Epinephrine Health Dictionary

Adrenaline is the secretion of the adrenal medulla (see ADRENAL GLANDS). Its e?ect is similar to stimulation of the SYMPATHETIC NERVOUS SYSTEM as occurs when a person is excited, shocked or frightened. In the United States Pharmacopoeia it is known as epinephrine. It is also prepared synthetically. Among its important effects are raising of the blood pressure, increasing the amount of glucose in the blood, and constricting the smaller blood vessels.

Adrenaline has an important use when injected intramuscularly or intravenously in the treatment of ANAPHYLAXIS. Many patients prone to this condition are prescribed a pre-assembled adrenaline-containing syringe and needle (Min-i-Jet, Epipen) and are taught how to self-administer in an emergency. Adrenaline may be applied directly to wounds, on gauze or lint, to check haemorrhage; injected along with some local anaesthetic it permits painless, bloodless operations to be performed on the eye, nose, etc. Nowadays it is rarely, if ever, used hypodermically and is no longer given to treat ASTHMA. In severe cardiac arrest, adrenaline (1 in 10,000) by central intravenous injection is recommended. It can be given through an endotracheal tube as part of neonatal resuscitation.... adrenaline

The inner part of the adrenals, derived embryonically from spinal nerve precursors, they secrete epinephrine, norepinephrine and dopamine; used locally as neurotransmitters, sensitive receptors can be mobilized totally by the adrenal medullas.... adrenal medulla

Called epinephrine in the U.S., this is a substance secreted into the bloodstream and reacted to by specialized receptors throughout the body, initiating a “code blue” or flight-or-fight response. Many receptors are a regular part of sympathetic function, and respond to their own local relative, norepinephrine or noradrenalin, in the course of normal autonomic nervous system interplay. See: SYMPATHETIC, PARASYMPATHETIC, LIMBIC... adrenalin

Functions that are dominated by epinephrine (the blood hormone) or norepinephrine (local sympathetic adrenergic nerve stimulus)... adrenergic

Drugs used to slow the response to epinephrine (released by the adrenal medulla), usually to attempt controlling high blood pressure... beta blockers

The o?cially approved name for a medicinal substance used in the UK. A 1992 European Union directive required the use of a Recommended International Non-proprietary Name (rINN) for these substances. Usually the BAN and rINN were identical; where there was a difference, the rINN nomenclature is now used. An exception is adrenaline, which remains the o?cial name in Europe with the rINN – epinephrine – being a synonym.... british approved names (ban)

Nutritional Profile Energy value (calories per serving): Low Protein: Trace Fat: Trace Saturated fat: None Cholesterol: None Carbohydrates: Trace Fiber: Trace Sodium: Low Major vitamin contribution: None Major mineral contribution: None

About the Nutrients in This Food Coffee beans are roasted seeds from the fruit of the evergreen coffee tree. Like other nuts and seeds, they are high in proteins (11 percent), sucrose and other sugars (8 percent), oils (10 to 15 percent), assorted organic acids (6 percent), B vitamins, iron, and the central nervous system stimulant caffeine (1 to 2 percent). With the exceptions of caffeine, none of these nutrients is found in coffee. Like spinach, rhubarb, and tea, coffee contains oxalic acid (which binds calcium ions into insoluble compounds your body cannot absorb), but this is of no nutritional consequence as long as your diet contains adequate amounts of calcium-rich foods. Coffee’s best known constituent is the methylxanthine central ner- vous system stimulant caffeine. How much caffeine you get in a cup of coffee depends on how the coffee was processed and brewed. Caffeine is Caffeine Content/Coffee Servings Brewed coffee 60 mg/five-ounce cup Brewed/decaffeinated 5 mg/five-ounce cup Espresso  64 mg/one-ounce serving Instant  47 mg/rounded teaspoon

The Most Nutritious Way to Serve This Food In moderation, with high-calcium foods. Like spinach, rhubarb, and tea, coffee has oxalic acid, which binds calcium into insoluble compounds. This will have no important effect as long as you keep your consumption moderate (two to four cups of coffee a day) and your calcium consumption high.

Diets That May Restrict or Exclude This Food Bland diet Gout diet Diet for people with heart disease (regular coffee)

Buying This Food Look for: Ground coffee and coffee beans in tightly sealed, air- and moisture-proof containers. Avoid: Bulk coffees or coffee beans stored in open bins. When coffee is exposed to air, the volatile molecules that give it its distinctive flavor and richness escape, leaving the coffee flavorless and/or bitter.

