Hello Dr. Gary,

What vitamin or mineral should I take to help with my brittle, soft nails?

Anne

Hi Anne,

While it’s not a vitamin or mineral, the best supplement for your nails is the essential fatty acid, gamma linolenic acid (GLA). Dietary sources are limited, but GLA can be found in a variety of plant seed oils, including borage (22-25% GLA), black current (15% GLA), and evening primrose (8-10% GLA). Spirulina, a type of blue-green algae rich in GLA, has been recommended by some, but unfortunately there exists the possibility of neurotoxins and/or contamination with heavy metals, and I don’t consider it safe under any circumstance.

Potential issues: 1) If you take antiplatelet or anticoagulant drugs, such as aspirin, Plavix, coumadin, or Eliquis, GLA supplements may increase the risk of bleeding. 2) Borage oil can contain amabiline, which is a pyrrolizidine alkaloid (PA) toxic to the liver. If you choose borage oil as a GLA source, find one that is PA free. 3) The side effects of GLA supplementation are generally mild and may include belching, upset stomach, nausea and diarrhea.

Besides helping with nails, GLA can promote healthy hair and skin. Because it has significant anti-inflammatory activity, GLA can potentially benefit arthritis, PMS, and autoimmune diseases. Like many natural remedies, don’t expect overnight improvement, rather, be patient and give supplementation a trial of at least six to eight weeks.

The medical/health information is provided for general educational and informational purposes only, and is not a substitute for personal, professional advice. Accordingly, before taking any recommendations based on the information here, please consult with your primary care provider and/or appropriate professionals.    

Hi Dr. Gary,

I have chronic pain in some of my joints, which my doctor says is due to osteoarthritis. I’ve been taking ibuprofen with some improvement, but I’ve been wondering if you could recommend any other remedies? I appreciate any help you might be able to give.

Hillary

Hi Hillary,

Osteoarthritis is the degeneration of joint cartilage and underlying bone, usually from middle age upward. Prior overuse and/or injury can be precipitating factors. The most common treatment utilizes nonsteroidal anti-inflammatory drugs (NSAIDS), which work by inhibiting production of prostaglandins, thus reducing inflammation and pain. Taking such medications, which include aspirin, ibuprofen, naproxen, among others, is generally considered to be safe if taken episodically, but chronic dosing, especially in older patients, has the potential for serious side-effects, including life-threatening gastrointestinal bleeding from peptic ulcer disease, acute renal failure, and a litany of other problems. A general rule of thumb is that NSAIDS should be used at the lowest effective dose for the shortest period of time.

So, what should you do after taking a limited course of NSAIDS? Do you have to give up and accept suffering? Consider joint replacement surgery? Not to worry, other options are available. One excellent choice is turmeric. This bright-yellow spice from India often used in curries has been shown to have significant anti-inflammatory activity, and in an Italian study, demonstrated greatly decreased osteoarthritis pain as well as reduced need for NSAIDS. I recommend culinary use and/or supplements fortified with the active ingredient of turmeric, curcumin, to get the maximal effect. Another anti-inflammatory spice worth considering is ginger, taken either as a supplement or included in your diet. Also, think about adding evening primrose oil (EPO) to your regimen, which has beneficial anti-inflammatory activity. Other supplements to ponder include glucosamine sulfate, with or without chondroitin sulfate, realizing it can take up to two months to see results, and SAMe, which seems to be as effective as NSAIDS, but requires about a month of treatment before you might notice improvement.

Of course, it goes without saying that if you are overweight, weight loss can substantially improve osteoarthritis pain. Exercise can be beneficial, though if your symptoms are worse in your lower extremities, I would consider swimming, water aerobics, or stationary cycling to minimize further joint trauma. As a footnote, acupuncture has shown promise in the treatment of osteoarthritis. In one trial, one-fourth of arthritis patients who had been scheduled for knee surgery cancelled their operations because of improvement with acupuncture, and now some rheumatologists recommend acupuncture as an adjunctive therapy along with conventional medication.

Since information exists that suggests osteoarthritis is likely an inflammatory process, please consider a diet that is anti-inflammatory, rich in omega-3 fatty acids (wild-caught salmon, walnuts, freshly ground flaxseed, algal oil, etc.), along with plenty of different colored fresh fruits and vegetables. Likewise, you should avoid foods which are proinflammatory in nature, such as partially hydrogenated oils (margarine and vegetable shortening), and polyunsaturated vegetable oils.

