merely point to the possibility of gout. Many people with hyperuricemia don’t have urate crystal deposits. Also, it has been shown that up to 30% of gout sufferers have normal serum urate levels, even at the time of an acute gout attack. The most definitive way to diagnose gout is to take a sample of fluid from an affected joint and test it for the presence of the urate crystals.

Treatment

The symptoms of gout will stop completely a week or so after an acute attack without any intervention. It is important, however, to be diagnosed and treated by a health care practitioner in order to avoid attacks of increasing severity in the future and to prevent permanent damage to the joints, kidneys, and other organs. During an acute attack, treatment should focus on relieving pain and inflammation. On an ongoing basis, the focus is on maintaining normal uric acid levels, repairing tissue damage, and promoting tissue healing.

Diet

Generally, gout is unheard of in vegetarians. It is a condition that responds favorably to improvements in diet and nutrition. Recurrent attacks can be avoided by maintaining a healthy weight and limiting the intake of purinerich foods. A diet high in fiber and low in fat is also recommended. Processed foods should be replaced by complex carbohydrates, such as whole grains. Protein intake should be limited to under 0.8g/kg of body weight per day.

Nutritional supplements

Vitamin E and selenium are recommended to decrease the inflammation and tissue damage caused by the accumulation of urates.

Folic acid has been shown to inhibit xanthine oxidase, the main enzyme in uric acid production. The drug allopurinol (see below) is used for this same purpose in the treatment of gout. The therapeutic use of folic acid for this condition should be prescribed and monitored under the supervision of a heath care practitioner. The recommended dosage range is 400–800 micrograms per day.

The amino acids alanine, aspartic acid, glutamic acid, and glycine taken daily improve the kidneys’ ability to excrete uric acid. Bromelain, an enzyme found in pineapples, is an effective anti-inflammatory. It can be used as an alternative to NSAIDs and other prescription anti-inflammatory drugs. It should be taken between meals at a dosage of 200–300 mg, three times per day.

The bioflavonoid quercetin helps the body absorb bromelain. It also helps decrease uric acid production and prevents the inflammation that leads to the acute symptoms of gout and the resulting tissue destruction. Quercetin should be taken at the same time and dosage as bromelain: 200–400 mg, between meals at a three times per day.

Herbs

Dark reddish-blue berries such as cherries, blackberries, hawthorn berries, and elderberries are very good sources of flavonoid compounds that have been found to help lower uric acid levels in the body. Flavonoids are effective in decreasing inflammation and preventing and repairing the destruction of joint tissue. An amount of the fresh, frozen, dried, juiced, or otherwise extracted berries equal to half a pound (about 1 cup) fresh should be consumed daily.

Devil’s claw, Harpagophytum procumbens, has been shown to be of benefit. It can be used to reduce uric acid levels and to relieve joint pain.

Gout represents a serious strain on the kidneys. The dried leaves of nettles, Urtica dioica, can be made into a pleasant tea and consumed throughout the day to increase fluid intake and to support kidney functions. However, some people are allergic to nettles.

Therapy

Colchicum is a general homeopathic remedy that can be used for pain relief during a gout attack. It is formulated from the same plant, Autumn crocus, as the drug colchicine, used in the conventional treatment of gout. Gout may be improved by having a constitutional remedy prescribed that is based on the tendency to develop the disease and its symptoms.

During the acute phase of gout, acupuncture can be helpful with pain relief.

Applications of ice or cold water can reduce pain and inflammation during acute attacks.

Allopathic treatment

Standard medical treatment of acute attacks of gout includes nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium (Aleve), ibuprofen (Advil), or indomethacin (Indocin). Daily doses until the symptoms have subsided are recommended. Colchicine(Colbenemid), is also used. Corticosteroids such as prednisone (Deltasone, prednisolone, and corticotropin [ACTH]) may be given orally or may be injected directly into the joint for a more concentrated effect.

