Guest guest Posted November 4, 2005 Report Share Posted November 4, 2005 I am a member of the American Botanical Society and have an alternative health practice. To the best of my knowledge, Goldenseal is not used to treat diabetes or the data is so new it is probably unreliable. Several years of studies are usually necessary before ethical claims can be made and dosage recommendations are defined. Ginseng and Goldenseal have many similarities and origins so it is very possible it may be a real consideration in the future. Ginseng however, has shown to have a substantial amount of data supporting it usage for lowering blood sugar in type 2 diabetes. Here is some very good info. Asian Ginseng This information is for online viewing only. To purchase printed copies visit our Herbal Education Catalog or email custserv. Panax ginseng by Steven Foster Ginseng, Panax ginseng C. A. Meyer, is the most famous of all Asian medicinal plants. Used in China for over 2,000 years, numerous scientific studies over the past 40 years have concentrated on the chemistry, pharmacology, and clinical aspects of ginseng use. Much of the research has provided a scientific basis for the traditional claims for ginseng use. Origins A member of the ginseng family (Araliaceae), the genus Panax contains about six species native to eastern Asia and two native to eastern North America. Confusion in taxonomic interpretation has resulted from use of P. pseudo-ginseng as a synonym for Panax ginseng (L. H. Bailey et al., 1976; Tyler, 1993). Panax schin-seng Nees is also a synonym for Panax ginseng (H. L. Li, 1942). The confusion may arise in part from the fact that T. F. L. Nees had, in 1833, expressly included the earlier and legitimate P. pseudo-ginseng under his P. schin-seng. According to S. A. Graham (1966), P. schin-seng was superfluous when published, thus illegitimate. The earliest legitimate botanical name is P. ginseng, first used by C.A. Meyer (1843). It is recognized as a distinct entity from P. pseudo-ginseng in recent Chinese taxonomic treatments on the genus Panax. Ho and Tseng (1978) recognize three Chinese species of Panax (P. ginseng, P. pseudo-ginseng, and P. zingiberensis). They list five varieties under P. pseudo-ginseng. Panax derives from Greek roots, pan meaning " all, " and akos, " cure, " referring to the " cure all " or " panacea " attributes of the root's healthful virtues. " Ginseng, " " jenseng, " " schin-seng, " or " ren-shen " (various transliterations of the same Chinese ideograms), means " essence of the earth in the form of a man " (Graham, 1966). S.Y. Hu (1976) states that seng is a term employed by Chinese medicinal root gatherers for fleshy roots used as tonics. Seng is preceded by modifiers to denote the source material or medicinal property (such as " bitter seng, " " black seng, " " Mingtang seng, " prince seng " ). All species of Panax do not produce seng and all seng-producing plants are not in the genus Panax. S.Y. Hu (1979) uses this metaphor, " A horse is a mammal, but not all mammals are horses. Likewise, ginseng is a Seng but not all sengs in Chinese medicine are ginseng. " She documents 62 species of " seng-producing " plants in 40 genera of 20 botanical families. History According to S.Y. Hu (1977a), the earliest written account of ginseng is from Shen Nong Ben Cao Jing, attributed to the Divine Plowman Shen-Nong, compiled in the late Han Dynasty (approx. the first century A.D.). The short account of 44 words included the name ginseng, two synonyms, taste and property, habitat, and medicinal uses of ginseng (S. Y. Hu, 1977a). In her translation of the account, S. Y. Hu (1977a, p. 289) writes, " It is used for repairing the five viscera, quietening the spirit, curbing the emotion, stopping agitation, removing noxious influence, brightening the eyes, enlightening the mind and increasing the wisdom. Continuous use leads one to longevity with light weight. " In the1596 classic of the Chinese materia medica Li Shi-zhen's Ben Cao Gang Mu, ginseng is listed in the superior class of herbs. Small amounts were said to develop light weight while improving vitality (S. Y. Hu, 1976). The first description of the plant by a Westerner was provided by Pere Jartoux, a Jesuit missionary stationed in Beijing. His observations, made in 1709, include uses, description, and habitat, plus historical and personal notes. In 1714 Jartoux's account was published in English. " Nobody can imagine that the Chinese and Tartars would set so high a value on this root, if it did not constantly produce a good effect. Those that are in health often make use of it, to render themselves more vigorous and strong; and I am persuaded that it would prove an excellent medicine in the hands of any European who understands pharmacy, if he had but a sufficient quantity of it to make such trials as are necessary, to examine the nature of it chemically, and to apply it in a proper quantity, according to the nature of the disease for which it may be beneficial " (Jartoux, 1714). Nearly three centuries after those words were written, European, Japanese, Chinese, Soviet, and, to a lesser extent, American researchers have examined the chemical nature of Panax ginseng, as well as its benefits, in dozens of chemical, pharmacological, and clinical studies. According to the tenets of Traditional , the taste of Panax ginseng is sweet-bitter, and it has a warming character. It is a tonic used to increase strength, increase blood volume, promote life and appetite, quiet the spirit, and give wisdom. It is used alone or in prescriptions for general weakness, deficient qi (chi) patterns, anemia, lack of appetite, shortness of breath with spontaneous perspiration, nervous agitation, forgetfulness, thirst, and impotence (S. Y. Hu, 1976). Current Usage Pharmacological and clinical studies conducted over the past 40 years focus on radioprotective, antitumor, antiviral, and metabolic effects; antioxidant activities; nervous system and reproductive performance; effects on cholesterol and lipid metabolism, and endocrinological activity (Ng and Yeung, 1986; S. Shibata et al., 1985). Inconsistent results have been reported on interpretation of various studies attempting to prove a scientific basis for the activity of ginseng products (W. H. Lewis et al., 1983; W. H. Lewis, 1986). However, S. Shibata et al. (1985) note that many of the inconsistencies are due mostly to different procedures in preparation, resulting in extractions lacking in biologically active components. Popular and scientific reviews of ginseng research may be predisposed to either advocacy or skeptical negativity. Peer scrutiny, polarization of research methods, and data interpretation, as evidenced by question and answer sessions at international ginseng symposia, are common in ginseng research (Proc. 1st-4th Int. Ginseng Symp. 1974-1984). Studies by the Bulgarian researcher Petkov (1959, 1961, 1965, 1975; Petkov and D. Staneva-Stoicheva, 1963, 1965) provided a pharmacological basis for a stimulative effect of ginseng on the central nervous system, a hypotensive