Storing This Food Store unopened vacuum-packed cans of ground coffee or coffee beans in a cool, dark cabinet—where they will stay fresh for six months to a year. They will lose some flavor in storage, though, because it is impossible to can coffee without trapping some flavor- destroying air inside the can. Once the can or paper sack has been opened, the coffee or beans should be sealed as tight as possible and stored in the refrigerator. Tightly wrapped, refrigerated ground coffee will hold its freshness and flavor for about a week, whole beans for about three weeks. For longer storage, freeze the coffee or beans in an air- and moistureproof container. ( You can brew coffee directly from frozen ground coffee and you can grind frozen beans without thawing them.)

Preparing This Food If you make your coffee with tap water, let the water run for a while to add oxygen. Soft water makes “cleaner”-tasting coffee than mineral-rich hard water. Coffee made with chlorinated water will taste better if you refrigerate the water overnight in a glass (not plastic) bottle so that the chlorine evaporates. Never make coffee with hot tap water or water that has been boiled. Both lack oxygen, which means that your coffee will taste flat. Always brew coffee in a scrupulously clean pot. Each time you make coffee, oils are left on the inside of the pot. If you don’t scrub them off, they will turn rancid and the next pot of coffee you brew will taste bitter. To clean a coffee pot, wash it with detergent, rinse it with water in which you have dissolved a few teaspoons of baking soda, then rinse one more time with boiling water.

What Happens When You Cook This Food In making coffee, your aim is to extract flavorful solids (including coffee oils and sucrose and other sugars) from the ground beans without pulling bitter, astringent tannins along with them. How long you brew the coffee determines how much solid material you extract and how the coffee tastes. The longer the brewing time, the greater the amount of solids extracted. If you brew the coffee long enough to extract more than 30 percent of its solids, you will get bitter compounds along with the flavorful ones. (These will also develop by let- ting coffee sit for a long time after brewing it.) Ordinarily, drip coffee tastes less bitter than percolator coffee because the water in a drip coffeemaker goes through the coffee only once, while the water in the percolator pot is circulated through the coffee several times. To make strong but not bitter coffee, increase the amount of coffee—not the brewing time.

How Other Kinds of Processing Affect This Food Drying. Soluble coffees (freeze-dried, instant) are made by dehydrating concentrated brewed coffee. These coffees are often lower in caffeine than regular ground coffees because caffeine, which dissolves in water, is lost when the coffee is dehydrated. Decaffeinating. Decaffeinated coffee is made with beans from which the caffeine has been extracted, either with an organic solvent (methylene chloride) or with water. How the coffee is decaffeinated has no effect on its taste, but many people prefer water-processed decaf- feinated coffee because it is not a chemically treated food. (Methylene chloride is an animal carcinogen, but the amounts that remain in coffees decaffeinated with methylene chloride are so small that the FDA does not consider them hazardous. The carcinogenic organic sol- vent trichloroethylene [TCE], a chemical that causes liver cancer in laboratory animals, is no longer used to decaffeinate coffee.)

Medical Uses and/or Benefits As a stimulant and mood elevator. Caffeine is a stimulant. It increases alertness and concentra- tion, intensifies muscle responses, quickens heartbeat, and elevates mood. Its effects derive from the fact that its molecular structure is similar to that of adenosine, a natural chemical by-product of normal cell activity. Adenosine is a regular chemical that keeps nerve cell activ- ity within safe limits. When caffeine molecules hook up to sites in the brain when adenosine molecules normally dock, nerve cells continue to fire indiscriminately, producing the jangly feeling sometimes associated with drinking coffee, tea, and other caffeine products. As a rule, it takes five to six hours to metabolize and excrete caffeine from the body. During that time, its effects may vary widely from person to person. Some find its stimu- lation pleasant, even relaxing; others experience restlessness, nervousness, hyperactivity, insomnia, flushing, and upset stomach after as little as one cup a day. It is possible to develop a tolerance for caffeine, so people who drink coffee every day are likely to find it less imme- diately stimulating than those who drink it only once in a while. Changes in blood vessels. Caffeine’s effects on blood vessels depend on site: It dilates coronary and gastrointestinal vessels but constricts blood vessels in your head and may relieve headache, such as migraine, which symptoms include swollen cranial blood vessels. It may also increase pain-free exercise time in patients with angina. However, because it speeds up heartbeat, doc- tors often advise patients with heart disease to avoid caffeinated beverages entirely. As a diuretic. Caffeine is a mild diuretic sometimes included in over-the-counter remedies for premenstrual tension or menstrual discomfort.