Because these drugs can cause undesirable side effects, they are used for only about 48 hours so as not to cause major problems. Aspirin and other salicylates should be avoided, because they can impair uric acid excretion and may interfere with the actions of other gout medications.

Once an acute attack has been successfully treated, doctors try to prevent future attacks of gout and long-term joint damage by lowering uric acid levels in the blood. Colchicine is the drug of choice to deter recurrence. This medication can be very hard on the vascular system and the kidneys, however, and it is incompatible with a number of antidepressants, tranquilizers, and antihistamines. It should be avoided by pregnant women and the elderly.

There are two types of drugs used for lowering uric acid levels. Sometimes these drugs resolve the problem completely. However, the use of low-level amounts may be required for a lifetime. Uricosuric drugs, such as probenecid (Benemid) and sulfinpyrazone (Anturane), decrease urates in the blood by increasing their excretion.

These drugs may also promote the formation of kidney stones, and they are contraindicated for patients with kidney disease. Xanthine oxidase inhibitors block the production of urates in the body. They can dissolve kidney stones as well as treat gout. Allopurinol is the drug most used in this respect. Its adverse effects include reactions with other medications, and the aggravation of existing skin, vascular, kidney, and liver dysfunction.

Expected results

Gout cannot be cured, but it can be managed successfully. Prompt attention to diet and reducing uric acid levels will rectify many of the problems associated with gout. Kidney problems can also be reversed or improved. Tophi can be dissolved or surgically removed, and with the tophi gone, joint mobility generally improves. Gout is generally more severe in those whose initial symptoms appear before age 30. The coexistence of hypertension, diabetes, or kidney disease can make for a much more serious condition.

Prevention

For centuries, gout has been known as the “rich man’s disease,” a disease of overindulgence in food and drink. While this view is perhaps oversimplified, lifestyle factors clearly influence a person’s risk of developing gout. For example, losing weight and limiting alcohol intake can help ward off gout. Since purines are broken down into urates by the body, consumption of foods high in purine should be limited. Foods that are especially high in purines are red meat, organ meats, meat gravies, shellfish, sardines, anchovies, mushrooms, cooked spinach, rhubarb, yeast, asparagus, beer, and wine.

Dehydration promotes the formation of urate crystals, so people taking diuretics, or “water pills,” may be better off switching to another type of blood pressure medication. Increased intake of fluids will dilute the urine and encourage excretion of uric acid. Therefore, six to eight glasses of water should be consumed daily, along with plenty of herbal teas and diluted fruit juices.

Consumption of saturated fats impedes uric acid excretion, and consumption of refined carbohydrates, such as sugar and white bread and pasta, increases uric acid production. Both should be seriously limited.

The use of vitamin C should be avoided by people with gout, due to the high levels of acidity.

Grains-of-paradise Fruit

Grains-of-paradise fruit is a member of the Zingiberaceae family (ginger group), which is a major family of tropical and subtropical fruits. It is also known as Guinea grains, Melegueta pepper, Piper melegueta and Aframomum melegueta roscoe, which is its botanical name.

Aframomum melegueta roscoe is a perennial herb that produces a spicy edible fruit commonly found in the tropical regions, particularly of western Africa. It is somewhat palm-like in appearance, forming dense clumps and growing to a height of 4-5 ft (1.2-1.5 m), with divided smooth leaves that can be up to 9 in (23 cm) long.

There are two types of grains-of-paradise fruit. They resemble the spice cardamom in appearance and pungency, and the commercial variety is perhaps even closer in appearance and scent. True grains-of-paradise fruit tends to be less pungent than cardamom once cooked or heated, however.


The seeds are approximately oval in shape, hard, shiny, and reddish-brown color, whereas cardamom is pale buff-colored. Powdered grains-of-paradise fruit are pale gray. This spice is aromatic and can be distinguished by its hot peppery taste.

General use

In Africa and throughout the tropics, grains-of-paradise fruit (Aframomum melegueta) is a cultivated crop and is used as a remedy for a variety of ailments, although it is now rarely used outside these areas. It is one of the plants extensively made use of by African ethnomedicine.