effect, respiratory stimulation effect, blood sugar lowering activity, an increase of reactivity of cerebrocortical cells in response to stress, increase of erythrocyte and hemoglobin counts, and blood cholesterol lowering effects. I. I. Brekhman, the pioneer Soviet researcher on the pharmacology of East Asian ginseng family members, gave Soviet soldiers a ginseng extract or placebo, and found that those who had the ginseng ran faster in a 3 km race. In another experiment, radio operators receiving a ginseng extract made fewer mistakes and transmitted text faster than those who took a placebo. The results suggested that ginseng extracts improved stamina (ex. S. Shibata et al., 1985). Brekhman attempted to confirm results of human trials with mice experiments, showing that mice given ginseng extract swam longer than controls, suggesting an antifatigue action. However, W. H. Lewis et al. (1983) showed no significant differences in stamina or longevity between mice ingesting infusions of Panax ginseng (and other species) compared with controls. Ginseng contains a number of active constituents including saponins, essential oil, phytosterol, carbohydrates and sugars, organic acids, nitrogenous substances, amino acids and peptides, plus vitamins and minerals (Hou, 1977). At least 22 saponins, known as ginsenosides (or panaxosides) have been isolated and found to be the most active constituents (Hou, 1977). (See Hou, 1977; Shibata et al., 1985 ; and Leung and Foster, 1996 for reviews of chemistry.) A number of experiments by Saito et al. (1974a, 1974b) employed pure ginseng saponins to determine the effect of ginseng components on normal and exhausted mice to determine anti-fatigue activity and the effect on the central nervous system. Results were opposite with different chemical fractions. Central nervous system sedative, tranquilizing, and hypotensive actions were shown for the ginseng saponin known as ginsenoside Rb-1. CNS-stimulant, hypertensive, and antifatigue activity were shown for ginsenoside Rg-1. While a CNS-stimulant at lower doses, higher doses of ginsenoside Rg-1 had sedative action (Shibata et al., 1985). The conflicting results of these studies are relative to type of preparation, route of administration, dosage, and presence or absence of biologically active compounds, among other factors. Review of the pharmacological actions of pure ginseng saponins by S. Shibata et al. (1985) indicates that ginsenoside Rb-1 has CNS-depressant activity, is anticonvulsant, analgesic, antipyretic, antipsychotic, ulcer-protective, inhibits conditioned avoidance response, has weak anti-inflammatory activity, an antihaemolytic action, and increases gastrointestinal motility. In addition it accelerates glycolysis, and accelerates serum and liver cholesterol, nuclear RNA, and serum protein synthesis. Ginsenoside Rg-1 has shown weak CNS-stimulant activity, anti-fatigue action, aggravation of stress ulcer, and a slight increase in motor activity. In behavioral tests it showed an acceleration of discrimination behavior in pole-climbing tests and the Y-maze tests, a reversal learning response in the Y-maze test, and one-trial passive avoidance learning using the step-down method. In experiments on embryonic cultures of animal nerve tissue, Saito (1980) found that ginsenosides Rb-1 and Rd potentiated nerve growth factor. Nerve growth factor is recognized as having an important role for the survival, regeneration, and regulation of catecholaminergic neurons of brain and ganglion in adult animals. While not providing definitive conclusions, the research suggested further mechanisms and research directions for determining possible pharmacological activity or applications of ginseng saponins. Radioprotective studies involving the effects of ginseng extracts on X-ray irradiated rodents protected animals from the damaging effect of radiation. This dose-dependent effect included an increase in survival rate, prevention of hemorrhage, recovery of spleen weight and DNA content, and recovery of white and red blood cells and blood platelets. Both positive and negative results have been reported from various ginsenoside fractions under varying conditions (Ng and Yeung, 1986). W. H. Lewis (1986) and Ng and Yueng (1986) report on various studies on antitumor activity (ether, alcohol, and water extracts) of Panax ginseng. Ether extracts showed weak positive activity in vitro on several types of cancer cells, while water, alcohol, and ether extracts showed negative results in other cancer cell types. Antioxidants which decrease lipid peroxides associated with adult diseases, including liver and eye disease, atherosclerosis, and nerve aging, have been suggested as possible therapeutic agents in the development of geriatric drugs. Studies have shown that certain glycoside fractions of processed (red) Panax ginseng have antioxidant activity. In Traditional , decocting ginseng in iron vessels is contraindicated. Ng and Yeung (1986) report on a rational scientific explanation for this tradition in reviewing antioxidant experiments with ginseng. Hypoglycemic activity has been shown for Panax ginseng extractions suggesting a preliminary scientific basis for the traditional use of ginseng in diabetes. While research results are promising, W. H. Lewis (1986) notes that much more research must be conducted before ginseng could be considered useful in the treatment of diabetes mellitus. Clinical trials have focused on the effect of red ginseng powder on diabetics, excessive fat in the blood, performance and stress, postoperative gynecological patients, and abuse of ginseng products (Ng and Yeung, 1986; W. H. Lewis, 1986; S. Shibata et al., 1985; S. Fulder, 1980). Seven European clinical studies involving extracts standardized to 4 percent and 7 percent of ginsenosides are reviewed by Ng and Yeung (1986). Results included a shortening of time to react to visual and auditory stimuli, increased respiratory quotient, increased alertness, power of concentration, grasp of abstract concepts, and increases in visual and motor coordination. While positive though conflicting results have been reported in a number of research parameters, most researchers agree that further clinical studies, especially those involving well-defined pure constituents or assays of chemical content of batch materials used in crude root preparations, are warranted. Currently, the German government's Commission E allows Panax ginseng products containing at least 1.5 percent ginsenosides, calculated as ginsenoside Rg1 to be labeled for use as a tonic for invigoration and fortification during times of fatigue and debility; for declining work capacity and concentration, as well as during convalescence. Commission E notes that adverse reactions or contraindications are not known for normal ginseng use. (Blumenthal et al., 1996). Summary Oriental ginseng, Panax ginseng, has more than a 2,000-year-old history of continuous safe use without reports of clear, predictable side effects when taken in moderation. Shrouded in a mix of mystery and extravagant claims, numerous