Obesity Health Dictionary

An inhibitor of the pancreatic enzyme LIPASE, which breaks down fats in food to their constituent parts. By inhibiting lipase, the drug reduces absorption of dietary fat from the INTESTINE. It is used as an ADJUVANT to a modest low-calorie diet in people with a BODY MASS INDEX of 30 kg/m2 or more. The drug should be prescribed only if diet alone has, over a period of four consecutive weeks, resulted in a person losing 2.5 kg or more. Orlistat may cause oily liquid faeces, urgency to defecate, excessive wind and, sometimes, headaches, tiredness and anxiety. (See OBESITY.)... orlistat

Adipose tissue, or fat, is a loose variety of ?brous tissue in the meshes of which lie cells, each of which is distended by several small drops, or one large drop, of fat. This tissue replaces ?brous tissue when the amount of food taken is in excess of the bodily requirements. Adipose tissue occurs as a layer beneath the skin and also around several internal organs. (See DIET; FAT; OBESITY.)... adipose tissue

Body Mass Index (BMI) provides objective criteria of size to enable an estimation to be made of an individual’s level or risk of morbidity and mortality. The BMI, which is derived from the extensive data held by life-insurance companies, is calculated by dividing a person’s weight by the square of his or her height (kilograms/ metres2). Acceptable BMIs range from 20 to 25 and any ?gure above 30 characterises obesity. The Index may be used (with some modi?cation) to assess children and adolescents. (See OBESITY.)... body mass index

Diabetes mellitus is a condition characterised by a raised concentration of glucose in the blood due to a de?ciency in the production and/or action of INSULIN, a pancreatic hormone made in special cells called the islet cells of Langerhans.

Insulin-dependent and non-insulindependent diabetes have a varied pathological pattern and are caused by the interaction of several genetic and environmental factors.

Insulin-dependent diabetes mellitus (IDDM) (juvenile-onset diabetes, type 1 diabetes) describes subjects with a severe de?ciency or absence of insulin production. Insulin therapy is essential to prevent KETOSIS – a disturbance of the body’s acid/base balance and an accumulation of ketones in the tissues. The onset is most commonly during childhood, but can occur at any age. Symptoms are acute and weight loss is common.

Non-insulin-dependent diabetes mellitus (NIDDM) (maturity-onset diabetes, type 2 diabetes) may be further sub-divided into obese and non-obese groups. This type usually occurs after the age of 40 years with an insidious onset. Subjects are often overweight and weight loss is uncommon. Ketosis rarely develops. Insulin production is reduced but not absent.

A new hormone has been identi?ed linking obesity to type 2 diabetes. Called resistin – because of its resistance to insulin – it was ?rst found in mice but has since been identi?ed in humans. Researchers in the United States believe that the hormone may, in part, explain how obesity predisposes people to diabetes. Their hypothesis is that a protein in the body’s fat cells triggers insulin resistance around the body. Other research suggests that type 2 diabetes may now be occurring in obese children; this could indicate that children should be eating a more-balanced diet and taking more exercise.

Diabetes associated with other conditions (a) Due to pancreatic disease – for example, chronic pancreatitis (see PANCREAS, DISORDERS OF); (b) secondary to drugs – for example, GLUCOCORTICOIDS (see PANCREAS, DISORDERS OF); (c) excess hormone production

– for example, growth hormone (ACROMEGALY); (d) insulin receptor abnormalities; (e) genetic syndromes (see GENETIC DISORDERS).

Gestational diabetes Diabetes occurring in pregnancy and resolving afterwards.

Aetiology Insulin-dependent diabetes occurs as a result of autoimmune destruction of beta cells within the PANCREAS. Genetic in?uences are important and individuals with certain HLA tissue types (HLA DR3 and HLA DR4) are more at risk; however, the risks associated with the HLA genes are small. If one parent has IDDM, the risk of a child developing IDDM by the age of 25 years is 1·5–2·5 per cent, and the risk of a sibling of an IDDM subject developing diabetes is about 3 per cent.

Non-insulin-dependent diabetes has no HLA association, but the genetic in?uences are much stronger. The risks of developing diabetes vary with di?erent races. Obesity, decreased exercise and ageing increase the risks of disease development. The risk of a sibling of a NIDDM subject developing NIDDM up to the age of 80 years is 30–40 per cent.

Diet Many NIDDM diabetics may be treated with diet alone. For those subjects who are overweight, weight loss is important, although often unsuccessful. A diet high in complex carbohydrate, high in ?bre, low in fat and aiming towards ideal body weight is prescribed. Subjects taking insulin need to eat at regular intervals in relation to their insulin regime and missing meals may result in hypoglycaemia, a lowering of the amount of glucose in the blood, which if untreated can be fatal (see below).

Oral hypoglycaemics are used in the treatment of non-insulin-dependent diabetes in addition to diet, when diet alone fails to control blood-sugar levels. (a) SULPHONYLUREAS act mainly by increasing the production of insulin;

(b) BIGUANIDES, of which only metformin is available, may be used alone or in addition to sulphonylureas. Metformin’s main actions are to lower the production of glucose by the liver and improve its uptake in the peripheral tissues.

Complications The risks of complications increase with duration of disease.

Diabetic hypoglycaemia occurs when amounts of glucose in the blood become low. This may occur in subjects taking sulphonylureas or insulin. Symptoms usually develop when the glucose concentration falls below 2·5 mmol/l. They may, however, occur at higher concentrations in subjects with persistent hyperglycaemia – an excess of glucose – and at lower levels in subjects with persistent hypo-glycaemia. Symptoms include confusion, hunger and sweating, with coma developing if blood-sugar concentrations remain low. Re?ned sugar followed by complex carbohydrate will return the glucose concentration to normal. If the subject is unable to swallow, glucagon may be given intramuscularly or glucose intravenously, followed by oral carbohydrate, once the subject is able to swallow.

Although it has been shown that careful control of the patient’s metabolism prevents late complications in the small blood vessels, the risk of hypoglycaemia is increased and patients need to be well motivated to keep to their dietary and treatment regime. This regime is also very expensive. All risk factors for the patient’s cardiovascular system – not simply controlling hyperglycaemia – may need to be reduced if late complications to the cardiovascular system are to be avoided.

Diabetes is one of the world’s most serious health problems. Recent projections suggest that the disorder will affect nearly 240 million individuals worldwide by 2010 – double its prevalence in 1994. The incidence of insulin-dependent diabetes is rising in young children; they will be liable to develop late complications.

Although there are complications associated with diabetes, many subjects live normal lives and survive to an old age. People with diabetes or their relatives can obtain advice from Diabetes UK (www.diabetes.org.uk).

Increased risks are present of (a) heart disease, (b) peripheral vascular disease, and (c) cerebrovascular disease.

Diabetic eye disease (a) retinopathy, (b) cataract. Regular examination of the fundus enables any abnormalities developing to be detected and treatment given when appropriate to preserve eyesight.

Nephropathy Subjects with diabetes may develop kidney damage which can result in renal failure.

Neuropathy (a) Symmetrical sensory polyneuropathy; damage to the sensory nerves that commonly presents with tingling, numbness of pain in the feet or hands. (b) Asymmetrical motor diabetic neuropathy, presenting as progressive weakness and wasting of the proximal muscles of legs. (c) Mononeuropathy; individual motor or sensory nerves may be affected. (d) Autonomic neuropathy, which affects the autonomic nervous system, has many presentations including IMPOTENCE, diarrhoea or constipation and postural HYPOTENSION.

Skin lesions There are several skin disorders associated with diabetes, including: (a) necrobiosis lipoidica diabeticorum, characterised by one or more yellow atrophic lesions on the legs;

(b) ulcers, which most commonly occur on the feet due to peripheral vascular disease, neuropathy and infection. Foot care is very important.

Diabetic ketoacidosis occurs when there is insu?cient insulin present to prevent KETONE production. This may occur before the diagnosis of IDDM or when insu?cient insulin is being given. The presence of large amounts of ketones in the urine indicates excess ketone production and treatment should be sought immediately. Coma and death may result if the condition is left untreated.

Symptoms Thirst, POLYURIA, GLYCOSURIA, weight loss despite eating, and recurrent infections (e.g. BALANITIS and infections of the VULVA) are the main symptoms.

However, subjects with non-insulindependent diabetes may have the disease for several years without symptoms, and diagnosis is often made incidentally or when presenting with a complication of the disease.

Treatment of diabetes aims to prevent symptoms, restore carbohydrate metabolism to as near normal as possible, and to minimise complications. Concentration of glucose, fructosamine and glycated haemoglobin in the blood are used to give an indication of blood-glucose control.

Insulin-dependent diabetes requires insulin for treatment. Non-insulin-dependent diabetes may be treated with diet, oral HYPOGLYCAEMIC AGENTS or insulin.

Insulin All insulin is injected – mainly by syringe but sometimes by insulin pump – because it is inactivated by gastrointestinal enzymes. There are three main types of insulin preparation: (a) short action (approximately six hours), with rapid onset; (b) intermediate action (approximately 12 hours); (c) long action, with slow onset and lasting for up to 36 hours. Human, porcine and bovine preparations are available. Much of the insulin now used is prepared by genetic engineering techniques from micro-organisms. There are many regimens of insulin treatment involving di?erent combinations of insulin; regimens vary depending on the requirements of the patients, most of whom administer the insulin themselves. Carbohydrate intake, energy expenditure and the presence of infection are important determinants of insulin requirements on a day-to-day basis.

A new treatment for diabetes, pioneered in Canada and entering its preliminary clinical trials in the UK, is the transplantation of islet cells of Langerhans from a healthy person into a patient with the disorder. If the transplantation is successful, the transplanted cells start producing insulin, thus reducing or eliminating the requirement for regular insulin injections. If successful the trials would be a signi?cant advance in the treatment of diabetes.

Scientists in Israel have developed a drug, Dia Pep 277, which stops the body’s immune system from destroying pancratic ? cells as happens in insulin-dependent diabetes. The drug, given by injection, o?ers the possibility of preventing type 1 diabetes in healthy people at genetic risk of developing the disorder, and of checking its progression in affected individuals whose ? cells are already perishing. Trials of the drug are in progress.... diabetes mellitus

A COLLOID which absorbs water to swell to about 25 times its original volume. It is used in the treatment of CONSTIPATION and also in the management of OBESITY. The rationale for its use in obesity is that by swelling up in the stomach, it reduces the appetite.... methylcellulose

A food that has more energy-producing power, weight for weight, than any other. Animal fat is a mixture in varying proportions of stearic, palmitic, and oleic acids combined with glycerin. Butter contains about 80 per cent of fat; ordinary cream, 20 per cent; and rich cream 40 per cent – whilst olive oil is practically a pure form of fat. When taken to a large extent in the diet, fat requires to be combined with a certain proportion of either CARBOHYDRATE or PROTEIN in order that it may be completely consumed, otherwise harmful products, known as ketones, may form in the blood. Each gram of fat has an energy-producing equivalent of 9·3 Calories (see CALORIE).

Fats are divided into saturated fats – that is, animal fats and dairy produce; and unsaturated fats, which include vegetable oils from soya bean, maize and sun?ower, and marine oils from ?sh (e.g. cod-liver oil). (See also ADIPOSE TISSUE; LIPID; OBESITY.)

Body fat Most of the body’s fat is stored in ADIPOSE TISSUE which is mainly sited beneath the skin and around various internal organs. Some, however, is stored in liver, muscle and other cellular structures such as bone marrow (see BONE). Various methods can be used to estimate the body’s fat content but all are indirect and not very accurate, depending as they do on hard-to-measure di?erences in composition between fat and lean tissues. The average body fat of healthy young men and women is below 20 per cent and 25 per cent respectively of their body weight. In economically developed countries, middle-aged men and women usually undergo a steady increase in body fat. This is probably not a feature of ageing, however, since in developing nations, which have di?erent diets and greater levels of physical activity, increased age does not bring with it an increase in body fat. One widely used means to estimate whether a person has excess fat is to measure his or her skinfold thickness on the arms and torso. The distribution of fat can be a pointer to certain disorders: those adults, for example, who deposit their fat abdominally rather than on their hips – an android rather than a gynaecoid distribution – are particularly susceptible to disease of the CARDIOVASCULAR SYSTEM and to DIABETES MELLITUS.

Adipose tissue comprises fat deposited as a result of eating more food than is metabolised by exercise and the body’s basic energy needs. Surplus fat can in some circumstances be a useful energy store. For example, hibernating animals ‘burn o?’ the fat stored during the summer months and are much leaner when they wake up in the spring. Excessive quantities of adipose tissue result in OBESITY, an increasingly serious problem among all age groups, including children, in countries with developed economies.... fat

Means high BLOOD PRESSURE (raised pressure of the circulating blood), but since there is a wide range of ‘normal’ blood pressure in the population, a precise level of pressure above which an individual is deemed hypertensive is arbitrary. (A healthy young adult would be expected to have a systolic pressure of around 120 mm Hg and a diastolic of 80 mm Hg, recorded as 120/80.) Hypertension is not a disease as such but a quantitative deviation from the norm. A person with a pressure higher than the average for his or her age group is usually symptomless – although sometimes such people may develop headaches. The identi?cation of people with hypertension is important because it is a signal that they will be more likely to have a STROKE or myocardial infarct (coronary thrombosis or heart attack) than someone whose pressure is in the ‘normal’ range. Preventive steps can then be taken to lessen the likelihood of their developing these potentially life-threatening conditions.

Blood pressure is measured using two values. The systolic pressure – the greater of the two – represents the pressure when blood is pumped from the left VENTRICLE of the heart into the AORTA. The diastolic pressure is the measurement when both ventricles relax between beats. The pressures are measured in millimetres (mm) of mercury (Hg). Despite the grey area between normal and raised blood pressure, the World Health Organisation (WHO) has de?ned hypertension as a blood pressure consistently greater than 160 mm Hg (systolic) and 95 mm Hg (diastolic). Young children have readings well below these, but blood pressure rises with age and a healthy person may well live symptom free with a systolic pressure above the WHO ?gure. A useful working de?nition of hypertension is the ?gure at which the bene?ts of treating the condition outweigh the risks and costs of the treatment.