Some confusion surrounds the identity of the true grains-of-paradise fruit, as approximately seven species of fruit are also sometimes mistakenly referred to as grains-of-paradise fruit, particularly Malabar cardamom, Cardamomum malabaricum, and Cardamomum minus, also the Zanzibar pepper. Grains-of-paradise fruit have even been confused with Nux vomica, which is used as a homeopathic remedy.

In fact, it is now recognized that Aframomum melegueta roscoe is the authentic species. The name “grains-of-paradise fruit” dates from the Middle Ages, and denotes the fact that it was once a highly valued commodity. The west African coast became known as the Grain Coast because grains-of-paradise fruit was traded there.

Considered to be spicy, hot, and slightly bitter, the active constituents of grains-of-paradise fruit include essential oils such as gingerol, paradol, and shagaol. It also contains manganese, gum, tannin, starch, and a brown resin. It has been proven to be an effective antifungal and antimicrobial agent.

Like cardamom, it is also used as a condiment, due to its pleasant taste, which is pungent without being intensely bitter. It is mainly used nowadays to flavor wines, spirits, and particularly beer, although during the Middle Ages it was a favorite spice in Europe and other parts of the world. This spice, despite its popular beginnings, is hardly known outside of Africa today. Nevertheless, it remains popular as a spice in Arab cuisine, particularly Morocco and Tunisia. It has also been used as a pepper substitute, and may be chewed in cold weather to warm the body. In addition, it is a common addition to veterinary remedies.

The essential oil of grains-of-paradise is available, though not easy to find. Its properties are similar to those of the fruit, but it is often chosen for its fragrance. Grainsof- paradise fruit is used in African countries as an aphrodisiac as well as a treatment for measles and leprosy. Interestingly, extract of Aframomum melegueta has been shown in laboratory studies to increase sexual arousal and behavior in male rats. It is also used to reduce hemorrhage, particularly associated with childbirth.

Other phytomedicinal uses of grains-of-paradise include as a purgative (strong laxative), galactogogue (to increase production of breastmilk), anthelmintic (antiparasitic— it is effective against worms, etc.), and hemostatic agent (purifies the blood). It has even been found to be effective against the dreaded schistosomiasis, which is a major problem to the medical authorities on the African continent.

Grains-of-paradise fruit is also effective against intestinal infections and infestations, and is also used to calm indigestion and heartburn. Interestingly, grainsof- paradise fruit is one of the plants presently being researched as a possible alternative to allopathic medicines in tropical countries, where they are attempting to find cheaper and more readily available local phyto-medicinal alternatives to their common health problems, which are chiefly the effects of tropical diseases. Phyto-medicines have often proved to be more effective than synthetic agents. In addition they have a more sympathetic effect on the body, and their production is compatible with current environmental concerns.

Grains of paradise are also used in Chinese herbal medicine, their use being interchangeable with the more readily available cardamom. It is taken for nausea and vomiting, intestinal discomfort, and pain and discomfort during pregnancy.

Preparations

The fruit is exclusively the part of the plant used, dried, whole, or powdered. The essential oil can also be obtained. The whole grains may be chewed or can be ground and incorporated into mixtures.

Precautions

As grains-of-paradise fruit is a name given to so many other spices, it is advisable to ensure that the correct species is obtained.

Aframomum melegueta roscoe is included in the FDA’s list of botanicals that are generally recognized as safe.

Side effects

No side effects have been reported from grains-ofparadise fruit as of 2002; however, this spice is not frequently used in the United States. People who are allergic to cardamom or ginger should use grains-of-paradise fruit with caution.

Interactions

As of 2002, no interactions have been reported with standard prescription medications.