Adverse Effects Associated with This Food Stimulation of acid secretion in the stomach. Both regular and decaffeinated coffees increase the secretion of stomach acid, which suggests that the culprit is the oil in coffee, not its caffeine. Elevated blood levels of cholesterol and homocysteine. In the mid-1990s, several studies in the Netherlands and Norway suggested that drinking even moderate amounts of coffee (five cups a day or less) might raise blood levels of cholesterol and homocysteine (by-product of protein metabolism considered an independent risk factor for heart disease), thus increas- ing the risk of cardiovascular disease. Follow-up studies, however, showed the risk limited to drinking unfiltered coffees such as coffee made in a coffee press, or boiled coffees such as Greek, Turkish, or espresso coffee. The unfiltered coffees contain problematic amounts of cafestol and kahweol, two members of a chemical family called diterpenes, which are believed to affect cholesterol and homocysteine levels. Diterpenes are removed by filtering coffee, as in a drip-brew pot. Possible increased risk of miscarriage. Two studies released in 2008 arrived at different conclusions regarding a link between coffee consumption and an increased risk of miscar- riage. The first, at Kaiser Permanente (California), found a higher risk of miscarriage among women consuming even two eight-ounce cups of coffee a day. The second, at Mt. Sinai School of Medicine (New York), found no such link. However, although the authors of the Kaiser Permanente study described it as a “prospective study” (a study in which the research- ers report results that occur after the study begins), in fact nearly two-thirds of the women who suffered a miscarriage miscarried before the study began, thus confusing the results. Increased risk of heartburn /acid reflux. The natural oils in both regular and decaffeinated coffees loosen the lower esophageal sphincter (LES), a muscular valve between the esopha- gus and the stomach. When food is swallowed, the valve opens to let food into the stomach, then closes tightly to keep acidic stomach contents from refluxing (flowing backwards) into the esophagus. If the LES does not close efficiently, the stomach contents reflux and cause heartburn, a burning sensation. Repeated reflux is a risk factor for esophageal cancer. Masking of sleep disorders. Sleep deprivation is a serious problem associated not only with automobile accidents but also with health conditions such as depression and high blood pres- sure. People who rely on the caffeine in a morning cup of coffee to compensate for lack of sleep may put themselves at risk for these disorders. Withdrawal symptoms. Caffeine is a drug for which you develop a tolerance; the more often you use it, the more likely you are to require a larger dose to produce the same effects and the more likely you are to experience withdrawal symptoms (headache, irritation) if you stop using it. The symptoms of coffee-withdrawal can be relieved immediately by drinking a cup of coffee.

Food/Drug Interactions Drugs that make it harder to metabolize caffeine. Some medical drugs slow the body’s metabolism of caffeine, thus increasing its stimulating effect. The list of such drugs includes cimetidine (Tagamet), disulfiram (Antabuse), estrogens, fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin, norfloxacin), fluconazole (Diflucan), fluvoxamine (Luvox), mexi- letine (Mexitil), riluzole (R ilutek), terbinafine (Lamisil), and verapamil (Calan). If you are taking one of these medicines, check with your doctor regarding your consumption of caf- feinated beverages. Drugs whose adverse effects increase due to consumption of large amounts of caffeine. This list includes such drugs as metaproterenol (Alupent), clozapine (Clozaril), ephedrine, epinephrine, monoamine oxidase inhibitors, phenylpropanolamine, and theophylline. In addition, suddenly decreasing your caffeine intake may increase blood levels of lithium, a drug used to control mood swings. If you are taking one of these medicines, check with your doctor regarding your consumption of caffeinated beverages. Allopurinol. Coffee and other beverages containing methylxanthine stimulants (caffeine, theophylline, and theobromine) reduce the effectiveness of the antigout drug allopurinol, which is designed to inhibit xanthines. Analgesics. Caffeine strengthens over-the-counter painkillers (acetaminophen, aspirin, and other nonsteroidal anti-inflammatories [NSAIDS] such as ibuprofen and naproxen). But it also makes it more likely that NSAIDS will irritate your stomach lining. Antibiotics. Coffee increases stomach acidity, which reduces the rate at which ampicillin, erythromycin, griseofulvin, penicillin, and tetracyclines are absorbed when they are taken by mouth. (There is no effect when the drugs are administered by injection.) Antiulcer medication. Coffee increases stomach acidity and reduces the effectiveness of nor- mal doses of cimetidine and other antiulcer medication. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal glands, secretes adrenalin, which is converted to VM A (vanillylmandelic acid) by the body and excreted in the urine. Until recently, the test for this tumor measured the levels of VM A in the patient’s urine and coffee, which contains VM A, was eliminated from patients’ diets lest it elevate the level of VM A in the urine, producing a false-positive test result. Today, more finely drawn tests make this unnecessary. Iron supplements. Caffeine binds with iron to form insoluble compounds your body cannot absorb. Ideally, iron supplements and coffee should be taken at least two hours apart. Birth control pills. Using oral contraceptives appears to double the time it takes to eliminate caffeine from the body. Instead of five to six hours, the stimulation of one cup of coffee may last as long as 12 hours. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated beverage such as coffee while you are taking an M AO inhibitor, the result may be a hypertensive crisis. Nonprescription drugs containing caffeine. The caffeine in coffee may add to the stimulant effects of the caffeine in over-the-counter cold remedies, diuretics, pain relievers, stimulants, and weight-control products containing caffeine. Some cold pills contain 30 mg caffeine, some pain relievers 130 mg, and some weight-control products as much as 280 mg caffeine. There are 110 –150 mg caffeine in a five-ounce cup of drip-brewed coffee. Sedatives. The caffeine in coffee may counteract the drowsiness caused by sedative drugs; this may be a boon to people who get sleepy when they take antihistamines. Coffee will not, however, “sober up” people who are experiencing the inebriating effects of alcoholic beverages. Theophylline. Caffeine relaxes the smooth muscle of the bronchi and may intensif y the effects (and/or increase the risk of side effects) of this antiasthmatic drug.... coffee