scientific studies over the past 40 years have begun to establish a chemical, pharmacological, and clinical basis for the traditional claims for this well-known, but little understood herb. Quoted in Blumenthal (1987), N.R. Farnsworth states, " Nothing is proven in pharmacology until different groups all publish and agree. " To evaluate the existing scientific studies published in Russian, Japanese, Chinese, German, English, and other languages is a nearly impossible task, given the complexities of interpreting the data (Blumenthal, 1987). Though hundreds of studies have been conducted on ginseng, there is a need for long-term controlled studies in humans, perhaps using unconventional or novel models, that will help identify its benefits in a predictable and safe manner (Blumenthal, 1987). Farnsworth and Bederka (1973) note however, " The use of ginseng as a general body tonic would seem to be well founded. " Ginseng root Latin Name: Panax ginseng Pharmacopeial Name: Ginseng radix Other Names: Asian Ginseng, Chinese ginseng, Korean ginseng, true ginseng Overview Description Chemistry and Pharmacology Uses Contraindications Side Effects Use During Pregnancy and Lactation Interactions with Other Drugs Dosage and Administration References Additional Resources Overview Ginseng is a slow-growing perennial herb native to the mountain forests of northeastern China, Korea, and the far eastern regions of the Russian Federation. In China, the natural range for ginseng extends from Hebei Province to the three northeastern provinces of Liaoning, Jilin, and Heilongjiang. It is cultivated extensively in China, Japan, Korea, and Russia. The Changbai mountain range is reportedly the only area in China where wild ginseng still occurs naturally (Bone, 1998; Foster and Chongxi, 1992; Leung and Foster, 1996; Melisch et al., 1997; Wichtl and Bisset, 1994). It usually starts flowering at its fourth year and the roots take four to six years to reach maturity. " White " ginseng root (unprocessed) is sometimes bleached and then dried and " red " ginseng is prepared from white ginseng by various processing methods, such as steaming the fresh root before drying. There are many types and grades of ginseng, depending on the origin, root maturity, parts of the root used, and methods of raw material preparation or processing (Bradley, 1992; Foster and Chongxi, 1992; Leung and Foster, 1996). In Russia, Panax ginseng comes mostly from cultivation and partly from permitted or illegal harvest in the wild. Wild ginseng is listed under protected status in the Russian Red Data Book and, therefore, its harvest and trade is prohibited under Russian law. Under China's nationally protected species schedule, ginseng is subject to the Protection Category 1, comparable to its status in the Russian Federation (Melisch et al., 1997). In China, North and South Korea, and Japan, P. ginseng comes from cultivated sources (Yen, 1992). Ginseng's genus name Panax is derived from the Greek pan (all) akos (cure), meaning cure-all. The transliteration of the word gin (man) seng (essence) is derived from the Chinese ideogram for " crystallization of the essence of the earth in the form of a man " (Foster, 1991; Hu, 1976). Ginseng's therapeutic uses were recorded in the oldest comprehensive materia medica, Shen Nong Ben Cao Jing, written around two thousand years ago. In Asian medicine, dried ginseng is used as a tonic to revitalize and replenish vital energy (qi). The usual effect of replenishing qi is not to give an energy boost like that of caffeine or amphetamine (Dharmananda, 1999). It is traditionally used as an aid during convalescence and as a prophylactic to build resistance, reduce susceptibility to illness, and promote health and longevity. Its activity appears to be based on whole body effects, rather than particular organs or systems, which lends support to the traditional view that ginseng is a tonic that can revitalize the functioning of the organism as a whole. There is no equivalent concept or treatment in Western conventional medicine. However, multivitamins are used in a similar manner. In traditional Chinese medicine it is usually prescribed in combination with other herbs and taken in an aqueous decoction dosage form (Bone, 1998; Foster and Chongxi, 1992; Leung and Foster, 1996; Wichtl and Bisset, 1994). Today, ginseng is official in the national pharmacopeias of Austria, China, France, Germany, Japan, Switzerland, and Russia (Bradley, 1992; DAB 10, 1994; JP XII, 1993; AB, 1981; Ph.Fr.X, 1990; Ph.Helv.VII, 1987; Tu, 1992; USSR X, 1973; Wichtl and Bisset, 1994). The Pharmacopoeia of the People's Republic of China indicates its use for prostration with impending collapse marked by cold limbs and faint pulse; diminished function of the spleen with loss of appetite; diabetes caused by " internal heat " ; general weakness with irritability and insomnia in chronic diseases; impotence or frigidity; and heart failure and cardiogenic shock (Tu, 1992). [it should be noted that in traditional Chinese medicine, the term " spleen " does not correlate to the western anatomical definition of spleen but rather to the entire digestive system, with regard to its functions of digestion, transport and distribution of nutrients, blood flow, and reinforcement of vital energy (qi). " Diabetes caused by internal heat " is a specific condition with symptoms including excessive thirst and urination, and sometimes accompanied by excessive eating (Tu, 1992; Yen, 1992).] In Germany, ginseng is one of a few economically important herbal drugs listed separately in the Foreign Trade Statistics. In 1992, Germany imported 174.6 tons, mainly from China and Hong Kong. A considerable amount of the roots are value-added in Germany and then exported mostly to France, Italy, and Argentina (Lange and Schippmann, 1997). Ginseng is official in the German Pharmacopoeia, approved in the Commission E monographs, and used in geriatric remedies, roborants (invigorating and strengthening medicines), and tonic preparations. The Commission E specifies powdered root or tea infusions (BAnz, 1998; Bradley, 1992; DAB 10, 1994; Meyer-Buchtela, 1999; Wichtl and Bisset, 1994). In the United States, it is used by itself and as a main ingredient in a wide range of tonic, energy, and immunostimulant dietary supplements. It is also used extensively in traditional Chinese medicine herbal teas and other fluid or solid forms prescribed to patients by licensed acupuncturists and naturopathic physicians. During the past fifty years, numerous scientific studies of varying quality have been published on ginseng (Foster and Chongxi, 1992). Modern human studies have investigated its preventive effect on several kinds of cancer (Yun et al., 1993; Yun and Choi, 1995, 1998), its effect on newly diagnosed non-insulin-dependent diabetes mellitus patients (Sotaniemi et al., 1995), its long-term immunological effect on HIV patients (Cho et al., 1994; Cho et al., 1997; Sankary, 1989), its ability to treat " qi-deficiency " and blood-stasis syndrome of coronary heart disease and angina pectoris (Jiang et al., 1992), its ability to treat hepatotoxin-induced liver disease in the elderly (Zuin et al., 1987), its effect on cell-mediated immune functions in healthy volunteers (Scaglione et al., 1990), its ability to induce a higher immune response in vaccination against influenza (Scaglione et al., 1996), its effect on blood pressure in patients with hypertension (Han et al., 1998), its effect on alveolar macrophages from patients suffering with chronic bronchitis (Scaglione et al., 1994), its ability to treat severe chronic respiratory diseases (Gross et al., 1995), its use in the treatment of functional fatigue (Le Gal et al., 1996), its ability to improve quality-of-life in persons subjected to high stress (Caso Marasco et al., 1996), its effect on psychomotor performance in healthy volunteers (D'Angelo et al., 1986), its effect on physical performance during exercise (Pieralisi et al., 1991), its ability to treat erectile dysfunction (Choi et al., 1995), and its ability to treat male infertility (Salvati et al., 1996). Some clinical trials have suggested the use of ginseng for fatigue and the improvement of physical and mental performance (Dorling and Kirchdorfer, 1980; Forgo et al., 1981). Ginseng has been studied for treatment of cerebrovascular insufficiency (Quiroga and Imbriano, 1979; Quiroga, 1982), psychophysical asthenia and depressive symptoms (Rosenfield, 1989), immunomodulation (Scaglione et al., 1990; Scaglione et al., 1996). Trials have also reported favorable results in treating post-menopausal symptoms (Reinold, 1990) and improving athletic performance (Forgo and Kirchdorfer, 1981, 1982). A review in a popular newsletter has raised questions regarding the design and results of some of these studies (Schardt, 1999). Several recent trials have reported negative results for improvement of performance during aerobic exercise (Allen et al., 1998; Morris et al., 1996; Engels and Wirth, 1997; Cherdrungsi et al., 1995) and in the secondary treatment of geriatric patients (Thommessen and Laake, 1996). Many of the clinical studies published in the scientific literature have been conducted on a proprietary extract of P. ginseng standardized to 4% total ginsensenosides (G115®, Ginsana®, Pharmaton, Lugano, Switzerland). There have been four studies conducted on G115 to measure the effect of ginseng on endurance and vitality (Dorling and Kirchdorfer, 1980; Forgo et al., 1981; Gross et al., 1995; Sandberg, 1980). Three studies have been conducted on psychoasthenia (Mulz et al., 1990; Rosenfeld, 1989; Gianoli and Riebenfeld, 1984). Ten clinical trials have attempted to determine if ginseng affects physical stress and psychomotor functions (Forgo and Kirchdorfer, 1981; Forgo and Kirchdorfer, 1982; Forgo, 1983; Forgo and Schimert, 1985; Van Schepdael, 1993; Pujol et al., 1996; Engels and Wirth, 1997; Engels et al., 1996; Collomp et al., 1996; D'Angelo et al., 1986). Two clinical trials have investigated cerebral blood flow deficits (Quiroga and Imbriano, 1979; Quiroga, 1982). Two studies on pharmacodynamics measured the immunomodulatory effects (Scaglione et al., 1990; Scaglione et al., 1994), oxygen uptake (von Ardenne and Klemm, 1987), doping substances in urine (Mulz and Degenring, 1989; Forgo, 1980), and serum glucose, serum cholesterol, and serum triglyceride levels (Cheah, 1994). One double-blind placebo-controlled study investigated the effect of ginseng on newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) patients (Sotaniemi et al., 1995). Thirty-six NIDDM patients (20 women and 16 men) were recruited in five health centers and were treated for eight weeks. Patients were randomized to ingest one tablet daily containing 0 (placebo), 100, or 200 mg ginseng, presumably an extract, but the authors did not state the type of preparation used in the study (manufactured by Dansk Droge, Copenhagen). Effects on psychophysical tests, measurements of glucose balance, serum lipids, aminoterminalpropeptide (PIINP) concentration, and body weight were tested. Ginseng therapy elevated mood, improved psychophysical performance, and reduced fasting blood glucose (FBG) and body weight. The 200 mg dose of ginseng improved glycated hemoglobin, serum PIINP, and physical activity. The authors concluded that ginseng may be a useful therapeutic adjunct in the management of NIDDM, but because the active material was not adequately identified, it is difficult to draw meaningful conclusions from this study. To test for possible anticancer effects, one case-controlled study, conducted at the Laboratory of Experimental Pathology at the Korea Cancer Center Hospital with 1,987 pairs of subjects, investigated the preventive effect of ginseng intake against various human cancers (Yun and Choi, 1995). In this study, those participants ingesting ginseng had a decreased risk for cancer compared with non-users. A decrease in risk with increased frequency and duration of ginseng ingestion was reported, showing a dose-response relationship. The preventive effect was reported with the ingestion of fresh undried root extract, white dried root extract, powdered white dried root, and red steamed root. Other ginseng dosage forms tested in this study did not show a decrease in cancer risk including fresh sliced root, fresh root juice, and white root tea. The authors concluded that their findings support the view that patients who take ginseng have a decreased risk for most cancers compared with those who do not. In a subsequent prospective study the non-organ specific cancer preventive effects of ginseng were investigated in 4,634 people over 40 years old, residing in ginseng production areas, from August, 1987 to December, 1992 (Yun and Choi, 1998). Among ginseng preparations, fresh ginseng extract consumers were associated with a significantly decreased risk of gastric cancer. The authors concluded that their results strongly suggest that ginseng has a non-organ specific preventive effect against cancer, providing support for the previous case-control studies. The approved modern therapeutic applications for ginseng appear to be generally supportable based on its history of use in well established systems of traditional medicine, extensive phytochemical investigations, pharmacological studies in animals, and human clinical studies. However, recent studies do not support results from earlier research. The World Health Organization (WHO) has issued a monograph reviewing standards and therapeutics of Asian ginseng, concluding that some general uses are warranted by clinical data (see Uses below) (WHO, 1999). Chinese and Japanese pharmacopeial grade ginseng must be composed of the dried mature root, collected in autumn, from which the rootlets have been removed. Botanical identity must be confirmed by thin-layer chromatography (TLC) as well as by macroscopic and microscopic examinations and organoleptic evaluation. It must contain not less than 14% dilute ethanol-soluble extractive, among other quantitative purity standards (JP XII, 1993; Tu, 1992). The British Herbal Pharmacopoeia requirements are