The Everything Guide to Herbal Remedies: An easy-to-use reference for natural health care

CHAPTER 5

Older Adults

In the United States today, the number of seniors—and their percentage of the entire population—is at a record high and getting higher. According to the latest government statistics, there are now more than 35 million people over the age of sixty-five in the United States (that’s 12 percent of the population). By 2030, a full 20 percent—more than 71 million people—will be sixty-five or older.

Living Longer—and Better?

Life expectancy in the U.S. continues to increase—men can expect to live to seventy-five years, and women to eighty. At the same time, mortality from diseases like cancer and cardiovascular disease are declining, meaning more and more Americans are surviving—and thriving—in their Golden Years.

Studies show that it’s never too late to improve your health. Seniors can see big benefits from fairly small changes, reducing obesity, cancer, osteoporosis, and cardiovascular disease by as much as 50 percent simply by improving their diet and exercise habits. In some cases, seniors reap more health benefits from these lifestyle changes than any other age group.

But despite the drop in rates of deadly diseases, chronic conditions like high blood pressure (hypertension) and osteoarthritis continue to plague seniors. Chronic diseases are the leading cause of death in older Americans and are also responsible for roughly two-thirds of all health care costs (and 95 percent of seniors’ health care expenditures). According to the Centers for Disease Control and Prevention (CDC), more than 80 percent of American seniors are living with at least one chronic condition, and 50 percent have at least two.

In the absence of disease, aging is a fairly noneventful process, and many people can maintain their regular activities for many years after retirement. Getting older doesn’t necessarily mean losing your health. In fact, many of the things that were once thought of as “normal” signs of aging, like wrinkles, cataracts, and arthritis, are now known to be signs of a disease process (or evidence of exposure to environmental factors that can be avoided).

The most common chronic conditions—including hypertension, arthritis, heart disease, diabetes, and stroke—cause pain, disability, and loss of functioning (and independence) for millions of people, and many produce cumulative and potentially fatal damage if left untreated.

Herbal medicine is uniquely suited to treating and preventing many of the chronic conditions that affect seniors. That’s because herbs work gently—and synergistically—within the body instead of attacking a single problem or masking symptoms. They work with your body’s own processes, not against them, meaning they support your body’s efforts to maintain health and help your body defend itself against a disease instead of attacking the disease itself.

Seniors and Health

Seniors have a unique set of health concerns. Their bodies are different from anyone else’s, they’re prone to different diseases and conditions, and in many cases their attitudes toward health care are different, too.

Aging produces changes in body weight and composition—both men and women typically get heavier as they enter the senior ranks, then tend to lose weight as they move into their seventies. As you get older, your body also becomes less efficient at regulating blood pressure, body temperature, and the balance of fluids.

Some diseases that are common in older people can disrupt cell production. For example, Alzheimer’s disease can cause the premature death of brain cells, and Parkinson’s disease can kill off too many nerve cells. In contrast, cancer slows normal cell death and allows cancer cells to multiply and spread instead of dying off like they’re supposed to. All of these changes affect how you live—how much and what kind of exercise you do, for example—as well as your health care needs.

Like any other segment of the population, seniors have a specific set of concerns regarding health care. But not all seniors are the same. No two people age at the same rate, and even within one person, not all body systems change in perfect harmony.

Seniors typically metabolize medicines, whether herbal or pharmaceutical, differently than younger people.

For example, because seniors typically weigh less and have a greater percentage of body fat, they have less lean muscle. As the ratio of body fat increases, the body reacts differently to drugs and other substances that are metabolized in fatty tissue, meaning that these substances typically remain in the body longer and thus may have stronger effects. Other substances accumulate because kidney function declines as people age. Nonsteroidal anti-inflammatory drugs, or NSAIDs, are more likely to cause gastrointestinal bleeding and kidney problems in seniors.

Many pharmaceuticals used by seniors can interact with herbs. For example, blood thinners and anticlotting agents can interact with Asian ginseng (Panax ginseng), dong quai (Angelica sinensis), ginkgo (Ginkgo biloba),ginger (Zingiber officinale), feverfew (Tanacetum parthenium), and garlic (Allium sativum). Heart medications like digoxin (Lanoxin) can cause problems when combined with Asian ginseng or Saint John’s wort (Hypericum perforatum).

