Photo by Katherine Hanlon on Unsplash

Transcript

Krysten Bennett: Hey there. Thanks for tuning in to today’s episode. I’m Krysten Bennett and my co-host, Mia Cunningham, and I are pleased to welcome Dr. Alexia Tsakiris back to the show.

Mia Cunningham: Alexia is an assistant professor for the College of Integrative Veterinary Therapies and vice president of the American College of Veterinary Botanical Medicine.

KB: She was on the show last year as part of our 2023 Midwest Veterinary Conference Preview series.

MC: And she’s here today to chat with us about the use of herbal medicine to treat animals with anxiety. Welcome to the show.

Alexia Tsakiris: Thank you for having me, everybody.

KB: So let’s just kick off our conversation with a quick reintroduction to you. Can you tell us a little bit about yourself and your background?

AT: Absolutely. I am Dr. Alexia Tsakiris. I graduated from the Royal Vet College in 2005. I started out as a totally conventional vet and about a year, two years into practice, I was really frustrated with how things were going, how my cases were going. I had this super supportive chief of staff who I’d go to her and be like, “This is what I’m doing, am I doing anything wrong?” And she was like, “No, you’re doing it right.” But things weren’t getting better with these cases. Like, what the heck? 

And so I happened upon some lectures in acupuncture at a conference out in San Diego, and I was totally engrossed. I didn’t want to leave the room. Acupuncture was just really, really calling me. And I signed up for the course, which is where I was exposed more to herbal medicine and how we can use them in our patients. My whole world was just opened up to other ways I can help my patients, and that’s what I’ve been doing ever since.

KB: I imagine that there are a lot of skeptics out there, both among veterinarians and pet owners. Can you give us a brief overview of research that supports the use of herbs and veterinary medicine specifically for anxiety?

AT: Absolutely. So I love me some Pub Med, as many of my clients know, because I talk about it all the time. But if you go into PubMed and just start searching anxiety or herbal medicine, which I did, 788 results show up. Anxiety and phototherapy have over 1,000 results. So there is research out there and there’s a lot more coming out every day, because we have to grow and expand as a profession. And where are we getting our ideas for medicines from? Usually it’s from plants. I think something like 50 percent of our medicines have been derived from plants. So using the actual whole plant and researching it, or even active constituents from plants, whatever it is, there’s a good amount of research out there. So not only do we have the traditional knowledge, where something may have been used for thousands of years and we let other people kind of perfect how it was used. We know how it’s used. And now using our modern research methods, we’re able to actually look at it and figure out why it’s working in that way and how it’s helping. So it’s really nice combination of old meets new.

MC: What kind of formal education and certification did you complete to become a registered herbalist?

AT:  First and foremost, I had to do a lot of continuing education. The American Herbalists Guild is kind of the main governing body for herbalists here in the States, and they have some really rigorous requirements to become a registered herbalist. So I had to complete over 2,000 hours of formal classes. I did this through a combination of veterinary as well as human schools.

I got my graduate diploma and my certificate in veterinary western herbal medicine from the College of Integrative Veterinary Therapies, which is based in Australia, and from Chi University in Florida. I also got my certificate in herbal studies from the David Winston School of Herbal Medicine, which is human based. And then just continuing education classes through the Veterinary Medical Botanical Association, the American College of Veterinary Botanical Medicine, and conferences put on by the AHVMA.

So there’s been a lot that I’ve done, because I am that person where I want to know that I’m qualified. You know, it’s like going to vet school. You got to be super qualified to get out of there. And so the same thing here, where I didn’t want it to be a willy nilly, oh, you know, I use herbs because I went on to Google. Not cool. I want to be super proficient, prolific, know what I’m doing, and be an expert at it before I’m going to go and use it in my patients.

MC: Do you have to be a veterinarian and/or certified to be able to prescribe herbs?