Organs whose function it is to secrete into the blood or lymph, substances known as HORMONES. These play an important part in general changes to or the activities of other organs at a distance. Various diseases arise as the result of defects or excess in the internal secretions of the di?erent glands. The chief endocrine glands are:

Adrenal glands These two glands, also known as suprarenal glands, lie immediately above the kidneys. The central or medullary portion of the glands forms the secretions known as ADRENALINE (or epinephrine) and NORADRENALINE. Adrenaline acts upon structures innervated by sympathetic nerves. Brie?y, the blood vessels of the skin and of the abdominal viscera (except the intestines) are constricted, and at the same time the arteries of the muscles and the coronary arteries are dilated; systolic blood pressure rises; blood sugar increases; the metabolic rate rises; muscle fatigue is diminished. The super?cial or cortical part of the glands produces steroid-based substances such as aldosterone, cortisone, hydrocortisone, and deoxycortone acetate, for the maintenance of life. It is the absence of these substances, due to atrophy or destruction of the suprarenal cortex, that is responsible for the condition known as ADDISON’S DISEASE. (See CORTICOSTEROIDS.)

Ovaries and testicles The ovary (see OVARIES) secretes at least two hormones – known, respectively, as oestradiol (follicular hormone) and progesterone (corpus luteum hormone). Oestradiol develops (under the stimulus of the anterior pituitary lobe – see PITUITARY GLAND below, and under separate entry) each time an ovum in the ovary becomes mature, and causes extensive proliferation of the ENDOMETRIUM lining the UTERUS, a stage ending with shedding of the ovum about 14 days before the onset of MENSTRUATION. The corpus luteum, which then forms, secretes both progesterone and oestradiol. Progesterone brings about great activity of the glands in the endometrium. The uterus is now ready to receive the ovum if it is fertilised. If fertilisation does not occur, the corpus luteum degenerates, the hormones cease acting, and menstruation takes place.

The hormone secreted by the testicles (see TESTICLE) is known as TESTOSTERONE. It is responsible for the growth of the male secondary sex characteristics.

Pancreas This gland is situated in the upper part of the abdomen and, in addition to the digestive enzymes, it produces INSULIN within specialised cells (islets of Langerhans). This controls carbohydrate metabolism; faulty or absent insulin production causes DIABETES MELLITUS.

Parathyroid glands These are four minute glands lying at the side of, or behind, the thyroid (see below). They have a certain e?ect in controlling the absorption of calcium salts by the bones and other tissues. When their secretion is defective, TETANY occurs.

Pituitary gland This gland is attached to the base of the brain and rests in a hollow on the base of the skull. It is the most important of all endocrine glands and consists of two embryologically and functionally distinct lobes.

The function of the anterior lobe depends on the secretion by the HYPOTHALAMUS of certain ‘neuro-hormones’ which control the secretion of the pituitary trophic hormones. The hypothalamic centres involved in the control of speci?c pituitary hormones appear to be anatomically separate. Through the pituitary trophic hormones the activity of the thyroid, adrenal cortex and the sex glands is controlled. The anterior pituitary and the target glands are linked through a feedback control cycle. The liberation of trophic hormones is inhibited by a rising concentration of the circulating hormone of the target gland, and stimulated by a fall in its concentration. Six trophic (polypeptide) hormones are formed by the anterior pituitary. Growth hormone (GH) and prolactin are simple proteins formed in the acidophil cells. Follicle-stimulating hormone (FSH), luteinising hormone (LH) and thyroid-stimulating hormone (TSH) are glycoproteins formed in the basophil cells. Adrenocorticotrophic hormone (ACTH), although a polypeptide, is derived from basophil cells.