Between 10 and 20 per cent of the adult population in the UK has hypertension, with more men than women affected. Incidence is highest in the middle-aged and elderly. Because most people with hypertension are symptomless, the condition is often ?rst identi?ed during a routine medical examination, otherwise a diagnosis is usually made when complications occur. Many people’s blood pressure rises when they are anxious or after exercise, so if someone’s pressure is above normal at the ?rst testing, it should be taken again after, say, 10 minutes’ rest, by which time the reading should have settled to the person’s regular level. BP measurements should then be taken on two subsequent occasions. If the pressure is still high, the cause needs to be determined: this is done using a combination of personal and family histories (hypertension can run in families), a physical examination and investigations, including an ECG and blood tests for renal disease.

Over 90 per cent of hypertensive people have no immediately identi?able cause for their condition. They are described as having essential hypertension. In those patients with an identi?able cause, the hypertension is described as secondary. Among the causes of secondary hypertension are:

Lifestyle factors such as smoking, alcohol, stress, excessive dietary salt and obesity.

Diseases of the KIDNEYS.

Pregnancy (ECLAMPSIA).

Various ENDOCRINE disorders – for example, PHAEOCHROMOCYTOMA, CUSHING’S DISEASE, ACROMEGALY, thyrotoxicosis (see under THYROID GLAND, DISEASES OF).

COARCTATION OF THE AORTA.

Drugs – for example, oestrogen-containing oral contraceptives (see under CONTRACEPTION), ANABOLIC STEROIDS, CORTICOSTEROIDS, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).

Treatment People with severe hypertension may need prompt admission to hospital for urgent investigation and treatment. Those with a mild to moderate rise in blood pressure for which no cause is identi?able should be advised to change their lifestyle: smokers should stop the habit, and those with high alcohol consumption should greatly reduce or stop their drinking. Obese people should reduce their food consumption, especially of animal fats, and take more exercise. Everyone with hypertension should follow a low-salt diet and take regular exercise. Patients should also be taught how to relax, which helps to reduce blood pressure and, if they have a stressful life, working patterns should be modi?ed if possible. If these lifestyle changes do not reduce a person’s blood pressure su?ciently, drugs to achieve this will be needed. A wide range of anti-hypertensive drugs are available on prescription.

A ?rst-line treatment is one of the THIAZIDES, e?ective at a low dosage and especially useful in the elderly. Beta blockers (see BETAADRENOCEPTOR-BLOCKING DRUGS), such as oxprenolol, acebutol or atenolol, are also ?rst-line treatments. ACE inhibitors (see ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS) and CALCIUM-CHANNEL BLOCKERS can be used if the ?rst-line choices are not e?ective. The drug treatment of hypertension is complex, and sometimes various drugs or combinations of drugs have to be tried to ?nd what regimen is e?ective and suits the patient. Mild to moderate hypertension can usually be treated in general practice, but patients who do not respond or have complications will normally require specialist advice. Patients on anti-hypertensive treatments require regular monitoring, and, as treatment may be necessary for several years, particular attention should be paid to identifying sideeffects. Nevertheless, e?ective treatment of hypertension does enable affected individuals to live longer and more comfortable lives than would otherwise be the case. Older people with moderately raised blood pressure are often able to live with the condition, and treatment with anti-hypertensive drugs may produce symptoms of HYPOTENSION.

In summary, hypertension is a complex disorder, with di?erent patients responding di?erently to treatment. So the condition sometimes requires careful assessment before the most e?ective therapy for a particular individual is identi?ed, and continued monitoring of patients with the disorder is advisable.

Complications Untreated hypertension may eventually result in serious complications. People with high blood pressure have blood vessels with thickened, less ?exible walls, a narrowed LUMEN and convoluted shape. Sometimes arteries become rigid. ANEURYSM may develop and widespread ATHEROMA (fat deposits) is apparent in the arterial linings. Such changes adversely affect the blood supply to body tissues and organs and so damage their functioning. Patients suffer STROKE (haemorrhage from or thrombosis in the arteries of the BRAIN) and heart attacks (coronary thrombosis

– see HEART, DISEASES OF). Those with hypertension may suffer damage to the retina of the EYE and to the OPTIC DISC. Indeed, the diagnosis of hypertension is sometimes made during a routine eye test, when the doctor or optician notices changes in the retinal arteries or optic disc. Kidney function is often affected, with patients excreting protein and excessive salt in their urine. Occasionally someone with persistent hypertension may suffer an acceleration of damage to the blood vessels – a condition described as ‘malignant’ hypertension, and one requiring urgent hospital treatment.

Hypertension is a potentially dangerous disease because it develops into a cycle of self-perpetuating damage. Faulty blood vessels lead to high blood pressure which in turn aggravates the damage in the vessels and thus in the tissues and organs they supply with blood; this further raises the affected individual’s blood pressure and the pathological cycle continues.... hypertension

Characterised by scanty (or absent) MENSTRUATION, INFERTILITY, hirsutism (excessive hairiness) and OBESITY and the sufferers often have multiple cysts in their OVARIES.

The condition is caused by an imbalance between LUTEINISING HORMONE (LH) and FOLLICLE-STIMULATING HORMONE (FSH); this imbalance stops OVULATION and varies the TESTOSTERONE output of the ovaries. The treatment may be with CLOMIPHENE; with a PROGESTOGEN drug; with LUTEINISING HORMONE-RELEASING HORMONE (LHRH); or with oral contraceptives (see under CONTRACEPTION – Non-barrier methods). The treatment chosen depends on the severity of the disease and whether the woman wants to conceive. Rarely a section of ovarian tissue is surgically removed.... polycystic ovary syndrome

Foeniculum vulgare, Mill. German: Fenchel. French: Fenouil. Spanish: Hinojo. Italian: Finocchio. Chinese: Shih-lo. Seeds, roots and leaves. Seeds contain an important essential oil (anethol). Constituents: coumarins, volatile oil, flavonoids (rutin), sterols.

Action: a gentle warming agent for delicate stomachs; carminative, aromatic, antispasmodic (children), digestive, orexigenic, rubefacient, diuretic (soothing), galactagogue, stimulant (mild), anti-inflammatory in polyarthritis, anticoagulant (Vitamin K antagonist). Antimicrobial. Expectorant. Oestrogen-effect – Aberdeen University.

Uses: To disperse windy colic in infants; griping; to arouse appetite, sweeten a sour stomach, soothe an irritable bowel. To increase milk in nursing mothers. Obesity (traditional tea). Wrinkle smoother (tea). Old Chinese remedy for cholera. Externally, an eyewash for red-eye and blepharitis.

Preparations: As necessary.

Tea. Fresh or dried leaves: 3-4 teaspoons to teapot; add boiling water. Dose: adult; half-1 cup; infants, 2- 3 teaspoons.

Tea. Crushed seeds: quarter to half a teaspoon to each cup boiling water; infuse 15 minutes. Quarter to half a cup (infants, 2-3 teaspoons).

Liquid Extract BMP (1983) 1:1 in 70 per cent alcohol. Dose: 0.8 to 2ml.

Fennel water (distilled). 5-15 drops.

Powder. 300mg capsules; 2 capsules before meals thrice daily.

Lotion. Half a teaspoon crushed seeds in cold water. Infuse 1 hour. Half fill eyebath and use as a douche. Diet. Young shoots and root as a cooked vegetable. Seeds sprinkled on salads.

Note: Fennel seeds were discovered among personal chattels of Egyptian rulers salvaged from among the tombs.

Side-effects: slight return of periods in menopausal women. ... fennel

Linn.

Family: Amaranthaceae.

Habitat: Throughout the tropical and subtropical regions, up to an altitude of 2,100 m, in the southern Andaman Islands.

English: Prickly Chaff Flower.

Ayurvedic: Apaamaarga, Chirchitaa, Shikhari, Shaikharika, Adahshalya, Mayura, Mayuraka, Kharamanjari, Kharapushpaa, Pratyakpushpaa, Aaghaat, Vashira, Kanihi.

Unani: Chirchitaa.

Siddha/Tamil: Naayuruvi.

Folk: Chirchitta, Chichidaa, Latjeeraa.

Action: Astringent, pectoral (ashes of the plant used in asthma and cough), diuretic, hepatoprotective, emmenagogue. Benzene extract of the plant exhibited abortifacient activity. The flowers, ground and mixed with sugar, are given for menorrhagia. Roots—astringent, haemostatic. Seeds—emetic; used for biliousness. Essential oil— antifungal.

Key application: As astringent, emetic. (Indian Herbal Pharmacopoeia.)

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of the whole plant in lipid disorders and obesity, the root for its blood-purifying property.

The plant juice and ash are used for treating bleeding piles. An alkaline powder of the plant is used in preparing Kshaarasutra of Ayurvedic medicine, which is recommended for treating fistula-in-ano.

The whole plant contains the alkaloids achyranthine and betaine. Achy- ranthine, a water-soluble alkaloid, is reported to dilate blood vessels, lower blood pressure, decrease heart rate and increase the rate and amplitude of respiration. It also shows spasmodic effects on the rectus muscle of frog, diuretic and purgative action in albino rats.

The presence of ecdysterone and oleanolic acid is also reported in the root.

The ashes of the plant yield large quantities of potash. The seeds yield saponins and oleanolic acid and its ester.

The presence of tannins and glyco- sides is also reported in the plant.

Dosage: Whole plant—20-30 g for decoction. Root—5-10 g. (API Vols. II, III.) Ash—500 mg to 2 g. (CCRAS.)... achyranthes aspera

See OBESITY.... adiposity

Absence of MENSTRUATION at the time of life at which it should normally occur. If menstruation has never occurred, the amenorrhoea is termed primary; secondary amenorrhoea is de?ned as menstruation ceasing after a normal cycle has been experienced for a number of years.

A few patients with primary amenorrhoea have an abnormality of their CHROMOSOMES or malformation of the genital tract such as absecence of the UTERUS (see TURNER’S SYNDROME). A gynaecological examination will rarely disclose an IMPERFORATE HYMEN in a young girl who may also complain of regular cycles of pain like period pains.

There are many causes of secondary amenorrhoea and management requires dealing with the primary cause. The commonest cause is pregnancy. Disorders of the HYPOTHALAMUS and related psychological factors such as anorexia nervosa (see EATING DISORDERS) also cause amenorrhoea, as can poor nutrition and loss of weight by extreme dieting. It is common in ballet dancers and athletes who exercise a great deal, but can also be triggered by serious illnesses such as tuberculosis or malaria. Excess secretion of prolactin, either due to a micro-adenoma (see ADENOMA) of the PITUITARY GLAND or to various prescription drugs will produce amenorrhoea, and sometimes GALACTORRHOEA as well. Malfunction of other parts of the pituitary gland will cause failure to produce GONADOTROPHINS, thus causing ovarian failure with consequent amenorrhea. In CUSHING’S SYNDROME, amenorrhoea is caused by excessive production of cortisol. Similarly, androgen-production abnormalities are found in the common POLYCYSTIC OVARY SYNDROME. These conditions also have abnormalities of the insulin/glucose control mechanisms. Taking the contraceptive pill is not now considered to provoke secondary amenorrhoea but OBESITY and HYPOTHYROIDISM are potential causes.

When the cause is weight loss, restoring body weight may alone restore menstruation. Otherwise, measuring gonadotrophic hormone levels will help show whether amenorrhoea is due to primary ovarian failure or secondary to pituitary disease. Women with raised concentrations of serum gonadotrophic hormones have primary ovarian failure. When amenorrhoea is due to limited pituitary failure, treatment with CLOMIPHENE may solve the problem.... amenorrhoea

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Moderate Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, phosphorus, zinc

About the Nutrients in This Food Like fish, pork, poultry, milk, and eggs, beef has high-quality proteins, with sufficient amounts of all the essential amino acids. Beef fat is slightly more highly saturated than pork fat, but less saturated than lamb fat. All have about the same amount of cholesterol per serving. Beef is an excellent source of B vitamins, including niacin, vitamin B6, and vitamin B12, which is found only in animal foods. Lean beef pro- vides heme iron, the organic iron that is about five times more useful to the body than nonheme iron, the inorganic form of iron found in plant foods. Beef is also an excellent source of zinc. One four-ounce serving of lean broiled sirloin steak has nine grams fat (3.5 g saturated fat), 101 mg cholesterol, 34 g protein, and 3.81 mg iron (21 percent of the R DA for a woman, 46 percent of the R DA for a man). One four-ounce serving of lean roast beef has 16 g fat (6.6 g saturated fat), 92 mg cholesterol, and 2.96 mg iron (16 percent of the R DA for a woman, 37 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Ascorbic acid increases the absorption of iron from meat. * These values apply to lean cooked beef.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet (for some forms of kidney disease)

Buying This Food Look for: Fresh, red beef. The fat should be white, not yellow. Choose lean cuts of beef with as little internal marbling (streaks of fat) as possible. The leanest cuts are flank steak and round steak; rib steaks, brisket, and chuck have the most fat. USDA grading, which is determined by the maturity of the animal and marbling in meat, is also a guide to fat content. U.S. prime has more marbling than U.S. choice, which has more marbling than U.S. good. All are equally nutritious; the difference is how tender they are, which depends on how much fat is present. Choose the cut of meat that is right for your recipe. Generally, the cuts from the cen- ter of the animal’s back—the rib, the T-Bone, the porterhouse steaks—are the most tender. They can be cooked by dry heat—broiling, roasting, pan-frying. Cuts from around the legs, the underbelly, and the neck—the shank, the brisket, the round—contain muscles used for movement. They must be tenderized by stewing or boiling, the long, moist cooking methods that break down the connective tissue that makes meat tough.