Grapefruit Seed Extract

Grapefruit seed is prepared in extract form from the seeds, pulp, and white membranes of grapefruits from grapefruit trees (Citrus paradisi). The grapefruit tree, first discovered on the Caribbean island of Barbados in the seventeenth century, was brought to Florida in 1823 for commercial cultivation. The plant was probably named grapefruit because its fruits grow in bunches or clusters. Grapefruit seed extract (GSE) is used as a broad spectrum, non-toxic, antimicrobial compound. The extract comes in two forms, liquid and powder.

GSE was developed by Dr. Jacob Harich, a physicist who was born in Yugoslavia in 1919 and educated in Germany. His education in nuclear physics was interrupted by Word War II. After witnessing the horror of war as a fighter pilot, Harich decided to devote the rest of his life to improving the human condition.

He then expanded his educational pursuits to include medicine, including gynecology and immunology. He came to the United States in 1957 to study at Long Island University in New York. As an immunologist, he was interested in studying natural substances that might help protect the body from undesirable microorganisms.


In 1963, he moved to Florida, the heart of grapefruit country, and began research on the use of grapefruit seeds as a biocide. By 1990, holistic health practitioners began to recommend the use of GSE to their patients. In 1995, Harich was invited to the Pasteur Institute of France, a leading AIDS research center.

Researchers at the Center have been investigating the potential of GSE as a prophylactic against the HIV virus as well as against some of the secondary infections associated with AIDS. He was also honored by farmers in Europe who use a powdered form of GSE in fish and poultry feed to control Salmonella and Escherichia coli. In 1996, Harich passed away.

General use

GSE is a broad spectrum bactericide, fungicide, antiviral, and antiparasitic compound. When used in vitro, GSE has been shown to be highly effective against a broad spectrum of bacteria, including Staphyloccus aureus, Streptococcus pyogenes, Salmonella typhi, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Shigella dysenteriae, Legionella pneumoniae, Clostridium tetani, Diploccus pneumoniae, and many others. GSE also strongly inhibits many types of pathogenic fungi and yeast.

Examples of external uses of GSE include:

• mouth and lips: mouthwash, mouth ulcers, thrush, bad breath, cracked lips, sunburned lips, and cold sores
• teeth and gums: plaque, tooth decay, toothaches, tooth extraction, gingivitis, and toothbrush cleaner
• nose and sinuses: sinusitis, runny nose (rhinitis), and nasal ulcer
• throat: sore throat, tonsillitis, coughs, hoarseness, and laryngitis
• ears: ear cleaning, earaches, and inflammation of the middle ear (otitis media) in conjunction with internal use
• face: acne and shaving
• scalp and hair: shampoo, dandruff, itching scalp, and head lice
• skin: small cuts, skin abrasions, scratches, minor burns, rashes, dermatitis, psoriasis, shingles, eczema, nettle rash, insect bites and stings, tick and leech bites, leg ulcers, warts, and skin fungi
• feet: athlete’s foot, sweaty feet, calluses, corns, blisters, nail fungi, and cuticular infections
• vagina and genitals: vaginitis, yeast infections, vaginal parasites, feminine hygiene, and fungal and parasitic diseases in the male genital area

Examples of internal uses include:

• acute and chronic inflammations in general
• colds and flu
• gastrointestinal infections
• vastritis and gastric and duodenal ulcers
• Candida albicans and other fungal diseases
• parasitic diseases
• allergies

Preparations

Grapefruit seeds and pulp contain a combination of bioflavonoids and polyphenolic compounds. The polyphenols are unstable but are chemically converted during the GSE synthesis process into more stable substances that belong to a class of compounds called quaternary ammonium compounds. The active quaternary ammonium compound in GSE believed to be responsible for its antimicrobial properties is a diphenol hydroxybenzene complex.

The antimicrobial activity appears to develop in the cytoplasmic membrane of the microorganisms. The active ingredients disorganize the cytoplasmic membrane so that the uptake of amino acids is prevented. At the same time there is a leakage of low molecular weight cellular contents through the cytoplasmic membrane. Studies have also shown that GSE inhibits cellular respiration.