The posterior pituitary lobe, or neurohypophysis, is closely connected with the hypothalamus by the hypothalamic-hypophyseal tracts. It is concerned with the production or storage of OXYTOCIN and vasopressin (the antidiuretic hormone).

PITUITARY HORMONES Growth hormone, gonadotrophic hormone, adrenocorticotrophic hormone and thyrotrophic hormones can be assayed in blood or urine by radio-immunoassay techniques. Growth hormone extracted from human pituitary glands obtained at autopsy was available for clinical use until 1985, when it was withdrawn as it is believed to carry the virus responsible for CREUTZFELDT-JAKOB DISEASE (COD). However, growth hormone produced by DNA recombinant techniques is now available as somatropin. Synthetic growth hormone is used to treat de?ciency of the natural hormone in children and adults, TURNER’S SYNDROME and chronic renal insu?ciency in children.

Human pituitary gonadotrophins are readily obtained from post-menopausal urine. Commercial extracts from this source are available and are e?ective for treatment of infertility due to gonadotrophin insu?ciency.

The adrenocorticotrophic hormone is extracted from animal pituitary glands and has been available therapeutically for many years. It is used as a test of adrenal function, and, under certain circumstances, in conditions for which corticosteroid therapy is indicated (see CORTICOSTEROIDS). The pharmacologically active polypeptide of ACTH has been synthesised and is called tetracosactrin. Thyrotrophic hormone is also available but it has no therapeutic application.

HYPOTHALAMIC RELEASING HORMONES which affect the release of each of the six anterior pituitary hormones have been identi?ed. Their blood levels are only one-thousandth of those of the pituitary trophic hormones. The release of thyrotrophin, adrenocorticotrophin, growth hormone, follicle-stimulating hormone and luteinising hormone is stimulated, while release of prolactin is inhibited. The structure of the releasing hormones for TSH, FSH-LH, GH and, most recently, ACTH is known and they have all been synthesised. Thyrotrophin-releasing hormone (TRH) is used as a diagnostic test of thyroid function but it has no therapeutic application. FSH-LH-releasing hormone provides a useful diagnostic test of gonadotrophin reserve in patients with pituitary disease, and is now used in the treatment of infertility and AMENORRHOEA in patients with functional hypothalamic disturbance. As this is the most common variety of secondary amenorrhoea, the potential use is great. Most cases of congenital de?ciency of GH, FSH, LH and ACTH are due to defects in the hypothalamic production of releasing hormone and are not a primary pituitary defect, so that the therapeutic implication of this synthesised group of releasing hormones is considerable.

GALACTORRHOEA is frequently due to a microadenoma (see ADENOMA) of the pituitary. DOPAMINE is the prolactin-release inhibiting hormone. Its duration of action is short so its therapeutic value is limited. However, BROMOCRIPTINE is a dopamine agonist with a more prolonged action and is e?ective treatment for galactorrhoea.

Thyroid gland The functions of the thyroid gland are controlled by the pituitary gland (see above) and the hypothalamus, situated in the brain. The thyroid, situated in the front of the neck below the LARYNX, helps to regulate the body’s METABOLISM. It comprises two lobes each side of the TRACHEA joined by an isthmus. Two types of secretory cells in the gland – follicular cells (the majority) and parafollicular cells – secrete, respectively, the iodine-containing hormones THYROXINE (T4) and TRI-IODOTHYRONINE (T3), and the hormone CALCITONIN. T3 and T4 help control metabolism and calcitonin, in conjunction with parathyroid hormone (see above), regulates the body’s calcium balance. De?ciencies in thyroid function produce HYPOTHYROIDISM and, in children, retarded development. Excess thyroid activity causes thyrotoxicosis. (See THYROID GLAND, DISEASES OF.)... endocrine glands

The suppression of monoamine oxydase (flavin-containing amine oxydase). MAO is critical in modifying nerve-ending storage of certain mono­amines (in this case, epinephrine, norepinephrine and dopamine...another type of MAO works on histamines), and MAO inhibitor drugs were, along with tricyclics, the first wave of anti-depressants. The problem was that if you ate brie cheese or chopped chicken livers while taking the drugs you could get a nosebleed or cerebral aneurysm...a double adrenergic whammy, since some foods are also strongly MAO-inhibiting (at least functionally). Although most current manuals (Merck’s and Harrison’s among others) consider these first generation drugs as safer and preferable to the recent Prozac and such, fashion am fashion, with docs as much as patients. Most of the patients a doctor sees are People That See Doctors (most Americans have infrequent medical contact). Some come with clippings in hand, a few find out about new stuff before their doctor does (they only have ONE patient..themselves) and the pressure for gilt-edged newness is hard to resist all around. The only herb I know of with any consequential MAO inhibition is Hypericum, and its effect, although not to be ignored, is less than French semi-soft cheeses.... mao inhibition

These drugs temporarily raise the BLOOD PRESSURE by constricting peripheral blood vessels. Sometimes they are used as a speedy way of raising blood pressure when other treatment has failed. EPHEDRINE and methoxamine hydrochloride are examples of this type of sympathomimetic.