All of this means that seniors should follow herbal dosing directions carefully. Most experts recommend people over seventy should take about 80 percent of the recommended adult dose of any herbal remedy; seniors who are very frail (or sensitive to other medications) should start at half the recommended dose. For more information on safety and possible interactions, see Chapter 17.

Cardiovascular Concerns

As you age, your heart muscle becomes less efficient and has to work harder to keep the blood circulating throughout your body. Blood vessels also suffer with age, becoming less elastic. As a result, cardiovascular disease, or CVD—a group of conditions that includes heart disease, hypertension, and stroke—becomes increasingly common in older people. For more information on CVD, see Chapter 7.

Burgeoning Blood Pressure

High blood pressure, a.k.a. hypertension, is a chronic condition involving elevated pressure of blood against the artery walls. It affects more than 65 million Americans, or one in three adults, and is most common in seniors (nearly 71 percent of adults over sixty-five have been diagnosed).

Chronic hypertension can leave your heart enlarged, which can cause heart failure. And it can create aneurysms, or bulges, in your arteries and other blood vessels, which can cause sudden death. Hypertension also can lead to atherosclerosis (see below), kidney failure, and blindness, and is the single biggest risk factor for stroke.

Cholesterol is tied to more than diet and family history. Several disorders that are common in seniors, including diabetes and hypothyroidism (low thyroid gland activity), can raise your cholesterol levels. And some prescription drugs, including steroidal anti-inflammatories like prednisone, dexamethasone, and hydrocortisone, can also affect lipid levels.

Hyperlipidemia, or High Cholesterol

Many seniors have hyperlipidemia, or elevated blood lipids (including cholesterol), which is one of the biggest risk factors for heart attack and stroke. Cholesterol is a soft, waxy substance that occurs throughout the body. Some is produced by the liver, some comes from food (especially eggs and meat). Cholesterol comprises a few different lipids: low-density lipoprotein (LDL), known as “bad cholesterol” because it tends to remain in the body, where it oxidizes and accumulates in your arteries as plaque, and high-density lipoprotein (HDL), the “good” cholesterol that’s generally eliminated from the body. Triglycerides are another type of lipid that’s measured along with LDL and HDL and included in your total cholesterol. Ideally, you’ll keep your total cholesterol (and LDL and triglycerides) low and your HDL high.

Hardening (and Clogged) Arteries

Arteriosclerosis is a general term for the thickening and hardening of arteries that occurs naturally as you get older. Atherosclerosis, which is a type of arteriosclerosis, involves the buildup of plaque, which is made up of cholesterol, cellular waste products, and other things that can accumulate in your arteries, narrowing and stiffening the passages.

Treatment Options

Conventional medicine treats CVD with drugs called ACE inhibitors, calcium channel blockers, and beta blockers, which can cause headaches, dizziness, fatigue, and nausea. Hyperlipidemia is generally treated with statin drugs, which decrease production of cholesterol by the liver and include atorvastatin (Lipitor) and rosuvastatin (Crestor); other drugs inhibit the absorption of dietary cholesterol, and include ezetimibe (Zetia), which recently was proven ineffective in preventing heart disease. These medicines can cause abdominal, back, and joint pain, among other things.

Purple grape (Vitis vinifera) juice, along with red wine, can lower blood pressure. Research shows that the chemicals in grapes work like a natural ACE inhibitor in the body (they decrease levels of angiotensin-converting enzyme, which constricts blood vessels in and around the heart).

But there are alternatives, including:

• Alfalfa (Medicago sativa)

The aboveground parts of this nutrient-rich plant can lower serum cholesterol levels.

• Artichoke (Cynara cardunculus, C. scolymus)

Extracts of this Mediterranean thistle lower cholesterol in a few ways. They stimulate the liver to release more bile, which helps eliminate dietary cholesterol and fat. And, like statin drugs, they inhibit a cholesterol- generating enzyme, so your body can’t make as much of its own. Artichoke extract also seems to improve your HDL/LDL ratio, and its antioxidants prevent LDL from turning into plaque.