Storing This Food Refrigerate raw beef immediately, carefully wrapped to prevent its drippings from contami- nating other foods. Refrigeration prolongs the freshness of beef by slowing the natural multi- plication of bacteria on the meat surface. Unchecked, these bacteria will convert proteins and other substances on the surface of the meat to a slimy film and change meat’s sulfur-contain- ing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Fresh ground beef, with many surfaces where bacteria can live, should be used within 24 to 48 hours. Other cuts of beef may stay fresh in the refrigerator for three to five days.

Preparing This Food Trim the beef carefully. By judiciously cutting away all visible fat you can significantly reduce the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the appearance and flavor of beef, alters nutritional value, makes it safer, and extends its shelf life. Browning meat after you cook it does not “seal in the juices,” but it does change the fla- vor by caramelizing sugars on the surface. Because beef’s only sugars are the small amounts of glycogen in the muscles, we add sugars in marinades or basting liquids that may also con- tain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When beef is cooked, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat and turn brown, the natural color of well-done meat. At the same time, the fats in the beef are oxidized. Oxidized fats, whether formed in cooking or when the cooked meat is stored in the refrigerator, give cooked meat a character- istic warmed-over flavor. Cooking and storing meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers, and other vitamin C-rich vegetables—reduces the oxidation of fats and the intensity of warmed-over flavor. Meat reheated in a microwave oven also has less warmed-over flavor. An obvious nutritional benefit of cooking is the fact that heat lowers the fat content of beef by liquif ying the fat so it can run off the meat. One concrete example of how well this works comes from a comparison of the fat content in regular and extra-lean ground beef. According to research at the University of Missouri in 1985, both kinds of beef lose mass when cooked, but the lean beef loses water and the regular beef loses fat and cholesterol. Thus, while regular raw ground beef has about three times as much fat (by weight) as raw ground extra-lean beef, their fat varies by only 5 percent after broiling. To reduce the amount of fat in ground beef, heat the beef in a pan until it browns. Then put the beef in a colander, and pour one cup of warm water over the beef. Repeat with a second cup of warm water to rinse away fat melted by heating the beef. Use the ground beef in sauce and other dishes that do not require it to hold together. Finally, cooking makes beef safer by killing Salmonella and other organisms in the meat. As a result, cooking also serves as a natural preservative. According to the USDA, large pieces of fresh beef can be refrigerated for two or three days, then cooked and held safely for another day or two because the heat of cooking has reduced the number of bacteria on the surface of the meat and temporarily interrupted the natural cycle of deterioration.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to the air, in a refrigerated room, reduces the moisture content and shrinks the meat slightly. As the meat ages enzymes break down muscle pro- teins, “tenderizing” the beef. Canning. Canned beef does not develop a warmed-over flavor because the high tempera- tures in canning food and the long cooking process alter proteins in the meat so that they act as antioxidants. Once the can is open, however, the meat should be protected from oxygen that will change the flavor of the beef. Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solution. The salt or sugar used in curing dissolves in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the microor- ganisms and protecting the meat from bacterial damage. Salt-cured meat is much higher in sodium than fresh meat. Freezing. When you freeze beef, the water inside its cells freezes into sharp ice crystals that can puncture cell membranes. When the beef thaws, moisture (and some of the B vitamins) will leak out through these torn cell walls. The loss of moisture is irreversible, but some of the vitamins can be saved by using the drippings when the meat is cooked. Freezing may also cause freezer burn—dry spots left when moisture evaporates from the surface of the meat. Waxed freezer paper is designed specifically to hold the moisture in meat; plastic wrap and aluminum foil are less effective. NOTE : Commercially prepared beef, which is frozen very quickly at very low temperatures, is less likely to show changes in texture. Irradiation. Irradiation makes meat safer by exposing it to gamma rays, the kind of high- energy ionizing radiation that kills living cells, including bacteria. Irradiation does not change the way meat looks, feels or tastes, or make the food radioactive, but it does alter the structure of some naturally occurring chemicals in beef, breaking molecules apart to form new com- pounds called radiolytic products (R P). About 90 percent of R Ps are also found in nonirradiated foods. The rest, called unique radiolytic products (UR P), are found only in irradiated foods. There is currently no evidence to suggest that UR Ps are harmful; irradiation is an approved technique in more than 37 countries around the world, including the United States. Smoking. Hanging cured or salted meat over an open fire slowly dries the meat, kills micro- organisms on its surface, and gives the meat a rich, “smoky” flavor that varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Meats treated with “artificial smoke flavoring” are not, since the flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements. One cooked 3.5- ounce hamburger provides about 2.9 mg iron, 16 percent of the R DA for an adult woman of childbearing age. Possible anti-diabetes activity. CLA may also prevent type 2 diabetes, also called adult-onset diabetes, a non-insulin-dependent form of the disease. At Purdue University, rats bred to develop diabetes spontaneously between eight and 10 weeks of age stayed healthy when given CLA supplements.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, beef contains cholesterol and saturated fats that increase the amount of cholesterol circulating in your blood, raising your risk of heart disease. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Increased risk of some cancers. According the American Institute for Cancer Research, a diet high in red meat (beef, lamb, pork) increases the risk of developing colorectal cancer by 15 percent for every 1.5 ounces over 18 ounces consumed per week. In 2007, the National Can- cer Institute released data from a survey of 500,000 people, ages 50 to 71, who participated in an eight-year A AR P diet and health study identif ying a higher risk of developing cancer of the esophagus, liver, lung, and pancreas among people eating large amounts of red meats and processed meats. Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meats con- taminated with other bacteria, viruses, or parasites pose special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; 165°F, the E. coli organism; and 212°F, Listeria monocytogenes. Antibiotic sensitivity. Cattle in the United States are routinely given antibiotics to protect them from infection. By law, the antibiotic treatment must stop three days to several weeks before the animal is slaughtered. Theoretically, the beef should then be free of antibiotic residues, but some people who are sensitive to penicillin or tetracycline may have an allergic reaction to the meat, although this is rare. Antibiotic-resistant Salmonella and toxoplasmosis. Cattle treated with antibiotics may pro- duce meat contaminated with antibiotic-resistant strains of Salmonella, and all raw beef may harbor ordinary Salmonella as well as T. gondii, the parasite that causes toxoplasmosis. Toxoplasmosis is particularly hazardous for pregnant women. It can be passed on to the fetus and may trigger a series of birth defects including blindness and mental retardation. Both Salmonella and the T. gondii can be eliminated by cooking meat thoroughly and washing all utensils, cutting boards, and counters as well as your hands with hot soapy water before touching any other food. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia, which is excreted through the kidneys. In laborator y animals, a sustained high-protein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Tetracycline antibiotics (demeclocycline [Declomycin], doxycycline [ Vibtamycin], methacycline [Rondomycin], minocycline [Minocin], oxytetracycline [Terramycin], tetracycline [Achromycin V, Panmycin, Sumycin]). Because meat contains iron, which binds tetracyclines into com- pounds the body cannot absorb, it is best to avoid meat for two hours before and after taking one of these antibiotics. Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking a M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis. Theophylline. Charcoal-broiled beef appears to reduce the effectiveness of theophylline because the aromatic chemicals produced by burning fat speed up the metabolism of the- ophylline in the liver.... beef

See OBESITY.... corpulence

A drug that stimulates the central nervous system. It can be used to treat NARCOLEPSY and hyperactive children but should not be used to combat obesity or treat depression. It is also a drug of abuse.... dexamphetamine

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: High Saturated fat: Moderate Cholesterol: High Carbohydrates: Low Fiber: None Sodium: Moderate to high Major vitamin contribution: Vitamin A, riboflavin, vitamin D Major mineral contribution: Iron, calcium

About the Nutrients in This Food An egg is really three separate foods, the whole egg, the white, and the yolk, each with its own distinct nutritional profile. A whole egg is a high-fat, high-cholesterol, high-quality protein food packaged in a high-calcium shell that can be ground and added to any recipe. The proteins in eggs, with sufficient amounts of all the essential amino acids, are 99 percent digestible, the standard by which all other proteins are judged. The egg white is a high-protein, low-fat food with virtually no cholesterol. Its only important vitamin is riboflavin (vitamin B2), a vis- ible vitamin that gives egg white a slightly greenish cast. Raw egg whites contain avidin, an antinutrient that binds biotin a B complex vitamin for- merly known as vitamin H, into an insoluble compound. Cooking the egg inactivates avidin. An egg yolk is a high-fat, high-cholesterol, high-protein food, a good source of vitamin A derived from carotenes eaten by the laying hen, plus vitamin D, B vitamins, and heme iron, the form of iron most easily absorbed by your body. One large whole egg (50 g/1.8 ounce) has five grams fat (1.5 g satu- rated fat, 1.9 g monounsaturated fat, 0.7 g polyunsaturated fat), 212 mg cholesterol, 244 IU vitamin A (11 percent of the R DA for a woman, 9 percent * Values are for a whole egg. of the R DA for a man), 0.9 mg iron (5 percent of the R DA for a woman, 11 percent of the R DA for a man) and seven grams protein. The fat in the egg is all in the yolk. The protein is divided: four grams in the white, three grams in the yolk.

The Most Nutritious Way to Serve This Food With extra whites and fewer yolks to lower the fat and cholesterol per serving.

Diets That May Restrict or Exclude This Food Controlled-fat, low-cholesterol diet Low-protein diet

Buying This Food Look for: Eggs stored in the refrigerated dair y case. Check the date for freshness. NOTE : In 1998, the FDA and USDA Food Safety and Inspection Service (FSIS) proposed new rules that would require distributors to keep eggs refrigerated on the way to the store and require stores to keep eggs in a refrigerated case. The egg package must have a “refrigera- tion required” label plus safe-handling instructions on eggs that have not been treated to kill Salmonella. Look for: Eggs that fit your needs. Eggs are graded by the size of the yolk and the thick- ness of the white, qualities that affect appearance but not nutritional values. The higher the grade, the thicker the yolk and the thicker the white will be when you cook the egg. A Grade A A egg fried sunny side up will look much more attractive than a Grade B egg prepared the same way, but both will be equally nutritions. Egg sizes ( Jumbo, Extra large, Large, Medium, Small) are determined by how much the eggs weigh per dozen. The color of the egg’s shell depends on the breed of the hen that laid the egg and has nothing to do with the egg’s food value.

Storing This Food Store fresh eggs with the small end down so that the yolk is completely submerged in the egg white (which contains antibacterial properties, nature’s protection for the yolk—or a developing chick embryo in a fertilized egg). Never wash eggs before storing them: The water will make the egg shell more porous, allowing harmful microorganisms to enter. Store separated leftover yolks and whites in small, tightly covered containers in the refrigerator, where they may stay fresh for up to a week. Raw eggs are very susceptible to Salmonella and other bacterial contamination; discard any egg that looks or smells the least bit unusual. Refrigerate hard-cooked eggs, including decorated Easter eggs. They, too, are suscep- tible to Salmonella contamination and should never be left at room temperature.

Preparing This Food First, find out how fresh the eggs really are. The freshest ones are the eggs that sink and lie flat on their sides when submerged in cool water. These eggs can be used for any dish. By the time the egg is a week old, the air pocket inside, near the broad end, has expanded so that the broad end tilts up as the egg is submerged in cool water. The yolk and the white inside have begun to separate; these eggs are easier to peel when hard-cooked. A week or two later, the egg’s air pocket has expanded enough to cause the broad end of the egg to point straight up when you put the egg in water. By now the egg is runny and should be used in sauces where it doesn’t matter if it isn’t picture-perfect. After four weeks, the egg will float. Throw it away. Eggs are easily contaminated with Salmonella microorganisms that can slip through an intact shell. never eat or serve a dish or bever age containing r aw fr esh eggs. sa lmonella is destroyed by cooking eggs to an inter nal temper atur e of 145°f ; egg-milk dishes such as custar ds must be cooked to an inter nal temper atur e of 160°f. If you separate fresh eggs by hand, wash your hands thoroughly before touching other food, dishes, or cooking tools. When you have finished preparing raw eggs, wash your hands and all utensils thoroughly with soap and hot water. never stir cooked eggs with a utensil used on r aw eggs. When you whip an egg white, you change the structure of its protein molecules which unfold, breaking bonds between atoms on the same molecule and forming new bonds to atoms on adjacent molecules. The result is a network of protein molecules that hardens around air trapped in bubbles in the net. If you beat the whites too long, the foam will turn stiff enough to hold its shape even if you don’t cook it, but it will be too stiff to expand natu- rally if you heat it, as in a soufflé. When you do cook properly whipped egg white foam, the hot air inside the bubbles will expand. Ovalbumin, an elastic protein in the white, allows the bubble walls to bulge outward until they are cooked firm and the network is stabilized as a puff y soufflé. The bowl in which you whip the whites should be absolutely free of fat or grease, since the fat molecules will surround the protein molecules in the egg white and keep them from linking up together to form a puff y white foam. Eggs whites will react with metal ions from the surface of an aluminum bowl to form dark particles that discolor the egg-white foam. You can whip eggs successfully in an enamel or glass bowl, but they will do best in a copper bowl because copper ions bind to the egg and stabilize the foam.

What Happens When You Cook This Food When you heat a whole egg, its protein molecules behave exactly as they do when you whip an egg white. They unfold, form new bonds, and create a protein network, this time with molecules of water caught in the net. As the egg cooks, the protein network tightens, squeez- ing out moisture, and the egg becomes opaque. The longer you cook the egg, the tighter the network will be. If you cook the egg too long, the protein network will contract strongly enough to force out all the moisture. That is why overcooked egg custards run and why overcooked eggs are rubbery. If you mix eggs with milk or water before you cook them, the molecules of liquid will surround and separate the egg’s protein molecules so that it takes more energy (higher heat) to make the protein molecules coagulate. Scrambled eggs made with milk are softer than plain scrambled eggs cooked at the same temperature. When you boil an egg in its shell, the air inside expands and begins to escape through the shell as tiny bubbles. Sometimes, however, the force of the air is enough to crack the shell. Since there’s no way for you to tell in advance whether any particular egg is strong enough to resist the pressure of the bubbling air, the best solution is to create a safety vent by sticking a pin through the broad end of the egg before you start to boil it. Or you can slow the rate at which the air inside the shell expands by starting the egg in cold water and letting it warm up naturally as the water warms rather than plunging it cold into boiling water—which makes the air expand so quickly that the shell is virtually certain to crack. As the egg heats, a little bit of the protein in its white will decompose, releasing sulfur that links up with hydrogen in the egg, forming hydrogen sulfide, the gas that gives rot- ten eggs their distinctive smell. The hydrogen sulfide collects near the coolest part of the egg—the yolk. The yolk contains iron, which now displaces the hydrogen in the hydrogen sulfide to form a green iron-sulfide ring around the hard-cooked yolk.