Cardiopulmonary resuscitation ADRENALINE (epinephrine) is given intravenously in cardiac arrest, and other drugs used include ATROPINE and CALCIUM.... vasoconstrictor sympathomimetics

Arousal of the sympathetic part of the autonomic nervous system in response to fear but which also occurs in anxiety disorders. Adrenaline (epinephrine), noradrenaline (norepinephrine), and other hormones are released from the adrenal glands and nervous system, leading to a raised heart-rate, pupil dilation, and increased blood flow to the muscles. These effects make the body more efficient in either fighting or fleeing the apparent danger.... fight-or-flight response

Taken at face value, the term ‘psychosomatic’ simply means the interaction of psyche (mind) and soma (body). As such it is a noncontroversial concept that points out the many ways in which psychological factors affect the expression of physical disorder and vice-versa. Few doubt that stress makes many physical illnesses worse, at least as far as symptoms are concerned. There are also few physical illnesses in which the outcome is not made worse by psychological factors: depression after a heart attack, for example, has a worse e?ect on prognosis than even smoking. A little more problematic is the very popular belief that stress causes relapses of physical disorders, such as cancer; some studies have found this to be the case, others not.

However, calling a condition psychosomatic implies something more – the primacy of the psyche over the soma. Going back to the in?uential theories and practice of PSYCHOANALYSIS as expounded from the 1930s, many diseases have been proposed as the result of psychological factors.These have included PEPTIC ULCER, ULCERATIVE COLITIS, ASTHMA, PSORIASIS and others. In this view, much physical disorder is due to repressed or excessive emotions. Likewise it is also argued that whereas some people express psychological distress via psychological symptoms (such as anxiety, depression and so on), others develop physical symptoms instead – and that they are also at greater risk of physical disease.

The trouble with this view is that medical advances repeatedly show that it goes too far. Stress certainly causes physical symptoms – for example, DYSPEPSIA – but the belief that it caused peptic ulcers vanished with the discovery of the true cause: colonisation of the stomach by the bacterium, Helicobacter pylori. Of course, stress and social adversity affect the risk of many diseases. For example, the incidence of heart disease among UK government employees (civil servants) has been shown to be in?uenced by their social class and their degree of job satisfaction. But we do not know how this works. Some argue that social adversity and stress in?uence how the heart functions (‘He died of a broken heart’). Stress can also affect IMMUNITY but it cannot cause AIDS/HIV and we do not know if there is a link running from stress to abnormal immune function to actual illness.

We can say that psychological factors provoke physical symptoms, and often even explain how this can happen. For example, when you are anxious you produce more epinephrine (adrenaline), which gives rise to chest pain, ‘butter?ies in the stomach’ and PALPITATION. These symptoms are not ‘all in the mind’, even if the trigger is a psychological one. People who are depressed are more likely to experience nearly every physical symptom there is, but especially pain and fatigue. Taken as a whole, psychologically induced symptoms are an enormous burden on the NHS and probably responsible for more doctor visits and sickness absence than any other single cause. Also we can be con?dent that social adversity and stress powerfully in?uence the outcome of many illnesses; likewise, a vast range of unhealthy activities and behaviours such as smoking, excessive alcohol intake, excessive eating, and so on. But we must be careful not to assume that our emotions directly cause our illnesses.... psychosomatic diseases

A division of the autonomic or involuntary nervous system that works in general opposition to the parasympathetic division (q.v.). Many of the sympathetic functions are local, specific, and involve secretion of acetylcholine, like any other of your normal nerves...stimulating or suppressing a specific muscle, gland, or whatever. A certain number of these nerves, however, unlike any others in the body, secrete epinephrine (adrenalin) and norepinephrine (noradrenalin). These are called adrenergic. Since the adrenal medulla also secretes the same substances into the bloodstream as hormones, all the muscles or glands that are affected by the adrenergic sympathetic nerves also react in toto to the epinephrine secreted into the blood. This forms the basis for a potentially lifesaving emergency fight or flight response and is meant for short, drastic activities. A chronic excess of the adrenergic response, however, is a major cause of stress-and a major contributor to many types of chronic disease. The more you use a particular nerve pathway or induce a particular group of functions, the more blood, fuel storage, and mitochondria are produced to strengthen that group of actions. Using adrenergic energy excessively gives literal dominance to those things that are stimulated or suppressed, and the effects of adrenalin stress linger in the body after the adrenalin is long gone. Since one of the first subjective symptoms of subclinical malnutrition, metabolic imbalances, and environmental pollution is irritability of the central nervous system, hypersympathetic function acts as an intermediate between poor diet, pollution, and disease.... sympathetic