In closing, I can personally attest to the benefit of an integrative approach to osteoarthritis. If you have read Oklahoma Is Where I Live, you know that some decades ago, I was told that due to osteoarthritis, I would need bilateral hip replacements. I resisted the notion and found that by simply doing Iyengar yoga, my symptoms were much improved. Years later, when my hips started once again with that gnawing, aching discomfort, sometimes waking me up at night, in addition to yoga I added a regimen that included fortified turmeric, EPO, and algal oil, along with my usual anti-inflammatory diet. This resulted in remarkable improvement, and while someday I may have to consider hip replacement, currently my symptoms are much improved, and for that, I am most grateful.

The medical/health information is provided for general educational and informational purposes only, and is not a substitute for personal, professional advice. Accordingly, before taking any recommendations based on the information here, please consult with your primary care provider and/or appropriate professionals.

Sometime back in the mid-1980s, I was attending a metaphysical workshop, an activity I enjoyed at that point in my life. While I don’t recall what the topic of the conference was, I do remember meeting Ann Smith. How could I not? She was friendly, exuberant, optimistic, and a sparkling bundle of spiritual energy. I liked her immediately, and we struck up a friendship.

Sharing an occasional lunch, I gradually learned more about her. She was deeply interested in the spiritual kingdom, believing that each angel and saint were there to guide humankind in their own unique way. Generally, Ann loved anything and everything that involved the occult, and that included auras, psychics, astrology, crystals, tarot cards, and continued connections with friends who had passed on before her. And talk about someone who loved good food! One of Ann’s great passions was fabulous eateries, and to describe her as a ardent and enthusiastic foodie would be a gross understatement. Will Rogers might have said, “Ann never met a restaurant she didn’t like.”

Looking back to the early 90s, when I realized my marriage was in trouble, I clearly recall the phone call I made to Ann. I was emotionally barely hanging on, and when she answered the phone, I haltingly mumbled, “Ann . . .” before I burst into uncontrollable tears. Trying to regain my composure, I said, “I’m so sorry . . .” before I began weeping again. She softly replied, “Keep crying,” and I did, until I had no more tears left. Ann knew tears were healing, and she allowed me to cry for as long as I needed. I would have never guessed how many years it would take me to heal from my divorce, but Ann was with me every step of the way, and for that, I will always be grateful.

I could go on and on about what a wonderful friend she was, but instead I’d like to share just a few highlights. Ann was delighted beyond words when I met and eventually married Sheridan, believing that the suffering I experienced with my divorce all those years ago was necessary not only for my spiritual growth, but also to give me the opportunity for a loving, new beginning. When I began writing books in 2008, starting with The Lhasa Trilogy, she was an enthusiastic supporter, and all of her friends simply had to have copies of each of my books. I could have not had a better promoter than the exuberant, energetic, bubbly Ann Smith. She was also known as “Auntie Ann” to our dogs, Karma and Buddy, and she lavished attention and care on them when Sheridan and I traveled to faraway places.

When Ann was diagnosed with colon cancer at eighty-four years of age, I knew her prognosis was poor, yet she maintained an upbeat attitude. She had experienced a full and rich life, and she was not afraid of dying. With time, our restaurant visits declined, a sure sign Ann was not doing well, and she eventually entered hospice care.

Before she died, Sheridan and I paid her a visit. I was surprised at how much weight she had lost. She was pale, her blood pressure was extremely low, yet she continued to be at peace with her approaching death. The three of us held each other’s hands, and after we expressed our love for each other, I asked her what she thought was the most important thing she had learned over her eighty-five years. She paused for a moment, smiled and said with a twinkle in her eyes, “Know when to say no.” Ann was a strong woman, always willing to speak her mind, not a shrinking violet by any stretch of the imagination, and I’ll remember her dying words for the rest of my life. Ann peaceably passed away two days later.