How Other Kinds of Processing Affect This Food Egg substitutes. Fat-free, cholesterol-free egg substitutes are made of pasteurized egg whites, plus artificial or natural colors, flavors, and texturizers (food gums) to make the product look and taste like eggs, plus vitamins and minerals to produce the nutritional equivalent of a full egg. Pasteurized egg substitutes may be used without additional cooking, that is, in salad dressings and eggnog. Drying. Dried eggs have virtually the same nutritive value as fresh eggs. Always refrigerate dried eggs in an air- and moistureproof container. At room temperature, they will lose about a third of their vitamin A in six months.

Medical Uses and/or Benefits Protein source. The protein in eggs, like protein from all animal foods, is complete. That is, protein from animal foods provides all the essential amino acids required by human beings. In fact, the protein from eggs is so well absorbed and utilized by the human body that it is considered the standard by which all other dietary protein is measured. On a scale known as biological value, eggs rank 100 ; milk, 93; beef and fish, 75; and poultry, 72. Vision protection. The egg yolk is a rich source of the yellow-orange carotenoid pigments lutein and zeaxanthin. Both appear to play a role in protecting the eyes from damaging ultraviolet light, thus reducing the risk of cataracts and age-related macular degeneration, a leading cause of vision of loss in one-third of all Americans older than 75. Just 1.3 egg yolks a day appear to increase blood levels of lutein and zeaxanthin by up to 128 percent. Perhaps as a result, data released by the National Eye Institute’s 6,000-person Beaver Dam ( Wisconsin) Eye Study in 2003 indicated that egg consumption was inversely associated with cataract risk in study participants who were younger than 65 years of age when the study started. The relative risk of cataracts was 0.4 for people in the highest category of egg consumption, compared to a risk of 1.0 for those in the lowest category. External cosmetic effects. Beaten egg whites can be used as a facial mask to make your skin look smoother temporarily. The mask works because the egg proteins constrict as they dry on your face, pulling at the dried layer of cells on top of your skin. When you wash off the egg white, you also wash off some of these loose cells. Used in a rinse or shampoo, the pro- tein in a beaten raw egg can make your hair look smoother and shinier temporarily by filling in chinks and notches on the hair shaft.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Although egg yolks are high in cholesterol, data from several recent studies suggest that eating eggs may not increase the risk of heart disease. In 2003, a report from a 14-year, 177,000-plus person study at the Harvard School of Public Health showed that people who eat one egg a day have exactly the same risk of heart disease as those who eat one egg or fewer per week. A similar report from the Multiple R isk Factor Intervention Trial showed an inverse relationship between egg consumption and cholesterol levels—that is, people who ate more eggs had lower cholesterol levels. Nonetheless, in 2006 the National Heart, Lung, and Blood Institute still recommends no more than four egg yolks a week (including the yolk in baked goods) for a heart-healthy diet. The American Heart Association says consumers can have one whole egg a day if they limit cholesterol from other sources to the amount suggested by the National Cholesterol Education Project following the Step I and Step II diets. (Both groups permit an unlimited number of egg whites.) The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food poisoning. Raw eggs (see above) and egg-rich foods such as custards and cream pies are excellent media for microorganisms, including the ones that cause food poisoning. To protect yourself against egg-related poisoning, always cook eggs thoroughly: poach them five minutes over boiling water or boil at least seven minutes or fry two to three minutes on each side (no runny center) or scramble until firm. Bread with egg coating, such as French toast, should be cooked crisp. Custards should be firm and, once cooked, served very hot or refrigerated and served very cold. Allergic reaction. According to the Merck Manual, eggs are one of the 12 foods most likely to trigger the classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stomach. The others are berries (blackberries, blueberries, raspberries, strawberries), choco- late, corn, fish, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls).

Food/Drug Interactions Sensitivity to vaccines. Live-virus measles vaccine, live-virus mumps vaccine, and the vac- cines for influenza are grown in either chick embryo or egg culture. They may all contain minute residual amounts of egg proteins that may provoke a hypersensitivity reaction in people with a history of anaphylactic reactions to eggs (hives, swelling of the mouth and throat, difficulty breathing, a drop in blood pressure, or shock).... eggs

A condition in children characterised by obesity, physical sluggishness, and retarded sexual development. It is the result of disturbed PITUITARY GLAND function.... fröhlich’s syndrome

Celery (Apium graveolens variety dulce).

Plant Part Used: Stalk, leaves, roots, seeds.

Dominican Medicinal Uses: The stalks and leaves are traditionally eaten raw or taken as a juice for treating obesity, high blood pressure, high cholesterol, diabetes and menopausal hot flashes.

Safety: The stalks, leaf and root are widely consumed and generally considered safe. Cases of allergic reaction to the root have been reported. Plants infected with pink rot fungus can cause phototoxicoses.

Contraindications: Internal use of the seeds and essential oil are contraindicated during pregnancy (emmenagoge, abortifacient, uterine stimulating effects) and patients with renal disorders (potential kidney-irritating effect of oil).

Drug Interactions: Celery seeds and seed extract: anticoagulants, warfarin (risk of bleeding, drug potentiation); thyroxine (lowered T4 levels).

Laboratory & Preclinical Data: In vivo: anti-hyperlipidemic, anti-inflammatory, antinociceptive (plant extract); hepatoprotective (seeds).

In vitro: antimicrobial, antioxidant (plant extract); cercaricidal (essential oil); vasodilation (chemical constituent).

* See entry for Apio in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... apio

Appetite is the craving for the food necessary to maintain the body and to supply it with suf?cient energy to carry on its functions. The ultimate cause of appetite is a question of supply and demand in the muscles and various organs, but the proximate cause is doubtful. Unlike hunger, it is probably an acquired, rather than an inborn, sensation. Whatever other factors may be concerned, the tone of the STOMACH is of importance. Signi?cant factors in stimulating appetite are anticipation and the sight and smell of well-cooked food. Individuals who eat unsuitable substances such as faeces are described as suffering from pica, which occurs sometimes during pregnancy, in children, and often in mental disorders. The two chief disorders, however, are excessive increase of appetite, and diminution or loss of appetite (see also EATING DISORDERS).

Excessive appetite may simply be a bad habit, due to habitual over-indulgence in good food and resulting in GOUT, OBESITY, etc. – according to the other habits and constitution of the person. It may also be a sign of DIABETES MELLITUS or thyrotoxicosis (see under THYROID GLAND, DISEASES OF).

Diminished appetite is a sign common to almost all diseases causing general weakness, because the activity of the stomach and the secretion of gastric juice fail early when vital power is low. It is the most common sign of DYSPEPSIA due to gastritis, and of cancer of the stomach. In some cases it is a manifestation of stress or strain such as domestic worry or dif?culties at work. Indeed, appetite seems to be particularly susceptible to emotional disturbances, as is evidenced by the linked conditions of BULIMIA (pathological overeating) and anorexia nervosa (pathological dieting) – see also EATING DISORDERS.... appetite

ARTERIES are the blood vessels that convey blood away from the heart to the tissues. The commonest cause of arterial disease is a degenerative condition known as atherosclerosis. Less commonly, in?ammation of the arteries occurs; this in?ammation is known as arteritis and occurs in a variety of conditions.

Atherosclerosis is due to the deposition of CHOLESTEROL into the walls of arteries. The process starts in childhood with the development of fatty streaks lining the arteries. In adulthood these progress, scarring and calcifying to form irregular narrowings within the arteries and eventually leading to blockage of the vessel. The consequence of the narrowing or blockage depends on which vessels are involved

– diseased cerebral vessels cause strokes; coronary vessels cause angina and heart attacks; renal vessels cause renal failure; and peripheral arteries cause limb ischaemia (localised bloodlessness).

Risk factors predisposing individuals to atherosclerosis include age, male gender, raised plasma cholesterol concentration, high blood pressure, smoking, a family history of atherosclerosis, diabetes and obesity.

Arteritis occurs in a variety of conditions that produce in?ammation in the arteries. Examples include syphilis – now rare in Britain

– which produces in?ammation of the aorta with subsequent dilatation (aneurysm formation) and risk of rupture; giant cell arteritis (temporal arteritis), a condition usually affecting the elderly, which involves the cranial arteries and leads to headache, tenderness over the temporal arteries and the risk of sudden blindness; Takayasu’s syndrome, predominantly affecting young females, which involves the aortic arch and its major branches, leading to the absence of pulse in affected vessels; and polyarteritis nodosa, a condition causing multiple small nodules to form on the smaller arteries. General symptoms such as fever, malaise, weakness, anorexia and weight loss are accompanied by local manifestations of ischaemia (bloodlessness) in di?erent parts of the body.... arteries, diseases of

(Bison, rabbit, venison)

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low Saturated fat: High Cholesterol: Moderate Carbohydrates: None Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Iron, zinc

About the Nutrients in This Food Like other animal foods, game meat has high-quality proteins with suf- ficient amounts of all the essential amino acids. Some game meat has less fat, saturated fat, and cholesterol than beef. All game meat is an excellent source of B vitamins, plus heme iron, the form of iron most easily absorbed by your body, and zinc. For example, one four-ounce serving of roast bison has 28 g protein, 2.7 g fat (1.04 g saturated fat), 93.7 mg cholesterol, 3.88 mg iron (25.8 percent of the R DA for a woman of childbearing age), and 4.1 mg zinc (27 percent of the R DA for a man). The Nutrients in Roasted Game Meat (4-ounce serving)

The Most Nutritious Way to Serve This Food With a food rich in vitamin C. Vitamin C increases the absorption of iron.

Diets That May Restrict or Exclude This Food Low-protein diet (for kidney disease)

Buying This Food In American markets, game meats are usually sold frozen. Choose a package with no leaks or stains to suggest previous defrosting.

Storing This Food Keep frozen game meat well wrapped in the freezer until you are ready to use it. The packaging protects the meat from oxygen that can change its pigments from reddish to brown. Freezing prolongs the freshness of the meat by slowing the natural multiplication of bacteria that digest proteins and other substances on the surface, converting them to a slimy film. The bacteria also change the meat’s sulfur-containing amino acids methionine and cystine into smelly chemicals called mercaptans. When the mercaptans combine with myoglobin, they produce the greenish pigment that gives spoiled meat its characteristic unpleasant appearance. Large cuts of game meat can be safely frozen, at 0°F, for six months to a year.

Preparing This Food Defrost the meat in the refrigerator to protect it from spoilage. Trim the meat to dispose of all visible fat, thus reducing the amount of fat and cholesterol in each serving. When you are done, clean all utensils thoroughly with hot soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw meat to other foods, keep one cutting board exclusively for raw meats, fish, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Cooking changes the way meat looks and tastes, alters its nutritional value, makes it safer, and extends its shelf life. Browning meat before you cook it does not “seal in the juices,” but it does change the flavor by caramelizing proteins and sugars on the surface. Because meat’s only sugars are the Game Meat  

63 small amounts of glycogen in muscle tissue, we add sugars in marinades or basting liquids that may also contain acids (vinegar, lemon juice, wine) to break down muscle fibers and tenderize the meat. (NOTE : Browning has one minor nutritional drawback. It breaks amino acids on the surface of the meat into smaller compounds that are no longer useful proteins.) When meat is heated, it loses water and shrinks. Its pigments, which combine with oxygen, are denatured (broken into fragments) by the heat. They turn brown, the natural color of well-done meat. At the same time, the fats in the meat are oxidized, a reaction that produces a characteristic warmed-over flavor when the cooked meat is refrigerated and then reheated. Cooking and storing the meat under a blanket of antioxidants—catsup or a gravy made of tomatoes, peppers and other vitamin-C rich vegetables—reduces fat oxidation and lessens the warmed-over flavor. Meat reheated in a microwave oven is also less likely to taste warmed-over.

How Other Kinds of Processing Affect This Food Aging. Hanging fresh meat exposed to air in a cold room evaporates moisture and shrinks the meat slightly. At the same time, bacterial action on the surface of the meat breaks down proteins, producing an “aged” flavor. (See below, Food/drug interactions.) Curing. Salt-curing preserves meat through osmosis, the physical reaction in which liquids flow across a membrane, such as the wall of a cell, from a less dense to a more dense solu- tion. The salt or sugar used in curing dissolve in the liquid on the surface of the meat to make a solution that is more dense than the liquid inside the cells of the meat. Water flows out of the meat and out of the cells of any microorganisms living on the meat, killing the micro-organisms and protecting the meat from bacterial damage. Salt-cured meat is higher in sodium than fresh meat. Smoking. Hanging fresh meat over an open fire slowly dries the meat, kills microorgan- isms on its surface, and gives the meat a rich, smoky flavor. The flavor varies with the wood used in the fire. Meats smoked over an open fire are exposed to carcinogenic chemicals in the smoke, including a-benzopyrene. Artificial smoke flavoring is commercially treated to remove tar and a-benzopyrene.

Medical Uses and/or Benefits Treating and/or preventing iron deficiency. Without meat in the diet, it is virtually impossible for an adult woman to meet her iron requirement without supplements.