The extract is prepared by grinding grapefruit seeds and pulp into a fine powder. The powder is dissolved into purified water and distilled to remove fiber and pectin. The distilled slurry is spray dried at low temperatures forming a concentrated grapefruit bioflavonoid powder.

This concentrated powder is dissolved in vegetable glycerin and heated. Food grade ammonium chloride and ascorbic acid are added. This mixture is heated under pressure where it undergoes catalytic conversion using natural catalysts, including hydrochloric acid and natural enzymes. The slurry is then cooled, filtered, and treated with ultraviolet light. Residual ammonium chloride in the final product is between 15 and 18%; residual ascorbic acid is between 25 and 35 mg/kg.

There is no residue of hydrochloric acid in the final product. In the United States, standardized GSE contains 60% grapefruit extract materials and 40% vegetable glycerin. A powdered form of GSE is also available that contains 50% grapefruit extract materials, 30% silicon dioxide, and 20% vegetable glycerine.

To treat infections, 15 drops in 8 oz of water is used. For diaper yeast infections and as a vaginal douche, 10–15 drops of grapefruit seed extract is used in 4 oz of water.

Precautions

GSE has been shown to be non-toxic at levels many times greater than the recommended dosages. Even when taken daily, GSE seldom produces a significant allergic reaction. However, people who are allergic to citrus fruits should exercise caution in the use of GSE.

Citricidal®, the brand name of a GSE product in the United States containing 60% grapefruit seed extract in an aqueous, vegetable glycerine solution, has, in the United States, been labeled as GRAS (Generally Recognized as Safe) in the Code of Regulations. The Food and Drug Administration (FDA) has approved Citricidal® for cosmetic preparations. In addition, Citricidal® has also been approved by the FDA for the disinfection of foods.

Generally, GSE should never be used at full strength. GSE is extremely irritating to the eyes. If it gets into the eyes, a person should wash the eyes with large amounts of warm water and consult a physician, if necessary.

After an excessive ingestion of GSE, an individual should drink large amounts of water and take up to 3 tsp of psyllium husks (or up to 6 psyllium capsules). A doctor should be consulted, if necessary.

Side effects

Since GSE is quite acidic, if it is not properly diluted, it may further irritate already irritated tissues, such as a stomach or intestinal lining.

Interactions

Over 75 different combination herbal preparations containing GSE are available, based on the assumption of Chinese herbal medicine that combinations of substances are more beneficial than single remedies. In addition, the antimicrobial properties of GSE make it an excellent preservative, thus enabling the herbs it accompanies to retain their potency.

Grape Seed Extract

Grape seed extract is the primary commercial source of a group of powerful antioxidants known as oligomeric proanthocyanidins (OPCs), also generically called pycnogenol, a class of flavonoids. Laboratory studies have indicated OPCs are much more effective than vitamin C and vitamin E in neutralizing free oxygen radicals, which contribute to organ degeneration and aging in humans.

The primary sources of OPCs are pine bark extract and grape seed extract. However, the grape seed extract is more widely recommended for its lower cost and because it contains an antioxidant not found in pine bark.

General use

Grape seed extract is a mixture of complex compounds. It has a wide range of therapeutic uses, from preventing cancer and cardiovascular disease to alleviating symptoms of allergies, ulcers, and cataracts. Its antioxidant properties are believed to help slow the aging process.


Procyanidins, a group of compounds found in the extract, are thought to increase the effectiveness of other antioxidants, especially vitamin C and vitamin E, by helping them regenerate after neutralizing free radicals in the blood and tissue. OPCs in the extract are water-soluble, making them easily absorbed by the body.

They also are able to cross the stubborn blood-brain barrier, providing antioxidant protection to the brain and nervous system. Most of the research on grape seed extract has been done in Europe, so many of its reported benefits have not been reviewed or approved by the U.S. Food and Drug Administration. It is available as an over-the-counter supplement.

