Myths and Facts about Vitex; what you need to know if you have PCOS [Podcast with Jillian Bar-av]
“When I looked at the studies to try to find out how Vitex was raising LH, what I actually found was that it’s lowering LH. And I also had to get back to the bottom of the issue, which was a guinea pig study that was done in 1961 in Germany.”
Vitex, also called “chaste tree”, is a plant used in many herbal supplements for hormonal symptoms, including PCOS. There is a lot of conflicting information regarding Vitex in the PCOS community.
In today’s podcast, I speak with Jillian Bar-av, a Registered Herbalist and Licensed Nutritionist. We discuss the pros and cons of taking Vitex and where the confusion around taking Vitex for PCOS comes from.
Join us as we chat about the following:
- Vitex effects on reproductive health
- Myths about Vitex raising Luteinizing Hormone
- What type of PCOS works best with Vitex
- Herbs to help with stress and anxiety
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Resources Mentioned:
Jillian Bar-av is a Registered Herbalist and Licensed Nutritionist who works with busy women to help them have the energy to do what they love. She specializes in conditions that affect the reproductive system and urinary tract, such as PCOS and Interstitial Cystitis. Jillian believes it takes healthy people to create a healthy planet, and she wants to make a difference for both.
Complete Transcript:
Amy:
Today on the PCOS Diva Podcast, we’re going to be talking about myths and facts about vitex and what you need to know if you have PCOS. And I have invited Jillian Bar-av, she’s a registered herbalist and licensed nutritionist, to really lead us in this discussion today. She works with busy women to help them have energy to do what they love and specializes in conditions that affect the reproductive system and urinary tract, such as PCOS and interstitial cystitis. So, Jillian, thank you for coming on and helping us demystify vitex for PCOS. I know a lot of us are confused with the conflicting information out there.
Jillian Bar-av:
Thank you so much for having me, Amy. It’s a pleasure to be here.
Amy:
So you actually reached out to me and I’m so glad that you did, because vitex is something that we’ve talked a lot about on the PCOS Diva Podcast. Different experts that I’ve had on have different thoughts on it. And you have recently done quite a bit of digging and research into the pros and cons of vitex for PCOS. So why don’t you just get us started?
Jillian Bar-av:
Sure. So in my clinical practice, I’ve always used vitex as part of a protocol for my clients that have PCOS. I mean, not for everyone, but it’s definitely not something that I’ve shied away from. And then I started to see a lot of information and hear information that it’s contraindicated in many cases of PCOS, because it raises something called luteinizing hormone. And the problem is that with PCOS there can be chronically elevated luteinizing hormone or LH already.
Jillian Bar-av:
And so you wouldn’t necessarily want something that does that. So naturally I was concerned and I looked at the research to see where this came from. And then I got confused. Because when I saw studies, they were actually showing that vitex lowers LH. And so I had to do quite a bit of sleuthing to get to the bottom of it. But the reason why this is a problem is because luteinizing hormone is a hormone secreted by the pituitary gland in a big surge at the midpoint of the menstrual cycle and it’s what stimulates ovulation. With PCOS, if LH is chronically elevated, it really messes with the whole balance and the way that ovulation happens.
Jillian Bar-av:
One of the really interesting things is that we have cells in our developing follicles, that under the influence of LH, are what transform cholesterol into androgens. This is part of the normal process. So androgens are then supposed to be transformed into estradiol. And when enough estradiol builds up, then a message, a positive feedback loop message, goes back up to the pituitary, which is what stimulates that big LH surge at mid cycle and therefore ovulation. So when there’s chronically elevated LH, women actually end up with way too many androgens, and that somehow prevents the estradiol from being concentrated enough to send that message back up to the pituitary and we don’t ovulate.
Amy:
Oh, that’s really interesting. Before we go any further with why people think that vitex raises luteinizing hormone, what could have caused that alarm, I guess, in the PCOS community. For those who have never heard of vitex before, what is it? Is it a pharmaceutical? Is it a supplement? Can you tell us, what is vitex?
Jillian Bar-av:
Yeah, that’s great to back up. So vitex is the botanical name for an herb called chaste tree berry. The full botanical name is vitex agnus-castus. And it’s the dried berry, that is the part of the plant that’s usually used, and it’s known to have hormonal modulating activity.