comparable to the Asian monographs with some exceptions, including not less than 20% ethanol-soluble extractive (70%), calculated with reference to the oven-dried material (BHP, 1996). The German Pharmacopoeia requires not less than 1.5% total ginsenosides calculated as ginsenoside Rg1, botanical identification by TLC, macroscopic and microscopic examination, organoleptic evaluation, and some quantitative purity standards (DAB 10, 1994). The Swiss Pharmacopoeia requires not less than 2% total ginsenosides calculated as ginsenoside Rg1 (Ph.Helv.VII, 1987). Description Ginseng root consists of the dried main and lateral root and root hairs of P. ginseng C.A. Meyer [Fam. Araliaceae] and their preparations in effective dosage. The root contains at least 1.5% ginsenosides, calculated as ginsenoside Rg1. Chemistry and Pharmacology The biologically active constituents in P. ginseng are a complex mixture of triterpene saponins known as ginsenosides (Lewis, 1986; Ng and Yeung, 1986; Liu and Xiao, 1992). The root contains 2–3% ginsenosides of which Rg1, Rc, Rd, Rb1, Rb2, and Rb0 are quantitatively the most important. At least 30 ginsenosides have been isolated and characterized (Ng and Yeung, 1986). The pharmacological actions of individual ginsenosides may work in opposition. For example, the two main ginsenosides, Rb1 and Rg1, respectively suppress and stimulate the central nervous system (Chong and Oberholzer, 1988). These opposing actions may contribute to the " adaptogenic " description of ginseng and its purported ability to balance bodily functions. Ginseng's pharmacological activities may be multiple and complex, due not only to ginsenosides but to a variety of compounds such as panacene (a peptidoglycan), which has exhibited hypoglycemic activity (Konno et al., 1984), a peptide with insulinomimetic properties (Ando et al., 1980), and salicylate and vanillic acid, which showed antioxidant and antifatigue effects in animals (Han et al., 1983). The Commission E reported that in various stress models such as immobilization test and coldness test, the resistance of rodents was enhanced. Ginseng is reported to possess hormone-like and cholesterol-lowering effects, promote vasodilatation, and act as an anxiolytic and antidepressant (Choi et al., 1995; Chong and Oberholzer, 1988). Many studies on animals have found ginseng extracts and ginsenosides to be effective in stimulating learning, memory, and physical capabilities (Petkov and Mosharrof, 1987), supporting radioprotection (Takeda et al., 1981; Takeda et al., 1982), providing resistance to infection (Singh et al, 1984), demonstrating antioxidant and antifatigue effects (Han et al., 1983; Saito et al., 1974), enhancing energy metabolism (Avakian et al., 1984), and reducing plasma total cholesterol and triglycerides while elevating HDL levels (Yamamoto et al., 1983). A recent study at Yale University has suggested that ginseng's vasodilatory action may be due to nitric oxide synthesis (Gillis, 1997). Uses The Commission E approved ginseng as a tonic for invigoration and fortification in times of fatigue and debility or declining capacity for work and concentration. Ginseng was also approved for use during convalescence. The World Health Organization (WHO) monograph section on " uses supported by clinical data " re-affirms the Commission E approved uses: " Ö used as a prophylactic and restorative agent for enhancement of mental and physical capacities, in cases of weakness, exhaustion, tiredness, and loss of concentration, and during convalescence " (WHO, 1999). Contraindications Hypertension (Bradley, 1992). Side Effects None known. Use During Pregnancy and Lactation The Commission E reports no known restrictions on the use of ginseng during pregnancy and lactation. Although the British Herbal Compendium contraindicates ginseng during pregnancy, this is not substantiated by use in Asia or by the Commission E (McGuffin et al., 1997). However, controlled, long-term safety studies have not been conducted. WHO has also reiterated that the safety of ginseng use during pregnancy has not been established, although it noted that ginseng is not teratogenic (WHO, 1999). Interactions with Other Drugs The British Herbal Compendium contraindicates the use of ginseng with stimulants, including excessive use of caffeine (Bradley, 1992). The WHO monograph cites two cases of ginseng interaction with phenelzine, a monoamine oxidase inhibitor, although the clinical significance of this interaction was yet to be determined (WHO, 1999). Dosage and Administration Unless otherwise prescribed: 1–2 g of root per day for up to three months; a repeated course is feasible. Decoction: 1–2 g in 150 ml of water. Fluidextract 1:1 (g/ml): 1–2 ml. Tincture 1:5 (g/ml): 5–10 ml. Standardized extract (4% total ginsenosides): 100 mg twice daily. Asian and American Ginsengs Act Differently on Acute Glycemia View Member Comments(0) Printer Friendly HerbalGram. 2004;64:24 © American Botanical Council (Buy This Issue) Reviewed: Sievenpiper JL, Arnason JT, Leiter LA, Vuksan V. Null and opposing effects of Asian ginseng (Panax ginseng C.A. Meyer) on acute glycemia: Results of two acute dose escalation studies. Journal of the American College of Nutrition. 2003;22(6)524–532. According to the authors, persons with diabetes have a relatively high prevalence of complementary and alternative medicine use, despite the paucity of evidence supporting the safety and efficacy of many of these therapies. These Canadian researchers state that this lack of evidence has “prompted a call for rigorous scientific evaluations” on many potentially useful botanical materials for the treatment of diabetes, which has led to the emergence of studies investigating the effects of ginseng in diabetes. Previous clinical studies conducted by several of these authors have repeatedly shown that American ginseng (Panax quinquefolius L., Araliaceae) decreases acute postprandial glycemia (elevated blood sugar levels after meals).1,2,3 The human studies from the authors’ laboratory have shown that this antihyperglycemic effect may be linked to the ratio between specific classes of ginsenosides (glycosidal saponins) of American ginseng. To investigate whether other ginseng species are able to replicate this acute glycemia-lowering effect, the authors conducted two acute dosing trials using Asian ginseng ( P. ginseng C.A. Meyer) following the same protocol they used previously to study the efficacy of American ginseng. Asian ginseng has previously shown activity in helping to stabilize blood sugar levels in noninsulin-dependent diabetes mellitus (NIDDM), also known as type 2 diabetes.4 Healthy male and female adults were enrolled in each of the 2 randomized, single-blind, placebo-controlled, multiple-crossover trials. The study design was the same for both trials, which were conducted 7 months apart; only the dosages differed. The Asian ginseng used was a 3-year-old root powder provided as 500 mg gel capsules (Korean Ministry of Agriculture and Forestry, Seoul, South Korea). In the first trial, the subjects received 