Adverse Effects Associated with This Food Increased risk of cardiovascular disease. Like all foods from animals, game meats are a source of cholesterol. To reduce the risk of heart disease, the National Cholesterol Education Project recommends following the Step I and Step II diets. The Step I diet provides no more than 30 percent of total daily calories from fat, no more than 10 percent of total daily calories from saturated fat, and no more than 300 mg of cholesterol per day. It is designed for healthy people whose cholesterol is in the range of 200 –239 mg/dL. The Step II diet provides 25– 35 percent of total calories from fat, less than 7 percent of total calories from saturated fat, up to 10 percent of total calories from polyunsaturated fat, up to 20 percent of total calories from monounsaturated fat, and less than 300 mg cho- lesterol per day. This stricter regimen is designed for people who have one or more of the following conditions: •  Existing cardiovascular disease •  High levels of low-density lipoproteins (LDLs, or “bad” cholesterol) or low levels of high-density lipoproteins (HDLs, or “good” cholesterol) •  Obesity •  Type 1 diabetes (insulin-dependent diabetes, or diabetes mellitus) •  Metabolic syndrome, a.k.a. insulin resistance syndrome, a cluster of risk fac- tors that includes type 2 diabetes (non-insulin-dependent diabetes) Food-borne illness. Improperly cooked meat contaminated with E. coli O157:H7 has been linked to a number of fatalities in several parts of the United States. In addition, meat con- taminated with other bacteria, viruses, or parasites poses special problems for people with a weakened immune system: the very young, the very old, cancer chemotherapy patients, and people with HIV. Cooking meat to an internal temperature of 140°F should destroy Salmo- nella and Campylobacter jejuni; to 165°F, E. coli, and to 212°F, Listeria monocytogenes. Decline in kidney function. Proteins are nitrogen compounds. When metabolized, they yield ammonia that is excreted through the kidneys. In laboratory animals, a sustained high-pro- tein diet increases the flow of blood through the kidneys, accelerating the natural age-related decline in kidney function. Some experts suggest that this may also occur in human beings.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Meat “tenderized” with papaya or a papain powder can interact with the class of antidepressant drugs known as monoamine oxidase inhibi- tors. Papain meat tenderizers work by breaking up the long chains of protein molecules. One by-product of this process is tyramine, a substance that constructs blood vessels and raises blood pressure. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine. If you eat a food such as papain-tenderized meat, which is high in tyramine, while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... game meat

A very rare form of HEPATITIS following exposure to HALOTHANE during anaesthesia (1:35,000 halothane anaesthetics). Jaundice develops three to four days after exposure and will occasionally develop into a fatal massive hepatic necrosis. It is of unknown aetiology but probably has an immunological basis. It is more common following multiple exposures in a short time (less than 28 days), and in obesity, middle age and females. It is rare in children.... halothane hepatitis

Heart disease can affect any of the structures of the HEART and may affect more than one at a time. Heart attack is an imprecise term and may refer to ANGINA PECTORIS (a symptom of pain originating in the heart) or to coronary artery thrombosis, also called myocardial infarction.

Arrhythmias An abnormal rate or rhythm of the heartbeat. The reason is a disturbance in the electrical impulses within the heart. Sometimes a person may have an occasional irregular heartbeat: this is called an ECTOPIC beat (or an extrasystole) and does not necessarily mean that an abnormality exists. There are two main types of arrhythmia: bradycardias, where the rate is slow – fewer than 60 beats a minute and sometimes so slow and unpredictable (heartblock) as to cause blackouts or heart failure; and tachycardia, where the rate is fast – more than 100 beats a minute. A common cause of arrhythmia is coronary artery disease, when vessels carrying blood to the heart are narrowed by fatty deposits (ATHEROMA), thus reducing the blood supply and damaging the heart tissue. This condition often causes myocardial infarction after which arrhythmias are quite common and may need correcting by DEFIBRILLATION (application of a short electric shock to the heart). Some tachycardias result from a defect in the electrical conduction system of the heart that is commonly congenital. Various drugs can be used to treat arrhythmias (see ANTIARRHYTHMIC DRUGS). If attacks constantly recur, the arrhythmia may be corrected by electrical removal of dead or diseased tissue that is the cause of the disorder. Heartblock is most e?ectively treated with an arti?cial CARDIAC PACEMAKER, a battery-activated control unit implanted in the chest.

Cardiomyopathy Any disease of the heart muscle that results in weakening of its contractions. The consequence is a fall in the e?ciency of the circulation of blood through the lungs and remainder of the body structures. The myopathy may be due to infection, disordered metabolism, nutritional excess or de?ciency, toxic agents, autoimmune processes, degeneration, or inheritance. Often, however, the cause is not identi?ed. Cardiomyopathies are less common than other types of heart diseases, and the incidence of di?erent types of myopathy (see below) is not known because patients or doctors are sometimes unaware of the presence of the condition.

The three recognised groups of cardiomyopathies are hypertrophic, dilated and restrictive.

•Hypertrophic myopathy, a familial condition, is characterised by great enlargement of the muscle of the heart ventricles. This reduces the muscle’s e?ciency, the ventricles fail to relax properly and do not ?ll suf?ciently during DIASTOLE.

In the dilated type of cardiomyopathy, both ventricles overdilate, impairing the e?ciency of contraction and causing congestion of the lungs.

In the restrictive variety, proper ?lling of the ventricles does not occur because the muscle walls are less elastic than normal. The result is raised pressure in the two atria (upper cavities) of the heart: these dilate and develop FIBRILLATION. Diagnosis can be di?cult and treatment is symptomatic, with a poor prognosis. In suitable patients, heart TRANSPLANTATION may be considered. Disorders of the heart muscle may also be

caused by poisoning – for example, heavy consumption of alcohol. Symptoms include tiredness, palpitations (quicker and sometimes irregular heartbeat), chest pain, di?culty in breathing, and swelling of the legs and hands due to accumulation of ?uid (OEDEMA). The heart is enlarged (as shown on chest X-ray) and ECHOCARDIOGRAPHY shows thickening of the heart muscle. A BIOPSY of heart muscle will show abnormalities in the cells of the heart muscle.

Where the cause of cardiomyopathy is unknown, as is the case with most patients, treatment is symptomatic using DIURETICS to control heart failure and drugs such as DIGOXIN to return the heart rhythm to normal. Patients should stop drinking alcohol. If, as often happens, the patient’s condition slowly deteriorates, heart transplantation should be considered.

Congenital heart disease accounts for 1–2 per cent of all cases of organic heart disease. It may be genetically determined and so inherited; present at birth for no obvious reason; or, in rare cases, related to RUBELLA in the mother. The most common forms are holes in the heart (atrial septal defect, ventricular septal defect – see SEPTAL DEFECT), a patent DUCTUS ARTERIOSUS, and COARCTATION OF THE AORTA. Many complex forms also exist and can be diagnosed in the womb by fetal echocardiography which can lead to elective termination of pregnancy. Surgery to correct many of these abnormalities is feasible, even for the most severe abnormalities, but may only be palliative giving rise to major diffculties of management as the children become older. Heart transplantation is now increasingly employed for the uncorrectable lesions.

Coronary artery disease Also known as ischaemic heart disease, this is a common cause of symptoms and death in the adult population. It may present for the ?rst time as sudden death, but more usually causes ANGINA PECTORIS, myocardial infarction (heart attack) or heart failure. It can also lead to a disturbance of heart rhythm. Factors associated with an increased risk of developing coronary artery disease include diabetes, cigarette smoking, high blood pressure, obesity, and a raised concentration of cholesterol in the blood. Older males are most affected.

Coronary thrombosis or acute myocardial infarction is the acute, dramatic manifestation of coronary-artery ischaemic heart disease – one of the major killing diseases of western civilisation. In 1999, ischaemic heart disease was responsible for about 115,000 deaths in England and Wales, compared with 153,000 deaths in 1988. In 1999 more than 55,600 people died of coronary thrombosis. The underlying cause is disease of the coronary arteries which carry the blood supply to the heart muscle (or myocardium). This results in narrowing of the arteries until ?nally they are unable to transport su?cient blood for the myocardium to function e?ciently. One of three things may happen. If the narrowing of the coronary arteries occurs gradually, then the individual concerned will develop either angina pectoris or signs of a failing heart: irregular rhythm, breathlessness, CYANOSIS and oedema.

If the narrowing occurs suddenly or leads to complete blockage (occlusion) of a major branch of one of the coronary arteries, then the victim collapses with acute pain and distress. This is the condition commonly referred to as a coronary thrombosis because it is usually due to the affected artery suddenly becoming completely blocked by THROMBOSIS. More correctly, it should be described as coronary occlusion, because the ?nal occluding factor need not necessarily be thrombosis.

Causes The precise cause is not known, but a wide range of factors play a part in inducing coronary artery disease. Heredity is an important factor. The condition is more common in men than in women; it is also more common in those in sedentary occupations than in those who lead a more physically active life, and more likely to occur in those with high blood pressure than in those with normal blood pressure (see HYPERTENSION). Obesity is a contributory factor. The disease is more common among smokers than non-smokers; it is also often associated with a high level of CHOLESTEROL in the blood, which in turn has been linked with an excessive consumption of animal, as opposed to vegetable, fats. In this connection the important factors seem to be the saturated fatty acids (low-density and very low-density lipoproteins [LDLs and VLDLs] – see CHOLESTEROL) of animal fats which would appear to be more likely to lead to a high level of cholesterol in the blood than the unsaturated fatty acids of vegetable fats. As more research on the subject is carried out, the arguments continue about the relative in?uence of the di?erent factors. (For advice on prevention of the disease, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELFHELP.)

Symptoms The presenting symptom is the sudden onset, often at rest, of acute, agonising pain in the front of the chest. This rapidly radiates all over the front of the chest and often down over the abdomen. The pain is frequently accompanied by nausea and vomiting, so that suspicion may be aroused of some acute abdominal condition such as biliary colic (see GALLBLADDER, DISEASES OF) or a perforated PEPTIC ULCER. The victim soon goes into SHOCK, with a pale, cold, sweating skin, rapid pulse and dif?culty in breathing. There is usually some rise in temperature.

Treatment is immediate relief of the pain by injections of diamorphine. Thrombolytic drugs should be given as soon as possible (‘rapid door to needle time’) and ARRHYTHMIA corrected. OXYGEN is essential and oral ASPIRIN is valuable. Treatment within the ?rst hour makes a great di?erence to recovery. Subsequent treatment includes the continued administration of drugs to relieve the pain; the administration of ANTIARRHYTHMIC DRUGS that may be necessary to deal with the heart failure that commonly develops, and the irregular action of the heart that quite often develops; and the continued administration of oxygen. Patients are usually admitted to coronary care units, where they receive constant supervision. Such units maintain an emergency, skilled, round-the-clock sta? of doctors and nurses, as well as all the necessary resuscitation facilities that may be required.

The outcome varies considerably. The ?rst (golden) hour is when the patient is at greatest risk of death: if he or she is treated, then there is a 50 per cent reduction in mortality compared with waiting until hospital admission. As each day passes the prognosis improves with a ?rst coronary thrombosis, provided that the patient does not have a high blood pressure and is not overweight. Following recovery, there should be a gradual return to work, care being taken to avoid any increase in weight, unnecessary stress and strain, and to observe moderation in all things. Smoking must stop. In uncomplicated cases patients get up and about as soon as possible, most being in hospital for a week to ten days and back at work in three months or sooner.

Valvular heart disease primarily affects the mitral and aortic valves which can become narrowed (stenosis) or leaking (incompetence). Pulmonary valve problems are usually congenital (stenosis) and the tricuspid valve is sometimes involved when rheumatic heart disease primarily affects the mitral or aortic valves. RHEUMATIC FEVER, usually in childhood, remains a common cause of chronic valvular heart disease causing stenosis, incompetence or both of the aortic and mitral valves, but each valve has other separate causes for malfunction.

Aortic valve disease is more common with increasing age. When the valve is narrowed, the heart hypertrophies and may later fail. Symptoms of angina or breathlessness are common and dizziness or blackouts (syncope) also occur. Replacing the valve is a very e?ective treatment, even with advancing age. Aortic stenosis may be caused by degeneration (senile calci?c), by the inheritance of two valvular leaflets instead of the usual three (bicuspid valve), or by rheumatic fever. Aortic incompetence again leads to hypertrophy, but dilatation is more common as blood leaks back into the ventricle. Breathlessness is the more common complaint. The causes are the same as stenosis but also include in?ammatory conditions such as SYPHILIS or ANKYLOSING SPONDYLITIS and other disorders of connective tissue. The valve may also leak if the aorta dilates, stretching the valve ring as with HYPERTENSION, aortic ANEURYSM and MARFAN’S SYNDROME – an inherited disorder of connective tissue that causes heart defects. Infection (endocarditis) can worsen acutely or chronically destroy the valve and sometimes lead to abnormal outgrowths on the valve (vegetations) which may break free and cause devastating damage such as a stroke or blocked circulation to the bowel or leg.

Mitral valve disease leading to stenosis is rheumatic in origin. Mitral incompetence may be rheumatic but in the absence of stenosis can be due to ISCHAEMIA, INFARCTION, in?ammation, infection and a congenital weakness (prolapse). The valve may also leak if stretched by a dilating ventricle (functional incompetence). Infection (endocarditis) may affect the valve in a similar way to aortic disease. Mitral symptoms are predominantly breathlessness which may lead to wheezing or waking at night breathless and needing to sit up or stand for relief. They are made worse when the heart rhythm changes (atrial ?brillation) which is frequent as the disease becomes more severe. This leads to a loss of e?ciency of up to 25 per cent and a predisposition to clot formation as blood stagnates rather than leaves the heart e?ciently. Mitral incompetence may remain mild and be of no trouble for many years, but infection must be guarded against (endocarditis prophylaxis).

Endocarditis is an infection of the heart which may acutely destroy a valve or may lead to chronic destruction. Bacteria settle usually on a mild lesion. Antibiotics taken at vulnerable times can prevent this (antibiotic prophylaxis) – for example, before tooth extraction. If established, lengthy intravenous antibiotic therapy is needed and surgery is often necessary. The mortality is 30 per cent but may be higher if the infection settles on a replaced valve (prosthetic endocarditis). Complications include heart failure, shock, embolisation (generation of small clots in the blood), and cerebral (mental) confusion.