Amy:
So you would take that in a pill form, then?
Jillian Bar-av:
It could be taken in a number of different ways, and there are a number of different products available. So there are standardized extracts. There are whole herb products where you just have ground up berries put into a capsule. There are tinctures made from the berry. So it’s really quite versatile.
Amy:
And I know that was one of the early supplements that I took. So the PCOS community has been talking about vitex agnus-castus or chasteberry, since, let’s see, I was started my PCOS journey back in like 2005 or so. So it’s been around for quite a while. And it really was just in the last, I would say five years that people had been cautioning women about taking it, because as you said, that it can raise luteinizing hormone. So why don’t you go into more detail about who do you think would be the right candidate, or how do you discern whether vitex is for you?
Jillian Bar-av:
So can I first talk about where this misinformation arose from?
Amy:
Yeah, yeah, please do.
Jillian Bar-av:
Okay. So like you, I also had been learning about vitex for many years and that it was specifically indicated for not just PCOS but anybody with amenorrhea, where they had irregular cycles. And so that’s one of the reasons that I have used it with PCOS and I still think it’s a valid reason to use it with PCOS. And like you, it wasn’t till more recently that I started hearing that it had this contraindication.
Jillian Bar-av:
And when I looked at the studies to try to find out how it was raising LH, what I actually found was that it’s lowering LH. And I also had to get back to the bottom of the issue, which was a rat study… I’m sorry, a guinea pig study that was done in 1961 in Germany, where the researchers fed the guinea pigs vitex and then saw changes happening in those guinea pigs. And they attributed those changes to elevation of LH and also reduction of follicle stimulating hormone, FSH. The problem is that those researchers never actually measured the hormone levels. So this was really an interpretation and it made its way into the literature from the 1960s through the 1990s. And it’s just become an insidious piece of information that’s really hard to remove. And it made its way into literature that’s well regarded in the herbal community. And so that is one of the problems.
Amy:
Oh, that’s very interesting. I love how you went back to really get to the root of where this information was coming from. Has there been any human studies done on women with PCOS and vitex?
Jillian Bar-av:
Yes, yes. And it’s found to be useful.
Amy:
Okay, great. So as we know, there’s lots of different kind of pheno types of PCOS. There’s lean PCOS. There’s more of a classic insulin driven PCOS. Do you have a sense in your practice, what type of PCOS or maybe the way PCOS presenting itself, which group of women work best with vitex?
Jillian Bar-av:
Yeah, that’s a great question. So what I look for is a clinical picture. And so again, I’m looking for irregular, skipped or long cycles, hormonal acne, breast tenderness before menses. And there is a lot of research on it being useful for PMS. So if that’s part of the problem, I will consider it as well. The one area where I may be more hesitant to use it, is if there’s depression, because for some people, taking vitex will cause feelings of depression.
Amy:
And I think that this is a perfect example of there’s really no one size fits all approach. That it does take some experimentation to figure out if it works for you. So if somebody was going to try vitex, what is the normal dosage, like a starting point?
Jillian Bar-av:
And so what I will say is that even though I think that there are no safety concerns about people with PCOS using vitex, that doesn’t mean it’s absolutely the right herb and that everybody with PCOS should use vitex. And so sometimes working with a practitioner to figure that out can be useful. But it’s not a dangerous herb and it’s a fairly low dose herb. So like I said before, there are some products that are standardized and those are going to be used in really low doses, like 20 to 40 milligrams per day. And then whole herb products, or just taking the whole herb itself, the generalized dose is around 500 milligrams per day. But for people with really severely elevated prolactin and androgen levels, there is clinical understanding that even higher doses can be useful.
Amy:
And how long of a time period would you give to experiment with it to see if it’s having any impact?
Jillian Bar-av:
There is a general rule of thumb with vitex that it takes about three months to be useful. And people will actually even see things go a bit wonky with their cycle during the first three months of use. So it’s not something to be concerned about. And then after about three months, it usually does tend to start helping to regulate the cycle. But I’ve worked with people where it did take a lot longer. And again, vitex wasn’t the only herb, but depending on what’s going on, it really can take a year or two to hit on the right mix of things. And using herbs is not the only thing that will impact PCOS, as we know. So the nutrition and the lifestyle are huge parts as well.