According to Varro E. Tyler, dean emeritus of the Purdue University School of Pharmacy and Pharmacal Sciences, the procyanidin compounds found in grape seed extract are useful in treating vascular disorders They also are antioxidants, or freeradical scavengers, that help prevent some age-related cancers and atherosclerosis.

Grape seed extract is a relatively new supplement in the United States, although it has been used in Europe for several decades. Its antioxidant properties were realized in the 1980s with the socalled French paradox, in which researchers discovered that the French had low rates of heart disease even though their diet was high in cholesterol.

This was credited to their widespread consumption of red wine. Further research led to the OPCs concentrated in grape seeds. More recent research suggests that grape seed extract may work at the genetic level, activating a gene that stops oxidation of bad cholesterol. A 2003 study found that grape seed extract worked well in replacing estrogen and blunting hypertension in postmenopausal women.

Cardiovascular disease

European studies have shown procyanidins to be useful in treating blood vessel disorders, such as fragile capillaries and poor circulation in the veins. Components bind to the walls of the capillaries, making them less likely to break down with the effects of aging. In one European study, researchers found that treatment with grape seed extract quickly relieved a chronic condition of poor circulation in the veins.

Grape seed extract also has been beneficial in treating edema, an excessive accumulation of fluid in tissue. Another use of grape seed extract is reducing blood pressure in people with hypertension. A study published in 1998 by cardiovascular researchers at the University of California, Davis, found that flavonoids in the extract helped increase flow in blood vessels, contributing to better regulation of blood pressure.

Cancer

A study published in 1998 by a team of researchers at Creighton University, Georgetown University Medical Center, and the University of Nebraska at Omaha, reported that grape seed extract significantly inhibited and sometimes killed human cancer cells, while promoting the growth of normal healthy cells.


The extract was effective in killing 34–48% of breast, lung, and stomach cancer cells. It was not effective in destroying leukemia cells. Other studies have shown grape seed extract, combined with other antioxidants, can reduce the overall risk of developing cancer.

Respiratory conditions

Grape seed extract has been found to be beneficial in treating several respiratory conditions, including asthma, emphysema, allergies, and sinusitis. Pycnogenol helps inhibit the production of histamines, which decreases sensitivity to pollens and food allergens, thereby reducing allergic reactions.

Other conditions

OPCs in grape seed extract have shown effectiveness in treating a variety of other conditions. As an antiinflammatory, it helps prevent swelling of joints, heals damaged tissue, and eases pain in people with arthritis. Studies have shown OPCs can stop cataract progression, treat and prevent glaucoma, and aid in treating several types of retinal disease.

One of the extract’s most popular uses is in treating the effects of aging, including preventing wrinkles by protecting the skin against ultraviolet radiation damage from sunburn, improving skin elasticity and tone, and helping reduce the appearance of scars and stretch marks. A wide range of anecdotal reports tell of grape seed extract helping treat or reduce the effects of headaches, hemorrhoids, diabetes, prostate enlargement, and cellulite, although no clinical research supports these claims.

Preparations

Grape seed extract generally is available in 50 mg (milligram) and 100 mg capsules. The acceptable adult daily dosage has been estimated at up to 150-200 mg, or 50 mg per 50 lb (22.7 kg) of body weight. In Europe, OPCs usually are prescribed at 300 mg a day to treat medical conditions such as varicose veins, edema, allergies, inflammation, and skin aging.

The extract contains varying amounts of proanthocyanics, although the label should indicate about 75–80% proanthocyanidins to be effective. Research in the United States and Europe has shown it is most effective when used in combination with other antioxidants, especially vitamin C and vitamin E. Grape seed extract is fully absorbed by the body within one hour after consumption. One-half the original dose is still functional within the body after seven hours.

In 2003, a liquid grape seed extract was made available in the United States. This version can be used in a number of beverages, including bottled water, without changing their taste. A 2003 trial at Ohio State University found that lotions made with grape seed extract helped cuts heal more quickly than they would on their own. The lotion helped improve blood flow to the wound site.