4 low-dose treatments: 0 (placebo), 1 g, 2 g, and 3 g of Asian ginseng. In the second trial, the subjects received 4 high-dose treatments: 0 (placebo), 3 g, 6 g, and 9 g of Asian ginseng. In both trials, subjects underwent a 5-minute 75 g oral glucose tolerance test 40 minutes after the ginseng treatments. Blood samples were drawn at - 40, 0, 15, 30, 45, 60, 90, and 120 minutes for measurement of plasma glucose and insulin concentrations. Eleven subjects completed both trials. The ginsenoside profile of the Asian ginseng tested was measured by high-performance liquid chromatography (HPLC) at the University of Ottawa, according to a method previously developed under the auspices of the American Botanical Council’s Ginseng Evaluation Program. In both trials, the effect of time on plasma glucose and insulin concentrations was significant (p < 0.0001, p < 0.0001; two-way repeated-measures analysis of variance). When the full data set was analyzed (all time points), the ginseng treatment had no significant effect on insulin and glucose levels, but there was a significant effect of overall ginseng treatment on glucose. When the two-hour plasma glucose concentrations were analyzed pooling all doses, there a significantly higher glucose level (p = 0.05) in the Asian ginseng treatment (5.46 ± 0.31 mmol/L) than in the placebo treatment (4.99 ± 0.03 mmol/L). The composition of the batch of Asian ginseng used was consistent with authentic P. ginseng ; however, the profile of ginsenosides and their total amounts are significantly different from the American ginseng studied previously by these authors. It contained up to 96% lower and 7-fold higher amounts of various ginsenosides. The authors have demonstrated recently that there is a high variability of ginsenosides across ginseng species.5 The finding of higher glycemia at the 2-hour time point for the mean of all Asian ginseng doses relative to placebo treatment is in direct contrast with the authors’ previous findings with American ginseng. The authors repeatedly showed an acute glucose-lowering effect of American ginseng, whereas “null to opposite effects were observed with the present Asian species.” There are at least 2 possible explanations for the discrepancy in findings between the two trials: (1) species-specific compositional differences, i.e., variability of chemical compositions between the two species, and (2) possibly insufficient treatment duration with the Asian ginseng. The authors caution that these contradictory effects should not be interpreted as representing all ginseng species, because of the “high variability” in ginsenoside composition of different ginseng species. Future investigations should aim “to identify candidate components” of ginseng “to provide a basis for standardization that allows for the development of profile-specific indications and contraindications.” But, for the present, based on the current research and the particular batch of Asian ginseng utilized in this trial, it appears that American ginseng root may be more effective in reducing post-prandial glycemia than Asian ginseng. Thus, American ginseng may be a more suitable herb for use in helping diabetics manage blood sugar levels than Asian ginseng. Nevertheless, this conclusion remains speculative until confirmed by further investigations. —Brenda Milot, ELS and Mark Blumenthal HerbalGram. 2001;53:19. American Botanical Council American Ginseng Reduces Blood Sugar Levels after Meals in Type II Diabetics in Small Trial Type II diabetes, also known as non-insulin-dependent diabetes-mellitus (NIDDM) or adult onset diabetes, is a matter of increasing public health concern, estimated to affect 14.9 million adult Americans.1 Among the numerous purported benefits of American ginseng (Panax quinquefolius L., Araliaceae) is its ability to influence carbohydrate metabolism and diabetes. Past research in humans in this area is quite limited, and the actual activity of American ginseng (AG) for this indication is unknown. This paper reports on a single-blind, placebo-controlled, crossover study of AG on blood sugar levels in both non-diabetic and Type II diabetic patients.2 Ten non-diabetic and nine Type II diabetic subjects participated in the study. Type II diabetics were under good control and continued to take their usual medications throughout the study. Eating, exercise, and sleeping patterns were controlled between the two groups and between treatments. Patients received 3 g of AG extract powder (manufactured by Chai-Na-Ta, Langley, B.C., Canada) orally or a matched placebo either 40 minutes before or simultaneous with the ingestion of 300 mL of a solution containing 25 g of glucose. Each patient completed each treatment with a one-week washout interval between treatments. Blood samples were taken by finger-prick at 5 or 6 intervals for 2 hours following glucose ingestion, and glucose levels were subsequently measured. In non-diabetic patients, blood glucose levels were unaffected when AG was taken simultaneously with glucose, but decreased significantly (-39%, 45 minutes post-ingestion) when AG was taken 40 minutes before glucose ingestion. In diabetic patients, glucose was significantly reduced when AG was administered before (-18%, 45 minutes post-ingestion) or with (-20%, 45 minutes post-ingestion) glucose. Glucose levels for all placebo treatments were highly uniform, indicating a reproducible glycemic effect under the experimental conditions. The data indicate that AG has a hypoglycemic effect in both non-diabetics and Type II diabetics when taken 40 minutes prior to a meal. Accordingly, the authors suggest that it may be important to take AG with a meal to avoid a hypoglycemic reaction. Because diabetic subjects remained on their medications throughout the study, it follows that AG can be a useful adjunct to conventional therapy. The resulting additional decrease in glycemic index may help decrease diabetic complications. The authors also suggest that since a reduction in glycemic index similar to that obtained with AG is associated with a reduced risk of developing diabetes, AG may be useful in prevention. The mechanism by which AG has these effects is not known, but may involve slowing the digestion of food, affecting glucose transport, or modulation of insulin secretion. This study is unique in its relatively higher dose (3 g) of AG than used in previous trials (usually 1.5 g or less), its use of American rather than Asian ginseng (P. ginseng C.A. Mey, Araliaceae), and its administration of AG 40 minutes before glucose ingestion. All these factors were informed by traditional Chinese use of AG. The authors acknowledge that additional longer-term research is warranted. Another team that included some of the same researchers recently published another clinical trial measuring the effect of AG on healthy volunteers (i.e., not diabetics) in which the effects of the ginseng on blood sugar levels after meals was measured.3 The results showed that American ginseng reduced postprandial glycemia in subjects without diabetes. These reductions were time dependent but not dose dependent: an effect was seen only when the ginseng was administered 40 minutes before the challenge. Doses within the range of 1-3 g were equally effective. -Risa N. Schulman, Ph.D. Hollie V Mulhaupt RN, RMT, TCM Practioner, MH, HHP, NC Texas Herbal Body Solutions 3707 Epperson Trail Austin, TX 78732 512-266-8141 texasherbalbodysolutions http://www.texasherbalbodysolutions.com Austin Alternative Health & Wellness Center http://www.austin-alternative-health.com - 11/04/05 4:40:56 PM WoW Holly~Thanks so much~and one more thing Dear Holly: Thank you so very much for that report on the goldenseal tops. That was great and reminded me that you were just the person that I should contact as I wanted to keep one of your previous posts. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 5, 2005 Report Share Posted November 5, 2005 Cinnamon Helps Type 2 Diabetes Also Helps Cholesterol -- But More Than A Sprinkle Required By Jeanie Lerche Davis WebMD Medical News Reviewed By Brunilda Nazario, MD on Friday, December 05, 2003 Dec. 5, 2003 -- A spicy tip: Cinnamon can improve glucose and cholesterol levels in the blood. For people with type 2 diabetes, and those fighting high cholesterol, it's important information. Researchers have long speculated that foods, especially spices, could help treat diabetes. In lab studies, cinnamon, cloves, bay leaves, and turmeric have all shown promise in enhancing insulin's action, writes researcher Alam Khan, PhD, with the NWFP Agricultural University in Peshawar, Pakistan. His study appears in the December issue of Diabetes Care. Botanicals such as cinnamon can improve glucose metabolism and the overall condition of individuals with diabetes -- improving cholesterol metabolism, removing artery-damaging free radicals from the blood, and improving function of small blood vessels, he explains. Onions, garlic, Korean ginseng, and flaxseed have the same effect. In fact, studies with rabbits and rats show that fenugreek, curry, mustard seeds, and coriander have cholesterol-improving effects. But this is the first study to actually pin down the effects of cinnamon, writes Kahn. Studies have shown that cinnamon extracts can increase glucose metabolism, triggering insulin release -- which also affects cholesterol metabolism. Researchers speculated that cinnamon might improve both cholesterol and glucose. And it did! The 60 men and women in Khan's study had a diagnosis of type 2 diabetes for an average of 6 1-2 years but were not yet taking insulin. The participants in his study had been on antidiabetic drugs that cause an increase in the release of insulin. Each took either wheat-flour placebo capsules or 500 milligram cinnamon capsules. * Group 1 took 1 gram (two capsules equaling about one-quarter of a teaspoon) for 20 days. * Group 2 took 3 grams (six capsules, equaling a little less than one teaspoon) for 20 days. * Group 3 took 6 grams (12 capsules, equaling about one and three-quarters teaspoons) for 20 days. Blood samples were taken at each level of the study. Cinnamon made a difference! Twenty days after the cinnamon was stopped, there were significant reductions in blood glucose levels in all three groups that took cinnamon, ranging from 18 to 29%. But these was one peculiar finding that researchers don't understand at this point. Only the group that consumed the lowest level of cinnamon continued with significantly improved glucose levels -- group 1. The placebo groups didn't get any significant differences. Taking more cinnamon seems to improve the blood levels of fats called triglycerides. All the patients had better triglyceride levels in their 40-day tests -- between 23% to 30% reductions. Those taking the most cinnamon had the best levels. In groups taking cinnamon pills, blood cholesterol levels also went down, ranging from 13% to 26%; LDL cholesterol also known as " bad " cholesterol went down by 10% to 24% in only the 3- and 6-gram groups after 40 days. Effects on HDL ( " good cholesterol " ) were minor. Cinnamon should be part of our daily diet -- whether we have type 2 diabetes or not, writes Kahn. However, for the best effects, just a sprinkle isn't enough. --- Hollie <hvmrn wrote: > I am a member of the American Botanical Society and > have an alternative health practice. To the best of > my knowledge, Goldenseal is not used to treat > diabetes or the data is so new it is probably > unreliable. Several years of studies are usually > necessary before ethical claims can be made and > dosage recommendations are defined. Ginseng and > Goldenseal have many similarities and origins so it > is very possible it may be a real consideration in > the future. Ginseng however, has shown to have a > substantial amount of data supporting it usage for > lowering blood sugar in type 2 diabetes. Here is > some very good info. > > > Asian Ginseng > > This information is for online viewing only. To > purchase printed copies visit our Herbal Education > Catalog or email custserv. > Panax ginseng > by Steven Foster > Ginseng, Panax ginseng C. A. Meyer, is the most > famous of all Asian medicinal plants. Used in China > for over 2,000 years, numerous scientific studies > over the past 40 years have concentrated on the > chemistry, pharmacology, and clinical aspects of > ginseng use. Much of the research has provided a > scientific basis for the traditional claims for > ginseng use. > Origins > A member of the ginseng family (Araliaceae), the > genus Panax contains about six species native to > eastern Asia and two native to eastern North > America. Confusion in taxonomic interpretation has > resulted from use of P. pseudo-ginseng as a synonym > for Panax ginseng (L. H. Bailey et al., 1976; Tyler, > 1993). Panax schin-seng Nees is also a synonym for > Panax ginseng (H. L. Li, 1942). The confusion may > arise in part from the fact that T. F. L. Nees had, > in 1833, expressly included the earlier and > legitimate P. pseudo-ginseng under his P. > schin-seng. According to S. A. Graham (1966), P. > schin-seng was superfluous when published, thus > illegitimate. The earliest legitimate botanical name > is P. ginseng, first used by C.A. Meyer (1843). It > is recognized as a distinct entity from P. > pseudo-ginseng in recent Chinese taxonomic > treatments on the genus Panax. Ho and Tseng (1978) > recognize three Chinese species of Panax (P. > ginseng, P. pseudo-ginseng, and P. zingiberensis). > They list five varieties under P. pseudo-ginseng. > Panax derives from Greek roots, pan meaning " all, " > and akos, " cure, " referring to the " cure all " or > " panacea " attributes of the root's healthful > virtues. " Ginseng, " " jenseng, " " schin-seng, " or > " ren-shen " (various transliterations of the same > Chinese ideograms), means " essence of the earth in > the form of a man " (Graham, 1966). S.Y. Hu (1976) > states that seng is a term employed by Chinese > medicinal root gatherers for fleshy roots used as > tonics. Seng is preceded by modifiers to denote the > source material or medicinal property (such as > " bitter seng, " " black