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Looks like prevention becomes all the more important now!

USPSTF Draft Recommendation: Do Not Screen for Asymptomatic Carotid Artery Stenosis

The U.S. Preventive Services Task Force is once again recommending against screening for asymptomatic carotid artery stenosis in the general population. The draft recommendation statement, available for public comment on the USPSTF website until March 17, reiterates the group’s 2007 stance. Following are some of the task force’s reasons for recommending against screening: The “most feasible” method, ultrasonography, has a high false-positive rate in the general population. There’s no reliable way to determine who with carotid stenosis is at increased risk for stroke. There’s no evidence that adding cardiovascular medications or increasing current dosages to manage asymptomatic stenosis yields any benefit. Adequate evidence shows that treatment with carotid endarterectomy can cause harm. The USPSTF concludes “with moderate certainty” that the harms of screening outweigh the benefits.


New Study Reveals Benefits of Ashwagandha in Mental Cognition and Physchomotor Function

By: Jeremy Appleton, ND

Ashwagandha (Withania somnifera) is an adaptogenic plant from the Ayurvedic tradition that has been shown in modern research to support stress adaptation, cognitive function and memory. A new prospective, randomized, double-blind, placebo-controlled clinical trial adds to the body of clinical research on ashwagandha.

In the new study, a standardized, dried aqueous extract of ashwagandha roots and leaves (Sensoril®, Natreon Inc, USA), or a matching placebo was administered to healthy human subjects in a crossover study, with the goal of ascertaining its effects on cognition and psychomotor function. Subjects consumed 500 mg twice daily of either ashwagandha extract or placebo.

The researchers conducted a series of psychometric tests on subjects at baseline and at the end of the 2-week trial. Compared to those taking placebo, subjects taking ashwagandha showed a significant improvement at the end of the trial in the following tests: Reaction Time (measures attention and sensory motor performance), Digital System Substitution (measures attention, response speed, integration, and visual-motor coordination), Digit Vigilance Task (measures alertness, vigilance, and selective capacity), and Card Sorting (measures sensory, motor, integrative, and executive functions).

The authors concluded that Sensoril® ashwagandha extract improved cognitive and psychomotor performance in healthy human volunteers.

Pingali U, Pilli R, Fatima N. Effect of standardized aqueous extract of Withania somnifera on tests of cognitive and psychomotor performance in healthy  human participants. Pharmacognosy Res 2014;6(1):12–18.

Caffeine: Seeking Natural Alternatives for Patients

By: Wendy Daly, MD

It seems as if every day there is a new study released on caffeine. A recent published study in the journal Mayo Clinic Proceedings looked at 43,727 men and women ages 20-87 and found that men under 55 who drank more than 4 cups of coffee per day had a 56% higher all-cause mortality risk and women in that age group had a 113% higher risk.1

However, there are other studies telling us that coffee is actually good for us. For example, Harvard’s School of Public Health revealed that consuming between 2-4 cups a day may reduce risk of suicide in adults by 50%.2 The American Cancer Society has shown that drinking four or more cups may reduce mortality from mouth and throat cancer.3

I am unsure if this type of information is helping anyone to decide. I, as a pediatrician, am very concerned about the use of caffeine in children and teens. It’s a time we should be focusing on how to help them learn and prepare for their future. But in a society that believes the answer for every time one is tired is caffeine; the use of caffeine in children is growing faster and in higher amounts than ever before.

I am alarmed to see that the market is encouraging our youth to choose caffeine for energy. Our children need a healthy diet and proper sleep (not caffeine) for energy.

Teenagers are back in school and even more prone to use energy drinks as they get into the day to day grind. Typical diets are so far from perfect. I believe we need to supplement their diet choices. But not only due to their food choices, the fact that we eat a majority of food that is pre-prepared for us already means that food has lost a great amount of nutrition. Nutrition studies indicate that once we wash, prepare, or cook foods there is a great loss of the nutrient value. Preston Andrews, PhD, a plant researcher and associate professor of horticulture at Washington State University states, “the nutrients in most fruits and vegetables start to diminish as soon as they are picked.” These already-prepared meals are even a stronger reason we should supplement with the daily essential vitamins and minerals they are lacking. Children need B vitamins, Vitamin C, and minerals like magnesium for energy, not caffeine.