It’s impossible to describe in words what a loss Ann Smith’s death is not only to me personally, but also to the world. Her radiant, effervescent optimism was completely infectious, and without fail, she made the darkest times better. For me, I have lost a dear friend, a counselor, a lunch buddy, and someone I could always count on, no matter the circumstances. While I feel a profound sense of loss, I don’t feel sad, rather, I’m happy God has blessed me to have known Ann for over thirty-five years, and I feel joyous knowing that her journey will continue in the spiritual realms, her true and everlasting home. After all, hanging around with angels, saints and sages of all religions, her beloved passed friends, combined with a gourmet meal every now and then, well, that’s Ann’s idea of heaven. I can think of no one who deserves it more, and I have no doubt God has already prepared a lavish table for her.

The world will miss you greatly, Ann. You are a shining, scintillating beacon of light. I know, because I know you.

Bon voyage, my friend.

Abstract

Stinging nettle leaf (Urtica dioica) has been extensively utilized for centuries as a folk remedy for many varied ailments. In this case report, the herb appears to be an effective preventive for vertigo related to baro-challenge-induced Eustachian tube dysfunction.

Keywords:  Stinging nettle, Urtica dioica, vertigo, Eustachian tube dysfunction, baro-challenge-induced Eustachian tube dysfunction

Introduction

For some time, I’ve been troubled with vertigo associated with Eustachian tube dysfunction (ETD) that occurred with air travel, specifically termed baro-challenge-induced ETD.  The symptoms I experienced were not trivial; they included nausea, difficulty keeping my balance, diaphoresis, inability to focus my eyes, and constant movement of my environment. Initially, my symptoms were somewhat ameliorated by taking vitamin C powder, in advance of and during my flight, because of its known antihistaminic effect and documented improvement of vertigo (1). During a more recent flight, though, I had concurrent vomiting and wondered if I should try conventional antihistamines beforehand, hoping they would keep my Eustachian tubes patent. Yet, I preferred not to deal with the potential side effects, such as drowsiness, dry mouth, difficulty urinating, and reduced coordination (2). So, I tried another option, stinging nettle, with its antihistamine and anti-inflammatory properties (3), and a suspected milder adverse reaction profile. Three hours before my next scheduled departure flight, I took three 300 mg capsules of wildcrafted, freeze-dried stinging nettle leaf, along with a hot cup of organic stinging nettle tea. I repeated only the capsules for my return flight.  The results were astonishing.  Not only did my eustachian tubes easily clear on both flights simply with sipping fluids and exaggerated yawning, I had no symptoms of vertigo whatsoever, and I experienced no adverse reactions to the herb.

Discussion

ETD is a problem that affects around 1% of the general population and can be categorized into three different types. Patulous, caused by overly patent Eustachian tubes. Dilatory, where inflammation and mucosal edema from rhinitis, upper respiratory tract infection, and/or gastro-esophageal reflux disease (GERD), leads to blockage and dysfunction. Baro-challenge-induced, which is the failure of the Eustachian tube to open with surrounding ambient pressure changes, such as with air travel or deep-sea diving, thus inhibiting the regulation of middle ear pressure (4).

Conventional medical and surgical treatment options depend upon the type of ETD.  For GERD-associated ETD, lifestyle changes and proton pump inhibitors should be considered. Otherwise, avoidance of allergens is recommended, and medical interventions may include oral antihistamines and/or nasal corticosteroids. Antibiotics may be prescribed for rhinosinusitis.  Surgical dilatation of the closed Eustachian tube may be performed, and ETD from otitis media with effusion can be managed with tympanostomy tube placement. If adenoid hypertrophy is felt to be a contributing factor, adenoidectomy should be considered.  Auto-inflation devices for reopening the Eustachian tubes by raising the pressure in the nose have shown positive results for correcting middle ear pressure and fluid clearance. (ibid., 3-4)

Urtica dioica, known as stinging nettle, greater nettle, common nettle, giant nettle, European nettle, or simply nettle, is native to Europe and Eurasia and grows wild in temperate parts of the world. The use of nettle dates to ancient times, having been mentioned by Hippocrates (ca. 460-370 BCE) and Theophrastus (ca. 371-287 BCE), by Dioscorides (40-90 CE) in Materia Medica, and by Pliny the Elder (23-79 CE) in Naturalis Historia. In the medieval period, nettle was recommended by German philosopher, mystic, composer, and abbess Hildegard von Bingen (1098-1179) in Physica, and by Swiss physician Paracelsus (1493 – 1541) in his writings on the doctrine of signatures (5).