A pair of small, triangular endocrine glands located above the kidneys. Each adrenal gland has 2 distinct parts: the outer cortex and the smaller, inner medulla.

The cortex secretes aldosterone, which, together with hydrocortisone and corticosterone and small amounts of androgen hormones helps to maintain blood pressure. Hydrocortisone controls the body’s use of fats, proteins, and carbohydrates and is also important in helping the body to cope with stress. Hydrocortisone and corticosterone also

suppress inflammatory reactions and some activities of the immune system. Production of adrenal cortical hormones is controlled by ACTH, which is produced in the pituitary gland.

The adrenal medulla is part of the sympathetic autonomic nervous system. In response to stress, it secretes the hormones adrenaline (epinephrine) and noradrenaline (norepinephrine), which increase heart-rate and blood flow.... adrenal glands

A type of reaction caused by allergy. Angioedema is characterized by large, well-defined swellings, of sudden onset, in the skin, larynx (voicebox), and other areas.

The most common cause is a sudden allergic reaction to a food. Less commonly, it results from allergy to a drug (such as penicillin), a reaction to an insect bite or sting, or from infection, emotional stress, or exposure to animals, moulds, pollens, or cold conditions. There is also a hereditary form of the disease.

Angioedema may cause sudden difficulty in breathing, swallowing, and speaking, accompanied by swelling of the lips, face, and neck, depending on the area of the body affected. Angioedema that affects the throat and the larynx is potentially life-threatening because the swelling can block the airway, causing asphyxia.

Severe cases are treated with injections of adrenaline (epinephrine) and may require intubation (passage of a breathing tube via the mouth into the windpipe) or tracheostomy (surgical creation of a hole in the windpipe) to prevent suffocation. Corticosteroid drugs may also be given. In less severe cases, antihistamine drugs may relieve symptoms.... angioedema

The part of the nervous system that controls the involuntary activities of a variety of body tissues. The autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems.

The sympathetic nervous system comprises 2 chains of nerves that pass from the spinal cord throughout the body tissues. Into these tissues, the nerve endings release the neurotransmitters adrenaline (epinephrine) and noradrenaline (norepinephrine). The system also stimulates adrenaline release from the adrenal glands. In general, the actions of the sympathetic nervous system heighten activity in the body, quickening the heartbeat and breathing rate, widening blood vessels, and inducing sweating.

The parasympathetic nervous system is composed of a chain of nerves that passes from the brain and another that leaves the lower spinal cord. The nerves are distributed to the same tissues that are supplied by the sympathetic nerves. The parasympathetic nerves release the neurotransmitter acetylcholine, which has the opposite effect to adrenaline and noradrenaline. The parasympathetic system is mainly concerned with everyday functions such as digestion and excretion.

The 2 systems act in conjunction and normally balance each other. During exercise or at times of stress, the sympathetic system predominates, however, while during sleep the parasympathetic system exerts more control.... autonomic nervous system

A group of drugs, also known as beta-adrenergic blocking agents, prescribed principally to treat heart and circulatory disorders such as angina and hypertension. Beta-blockers block the effects of the sympathetic nervous system, which releases adrenaline (epinephrine) and noradrenaline (norepinephrine) at nerve endings that are known as beta receptors.

There are 2 types of beta receptor: beta 1 and beta 2. Beta 1 receptors are present in the heart and blood vessels, and beta 2 in the lungs. Some betablockers (such as acebutolol, atenolol, and metoprolol) are termed cardioselective and, because they act mostly on beta 1 receptors, are used mainly to treat heart disease such as angina, hypertension, and cardiac arrhythmia. The drugs are sometimes given after a myocardial infarction (heart attack) to reduce the likelihood of further damage to the heart muscle.

Other types of beta-blocker, such as oxprenolol, propranolol, and timolol, may be given to prevent migraine attacks by acting on blood vessels in the head; reduce the physical symptoms of anxiety; or control the symptoms of thyrotoxicosis. Beta-blocker drugs such as timolol are sometimes given in the

form of eye drops to treat glaucoma and work by lowering the fluid pressure in the eyeball.