Precautions

There are no known precautions associated with grape seed extract. However, persons with serious conditions such as cancer, diabetes, and cardiovascular disease should not substitute grape seed extract for their existing treatments without first consulting with their doctor. There is no clinical evidence that grape seed extract can cure any of these conditions.

Since grape seed extract is water-soluble, any excess intake that is not used by the body is eliminated in the urine. Studies have shown it is not carcinogenic, does not cause birth defects, and does not cause cells to mutate. Pregnant women and those with autoimmune conditions should probably avoid grape seed extracts. It is best to check with a clinician to ensure the safest dosage is being taken, as reports may vary on the latest research.

Side effects

Nausea and upset stomach have been reported on occasion. More rarely, allergic reactions in the form of temporary skin rashes have occurred in persons sensitive to grape products. There are no reported serious side effects associated with taking grape seed extract. It is non-toxic, even at high dosages.

Interactions

There are no reported negative interactions associated with grape seed extract. However, several studies done in the United States and Europe show the extract has a positive reaction with vitamin C and vitamin E. Studies have shown that OPCs in grape seed extract are as much as 50 times more potent than those in vitamin E and up to 20 times more potent than OPCs in vitamin C.

Grape Skin

Grape skin, the outer layer of the grape (Vitisvinifera), is either green, red, or purplish-black in color. The skin, stem, seeds, and juice of the grape are used in making wine. Although the skin, stem, and seeds are often used in making the nutritional supplement, grape skin extract, the extract sometimes contains grape skin only. Generally, the skin of red grapes is used in making nutritional supplements.

History

In 1535, sailors on Jacques Cartier’s expedition to Canada became seriously ill with scurvy, a vitamin deficiency. This degenerative disease of connective tissues was caused by the lack of vitamins in the typical seafarer’s diet—a menu of dried meat and biscuits. The crew was saved by the advice of a Native American, who recommended drinking tea made from the bark of a particular species of pine tree. In the 1930s, researchers discovered that the ascorbic acid (vitamin C) in fruits and vegetables prevented scurvy.

The pine extract, however, contained very little vitamin C. For more than 50 years, European biochemists have been researching the seafarers’ more likely rescuer— a family of antioxidant polyphenols (acid compounds) called pycnogenols, whose primary active compounds are pigments called oligomeric proanthocyanidins (OPCs). French chemist Jack Masquelier isolated OPCs from peanut skins in 1947 and coined the term “pycnogenols” to describe the unique class of polyphenols to which OPCs belong.


Although people have been drinking wine for centuries, scientific research into the health benefits of products derived from red grapes began in Europe in the mid to late twentieth century. Supplemental OPCs have been used in Europe since 1950 to treat weak blood capillaries, postsurgical edema (swelling), cirrhosis (liver disease), varicose veins, and diabetic retinopathy (eye disease resulting from diabetes).

Early identification of OPCs as useful for treating capillary fragility gave researchers some indication of their potential value in connective tissue disorders. However, this limited focus tended to overlook the additional therapeutic possibilities of OPCs and, until the latter part of the twentieth century, distracted scientists from investigating broader uses for OPCs.

Aside from pine bark, OPCs are concentrated in grape seeds and skins, wine, green and black teas, beans, and the skins of many fruits. Generally, the more intense the color, the more OPCs in the food, which explains why red wine has a greater health benefit than white wine. When red wine is made, the “must” is used—the skins, seeds, and stems.

The must is left in the mixture for a long period of time as the wine ferments and the OPCs emerge, giving red wine its characteristic flavor and color. In the case of white wine, however, the must is taken out early, so the wine neither darkens nor absorbs as many OPCs. Grape juice also contains OPCs. However, researchers have found that grape juice may not confer the same health benefits as red wine.