AT: Oh, we’re getting into shady areas now! So because herbs are not FDA regulated, it is a really interesting gray area here. As a veterinarian, I am able to prescribe for my patients, because they are my patients, and I’m a doctor. But you’ll find people out there who are herbalists or they say they’re herbalists. They may have a certification, they may not, but they’re out there, and you can book a consultation with them, and they can treat your pet. Listen, if they are registered herbalists, they know what they’re doing. As long as they have a background in animal pathology and pathophysiology, and as long as they understand their patient, that’s one thing. But it’s like everything else out there where you have to be really careful with who you’re trusting. What is their education and their background? I’ve had people who I couldn’t treat because they were in a different state, and they called some random herbalist because they could. And again, there are people out there calling themselves herbalists and they’re not certified or trained properly.

KB: And I imagine there’s a lot of confusion around that title. You know, it’s not like a DVM or an M.D. where you know there’s a lot of education and a whole regulatory body behind it. It’s a lot more nebulous when you’re talking about alternative therapies. Most people probably don’t know if there are any regulations or what standards herbalists are held to.

AT: Yeah. We live in a world where I can make up a certification and give it to you, you know, like there’s no governing body over me if I’m not a college or university that’s accredited, right? It’s the world we live in. And people really, really, really need to educate themselves before jumping in. I have people coming in with bags of supplements and they’re like, “I have all of this!” I don’t have time to call every company and find out their manufacturing processes. So if we as veterinarians could be there to help them, that would be lovely.

KB: Well, along those same lines of being educated, for anybody who is new to herbal medicine, myself included, can you explain how the process works from a logistical standpoint? Like, do you grow the herbs and mix them yourself? And if not, where do you get them and how do you verify the quality? What does that process look like?

AT: Oh, I wish I grew the herbs and made them myself. But no, I’d need a massive farm. I live on, like, half an acre in New Jersey. 

So I do grow some herbs, but I’ll make tea with it for myself and my kids, my dog. But otherwise, I’m buying my herbs from really good companies, like Standard Process or Herbalist and Alchemist. I’m always looking for a company that has good manufacturing; they’re part of the GMP. I’m calling them to find out who’s doing their third-party testing, if they’re testing it before they make the product, if they test it after making the product, and how do you know how much is in there? And so it’s really about vetting the companies to make sure that you’re getting a quality product.

I’ll use herbs and all sorts of forms. I’ll use liquid formulations, which are called tinctures, and those are either alcohol-, glycerin- or vinegar-extracted herbs, where you stick it in there—this is making it sound really easy!—but you put it in and then all the active constituents are pulled out into the liquid. And then that liquid form is what we give our patients and ourselves.

There’s also powdered formulations. There’s tablets. And then if you use the whole herb, which I really love, you can make teas that you can drink, you can apply topically, you can soak your feet in it, whatever you like. So there’s all sorts of different forms that I’ll use. 

If I’m kind of using a standardized product, like a lot of the traditional Chinese medicine formulas or the chemical formulas, they’ll come kind of pre-made and a combination of like 4 to 20 different herbs. 

If I’m creating a formula for a patient specifically, usually I’ll use tinctures, because then I can combine 5 to 10 herbs based on whatever that patient is needing. The sky’s the limit, whatever you want to do with them.

KB: When you’re creating these treatments, how do you determine whether you need a tincture or a tea or a capsule? Is it based on the ingredients you’re using, or the specific condition you’re treating, or something else entirely?

AT: That’s a great question. So sometimes I’ll see a patient and I know there’s a formula that they need, and maybe it’s a TCVM formula that I’m like, “Oh, this pre-made one fits you perfectly. This fits your pattern. Let’s do that.” And then there’s others where I have to address your heart, I have to address your stress, I have to address your gut, I have to address circulation, and then I’ll make a tincture.

Sometimes it comes down to, what can I get the patient to take? And so I have to kind of readjust and pivot, based on that. Can they take a tincture hidden in a delicious treat, or is a tablet better? And if it tablets better, then what formulas are out there that would best fit them? So it’s kind of combination of everything. Compliance is huge, because if they’re not taking it, then it’s useless.

MC: What are some of the herbs that are commonly used to treat stress and anxiety in pets?