Lately I have looked at Rhodiola rosea as a caffeine alternative for young adults. Thinking on how this appears to help provide energy but doesn’t appear to interfere with the health of the body as caffeine can. Is this a great way to start to re-educate the population on energy drinks. Can we find a better alternative? Would this not be better for the body and the brain? If we can re-educate the adult population to look for healthier alternatives will our children grow up to not think caffeine is the be-all?

Let’s do some comparisons.

Caffeine Rhodiola rosea
Non-adaptogen Adaptogen:  it causes minimal disturbance to the normal physiological function, the action is nonspecific, and it has normalizing action.
Provides a “crash and burn”  energy Increases physical work capacity and shortens the recovery time between periods of high-intensity exercise.4-6
Digestive discomfort and acidity No negative effect known on digestion.
May increase blood pressure and heart beat irregularities Supports the heart during emotional and physical stress7, supports C-reactive protein and creatinine kinase.8
CNS stimulation; irritability, nervousness, and jitteriness Positive effects on the CNS- may affect many neurotransmitters (chemical messengers) in the brain, including norepinephrine, serotonin, dopamine, and acetylcholine. These are responsible for thinking, analyzing, evaluating, calculating, planning, and remembering.  The antioxidant effects of R. rosea may help protect the nervous system from the effects of free radicals.9-12

Rhodiola rosea should be standardized for 3% rosavins and 1% salidroside, matching clinical trials. In a double-blind randomized placebo controlled study on rhodiola for 20 days, students in the rhodiola group had significant improvement in physical fitness, mental fatigue and neuromotor tests. The self-assessment of the general well-being was also significantly better in the rhodiola group.13

A double-blind, placebo-controlled study of 56 physicians on night-duty evaluated the potential benefits of rhodiola for maintaining mental acuity. Participants received either placebo or rhodiola extract (170 mg daily) for a period of 2 weeks. The results showed that participants taking rhodiola retained a higher level of mental function as measured by tests, such as mental arithmetic.14

Another double-blind, placebo-controlled study evaluated one-time use of the same rhodiola extract (at a dose of 370 mg or 555 mg) in 161 male military cadets undergoing occasional sleep deprivation and stress. The results showed that rhodiola, at either dose, was more effective than placebo at fighting the effects of fatigue.15