PERICARDITIS is an in?ammation of the sac covering the outside of the heart. The sac becomes roughened and pain occurs as the heart and sac rub together. This is heard by stethoscope as a scratching noise (pericardial rub). Fever is often present and a virus the main cause. It may also occur with rheumatic fever, kidney failure, TUBERCULOSIS or from an adjacent lung problem such as PNEUMONIA or cancer. The in?ammation may cause ?uid to accumulate between the sac and the heart (e?usion) which may compress the heart causing a fall in blood pressure, a weak pulse and circulatory failure (tamponade). This can be relieved by aspirating the ?uid. The treatment is then directed at the underlying cause.... heart, diseases of

Having either low secretion levels of testosterone by the testes, having low functional effects because of poor circulation, having competition by less active testosterone metabolites, or having high levels of adipose-released estradiol (former testosterone) in obesity that ends up suppressing testosterone. There are, of course, organic diseases that can cause the condition.... hypotestosteronism

Commiphora mukul

Burseraceae

San: Gugulu, Mahisaksah, Koushikaha, Devadhupa

Hin: Gugal Mal:Gulgulu Tam,

Tel: Gukkulu

Kan: Guggul

Ben: Guggul

Importance: Indian bdellium is a small, armed, deciduous tree from the bark of which gets an aromatic gum resin, the ‘Guggul’ of commerce. It is a versatile indigenous drug claimed by ayurvedists to be highly effective in the treatment of rheumatism, obesity, neurological and urinary disorders, tonsillitis, arthritis and a few other diseases. The fumes from burning guggul are recommended in hay- fever, chronic bronchitis and phytises.

The price of guggulu gum has increased ten fold in ten years or so, indicating the increase in its use as well as decrease in natural plant stand. It has been listed as a threatened plant by Botanical Survey of India (Dalal, 1995) and is included in the Red Data Book (IUCN) and over exploited species in the country (Billare,1989).

Distribution: The center of origin of Commiphora spp. is believed to be Africa and Asia. It is a widely adapted plant well distributed in arid regions of Africa (Somalia, Kenya and Ethiopia in north east and Madagascar, Zimbabwe, Botswana, Zaire in south west Africa), Arabian peninsula (Yemen, Saudi Arabia and Oman). Different species of Commiphora are distributed in Rajasthan, Gujarat, Maharashtra and Karnataka states of India and Sind and Baluchistan provinces of Pakistan (Tajuddin et al, 1994). In India, the main commercial source of gum guggul is Rajasthan and Gujarat.

Botany: The genus Commiphora of family Burseraceae comprises about 185 species. Most of them occur in Africa, Saudi Arabia and adjoining countries. In India only four species have been reported. They are C. mukul(Hook. ex Stocks) Engl. syn. Balsamodendron mukul (Hook. ex Stocks), C. wightii (Arnott) Bhandari, C.stocksiana Engl., C. berryi and C.agallocha Engl.

In early studies about the flora of India, the ‘guggul’ plant was known as Commiphora mukul(Hook. ex Stocks) Engl. or Balsamodendron mukul (Hook. ex Stocks). It was renamed as C. roxburghii by Santapau in 1962. According to Bhandari the correct Latin name of the species is C. wightii(Arnott) Bhandari, since the specific name ‘wightii’ was published in 1839, prior to ‘roxburghi’ in 1848 (Dalal and Patel, 1995).

C. mukul is a small tree upto 3-4m height with spinescent branching. Stem is brownish or pale yellow with ash colored bark peeling off in flakes. Young parts are glandular and pubescent. Leaves are alternate, 1-3 foliate, obovate, leathery and serrate (sometimes only towards the apex). Lateral leaflets when present only less than half the size of the terminal ones. Flowers small, brownish red, with short pedicel seen in fascicles of 2-3. Calyx campanulate, glandular, hairy and 4-5 lobed. Corolla with brownish red, broadly linear petals reflexed at apex. Stamens 8-10, alternatively long and short. Ovary oblong, ovoid and stigma bifid. Fruit is a drupe and red when ripe, ovate in shape with 2-3 celled stones. The chromosome number 2n= 26 (Warrier et al, 1994; Tajuddin et al, 1994).

Agrotechnology: Guggal being a plant of arid zone thrives well in arid- subtropical to tropical climate.

The rainfall may average between 100mm and 500mm while air temperature may vary between 40 C in summer and 3 C during winter. Maximum relative humidity prevails during rainy season (83% in the morning and 48% in the evening).Wind velocity remains between 20-25 km/hour during the year is good. Though they prefer hard gypseous soil, they are found over sandy to silt loam soils, poor in organic matter but rich in several other minerals in arid tracks of western India (Tajuddin et al, 1994).

Plants are propagated both by vegetatively and seeds. Plants are best raised from stem cuttings from the semi woody (old) branch. For this purpose one metre long woody stem of 10mm thickness is selected and the cut end is treated with IBA or NAA and planted in a well manured nursery bed during June-July months; the beds should be given light irrigation periodically. The cuttings initiate sprouting in 10-15 days and grow into good green sprout in 10-12 months. These rooted plants are suitable for planting in the fields during the next rainy season. The cuttings give 80-94% sprouting usually. Air layering has also been successfully attempted and protocol for meristem culture is available in literature. Seed germination is very poor (5%) but seedling produce healthier plants which withstand high velocity winds.

The rooted cuttings are planted in a well laid-out fields during rainy season. Pits of size 0.5m cube are dug out at 3-4 m spacing in rows and given FYM and filler soil of the pit is treated with BHC (10%) or aldrin (5%) to protect the new plants from white ants damage. Fertilizer trials have shown little response except due to low level of N fertilization. Removal of side branches and low level of irrigation supports a good growth of these plants. The plantation does not require much weeding and hoeing. But the soil around the bushes be pulverised twice in a year to increase their growth and given urea or ammonium sulphate at 25- 50g per bush at a time and irrigated. Dalal et al (1989) reported that cercospora leaf spot was noticed on all the cultures. Bacterial leaf blight was also noticed to attack the cultures. A leaf eating caterpillar (Euproctis lanata Walker) attack guggal, though not seriously. White fly (Bemisia tabaci) is observed to suck sap of leaves and such leaves become yellowish and eventually drop. These can be effectively controlled by using suitable insecticide.

Stem or branch having maximum diameter of about 5cm at place of incision, irrespective of age is tapped. The necrotic patch on the bark is peeled off with a sharp knife and Bordeaux paste is applied to the exposed (peeled off) surface of the stem or branch. A prick chisel of about 3cm width is used to make bark- deep incisions and while incising the bark, the chisel is held at an acute angle so that scooped suspension present on the body of the chisel flows towards the blade of the chisel and a small quantity of suspension flows inside the incised bark. If tapping is successful, gum exudation ensures after about 15-20 days from the date of incision and continues for nearly 30-45 days. The exuded gum slides down the stem or branch, and eventually drops on the ground and gets soiled. A piece of polythene sheet can be pouched around the place of incision to collect gum. Alternatively, a polythene sheet can be spread on the ground to collect exuded gum. A maximum of about 500g of gum has been obtained from a plant (Dalal, 1995).

Post harvest technology: The best grade of guggul is collected from thick branches of tree. These lumps of guggul are translucent. Second grade guggul is usually mixed with bark, sand and is dull coloured guggul. Third grade guggul is usually collected from the ground which is mixed with sand, stones and other foreign matter. The final grading is done after getting cleansed material. Inferior grades are improved by sprinkling castor oil over the heaps of the guggul which impart it a shining appearance (Tajuddin et al, 1994).

Properties and activity: The gum resin contains guggul sterons Z and E, guggul sterols I-V, two diterpenoids- a terpene hydrocarbon named cembreneA and a diterpene alcohol- mukulol, -camphrone and cembrene, long chain aliphatic tetrols- octadecan-1,2,3,4-tetrol, eicosan-1,2,3,4-tetrol and nonadecan-1,2,3,4-tetrol. Major components from essential oil of gum resin are myrcene and dimyrcene. Plant without leaves, flowers and fruits contains myricyl alcohol, -sitosterol and fifteen aminoacids. Flowers contain quercetin and its glycosides as major flavonoid components, other constituents being ellagic acid and pelargonidin glucoside (Patil et al, 1972; Purushothaman and Chandrasekharan, 1976).

The gum resin is bitter, acrid, astringent, thermogenic, aromatic, expectorant, digestive, anthelmintic, antiinflammatory, anodyne, antiseptic, demulcent, carminative, emmenagogue, haematinic, diuretic, lithontriptic, rejuvenating and general tonic. Guggulipid is hypocholesteremic (Husain et al, 1992; Warrier et al, 1994).... indian bdellium

Drugs used for non-health problems or for disorders that are in the grey area between a genuine health need and a desire to change a ‘lifestyle failing’ by the use of medication. Examples are: SILDENAFIL CITRATE, which is prescribed for men unable to achieve penile erection (erectile dysfunction); and ORLISTAT, a drug used to combat OBESITY.... lifestyle medicines

Hook. ex Stocks

Synonym: Commiphora mukul (Hook. ex Stocks) Engl. C. wightii (Arn.) Bhandari.

Family: Burseraceae.

Habitat: Rajasthan, Madhya Pradesh, Assam, Andhra Pradesh, Karnataka.

English: Indian Bdellium, Gum Guggul.

Ayurvedic: Guggul, Devadhoop, Kaushika, Pur, Mahishaaksha, Palankash, Kumbha, Uluukhala.

Unani: Muqallal yahood, Muql, Bu-e-Jahudaan

Siddha/Tamil: Erumaikan Kungiliyam.

Action: Oleo-gum-resin—used for reducing obesity and in rheumatoid arthritis, osteoarthritis, sciatica.

Key application: In the treatment of hyperlipidemia, hypercholestero- laemia and obesity. (WHO.)

Guggulipid is hypocholesteremic. Guggul resin contains steroids—gug- glsterones Z and E, guggulsterols IV, diterpenoids; volatile oil, including other constituents, contains a terpene hydrocarbon cembrene A. E- and Z- guggulsterones are characteristic constituents, which distinguish C. mukul from other Commiphore sp.

Guggul resin increases catechola- mine biosynthesis and activity in cholesterol-fed rabbits, inhibits platelet aggregation, exhibits anti-inflammatory activity and appears to activate the thyroid gland in rats and chicken. Z- guggulsterone may increase uptake of iodine by thyroid gland and increase oxygen uptake in liver and bicep tissues. (Planta Med 1984,1, 78-80.)

The gum is also used in hemiplegia and atherosclerotic disorders; as a gargle in pyrrhoea aveolaris, chronic tonsilitis and pharyngitis. Fumes are recommended in hay fever, chronic bronchitis and nasal catarrh.

Oleo-gum resin of Balsamodendron caudatum is also equated with Guggul in Siddha medicine.

Dosage: Oleo-gum-resin—2-4 g (API Vol. I.) 500 mg to 1 g (CCRAS.)... balsamodendron mukul

Linn.

Synonym: B. candida Roxb.

Family: Caesalpiniaceae.

Habitat: Punjab, Western Peninsula and Assam. Also cultivated in gardens.

English: Mountain Ebony, Buddhist Bauhinia.

Ayurvedic: Kaanchanaara, Kaan- chanaaraka, Kanchanak, Kaan- chana, Gandhaari, Sonapushpaka, Ashmantaka.

Siddha/Tamil: Sivappumanchori.

Action: Buds—a decoction is given in piles (also used against tumours), haematuria, menorrhagia. Dried buds are used in diarrhoea, dysentery, worm infestation, piles and tumours. Root— carminative, used in dyspepsia and flatulence (a decoction is reported to prevent obesity). Bark—astringent, anthelmintic; used externally in scrofula and skin diseases. Seeds—possess human blood agglutinating activity. Leaf— antifungal.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicated the use of the stem bark in lymphadenitis and goitre. (Ka- anchnaar Guggulu is prescribed for glandular swellings and goitre.)

Water-soluble portion of alcoholic extract of the plant showed preventive effect against goitre in rats.

Flowers gave flavonoids, kaempfe- rol-3-galactoside and kaempferol-3- rhamnoglucoside. The stem bark yields hentriacontane, octacosanol and stigmasterol. Stem contains beta-sitos- terol, lupeol and a flavanone glyco- side.

Dosage: Stem bark—20-30 g for decoction. (API Vol. I.)... bauhinia variegata

Eggplant (Solanum melongena).

Plant Part Used: Fruit.

Dominican Medicinal Uses: The raw fruit is traditionally chopped and soaked in water to extract its bitter constituents, and this water is taken as a drink for diabetes, high cholesterol and obesity.

Safety: The fruit is considered safe as a widely consumed vegetable.

Clinical Data: The fruit has been investigated in human clinical trials as a potential treatment for eye and vision problems due to its interocular pressure-lowering effects.

Laboratory & Preclinical Data: In laboratory and preclinical studies the fruit constituents have shown antioxidant activity in animal models. The following activities of this plant have been demonstrated using in vitro assays: antioxidant, antitumor and spasmogenic.