Amy:
Yeah. I mean, I think that it’s such a good thing to remember that you can’t out supplement a bad diet. The nutrition piece, I think, is number one. And certainly lifestyle factors, lowering stress, getting enough sleep, moving your body, eliminating endocrine disruptors in your life. And then adding on some of these supplements like vitex can certainly help. So what-
Jillian Bar-av:
I totally agree.
Amy:
Yeah. So what do you think would be some of the improvements in PCOS symptoms to look for if you’re experimenting with vitex?
Jillian Bar-av:
Well, I would look for the cycle to start approaching that normal 28 to 30 day cycle. I would look for acne to start clearing up and a lessening of any PMS symptoms or that breast tenderness before menses. Those would be really the main things that I would be looking for.
Amy:
So I wanted to just see if you had any other comments that you wanted to make on vitex, because I wanted to pick your brain on some of the other herbs that you use with your clients that have PCOS.
Jillian Bar-av:
Well there’s one last interesting thing I want to mention about vitex just because it fascinates me, which is there’s research that the effects of it are dose dependent. And much of this is related to its effect on prolactin. So elevated prolactin can go in part with people who have PCOS and be part of that hormonal imbalance. And one of the ways that we now know that vitex is working, is by stimulating dopamine, which then inhibits prolactin release. So if somebody has known high prolactin, vitex might be a really good choice for them.
Jillian Bar-av:
But there is also information that at different doses, it may actually increase prolactin. And I find this fascinating because of the historical and common names for vitex. So the fact that we call it chaste tree berry, kind of leads you to wonder why would it have that name chaste in it, which implies some sort of suppression of libido or a sexual excitability. And then another historical name for it, is monks pepper. And we know that monks were celibate and might have been trying to control their libidos. So the fact that it could potentially raise prolactin and this has been shown in studies, I just find really fascinating.
Amy:
Oh, that’s really interesting. So you’re saying that higher levels of the chaste tree berry or vitex, is showing that it lowers the prolactin?
Jillian Bar-av:
So it’s a little bit unclear as to what dose does what, I’ll tell you.
Amy:
Oh, okay.
Jillian Bar-av:
Yeah. Unfortunately I wish there was more research into this, but what has been clinically shown among practitioners, not maybe in studies, is that higher doses will have a lowering effect on prolactin. So we think that much is clear.
Amy:
Do you think it’s also just lowering the androgens?
Jillian Bar-av:
Possibly. Possibly.
Amy:
Yeah. So there’s a lot of other herbs out there. I think about the Ayurvedic herbs, like ashwagandha, that I think can really help women with PCOS that kind of have that adrenal driven PCOS. Well, tell me in your clinic, what other herbs do you like to use for women?
Jillian Bar-av:
Well, certainly adaptogens are a huge part if there is a stress component to it. So I do like ashwagandha, especially if somebody is stressed out and depleted perhaps. Another adaptogenic herb that I’ll often use is licorice. And I’m sure you’re aware that formula, that combines licorice and peony root, and that this is a classic combination for women with PCOS to help regulate the hormones. And there’s actually a study that was trying to determine, is it the peony or is it the licorice that’s having more of an effect? And the study actually showed that the licorice clearly had an anti-androgenic effect and the peony, it was kind of less clear.
Amy:
So I think about that herb and the reading that I’ve done as helping women to induce ovulation, like that combination. Is that something that, I suppose it regulates cycles, but do you find that it helps to induce ovulation?
Jillian Bar-av:
I haven’t used it in that way.
Amy:
Okay. And I know that the other thing that I’ve read too, is that is something that you don’t want to be using long-term, and you should really work with a practitioner if you’re going to use that combination.
Jillian Bar-av:
So the safety concern would be mostly around the licorice, not the peony. Licorice, in high doses, can induce high blood pressure. So it really is dose dependent, but in a low dose, I really don’t think there’s anything wrong with long-term use of licorice.
Amy:
Like the licorice and the peony formula together?
Jillian Bar-av:
Yeah. Because I don’t think there’s anything dangerous about taking peony long-term either.
Amy:
Okay. Is that something that you use only on certain times of your cycle, or do you use that continuously through the cycle?
Jillian Bar-av:
I haven’t found it to be that important to do the follicular phase versus luteal phase formulations. So I have tried that, but licorice and peony, if I were even doing a two phase formula, they would be in both parts of the formula.