• Flax (Linum usitatissimum)

High-fiber flaxseeds attach to cholesterol and prevent it from being absorbed. Research shows that taking almost any kind of flax—whole seeds, ground seeds, even muffins made with flax—can lower your cholesterol.

• Guggul (Commiphora wightii, C. mukul)

Ayurvedic practitioners use the resin from the guggul tree to treat hyperlipidemia. Studies have shown that guggul extracts can lower total cholesterol, “bad” cholesterol, and triglycerides.

• Maritime pine (Pinus pinaster)

Pine bark extracts can reduce blood pressure in cases of mild hypertension.

• Olive (Olea europaea)

There’s evidence that replacing other dietary fats with olive oil can lower your cholesterol and significantly reduce your risk of heart attack. Adding onion (Allium cepa) to your diet could also help lower your lipids.

• Pomegranate (Punica granatum)

Research shows that this antioxidant-rich fruit can improve several markers of CVD, including atherosclerosis, hypertension, ischemia (restricted blood flow), and elevated cholesterol.

• Turmeric (Curcuma longa)

Studies show that this anti-inflammatory and antioxidant spice can counteract high blood pressure and prevent heart failure.

• Garlic (Allium sativum)

Garlic has been shown to decrease the oxidation of LDL cholesterol, which is the mechanism that damages the heart arteries.

Maintaining Your Vision

Getting older also affects your eyes. They begin to produce fewer tears and also undergo structural changes: The retinas get thinner, the lenses get cloudier, and the irises lose flexibility, all of which mean loss in eyesight. In addition, seniors with diabetes are at risk of diabetic retinopathy, which can also cause vision problems.

Cataracts

A cataract is a clouding of the eye’s lens. It doesn’t hurt, but it can interfere with your vision and make it harder to read or drive a car. Age is the biggest risk factor for cataracts: About half of Americans over the age of sixty-five have some degree of cataract formation, and by the age of seventy-five, about 70 percent have cataracts serious enough to interfere with their vision.

Other factors that can contribute to cataracts include diabetes, excessive sun exposure, smoking, and prolonged use of corticosteroid medications.

Glaucoma

Glaucoma, a leading cause of vision loss and blindness in the United States, is actually a group of diseases that create excessive pressure inside the eye and damage the optic nerve, which takes the images that your retina picks up and transfers them to your brain. Glaucoma can reduce your peripheral vision or create “blind spots.” If left untreated, it can cause total blindness.

To save your sight, most experts recommend upping your dietary intake of plant foods such as leafy green vegetables and brightly colored fruits, which contain antioxidants such as vitamins C and E, beta-carotene, riboflavin, lutein, and lycopene. There’s extensive research that these nutrients can stave off age-related eye problems.

As with cataracts, age is the biggest risk factor (anyone over sixty is considered at risk). Glaucoma strikes blacks and Hispanics more often than whites, and is also more common in people who are nearsighted. Other risk factors include diabetes and corticosteroid use.

Macular Degeneration

Age-related macular degeneration, or AMD, is the leading cause of blindness and serious vision loss in seniors and affects more than 10 million Americans. AMD involves deterioration of the macula, which are cells shaped like cones and rods in your retina that control your ability to see what’s in the center of your field of vision.

Age is the biggest factor in developing AMD, but it’s also more common in women and whites (especially people with light-colored eyes). Cardiovascular disease, smoking, obesity, and long-term exposure to sunlight can also up your risk.

Diabetic Retinopathy

As its name implies, this is a disease of the retina that often accompanies diabetes—in fact, as many as 45 percent of diabetics have some degree of retinopathy. It’s caused by diabetes-induced damage to the blood vessels in the retina and can create symptoms ranging from mild vision problems to total blindness. It’s one of the biggest causes of blindness in U.S. adults. For more on diabetes, see Chapter 7.

Treatments for Eye Troubles

Because these conditions can advance rapidly and cause serious consequences, you should see your doctor immediately if you experience any significant changes in your vision. Advanced cases of eye disease may require surgery or other procedures (macular degeneration is sometimes treated with a laser).

Consuming lots of omega-3 fatty acids—the essential fatty acids (EFAs) found in flax (Linum usitatissimum) seeds and oil—has been associated with lower rates of age-related macular degeneration. Flax is one of the few nonanimal sources of omega-3s (they’re mostly found in fatty fish like salmon).