1 Liu J, Sui X, Lavie CJ, Hebert JR, Earnest CP, Zhang J, Blair SN. Association of coffee consumption with all-cause and cardiovascular disease mortality. Mayo Clin Proc. 2013 Oct;88(10):1066–74. doi: 10.1016/j.mayocp.2013.06.020. Epub 2013 Aug 15. 2 Lucas M, O’Reilly EJ, Pan A, et al. Coffee, caffeine, and risk of completed suicide: Results from three prospective cohorts of American adults. World J Biol Psych. 2013 Jul 2 [Epub ahead of print]. 3 Hildebrand JS, Patel AV, McCullough ML, et al. offee, tea, and fatal oral/pharyngeal cancer in a large prospective US cohort. Am J Epidemiol. 2013 Jan 1;177(1):50-8. doi: 10.1093/aje/kws222. Epub 2012 Dec 9. 4 De Bock K, Eijnde BO, Ramaekers M, Hespel P. Acute Rhodiola rosea intake can improve endurance exercise performance. Int J Sport Nutr Exerc Metab. 2004 Jun;14(3):298–307. 5 Adamchuk LV, Salnik BU. Effect of Rhodiola rosea extract and piridrol on metabolism of rats under high muscular load. Proc Inst Cytol Russ Acad Sci. 1971;89–92. 6 Abidov M, Crendal F, Grachev S, Seifulla R, Ziegenfuss T. Effect of extracts from Rhodiola rosea and Rhodiola crenulata (Crassulaceae) roots on ATP content in mitochondria of skeletal muscles. Bull Exp Biol Med. 2003 Dec;136(6):585–7. 7 Maslova LV, Kondrat’ev BI, Maslov LN, Lishmanov I. The cardioprotective and antiadrenergic activity of an extract of an extract of Rhodiola rosea in stress. Eksp Klin Farmakol. 1994 Nov;57(6):61–3. 8 Abidov M, Grachev S, Seifulla RD, Ziegenfuss TN. Extract of Rhodiola rosea radix reduces the level of C-reactive protein and creatinine kinase in the blood. Bull Exp Biol Med. 2004 Jul;138(1):63–4. 9 Kim SH, Hyun SH, Choung SY. Antioxidative effects of Cinnamomi cassiae and Rhodiola rosea extracts in liver of diabetic mice. Biofactors. 2006;26(3):209–19. 10 Brown RP, Gerbarg PL, Ramazanov. Rhodiola Rosea: A Phytomedicinal Overview. Herbalgram, 2002; 56:40–52. 11 Stancheva SL, Mosharrof A. Effect of the extract of Rhodiola rosea L. on the content of the brain biogenic monamines. Med Physiol 1987;40:85–87. 12 Furmanowa M, Skopinska-Rozewska E, Rogala E, Malgorzata H. Rhodiola rosea in vitro culture: phytochemical analysis and antioxidant action. Acta Soc Bot Pol Pol Tow Bot 1998;76(1):69–73. 13 Spasov AA, Wikman GK, Mandrikov VB, Mironova IA, Neumoin VV. A double-blind, placebo-controlled pilot study of the stimulating and adaptogenic effect of Rhodiola rosea SHR-5 extract on the fatigue of students caused by stress during an examination period with a repeated low-dose regimen. Phytomedicine 2000;7(2):85–9. 14 Darbinyan V, Kteyan A, Panossian A, et al. Rhodiola rosea in stress induced fatigue–a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine. 2000 Oct ;7(5):365–71. 15 Shevtsov VA, Zholus BI, Shervarly VI, et al. A randomized trial of two different doses of a SHR-5 Rhodiola rosea extract versus placebo and control of capacity for mental work. Phytomedicine. 2003;10:95–105.

Dr. Wendy C. Daly is originally from Connecticut. She graduated from Hartford Hospital School of Nursing in 1972 and Eastern Connecticut State University in 1975. She practiced as a nurse for six years before entering medical school. Upon graduating from the University of Louisville School of Medicine, she completed a three-year residency in Pediatrics in Louisville and has been board-certified by the American Academy of Pediatrics since 1988. Prior to starting Brownsboro Park Pediatrics, she worked as an attending physician in the emergency room at Kosair Children’s Hospital and spent four years at the Park DuValle Community Health Center. Dr. Daly is married to Dave Ingram and has two sons, Greg and Jordan Daly.

Alan C. Simon R.Ph. shared:

Here is a prospective study involving over 20,000 men:

A 22-y prospective study of fish intake in relation to prostate cancer incidence and mortality

Background: Fish and seafood n3 fatty acids may prevent or
delay the progression of prostate cancer, but epidemiologic studies
do not uniformly support this hypothesis.
Objective:We examined the relation of fish and seafood n3 fatty
acid intakes with prostate cancer incidence and mortality.
Design: We conducted a prospective cohort study among 20 167
men participating in the Physician’s Health Study who were free of
cancer in 1983.
Results:During 382 144 person-years of follow-up, 2161 men were
diagnosed with prostate cancer and 230 died of prostate cancer. Fish
intake was unrelated to prostate cancer incidence. Survival analysis
among the men diagnosed with prostate cancer revealed that those
consuming fish 5 times/wk had a 48% lower risk of prostate cancer
death than did men consuming fish less than once weekly [relative
risk (RR)0.52; 95% CI: 0.30, 0.91;Pfor trend0.05]. A similar
association was found between seafood n3 fatty acid intake and
prostate cancer mortality (RRQ5 versus Q10.64; 95% CI: 0.42, 0.99;
P for trend 0.02). These associations became stronger when the
analyses were restricted to clinically detected cases.
Conclusion: These results suggest that fish intake is unrelated
to prostate cancer incidence but may improve prostate cancer
survival. Am J Clin Nutr 2008;88:1297–303.

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