AT: Well, the beauty of herbal medicine is that, because there are so many different herbs out there, there’s so many different ways to address the underlying causes of anxiety in the patients. So, by using herbs, we’re bypassing the conventional reductionistic concept of how drugs work, where you’ve got this thing, it goes into the receptor, and bang. But herbs are affecting multiple physiological functions. They call it a polyvalent pharmacological activity, because we’re affecting so many different areas of the body, because herbs have hundreds of active constituents. So because of that, it always depends on the patient, right? So, yes, there’s herbs out there like Valerian, which is fantastic for muscle tension and stress, but if that’s not fitting my patient, then that’s not what I’m going to use.

For the most part, I’m almost always using herbs which are categorized as adaptogens. I’ll use at least one adaptogen in a formula. Adaptogens are a therapeutic group of herbs which increase adaptability. It increases survival and resilience in stress and aging by triggering intracellular and extracellular adaptive signaling pathways. They help regulate the HPA axis—he hypothalamic pituitary adrenal axis. So it really helps in metabolic regulation, homeostasis, as well as just keeping things at a more balanced level. So almost always, I use an adaptogen in a formula. 

I also want to make sure I’m addressing the gut and gut health, because we know that something like 60 to 80 percent of our serotonin is made in the gut. And so, if the gut’s inflamed and out of control and we’re not making things, then I can give you all the adaptogens you want. But like, we need to be addressing the gut, right? So I want to make sure I’m addressing the gut. I want to make sure I’m addressing pain anywhere, circulation—especially with our older patients and our older selves, getting blood flowing to the brain, right? Like, is that part of what’s going on, and is there pain? Because someone who wakes up with pain in the morning, that’s going to also increase your stress and anxiety. So I want to make sure I’m addressing that as well. 

The long and the short is there’s many herbs, but it always depends on the patient. And here’s the thing. You can make a kind of standard formula and give it to 100 people and honestly, probably working at least 50 of them. Maybe it’s not super specific for them, but something like chamomile, right? Whether you have an upset stomach or, you know, sleepy time to go to bed, just kind of that take the edge off. Chamomile also is a digestive bitter. It’s anti-inflammatory for the gut. So it also helps in that way. And there’s other herbs like passionflower, milky oats, ashwagandha. Everybody’s talking about it. Ashwagandha is amazing. We all should be taking it. So there’s many, many herbs out there. 

I don’t know if anybody out there has ever been put on an anti-depressant. I was, way back in vet school. You know, you go to the doctor and they’re like, “Let’s start with Lexapro, and you give it a month.” And then maybe you’re like, “That did nothing for me.” And then you move on to the next one and then you move on to the next one, right? I know they talk about doing tests to see what would specifically fit you, but we’re not there yet. But it can be the same thing with herbs, where we make a formula and re-evaluate in a month. How are we doing? Is the edge taken off 10 percent, 20 percent, 50 percent? I’m always praying for a miracle, but sometimes there is some trial and error in it. There’s not a one size fits all. And then also it’s about addressing everything else in life too.

KB: Well, and that’s that’s got to be hard to evaluate in animals, too, because, you know, they can’t be like, yeah, I feel 25 percent better. So how do you begin to evaluate the effectiveness of any given treatment?

AT: Exactly. So I’m always looking at what were the main complaints when the client first came in, and how was the pet on the first visit? I mean, sometimes the first time they’re just anxious no matter what. Like it’s a new place. I do everything I can to make them calm and comfortable. But like at the end of the day, it’s a new place.

So, for the second visit, I’m always asking clients, “Were they 5 percent better, were they 10 percent better?” Let’s say a dog is noise reactive. Were you able to refocus them faster? Let’s say it took them 10 minutes to settle down in the past. Maybe they settled down now after 5 minutes, maybe after one minute, or maybe they’re eating better. Maybe they’re going for more walks; they have more energy. So we’re looking at little clues to see how they’re doing.

KB: You talked a little bit about how there’s no one-size-fits-all approach, but are there any herbs that are universally bad for stress and anxiety that you should stay away from?