Anti-inflammatory drugs, including steroids, are also prescribed in some cases. Several herbs have been proven effective in preventing eye diseases and lessening their progression and symptoms. They include:

• Bilberry (Vaccinium myrtillus)

Bilberry and its cousin the blueberry (Vaccinium angustifolium) contain a number of antioxidants. They’ve been proven effective against several age-related eye disorders, including cataracts, macular degeneration, and retinopathy caused by diabetes and hypertension.

• Ginkgo (Ginkgo biloba)

Ginkgo has proven antioxidant effects and has been shown to improve vision in people with diabetic retinopathy, glaucoma, and AMD.

• Grape (Vitis vinifera)

Grape seeds contain powerful antioxidants called proanthocyanidins, which reduce oxidative damage to eye tissues. Research shows that grape seed extracts can improve vision and decrease eye stress.

• Maritime pine (Pinus pinaster)

Taking pine bark extracts can halt the progression of diabetic and other types of retinopathy and improve vision.

Healthy Bones and Joints

Getting older means losing bone mass and density: Bones are at their peak in your early thirties and go downhill from there. This creates changes, some harmless (you might get shorter) and some problematic (you can develop osteoporosis and be more prone to fractures). Many seniors also develop osteoarthritis from years of wear and tear on their joints.

The Challenges of Osteoarthritis

Osteoarthritis is a chronic condition that attacks the cartilage in the joints, wearing it away and eventually leaving bone rubbing against bone. Osteoarthritis is the most common type of arthritis, in seniors as well as the rest of the population. See Chapter 8 for more.

Osteoporosis

Osteoporosis involves a loss of bone mineral density that can lead to fractures. It occurs most often—about 80 percent of the time—in postmenopausal women, but it can also strike men or people with hormonal imbalances or who have used steroidal medications.

Around age thirty, most people stop building more bone, and the process of degradation begins. In women, this process accelerates right after menopause, but by age seventy, the rate of loss levels off in both men and women.

Many seniors can have balance and vision difficulties, suffer from conditions like Parkinson’s disease and arthritis (which can affect gait), and take one or more medications—including antidepressants and antianxiety drugs that can cause muscular problems, dizziness, and confusion—all of which make them vulnerable to falls.

Falls and Fractures

According to the CDC, one of every three U.S. seniors falls each year. Fractures are the most serious consequence of falling, and bones that are weaker than average due to osteoporosis simply break more easily. In fact, half of all women and a quarter of all men will have an osteoporosis-related fracture in their lifetimes.

Treatment Options

Conventional medicine treats osteoarthritis with NSAIDs, which can cause stomach bleeding and increased risk of heart attack. Many people also use topical creams that contain capsaicin, which is the primary constituent of the herb cayenne (Capsicum annuum, C. frutescens). Osteoporosis is usually treated with a class of drugs called bisphosphonates, the best known of which is alendronate (Fosamax). Fosamax can cause abdominal pain, gas, acid reflux, bone and joint pain, and nausea. Herbal treatments for osteoporosis include:

• Evening primrose oil (Oenothera biennis)

The seeds of this plant are rich in gamma-linolenic acid (GLA) and linoleic acid, which are used in the body to manufacture anti-inflammatory substances. Studies show that taking evening primrose oil can decrease bone turnover and increase bone mineral density in people with osteoporosis.

• Red clover (Trifolium pratense)

The isolflavones in red clover seem to inhibit bone loss in women by acting like weak estrogens in the body.

• Soy (Glycine max)

Soy can both prevent bone loss and increase bone mineral density. Research has shown that soy can reduce signs of osteoporosis in pre-and postmenopausal women.

• Tea (Camellia sinensis)

Tea contains compounds that seem to build and strengthen bone. Research suggests that drinking green tea for several years can increase bone mineral density in both men and women.

Herbs for osteoarthritis include the following:

• Devil’s claw (Harpagophytum procumbens)

Studies show that extracts of this South African herb can reduce osteoarthritis pain.

• Ginger (Zingiber officinale)

Ginger is an anti-inflammatory, and studies have shown that ginger extracts can reduce the pain of osteoarthritis. Ginger also seems to act as a structure-modifying agent, meaning it can foster changes in the arthritic joints instead of just masking the pain.