What are the current clinical uses for stinging nettle leaf?  The herb can be beneficial in the treatment of allergic rhinitis, osteoarthritis, and rheumatoid arthritis. Its diuretic effect has been demonstrated in vivo, and it has been shown in an isolated study to be effective in the treatment of migraine headaches (6).  Stinging nettle root, as opposed to the leaf, has been utilized to improve urine flow, decrease residual urine volume, and reduce urinary frequency and nocturia in the early stages of benign prostatic hypertrophy (BPH)(5). Despite much previous clinical research on stinging nettle leaf, I have discovered no study that indicates the herb can be utilized for the prevention of vertigo in general, or specifically, vertigo caused by baro-challenge-induced ETD.

As far as safety is concerned, the Botanical Safety Handbook (1997) of the American Herbal Products Association (AHPA) assigns Urtica dioica as a Class 1 herb: Can be safely consumed when used appropriately (6).

I have carefully evaluated the scientific data, and while the exact mechanism of how stinging nettle prevented my disabling vertigo is unknown, one might intuit this effect was due to the herb’s unique antihistaminic and anti-inflammatory activities.

Finally, on a personal note, I can’t explain in words the sense of relief that I had after my experience with the use of stinging nettle. I was, at long last, given hope that vertigo might no longer hang over my head like the proverbial sword of Damocles, dampening my enthusiasm for travel to faraway places.

Conclusion

In this case study, stinging nettle leaf appears to have aborted vertigo secondary to baro-challenge-induced ETD. Further human studies are needed for confirmation.

Acknowledgements

I want to express my gratitude to Andrew Weil MD for his helpful suggestions and review of this article.  Thanks to Dr. Chris Corbett for his adept editorial assistance.  Much appreciation to Dr. Stefan Gafner of the American Botanical Council for his aid in information gathering. 

References

1) R. Jarisch; D. Weyer; E. Ehlert; C. Koch; E. Pinkowski; P. Jung; W. Kähler; R. Girgensohn, W. Hemmer, A. Koch. Influence of Orally Taken Vitamin C on Histamine Levels and Motion Sickness. Journal of Allergy and Clinical Immunology, Volume 127, Issue 2, Supplement, February 1, 2011.

2) Khashayar Farzam; Sarah Sabir; Maria C. O’Rourke. National Library of Medicine, National Institutes of Health.  Antihistamines, January, 2022.

3) Bill Roschek; Ryan C. Fink; Matthew McMichael; Randall S. Alterte. Nettle extract (Urtica dioica) affects key receptors and enzymes associated with allergic rhinitis, Phytother Res. 2009 Jul;23(7):920-6

4) Sahar Hamrang-Yousefi; Jimmy Ng; Claudio Andaloro, NCBI Bookshelf, National Institutes of Health, Eustachian Tube Dysfunction, January 2022, updated July 15, 2022.

5)  Gayle Engels; Josef Brinckmann. Stinging Nettle, Herbalgram, American Botanical Council, Issue #110, pages 8-16.

6)  Roy Upton RH, Editor; Teresa Soria BS, Associate Editor and Monograph Coordinator; Teresa Soria BS and Diana Swisher MA, Research Associates. Stinging Nettle Herb, American Herbal Pharmacopoeia, 2009.

About the Author

Gary D. Conrad, MD, is an integrative medicine physician and author who is currently retired from a forty-three-year practice in emergency medicine. 

After the death of my mother on August 12, 2016, my father was abruptly left by himself after sixty-five years of marriage. While we all missed our beloved mother, the family had a sense of relief, knowing she had suffered for years with polymyalgia rheumatica, and at long last, she was no longer in intractable pain.

We all did what we could to support Dad during this challenging time. For myself, I called him a couple of times a day just to check in, and I visited him weekly, oftentimes going to Olive Garden for a hearty Italian lunch. Sometime later, after the acute pain of Mom’s death had waned, I thought it was high time to inject a little humor into the situation. After all, according to author and world peace advocate, Norman Cousins, wasn’t laughter the best medicine? Given Dad’s farming heritage, I decided to nickname him the “Top Rooster.” When Dad answered the phone in the morning, our conversations would go something like this:

I would say, “Is this the Top Rooster?”