AT: So, yes, there are toxic herbs out there, and you have to be careful. That’s also where third-party testing is kind of huge, because you want to know that there’s not any contaminants in there. There are some herbs which are toxic that can be used in like really small doses, like drop dosing, but only an experienced herbalist should ever use those. Like poke: The berries are toxic. If you eat more than one berry, you’re going to like be purging yourself all day long. No, thank you. But the root, in very low doses, can be really, really good for lymph flow. I personally don’t tend to use the toxic herbs ever, so I’m going to play with anything. I’ll play with it with myself, but I’m not going to give it to a patient.

I don’t want to scare people and be like, oh, there’s a ton of toxic herbs out there—because again, you have to really go looking for them. You’re not going to find anything commercially available that’s going to be toxic if you’re buying from a quality source. I’m sure you can buy anything from anybody these days, but there’s so many other herbs out there, why are we going to bother with the super toxic ones?

MC: Are there any cases that you find that are better suited for herbal medicine versus conventional?

AT: I don’t like to put anything in a box anymore. I want to be very open minded in my approach. So I don’t think that there’s cases that we can say like, “Oh, you should only have herbs for this,” or “You should only have conventional pharmaceuticals for that.” I think no matter what, adding herbs in can always be helpful. I’ve had patients come in who can’t handle incense at all, right? They’re getting diarrhea. They don’t want to eat. They just can’t do it. But they’re in pain. So what are we going to do? And so they are managed just on herbal medicine. And so these are the cases where it’s not saying that herbs are the only way, but maybe for these patients they are. And so that’s where we really have to take the time to look at individual cases. 

And anxiety wise, it’s the same thing. I have some clients come in and say they don’t want to put their dog on an SSRI or another type of anxiolytic. Like, I have people coming in saying, “I don’t want my dog to be a zombie,” which I agree. I don’t want anybody’s dog or anyone to be a zombie. But that’s not necessarily always the case. If you’re going to go on a conventional medicine, sometimes you need to, and as long as you’re getting proper dosing, then you shouldn’t be a zombie. And if you are, that’s the wrong medicine for you. 

But I’ll have people come in who want to start with herbs and see if they can get their pet more settled. And then if we can’t fully do it, then we add in a conventional antidepressant. But I also really believe that there is no magic pill, especially for stress and anxiety. You have these people who come in, they want the magic pill, right? As someone who has been through it ever since childhood, I know: There’s no magic pill. It is a multimodal approach, whether you’re taking medicine or herbs or herbal medicine, whatever it is. You also have to look at your diet, right? You have to look at your gut, your microbiome, your environment, your immune system. You have to take everything into consideration. I’m not like, “Here’s an herb; you’re going to be fixed magically.” The herb is definitely going to help you. But we have to look at all the other areas of life to see what else is contributing to the stress. Because it’s like if a dog comes in and they’re a chronic vomiter because they’re eating something that just irritates them, I can give you all the things that I want to give you, but if you continue to eat that thing, you’re going to continue to irritate yourself. And so we should look at the cause of the problem.

MC: In what circumstances do you think a more conventional approach would be preferable over a holistic one?

AT: I hate the like conventional versus holistic debate. I think we should all just really be working as one. A holistic approach just means we’re looking at the whole patient. It’s not saying we’re using only natural medicine or medicine from nature. I’m literally looking at my whole patient. 

When it comes to stressed-out patients, I do have some patients where I’m like, “This dog needs everything! Like, you need conventional medicine, you need herbs, you need everything.” And I’m not afraid to say that—like, do it all! Because I’ve had them come in on three medicines for their behavior, and it’s not touching them. Obviously that’s it’s not the answer. So let’s take a step back, re-approach this case. How can we get to the bottom of things? That’s also where, like, I don’t know, maybe we need to look at neurodiversity, where sometimes we are who we are. How can we work with it, and what are our expectations as well?

KB: That’s all we have time for today, but be sure to tune in next time as we finish our conversation with Dr. Tsakiris.