seng, " " Mingtang seng, " prince > seng " ). All species of Panax do not produce seng and > all seng-producing plants are not in the genus > Panax. S.Y. Hu (1979) uses this metaphor, " A horse > is a mammal, but not all mammals are horses. > Likewise, ginseng is a Seng but not all sengs in > Chinese medicine are ginseng. " She documents 62 > species of " seng-producing " plants in 40 genera of > 20 botanical families. > History > According to S.Y. Hu (1977a), the earliest written > account of ginseng is from Shen Nong Ben Cao Jing, > attributed to the Divine Plowman Shen-Nong, compiled > in the late Han Dynasty (approx. the first century > A.D.). The short account of 44 words included the > name ginseng, two synonyms, taste and property, > habitat, and medicinal uses of ginseng (S. Y. Hu, > 1977a). In her translation of the account, S. Y. Hu > (1977a, p. 289) writes, " It is used for repairing > the five viscera, quietening the spirit, curbing the > emotion, stopping agitation, removing noxious > influence, brightening the eyes, enlightening the > mind and increasing the wisdom. Continuous use leads > one to longevity with light weight. " > In the1596 classic of the Chinese materia medica Li > Shi-zhen's Ben Cao Gang Mu, ginseng is listed in the > superior class of herbs. Small amounts were said to > develop light weight while improving vitality (S. Y. > Hu, 1976). > The first description of the plant by a Westerner > was provided by Pere Jartoux, a Jesuit missionary > stationed in Beijing. His observations, made in > 1709, include uses, description, and habitat, plus > historical and personal notes. In 1714 Jartoux's > account was published in English. > " Nobody can imagine that the Chinese and Tartars > would set so high a value on this root, if it did > not constantly produce a good effect. Those that are > in health often make use of it, to render themselves > more vigorous and strong; and I am persuaded that it > would prove an excellent medicine in the hands of > any European who understands pharmacy, if he had but > a sufficient quantity of it to make such trials as > are necessary, to examine the nature of it > chemically, and to apply it in a proper quantity, > according to the nature of the disease for which it > may be beneficial " (Jartoux, 1714). > Nearly three centuries after those words were > written, European, Japanese, Chinese, Soviet, and, > to a lesser extent, American researchers have > examined the chemical nature of Panax ginseng, as > well as its benefits, in dozens of chemical, > pharmacological, and clinical studies. > According to the tenets of Traditional Chinese > Medicine, the taste of Panax ginseng is > sweet-bitter, and it has a warming character. It is > a tonic used to increase strength, increase blood > volume, promote life and appetite, quiet the spirit, > and give wisdom. It is used alone or in > prescriptions for general weakness, deficient qi > (chi) patterns, anemia, lack of appetite, shortness > of breath with spontaneous perspiration, nervous > agitation, forgetfulness, thirst, and impotence (S. > Y. Hu, 1976). > Current Usage > Pharmacological and clinical studies conducted over > the past 40 years focus on radioprotective, > antitumor, antiviral, and metabolic effects; > antioxidant activities; nervous system and > reproductive performance; effects on cholesterol and > lipid metabolism, and endocrinological activity (Ng > and Yeung, 1986; S. Shibata et al., 1985). > Inconsistent results have been reported on > interpretation of various studies attempting to > prove a scientific basis for the activity of ginseng > products (W. H. Lewis et al., 1983; W. H. Lewis, > 1986). However, S. Shibata et al. (1985) note that > many of the inconsistencies are due mostly to > different procedures in preparation, resulting in > extractions lacking in biologically active > components. > Popular and scientific reviews of ginseng research > may be predisposed to either advocacy or skeptical > negativity. Peer scrutiny, polarization of research > methods, and data interpretation, as evidenced by > question and answer sessions at international > ginseng symposia, are common in ginseng research > (Proc. 1st-4th Int. Ginseng Symp. 1974-1984). > Studies by the Bulgarian researcher Petkov (1959, > 1961, 1965, 1975; Petkov and D. Staneva-Stoicheva, > 1963, 1965) provided a pharmacological basis for a > stimulative effect of ginseng on the central nervous > system, a hypotensive effect, respiratory > stimulation effect, blood sugar lowering activity, > an increase of reactivity of cerebrocortical cells > in response to stress, increase of erythrocyte and > hemoglobin counts, and blood cholesterol lowering > effects. > I. I. Brekhman, the pioneer Soviet researcher on the > pharmacology of East Asian ginseng family members, > gave Soviet soldiers a ginseng extract or placebo, > and found that those who had the ginseng ran faster > in a 3 km race. In another experiment, radio > operators receiving a ginseng extract made fewer > mistakes and transmitted text faster than those who > took a placebo. The results suggested that ginseng > extracts improved stamina (ex. S. Shibata et al., > 1985). Brekhman attempted to confirm results of > human trials with mice experiments, showing that > mice given ginseng extract swam longer than > controls, suggesting an antifatigue action. However, > W. H. Lewis et al. (1983) showed no significant > differences in stamina or longevity between mice > ingesting infusions of Panax ginseng (and other > species) compared with controls. > Ginseng contains a number of active constituents > including saponins, essential oil, phytosterol, > carbohydrates and sugars, organic acids, nitrogenous > substances, amino acids and peptides, plus vitamins > and minerals (Hou, 1977). At least 22 saponins, > known as ginsenosides (or panaxosides) have been > isolated and found to be the most active > constituents (Hou, 1977). (See Hou, 1977; Shibata et > al., 1985 ; and Leung and Foster, 1996 for reviews > of chemistry.) > A number of experiments by Saito et al. (1974a, > 1974b) employed pure ginseng saponins to determine > the effect of ginseng components on normal and > exhausted mice to determine anti-fatigue activity > and the effect on the central nervous system. > Results were opposite with different chemical > fractions. Central nervous system sedative, > tranquilizing, and hypotensive actions were shown > for the ginseng saponin known as ginsenoside > Rb-1. CNS-stimulant, hypertensive, and antifatigue > activity were shown for ginsenoside Rg-1. While a > CNS-stimulant at lower doses, higher doses of > ginsenoside Rg-1 had sedative action (Shibata et > al., === message truncated === Best regards, Carol _______________________________ Never Accept Only Two Choices in Life. The problems of Today cannot be solved by the same thinking that created them. -Al Einstein. FareChase: Search multiple travel sites in one click. http://farechase. Quote Link to comment Share on other sites More sharing options...
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