Amy:
And is there a specific type of women with PCOS that that seems to work better for? Have you noticed anything like that in your practice?
Jillian Bar-av:
I can’t say with the phenotypes that you’re talking about, that there’s a particular one that I find it more effective for. Have you seen that to be more effective [inaudible 00:18:31]
Amy:
You know what, honestly, I don’t. So I don’t sell that combination and I don’t usually use it in my practice, but I know that it can, just like what I had said, what I have read, that it’s really helps for those women that have struggled with ovulating on Clomid, that it often does the trick. So it’s something to think about trying, if you are struggling with ovulation. That has been the anecdotal evidence that I’ve read about that combination herb.
Jillian Bar-av:
Interesting.
Amy:
Do you make your own herbal blends or is there a product that you like? Because I think it’s been hard to find that specific blend commercially that isn’t compounded at an herbalist.
Jillian Bar-av:
So I do formulate specifically for each person that I see. So I will be taking into account, okay, stress is at play here, blood sugar regulation, the hormone balance or any labs that we have that might point me in the right direction of herbs. If there’s acne, is there something at play besides just the hormones? So I’m making specific formulations for each person that comes and I have those created by an herbal dispensary.
Amy:
I think that that’s the optimal way to approach using those types of herbs for PCOS. So I agree. Yeah. Anything else, other herbs that you like to use?
Jillian Bar-av:
Well, I think spearmint is something to keep in mind for the excess androgens. It can’t hurt to have spearmint tea a few times a day. There is some research showing that it lowers androgens. There is also a study that was done that included it in a simple herbal capsule that was shown to have positive effects. So that’s one that I like to think about too.
Amy:
And I’ve heard a lot of anecdotal evidence on my PCOS private community page on Facebook, of women seeing dramatic effects using spearmint tea in terms of hirsutism. So the hair growth really slowing down after drinking spearmint tea in particular.
Jillian Bar-av:
Yeah, it’s very interesting. I went through a time in my 20s where I just drank great volumes of spearmint tea. It was like, I could not get enough of it. And I didn’t know anything about that, but it is interesting.
Amy:
And you mentioned that you had PCOS?
Jillian Bar-av:
I do have it. Yes.
Amy:
Yeah. So isn’t that interesting how your body innately wants to bring you back into balance and maybe that’s exactly what you needed to lower androgens at that point.
Jillian Bar-av:
Yeah, it could be.
Amy:
So in your work, what else do you find is just helpful overall in managing PCOS?
Jillian Bar-av:
Well, I have found that food intolerances are one of the main things that need to be dealt with. The primary one that comes up is usually gluten. But I have seen that when the food allergies are taken out of the diet, that the period will just start to regulate itself.
Amy:
And do you think that has to do with the inflammation factors of PCOS?
Jillian Bar-av:
Yeah, definitely.
Amy:
There’s a fertility practitioner, her name’s Aimee Raupp, and she wrote a book recently called The Egg Quality Diet. I’ve had her on the podcast talk about that book. And it’s essentially a pretty strict elimination diet, but for those women who have really struggled to get pregnant, that elimination diet has made a tremendous impact with their fertility. So I think you’re definitely on to something with that elimination, figuring out what foods are causing inflammation in your body and eliminating them.
Amy:
So this has been really helpful. I know you have a more detailed presentation. It’s like a 15 minute presentation, if women want to dive deeper on this subject of vitex and the myths and facts. So tell us where we can find that.
Jillian Bar-av:
Yeah, you can find that at my website, greenspringherbs.com and it is posted in a blog, so that should be easy to find.
Amy:
And I’ll also post a link to that in the show notes. How can women find out more about your work and if they would like their own specialized herbal blend for PCOS?
Jillian Bar-av:
Yeah. Again, my website greenspringherbs.com is the best place to find me and people can sign up for my newsletter there if they want to keep in touch. Or if you’re hearing this and thinking that you might benefit from clinical services, I would encourage you to sign up for a free discovery call there.
Amy:
Perfect. Well, thank you so much, Jillian, for taking time out of your schedule to share this info with us. I think it’s definitely clarified things for me, especially after watching your presentation.
Jillian Bar-av:
Thank you so much for having me, Amy. It’s been a pleasure.
Amy:
And thank you everyone for listening. I look forward to being with you again very soon.