Biologic components

Red grape skins contain an array of bioflavonoids (quercetin, catechins, flavonols, and anthocyanidins) and nonbioflavonoid polyphenols (acid derivatives). One important nonbioflavonoid in grape skin is called resveratrol. Resveratrol is a plant-specific enzyme that exists in 72 plant species, such as grapes, peanuts, and pine trees. Grapes are the most abundant source of this health-promoting enzyme.

Resveratrol’s presence in the plant is induced by stress, injury, infection or ultraviolet irradiation. It is thought that the injury to the grape skin, produced during the wine-making process, significantly increases resveratrol levels. The relatively high quantities of the enzyme in the grape skins are thought to help the plant resist fungal infections, diseases, adverse weather, and insect or animal attack.

General use

There are many possible therapeutic applications of the resveratrol in red grape skin. In clinical studies, resveratrol demonstrated equivalent or better anti-inflammatory effects compared to the well-established anti-inflammatory drugs phenylbutazone and indomethacin. In animal studies, resveratrol inhibited both the acute and chronic phases of inflammation.


In humans, some researchers have found that resveratrol thins the blood more effectively than aspirin, which is often used to decrease the risk of a heart attack. In fact, the phrase “French paradox” refers to the idea that although French men consume a high-fat diet, they have one-third as many heart attacks as American men. Moreover, French men have high cholesterol and blood pressure levels similar to their American counterparts. Researchers have discovered that the main reason for this phenomenon is the OPCs from the grape skin, not the alcohol content, in the red wine that the French drink.

Preliminary tests in animals also indicate that resveratrol may interfere with the development of cancer in three ways: by blocking the action of cancer-causing agents, by inhibiting the development and growth of tumors, and by causing precancerous cells to revert to normal.

Although researchers are uncertain about how much resveratrol is needed to produce beneficial effects in humans, supplementation with red grape skin extract or consuming a glass or two of red wine may prevent or alleviate the following conditions:

• aging 
• bruising (capillary fragility) 
• cancer (cancer-inhibiting effects) 
• diabetes 
• fungal infection 
• heart disease (hardening of the arteries and high cholesterol) 
• inflammation (including bursitis and tendonitis) 
• Raynaud’s syndrome (a blood vessel disorder) 
• varicose veins 
• vision problems (including cataracts and glaucoma) 
• wound healing

Preparations

Red grape skin extract is prepared in capsule form as a nutritional supplement. For adult maintenance, the therapeutic range is thought to be 200–600 mg at 30% anthocyanins (OPCs), although guidelines have not been definitively established.

The resveratrol found in red grape skin and its extract is also found in red wine and concord grape juice. However, grape juice has been found to have fewer benefits than red wine, due to the technique for processing the grapes. For example, grape juice has only one-third the anti-clotting properties of red wine.

Precautions

Although research is limited, scientific investigators have not issued any precautions regarding the use of grape skin or grape skin extract. However, people should be aware of the known side effects of red wine and resveratrol.

Side effects

There are many potential side effects to consuming excessive quantities of red wine (such as allergic reactions to sulfites, intoxication, and liver damage) in order to obtain the health benefits of resveratrol. Each individual must weigh the risks versus the benefits of consuming alcohol.

However, resveratrol itself is also a phytoestrogen (plant estrogen). The estrogenic properties of this chemical may play a role in the beneficial cardiovascular effects in red wine. These positive effects include increasing high-density lipoprotein (HDL), the “good cholesterol.”

On the other hand, it has been noted that drinking red wine may support the proliferation of certain breast cancer cells that require estrogen for growth. Thus, resveratrol may have undesirable side effects in some people, including those women with a history of breast cancer or postmenopausal women taking hormone replacement therapy.

Interactions

Scientific investigation on the interactions of grape skin or grape skin extract with drugs, foods, or diseases is very limited and inconclusive. However, if the resveratrol in grape skin is consumed in red wine, a wide range of adverse interactions with drugs and foods may result. It is advisable to consult a physician before consuming alcohol in combination with any type of prescription or over-the-counter medication.