* See entry for Berenjena in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... berenjena

These drugs reduce the amount of low-density LIPOPROTEINS, which transport CHOLESTEROL and triglycerides (see TRIGLYCERIDE) in the blood, or raise the concentration of high-density lipoproteins. The aim is to reduce the progression of ATHEROSCLEROSIS and therefore help prevent coronary heart disease (see HEART, DISEASES OF). These drugs should be combined with reducing other risk factors for raised lipid concentrations, such as a high-fat diet, smoking and obesity. Lipid-regulating drugs include STATINS, ?brates, anion-exchange resins, and NICOTINIC ACID, which may be used singly or in combination under careful medical supervision (see HYPERLIPIDAEMIA).... lipid-regulating drugs

A periodic change occurring in (female) human beings and the higher apes, consisting chie?y in a ?ow of blood from the cavity of the womb (UTERUS) and associated with various slight constitutional disturbances. It begins between the ages of 12 and 15, as a rule – although its onset may be delayed until as late as 20, or it may begin as early as ten or 11. Along with its ?rst appearance, the body develops the secondary sex characteristics: for example, enlargement of the BREASTS, and characteristic hair distribution. The duration of each menstrual period varies in di?erent persons from 2– 8 days. It recurs in the great majority of cases with regularity, most commonly at intervals of 28 or 30 days, less often with intervals of 21 or 27 days, and ceasing only during pregnancy and lactation, until the age of 45 or 50 arrives, when it stops altogether – as a rule ceasing early if it has begun early, and vice versa. The ?nal stoppage is known as the MENOPAUSE or the CLIMACTERIC.

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

Roxb.

Family: Burseraceae.

Habitat: The drier parts of Peninsular India.

English: Indian Frankincense, Indian Olibanum.

Ayurvedic: Shallaki, Susravaa, Gajabhakshyaa, Salai. Gum— Kunduru.

Unani: Kundur (gum).

Siddha/Tamil: Parangisambirani, Kungli.

Folk: Salai Guggul.

Action: Gum-resin—antiseptic, anti-inflammatory, antiatheroscle- rotic, emmenagogue, analgesic, sedative, hypotensive. Also used in obesity, diarrhoea, dysentery, piles, urinary disorders, scrofulous affections. Oil—used topically in chronic ulcers, ringworm.

Nonphenolic fraction of gum-resin exhibited marked sedative and analgesic effect in rats. It produced a marked and long-lasting hypotension in anaesthetized dogs.

Many derivatives of 3-keto-methyl- beta-boswellic ester, isolated from the gum-resin., have been prepared; a py- razoline derivative exhibited maximum anti-inflammatory activity. (Gum-resin is used in osteoarthri- tis, juvenile rheumatoid arthritis, soft tissue fibrositis and spondylitis, also for cough, bronchitis, asthma, mouth sores.)

Essential oil from gum-resin—anti- fungal.

Gum-resin contains triterpenes of oleanane, ursane and euphane series. Stem and fruit—hypoglycaemic.

Dosage: Gum-resin—1-3 g (API Vol. IV.)... boswellia serrata

Breathlessness, or dyspnoea, may be due to any condition which renders the blood de?cient in oxygen, and which therefore produces excessive involuntary e?orts to gain more air. Exercise is a natural cause, and acute anxiety may provoke breathlessness in otherwise healthy people. Deprivation of oxygen – for example, in a building ?re – will also cause the victim to raise his or her breathing rate. Disorders of the lung may diminish the area available for breathing – for example, ASTHMA, PNEUMONIA, TUBERCULOSIS, EMPHYSEMA, BRONCHITIS, collections of ?uid in the pleural cavities, and pressure caused by a TUMOUR or ANEURYSM.

Pleurisy causes short, rapid breathing to avoid the pain of deep inspiration.

Narrowing of the air passages may produce sudden and alarming attacks of di?cult breathing, especially among children – for example, in CROUP, asthma and DIPHTHERIA.

Most cardiac disorders (see HEART, DISEASES OF) cause breathlessness, especially when the person undergoes any special exertion.

Anaemia is a frequent cause.

Obesity is often associated with shortness of breath. Mountain climbing may cause breathlessness

because, as altitude increases, the amount of oxygen in the air falls (see ALTITUDE SICKNESS). (See also LUNGS and RESPIRATION.)... breathlessness

Bulimia means insatiable appetite of psychological origin. This eating-disorder symptom may be of psychological origin or the result of neurological disease – for example, a lesion of the HYPOTHALAMUS. Bulimia nervosa is linked to anorexia nervosa and is sometimes called the binge and purge syndrome. Bulimia nervosa is characterised by overpowering urges to eat large amounts of food, followed by induced vomiting or abuse of laxatives to avoid any gain in weight. Most of the victims are prone to being overweight and all have a morbid fear of obesity. They indulge in bouts of gross overeating, or ‘binge rounds’ as they describe them, to ‘?ll the empty space inside’. By their bizarre behaviour, most of them manage to maintain a normal weight. The condition is most common in women in their 20s; it is accompanied by irregular menstruation, often amounting to amenorrhoea (see MENSTRUATION). Although there are many similarities to anorexia nervosa, bulimia nervosa di?ers in that there is no attempt at deceit; sufferers freely admit to an eating disorder and feel distress about the symptoms that it produces. In spite of this, the response to treatment is, as in anorexia nervosa, far from satisfactory. (See EATING DISORDERS.)... bulimia

(Linn.) Millsp.

Synonym: C. indicus Spreng.

Family: Papilionaceae; Fabaceae.

Habitat: Cultivated as pulse crop, chiefly in Madhya Pradesh, Bihar, Andhra Pradesh, Maharashtra, Uttar Pradesh and Karnataka.

English: Pigeon Pea, Red Gram.

Ayurvedic: Aadhaki, Tuvari, Tuvara, Shanapushpikaa.

Unani: Arhar.

Siddha/Tamil: Thuvarai.

Action: Green leaves are considered hypocholesterolaemic. Pulse shows cholesterol and phospholipid lowering effect (reported to cause flatulence). A paste of leaves with salt and water, is taken on an empty stomach for jaundice. Leaves are used in diseases of the mouth, and topically for treating measles and other eruptions.

The Ayurvedic Pharmacopoeia ofIn- dia indicated the use of the seed in lipid disorders and obesity; externally for promoting breast development, and attributed blood purifying properties to the root.

Amino acid analysis of the seed extract showed that phenylalanine (26.3% of the total amino acids) is responsible for about 70% of the anti- sickling potency of the seed extract.

Seeds also contain riboflavin and pyridoxine. Root bark contains isofla- vones, sterols, triterpenoids, flavones, anthraquinone derivatives. Plant also contains an isoflavone, cajanol.

The aqueous extract of leaves showed vasodilatory effect in experimental animals.

Unroasted nuts had hypoglycaemic effect in mice; roasted seeds, in contrast, had a hyperglycaemic effect. (Sharon M. Herr.)

Dosage: Root—2-6 g powder. (API Vol. III.)... cajanus cajan

An environmental or genetic factor which makes the occurrence of a disease in an individual more likely. For example, male sex, OBESITY, smoking and high blood pressure (HYPERTENSION) are all risk factors for ischaemic heart disease (see under HEART, DISEASES OF).... risk factor

A term applied to a group of symptoms occurring together regularly, and thus constituting a disease to which some particular name is given: for example, CUSHING’S SYNDROME comprising obesity, hypertension, purple striae and osteoporosis; or KORSAKOFF’S SYNDROME, comprising loss of appreciation of time and place combined with talkativeness, forming signs of alcoholic delirium.... syndrome

A LIPID that is an important constituent of body cells and so widely distributed throughout the body. It is especially abundant in the brain, nervous tissue, adrenal glands and skin. It is also found in egg yolk and gall-stones (see GALLBLADDER, DISEASES OF). Cholesterol plays an important role in the body, being essential for the production of the sex hormones as well as for the repair of membranes. It is also the source from which BILE acids are manufactured. The total amount in the body of a man weighing 70 kilograms (10 stones) is around 140 grams, and the amount present in the blood is 3·6–7·8 mmol per litre or 150–250 milligrams per 100 millilitres.

A high blood-cholesterol level – that is, one over 6 mmol per litre or 238 mg per 100 ml – is undesirable as there appears to be a correlation between a high blood cholesterol and ATHEROMA, the form of arterial degenerative disease associated with coronary thrombosis and high blood pressure. This is well exempli?ed in DIABETES MELLITUS and HYPOTHYROIDISM, two diseases in which there is a high blood cholesterol, sometimes going as high as 20 mmol per litre; patients with these diseases are known to be particularly prone to arterial disease. There is also a familial disease known as hypercholesterolaemia, in which members of affected families have a blood cholesterol of around 18 mmol per litre or more, and are particularly liable to premature degenerative disease of the arteries. Many experts believe that there is no ‘safe level’ and that everybody should attempt to keep their cholesterol level as low as possible.

Cholesterol exists in three forms in the blood: high-density lipoproteins (HDLs) which are believed to protect against arterial disease, and a low-density version (LDLs) and very low-density type (VLDLs), these latter two being risk factors.

The rising incidence of arterial disease in western countries in recent years has drawn attention to this relationship between high levels of cholesterol in the blood and arterial disease. The available evidence indicates that there is a relationship between blood-cholesterol levels and the amount of fat consumed; however, the blood-cholesterol level bears little relationship to the amount of cholesterol consumed, most of the cholesterol in the body being produced by the body itself.

On the other hand, diets high in saturated fatty acids – chie?y animal fats such as red meat, butter and dripping – tend to raise the blood-cholesterol level; while foods high in unsaturated fatty acids – chie?y vegetable products such as olive and sun?ower oils, and oily ?sh such as mackerel and herring – tend to lower it. There is a tendency in western society to eat too much animal fat, and current health recommendations are for everyone to decrease saturated-fat intake, increase unsaturated-fat intake, increase daily exercise, and avoid obesity. This advice is particulary important for people with high blood-cholesterol levels, with diabetes mellitus, or with a history of coronary thrombosis (see HEART, DISEASES OF). As well as a low-cholesterol diet, people with high cholesterol values or arterial disease may be given cholesterol-reducing drugs such as STATINS, but this treatment requires full clinical assessment and ongoing medical monitoring. Recent research involving the world’s largest trial into the effects of treatment to lower concentrations of cholesterol in the blood showed that routine use of drugs such as statins reduced the incidence of heart attacks and strokes by one-third, even in people with normal levels of cholesterol. The research also showed that statins bene?ted women and the over-70s.... cholesterol

Described in 1932 by Harvey Cushing, the American neurosurgeon, Cushing’s syndrome is due to an excess production of CORTISOL. It can thus result from a tumour of the ADRENAL GLANDS secreting cortisol, or from a PITUITARY GLAND tumour secreting ACTH and stimulating both adrenal cortexes to hypertrophy and secrete excess cortisol. It is sometimes the result of ectopic production of ACTH from non-endocrine tumours in the LUNGS and PANCREAS.

The patient gains weight and the obesity tends to have a characteristic distribution over the face, neck, and shoulder and pelvic girdles. Purple striae develop over the abdomen and there is often increased hairiness or hirsutism. The blood pressure is commonly raised and the bone softens as a result of osteoporosis. The best test to establish the diagnosis is to measure the amount of cortisol in a 24-hourly specimen of urine. Once the diagnosis has been established, it is then necessary to undertake further tests to determine the cause.... cushing’s syndrome

A group of drugs used to treat type-2 diabetes (see under DIABETES MELLITUS) which work by suppressing the activity of RESISTIN, a recently discovered hormone that acts against INSULIN. Resistin links obesity to type-2 diabetes which has long been known to be associated with overweight subjects.... thiazolidinedione drugs

The formation of a blood clot within the circulatory system. It may form in the roughened vein wall in a varicosity, form around arteriosclerotic plaques, or result from trauma and surgery. The tendency rises with thick blood, age, obesity and in those once physically active and now sedentary.... thrombosis

A hormone secreted by the cortex of the adrenal glands. Prepares the body for ‘fight or flight’. Surface blood vessels constrict, heart rate and blood pressure rises, breathing is stimulated, muscle activity increases, sweat is released, pupils contract, the mouth becomes dry and blood clots faster. One of its properties is to mobilise fatty acids from adipose tissue, thus being of value in obesity. ... adrenalin

Camellia thea. Part used: first two leaves and the buds of spray. Domestic tea which has not been processed into black tea. China tea.

Action: anti-fat, diuretic.

Uses: Obesity, swollen ankles, oedema.

Preparations: Tea: prepare as domestic tea.

Powder. 500mg or two 250mg capsules thrice daily at meals.

Note: Anti-cancer effects have been observed in Chinese green tea extract. Clinical trials on therapeutic effects against early stomach cancer were promising. (Chin.J. Prev. Med. 1990, 24 (2) 80-2) ... green tea

A group of drugs that reduce the desire to eat. Appetite suppressants may be used in the treatment of severe obesity, along with diet and exercise. Their use is limited to a maximum of 12 weeks due to the risk of serious effects on the blood supply to the lungs and on heart valves.... appetite suppressants

Linn.

Family: Cyperaceae.

Habitat: Throughout India, as a weed upto 2,000 m.

English: Nut Grass.

Ayurvedic: Musta, Mustaa, Mus- taka, Abda, Ambuda, Ambhoda, Ambodhara, Bhadra, Bhadraa, Bhadramusta, Bhadramustaa, Bhadramustaka, Ghana, Jalada, Jaldhara, Meghaahvaa, Nirada, Vaarida, Vaarivaaha, Payoda, Balaahaka. Ganda-Duurvaa (var.).

Unani: Naagarmothaa, Saad-e-Kufi.

Siddha/Tamil: Koraikkizhangu.

Folk: Mothaa.

Action: Carminative, astringent, anti-inflammatory, antirheumat- ic, hepatoprotective, diuretic, antipyretic, analgesic, hypoten- sive, emmenagogue and nervine tonic.

Used for intestinal problems, indigestion, sprue, diarrhoea, dysentery, vomiting and fever; also as a hypoc- holesterolaemic drug and in obesity.

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicated the use of the rhizome in rheumatism, inflammations, dysuria, puerperal diseases and obesity.

The tuber is rich in Cu, Fe, Mg and Ni. Beta-sitosterol, isolated from the tubers, exhibits significant anti- inflammatory activity against carra- geenan- and cotton pellet-induced oedema in rats; the activity is comparable to hydrocortisone and phenylbutazone when administered intraperi- toneally.