• Guggul (Commiphora wightii, C. mukul)

This Indian shrub produces a resin that’s a traditional Ayurvedic remedy for arthritis. Modern researchers have shown that oral preparations can relieve osteoarthritis pain.

• Nettle (Urtica dioica)

Best known as an herbal remedy for allergies, nettle extracts—taken orally or applied topically—seem to reduce arthritis pain, too.

Keeping Your Mind Sharp

As you age, the number of neurons, or nerve cells, in your brain naturally decreases, and you may notice changes in your short-term memory and other cognitive functions. Everyone can expect to develop some degree of age-related cognitive impairment, but some seniors will also develop dementia, which is a more serious condition.

Research shows that maintaining an active social life can significantly reduce your risk of dementia and Alzheimer’s disease. Older people who have large social networks—and maintain daily contact with friends and loved ones—are much less likely to develop dementia and more likely to maintain cognitive functioning.

Dementia

Dementia is not a disease, per se, but instead is a group of symptoms—including loss of memory, reasoning, planning, and social abilities—caused by degeneration of the tissues in the brain. It is diagnosed when a person shows impairment in two or more brain functions severe enough to interfere with daily functioning; it’s not associated with a loss of alteration or consciousness (meaning it’s not a type of amnesia) and it has not been present since birth (it’s not a congenital condition).

Although most people with dementia are elderly, dementia is not an inevitable part of aging. It’s caused by a group of brain diseases, of which Alzheimer’s disease is the most common.

Mild Cognitive Impairment (MCI)

Mild cognitive impairment is a type of dementia that lies somewhere between the changes of normal aging and the serious deficits of Alzheimer’s. While it’s not a definite predictor of Alzheimer’s, people with MCI are three to four times more likely to develop AD than people without it. Experts at the Mayo Clinic estimate that 12 percent of people over the age of seventy have MCI.

Alzheimer’s Disease

Alzheimer’s disease (AD), the most common cause of dementia in older people, affects about 5 million Americans—roughly 5 percent of people between sixty-five to seventy-four and nearly half of those over the age of eighty-five.

Treatment Options

There is no cure for dementia. Treatments—both conventional and herbal—focus on improving the patient’s quality of life and delaying, as much as possible, the disease’s progression.

AD drugs include galantamine (Razadyne) and donepezil (Aricept), which boost the levels of an enzyme called choline acetyltransferase that’s in short supply in people with Alzheimer’s. These drugs can produce side effects like diarrhea, fatigue, insomnia, muscle cramps, nausea, and vomiting.

Several herbs have a long history of use as brain aids, and several have shown promise against age-related cognitive decline, dementia, and Alzheimer’s, and can be taken in conjunction with conventional AD remedies.

• Garlic (Allium sativum)

Aged extracts of garlic have been proven in numerous studies to reduce inflammation and cholesterol levels, which can contribute to the development of dementia.

• Ginkgo (Ginkgo biloba)

The best known of the cognition-boosting botanicals, ginkgo has proven antioxidant and anti-inflammatory actions and has been shown to fight normal age-related cognitive decline as well as cerebral insufficiency (impaired blood flow to the brain) and several types of clinical dementia. Ginkgo has been shown to improve memory and attention in healthy young people, too.

• Grape (Vitis vinifera)

Several studies have found that drinking red wine is associated with lower incidence of Alzheimer’s disease. Other research has shown that extracts of grape seeds and skin can reduce age-related dementia and cognitive loss.

• Lemon balm (Melissa officinalis)

Extracts of this herb, long revered for its ability to calm anxiety, have been shown to reduce symptoms of mild to moderate Alzheimer’s disease.

• Rooibos (Aspalathus linearis)

Research shows that this South African “tea” can offset the damage to the central nervous system caused by aging.

• Sage (Salvia officinalis, S. lavandulaefolia)

Sage extracts have been shown to improve cognitive function in people with mild to moderate Alzheimer’s. Sage can also improve memory in younger people.

• Turmeric (Curcuma longa)

This aromatic South Asian spice contains a chemical called curcumin, which has been shown to inhibit the oxidation and other processes that are behind AD and other neurodegenerative diseases.