Beta-blockers may reduce an individual’s capacity for strenuous exercise. The drugs may worsen the symptoms of asthma, bronchitis, or other forms of lung disease. They may also reduce the flow of blood to the limbs, causing cold hands and feet. In addition, sleep disturbance and depression can be side effects of beta-blockers.... beta-blocker drugs

An inappropriate or exaggerated reaction of the immune system to a food. Sensitivity to cow’s milk protein is a fairly common food allergy in young children. Other foods most commonly implicated in food allergy are nuts, wheat, fish, shellfish, and eggs. Food allergy is more common in people who suffer from other forms of allergy or hypersensitivity, such as asthma, allergic rhinitis, and eczema.Immediate reactions, occurring within an hour or sometimes minutes of eating the trigger food, include lip swelling, tingling in the mouth or throat, vomiting, abdominal distension, abnormally loud bowel sounds, and diarrhoea. Some serious allergies can cause anaphylactic shock, requiring immediate self-injection with adrenaline (epinephrine). The only effective treatment for food allergy is avoidance of the offending food. (See also food intolerance.)... food allergy

Reactions produced by the sting of insects such as bees and wasps.

Venom injected by the insect contains inflammatory substances that cause local pain, redness, and swelling for about 48 hours. Any sting in the mouth or throat is dangerous because the swelling may obstruct breathing. About 1 person in 200 is allergic to insect venom, and a severe allergic reaction can occur, leading to anaphylactic shock. A procedure known as hyposensitization is sometimes recommended for such people.

If the symptoms of anaphylactic shock develop, it is essential to seek emergency medical treatment. Any person who is known to be hypersensitive to bee or wasp venom should obtain and carry an emergency kit for the self-injection of adrenaline (epinephrine).... insect stings

A collective term for all the chemical processes that take place in the body. It is divided into catabolism (breaking down of complex substances into simpler ones) and anabolism (building up of complex substances from simpler ones). Usually, catabolism releases energy, while anabolism uses it.

The energy needed to keep the body functioning at rest is called the basal metabolic rate (BMR). It is measured in joules (or kilocalories) per square metre of body surface per hour. The BMR increases in response to factors such as stress, fear, exertion, and illness, and is controlled principally by various hormones, such as thyroxine, adrenaline (epinephrine), and insulin. (See also metabolism, inborn errors of; metabolic disorders.)... metabolism

Any interference that disturbs a person’s mental and physical well-being. Stress may be experienced in response to a range of physical and emotional stimuli. When faced with stressful situations, the body responds by increasing production of the hormones adrenaline (epinephrine) and cortisol, which produce changes in heart-rate, blood pressure, and metabolism to improve performance. However, at a certain level, they disrupt a person’s ability to cope.Continued exposure to stress often leads to mental and physical symptoms, such as anxiety and depression, indigestion, palpitations, and muscular aches and pains. Post-traumatic stress disorder is a direct response to a specific stressful event. (See also relaxation techniques.)... stress

An involuntary, rhythmic, oscillating movement in the muscles of part of the body, most commonly those of the hands, feet, jaw, tongue, or head. Tremor is the result of rapidly alternating muscle contraction and relaxation. Occasional tremors are experienced by most people and are due to increased production of the hormone adrenaline (epinephrine). A slight, persistent tremor is common in elderly people.

Essential tremor, which runs in families, is a slight-to-moderate tremor that may be temporarily relieved by consuming a small amount of alcohol or by taking beta-blocker drugs.

Coarse tremor (4–5 muscle movements per second), which is present at rest but reduced during movement, is often a sign of Parkinson’s disease.

An intention tremor (tremor that is worse on movement of the affected part) may be a sign of cerebellar ataxia.

Tremor may also be caused by multiple sclerosis, Wilson’s disease, mercury poisoning, thyrotoxicosis, or hepatic encephalopathy; drugs, such as amfetamines and caffeine; and withdrawal from drugs, including alcohol.... tremor

n. an emergency condition resulting from an abnormal and immediate allergic response to a substance to which the body has become intensely sensitized. It results in flushing, itching, nausea and vomiting, swelling of the mouth and tongue and airway enough to often cause obstruction, wheezing, a sudden drop in blood pressure, and even sudden death. In this extreme form it is called anaphylactic shock. Common causes are peanuts, latex, and wasp or bee stings. Treatment, which must be given immediately, consists of adrenaline (epinephrine) injection, oxygen with possible advanced support of the airway, intravenous fluids, intravenous corticosteroids, and antihistamines. —anaphylactic adj.... anaphylaxis