Dad would answer with a chuckle. “Yes.”

“How are you doing?”

“I’m okay.”

“Are you off the roost?”

“Yes.” Yet another distinctive chuckle.

“Are you crowing?”

“No.”

“Are you still kicking?”

“Yes, by golly.”

“Are you kicking high?”

“No, but I’m kicking.”

At that point, we would go over the upcoming events of our respective days, but conversations with Dad were never very long. Dad was not windy, as we say in Oklahoma, and he felt everything he needed to say could take place in no more than a few words. One was destined to failure if one expected to engage Dad in a long conversation. When I called Dad from the emergency department, sometimes others would overhear our brief chats, and Dad became known as the Top Rooster. It was not uncommon at all for my fellow healthcare practitioners to ask me later, “How’s the Top Rooster doing today?”

I’d answer, “He’s doing okay,” knowing that Dad would rarely complain. Dad grew up in a farming family in southwest Oklahoma while in the middle of the Dust Bowl and the Great Depression, yet these hardy folks somehow found a way to get by. Couple his upbringing with his role as an Army lieutenant on the front lines of the Korean War, Dad was as tough as a boot. Unless something was terribly wrong, I would never hear a gripe from him. It just wasn’t his nature.

While greatly missing his wife, Dad did the best he could to get by. He continued to garden, and his neighbors and friends said Dad grew the best tomatoes in Oklahoma. After sampling a few of his heirloom Cherokee Purple tomatoes, I was certain they were right. He enjoyed watching the Oklahoma City Thunder games, and usually once a week, my son-in-law Anthony and I would go over to his home and enjoy a game along with pizza and beer. Dad loved being with the family, and for a while he continued to have a massive egg hunt at his home on Easter, with the well-known and highly appreciated “money eggs” – stuffed with bills of varied denominations – which kept everyone interested, even the young adults. Dad was very proud of the fact that he was still able to live at home, enabled by the willing assistance of family and friends, along with a number of rather amazing neighbors.

Aging gradually began to take a toll on Dad, though. His balance became so poor that he sustained a horrific fall while working outside, fracturing his right shoulder, requiring an extended period of rehabilitation. This effectively ended his precious time working in the garden. His eyesight began to fail, caused by a deadly combination of macular degeneration, glaucoma, and corneal issues. His vision became so impaired that he was no longer able to read, something he had previously greatly enjoyed. Having family over for Thunder games was no longer an option, and he didn’t feel healthy enough to leave the home except for intraocular injections for macular degeneration. Dad’s life came to an end on May 9, 2022, a consequence of a fall after which he developed bilateral subdural hematomas – blood clots on his brain. He died at ninety-two – almost ninety-three – years of age.

As I reflect on Dad’s life, I recall once when I asked him, “Hey Dad, what’s the most important thing you have learned over your years?”

Dad paused not a second. “Family.”

Family was critical to Dad, as it was with Mom, and his priorities were being the best husband, brother, uncle, father, grandfather, and great-grandfather he could be. In all these roles, he succeeded admirably.

In retrospect, what amazed me most about Dad was his resiliency, and how he found reasons to live in spite of much that he loved being inexorably taken away. His will to live was strong, though, and he pressed on as a good soldier and Oklahoma farmer would.

Toward the end of his life, while Dad was still lucid, I explained to him that there was a chance that the blood clots on his brain could kill him. He said, “If I live, it’s okay. If I die, it’s okay.” As a Christian, Dad accepted God’s will for him, no matter the end result.

While I would have preferred that Dad had stayed in the world, he died on his terms. The course of his life-ending illness was comparatively short, he didn’t have to go to a nursing facility, which he had fiercely resisted, and to his delight, many family members paid him a visit as the end of his life approached. Even though his ability to communicate was limited in his final days, he still found a way to break into a smile when he recognized loved ones at his bedside.

I miss Dad greatly, and I expect the tears will continue to flow for a while. Letting go of my father, the only person left on the Earth who knew me for all of my sixty-nine years, will be no easy task. That said, the Top Rooster died well, and for that, I am most grateful. How could I not be? At ninety-two years of age, he lived as full and as rich of a life as anyone could ever imagine, and the world is a better place for it.

By golly.