The alcoholic and aqueous extracts of the tubers possess lipolytic action and reduce obesity by releasing enhanced concentrations of biogenic amines from nerve terminals of the brain which suppress the appetite centre. Presence of eudalne group of ses- quiterpenic compounds of sesquiter- pene alcohol, isocyperol is said to play an important role in lipid metabolism.

An alcoholic extract of the plant exhibits liver-protective activity against CCL4-induced liver damage in mice.

Methanolic extract of the plant stimulates the production of melanin in cultured melanocytes. (Plant extract is used in preparations used for pigmentation of skin and hair, also in suntan gels.) Aqueous-alcoholic extract of the tuber exhibited hypotensive, diuretic, antipyretic and analgesic activities. These are attributed to a triterpenoid.

The essential oil (0.5-0.9%) from the tubers contains mainly sesquiterpenes.

C. platystilis Br. is equated with Kaivarta-mustaka.

Dosage: Rhizome—3-6 g powder; 20-30 ml decoction. (API Vol. III.)... cyperus rotundus

Roxb.

Synonym: D. emerginata Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Bengal, Bihar, Madhya Pradesh and Western Peninsula.

English: East Indian Rosewood, Bombay Blackwood.

Ayurvedic: Shimshapaa (related sp.)

Unani: Sheesham.

Siddha/Tamil: Itti, Eravadi, Karun- doroiral.

Folk: Sisu.

Action: Stimulant, appetiser, anthelmintic, spasmogenic. Used in dyspepsia, diarrhoea; also in obesity, cutaneous affections and leprosy.

The bark contains hentriacontane, latifolin, beta-sitosterol and tannins. EtOH (50%) extract of the bark exhibits spasmogenic, and anthelmintic activity against Ascaridia galli.... dalbergia latifolia

A rare inherited disorder characterized by increasing obesity, retinitis pigmentosa that may lead to blindness, learning difficulties, polydactyly, and hypogonadism.

(See also genetic disorders.)... laurence–biedl–moon syndrome

Dandelion tea is an excellent source of vitamins and an unbeatable way to maintain healthy body and mind. About Dandelion tea Dandelion is a perennial yellow plant scientifically called Taraxacum officinale. Itcan be used as a herbal plant but also in the kitchen in many recipes, salads etc. It grows everywhere and it appears in early spring. Its flowers last until late fall. For medical purposes, the young flowers are usually used before flowering along with the root. The flowers are an important source of vitamins (A, B, C and D), minerals (is very rich in potassium) proteins, carbohydrates, and tannins, caffeic acid. The leaves are also important. The root contains a bitter compound - taraxacina - but it is also rich in pectins, sterols, vitamins B1, C and D, inulin, tannin, volatile oils and reshines. You can use the leaves to prepare salads, juices, infusions or tinctures. The roots are mostly used for teas, tinctures and decoction. Dandelion tea is considered an overall tonic with multiple benefits. How to brew Dandelion tea For regular use, you can drink 2 cups of dandelion tea per day. Use 2 teaspoons of dried plant for a hot water cup. Let it infuse for a couple of minutes and then let it rinse. Another way of drinking the dandelion tea is by using small cutted leaves and dried roots. Pour into a container approximately 200 ml of water, add the plant and let it boil. After that, cover the container with something and keep it to infuse for 15 minutes. In the end, filter it and enjoy the tea. You may add some honey or sugar. Benefits of Dandelion tea Dandelion tea has lots of benefits as it is considered one of the healthiest teas. - Dandelion tea is depurative, sudorific and diuretic - Dandelion tea helps to diminish high cholesterol - It promotes gastrointestinal health, enhancing digestion, stimulating the appetite and treating digestive problems such as heartburn or upset stomach - Dandelion tea is suitable in diets or in fighting obesity as it helps the body eliminate water, having a detoxifying role -The tea is considered to be aliver, kidney and gallbladder tonic and it normalizes blood circulation - It is used with success in treating several skin ailments like acne, gout, atherosclerosis, varicose veins - Dandelion tea has an antirheumatic effect and some studies underlined that it also boosts the immunity - Dandelion tea also has a cosmetic  use as it improves skin clarity and cleanses complexion Side effects of Dandelion tea Although dandelion tea has many benefits, it also has several warnings that you should take into consideration. It is not advisable to use the plant after flowering. Dandelion tea can reduce the efficiency of some medicines and may interact with some drugs or other herbs. Avoid combining this tea with antibiotics, garlic, gingko biloba, blood thinners or pain relievers, as a risk of bleeding may arise. Some studies pointed out that those suffering of diabetes and low blood sugar, as well as pregnant women or breastfeeding women should consult their physician before drinking dandelion tea. If you are allergic to daisies, chrysanthemum, chamomile or marigold you may also develop same reaction for dandelion. Some people call dandelion tea the elixir of long life as it brings vitality and makes you strong if you consume it on a regular basis. However, it’s best to keep the moderation and to search for information before you decide to drink it on a regular basis.... dandelion tea

Linn.

Synonym: F. glomerata Roxb.

Family: Moraceae.

Habitat: Throughout India. Grows wild in forests and hills. Often found around subterranean water streams.

English: Cluster Fig, Country Fig.

Ayurvedic: Udumbara, Sadaaphala, Hema-daudhaka, Jantuphala, Yagyaanga.

Unani: Anjir-e-Aadam, Anjir-e- Ahmak, Gular.

Siddha/Tamil: Atthi.

Action: Astringent and antiseptic; used in threatened abortions, menorrhagia, leucorrhoea, urinary disorders, skin diseases, swellings, boils, haemorrhages. Unripe fruits—astringent, carminative, digestive, stomachic; used in diarrhoea, dyspepsia, dysentery, menorrhagia and haemorrhages. Ripe fruits—antiemetic, also

used in haemoptysis. Root and fruit—hypoglycaemic. Bark— decoction is used in skin diseases, inflammations, boils and ulcers.

The Ayurvedic Pharmacopoeia of India recommends the use of the bark in lipid disorders and obesity.

Leaves and fruit contain gluacol. The fruit also contains beta-sitosterol, lupeol acetate, friedelin, higher hydrocarbons and other phytosterols.

Petroleum ether extract of the stem bark significantly reduced blood sugar level of rats with streptozotocin- induced diabetes. It completely inhibited glucose-6-phosphate dehydrogenase from rat liver. Extracts of fruit and latex did not show any significant effect on blood sugar level of diabetic rats, they inhibited only glucose-6- phosphate but not arginase from rat liver.

An alcoholic extract of the bark has been found to be very effective in reducing blood sugar in alloxan-induced diabetic albino rats. It helped in improving the damaged beta cells of islets of Langerhans, thus exerting permanent blood sugar lowering effect.

The ethanolic extract of seeds also showed hypoglycaemic activity.

Lignin, the main fiber constituent of the fruit, prevented the rise in serum cholesterol levels of some extent. Fresh whole fruits, used as a source of dietary fibre, exhibited more hypoc- holesterolemic activity than pure cellulose.

Dosage: Bark—20-30 g for decoction. (API Vol. I.)... ficus racemosa

See obesity.... overweight

An unusual disorder characterized by extreme obesity, shallow breathing, and sleep apnoea.

The cause is unclear.

Symptoms usually improve with weight loss.... pickwickian syndrome

A centrally acting appetite suppressant drug used to treat obesity in people who have not responded to other methods of weight loss, such as dieting.

Common side effects include constipation, dry mouth, and hypertension.

People taking this drug should have regular follow-ups and have their blood pressure and pulse monitored.... sibutramine

a malignant tumour of the lining (*endometrium) of the uterus. Risk factors are nulliparity (never having given birth), obesity, and tamoxifen use as chemotherapy for breast cancer. The presenting symptom is usually *postmenopausal bleeding, but this cancer may present with postmenopausal discharge or *pyometra. The tumour invades the *myometrium and spreads down to the cervix and through the Fallopian tubes to the ovaries and peritoneal cavity and through the lymphatics to pelvic and aortic nodes. Prognosis depends on tumour differentiation, depth of myometrial invasion, extent of tumour spread, and involvement of retroperitoneal nodes. Treatment is laparoscopic abdominal *hysterectomy and bilateral *salpingo-oophorectomy, with *lymphadenectomy and radiotherapy if indicated.... endometrial cancer

diabetes or impaired glucose tolerance that is diagnosed during pregnancy (see glucose tolerance test). Women at increased risk of gestational diabetes include those with a personal history of the condition, obesity, or a family history of diabetes, and those who have had a previously unexplained stillbirth. In most cases gestational diabetes resolves at the end of the pregnancy, but such women are at increased risk of developing type 2 diabetes thereafter. It is treated by dietary control with or without insulin or metformin to avoid the fetal complications of *macrosomia and hypoglycaemia. See also pregestational diabetes.... gestational diabetes mellitus

(NAFLD) a spectrum of conditions affecting the liver in the absence of excessive alcohol consumption. NAFLD is a common cause of referral for patients with abnormal liver function tests. Fatty liver is excessive fat accumulation in the liver seen as an area of brightness within the liver on ultrasound examination. Fatty liver does not lead to irreversible liver damage in the majority of cases. Nonalcoholic steatohepatitis (NASH) is inflammation of the liver associated with accumulation of fat. It is often linked to insulin resistance, diabetes, hypertension, obesity, and *metabolic syndrome. Treatment involves dietary modification, regular physical exercise, weight reduction, and management of underlying conditions (e.g. diabetes, hypertension, and hiperlipidaemia). NASH may predispose to *cirrhosis and may ultimately require liver transplantation.... nonalcoholic fatty liver disease

a difficult birth (see dystocia) in which the anterior or, less commonly, the posterior fetal shoulder impacts on the maternal symphysis or sacral promontory. It is an obstetric emergency and is diagnosed when the shoulders fail to deliver after the fetal head and when gentle downward traction has failed. Additional obstetric manoeuvres (e.g. *McRobert’s manoeuvre) are required to release the shoulders from below the pubic symphysis. It occurs in approximately 1% of vaginal births. There are well-recognized risk factors, such as maternal diabetes and obesity and fetal *macrosomia. There can be a high *perinatal mortality rate and morbidity associated with the condition; the most common fetal injuries are to the brachial plexus, causing an *Erb’s palsy or *Klumpke’s paralysis. Maternal morbidity is also increased, particularly *postpartum haemorrhage.... shoulder dystocia

Betula alba

FAMILY: Betulaceae

SYNONYMS: B. alba var. pubescens, B. odorata, B. pendula, European white birch, silver birch.

GENERAL DESCRIPTION: Decorative tree, up to 15–20 metres high, with slender branches, silvery-white bark broken into scales, and light green oval leaves. The male catkins are 2–5 cms long, the female up to 15 cms long.

DISTRIBUTION: Native to the northern hemisphere; found throughout Eastern Europe, Russia, Germany, Sweden, Finland, the Baltic coast, northern China and Japan.

OTHER SPECIES: Many cultivars exist of this species of birch. The paper birch (B. papyrifera) and B. verrucosa are also used for the production of birch bud oil and/or birch tar. NB Should not be confused with the oil from the sweet birch (B. lenta) which is potentially toxic.

HERBAL/FOLK TRADITION: Birch buds were formerly used as a tonic in hair preparations. Birch tar is used in Europe for all types of chronic skin complaints: psoriasis, eczema, etc. In Scandinavia the young birch leaflets and twigs are bound into bundles and used in the sauna to tone the skin and promote the circulation. The sap is also tapped in the spring and drunk as a tonic. Buds, leaves and bark are used for ‘rheumatic and arthritic conditions, especially where kidney functions appear to need support … oedematous states; urinary infections and calculi.’.

ACTIONS: Anti-inflammatory, antiseptic, cholagogue, diaphoretic, diuretic, febrifuge, tonic.

EXTRACTION: 1. Essential oil by steam distillation from the leaf-buds. 2. Crude birch tar is extracted by slow destructive distillation from the bark; this is subsequently steam distilled to yield a rectified birch tar oil.

CHARACTERISTICS: 1. Pale yellow, viscous oil with a woody-green balsamic scent. It crystallizes at low temperatures. 2. The crude tar is an almost black, thick oily mass. The rectified oil is a brownish-yellow, clear oily liquid with a smoky, tar-like, ‘Russian leather’ odour. It blends well with other woody and balsamic oils.

PRINCIPAL CONSTITUENTS: 1. Mainly betulenol and other sesquiterpenes. 2. In the tar oil: phenol, cresol, xylenol, guaiacol, creosol, pyrocatechol, pyrobetulin (which gives the ‘leather’ scent).

SAFETY DATA: Non-toxic, non-irritant, non-sensitizing.

AROMATHERAPY/HOME: USE

Skin Care: Dermatitis, dull or congested skin, eczema, hair care, psoriasis etc.

Circulation Muscles And Joints: Accumulation of toxins, arthritis, cellulitis, muscular pain, obesity, oedema, poor circulation, rheumatism.

OTHER USES: Birch bud oil is used primarily in hair tonics and shampoos, and in some cosmetics for its potential skin-healing effects. The crude tar is used in pharmaceutical preparations, ointments, lotions, etc. for dermatological diseases. It is also used in soap and leather manufacture – rectified birch tar oil provides the heart for many ‘leather’ type perfumes and aftershaves.... birch, white

The mixture of food and drink consumed by an individual. Variations in morbidity and mortality between population groups are believed to be due, in part, to di?erences in diet. A balanced diet was traditionally viewed as one which provided at least the minimum requirement of energy, protein, vitamins and minerals needed by the body. However, since nutritional de?ciencies are no longer a major problem in developed countries, it seems more appropriate to consider a ‘healthy’ diet as being one which provides all essential nutrients in su?cient quantities to prevent de?ciencies but which also avoids health problems associated with nutrient excesses.

Major diet-related health problems in prosperous communities tend to be the result of dietary excesses, whereas in underdeveloped, poor communities, problems associated with dietary de?ciencies predominate. Excessive intakes of dietary energy, saturated fats, sugar, salt and alcohol, together with an inadequate intake of dietary ?bre, have been linked to the high prevalence of OBESITY, cardiovascular disease, dental caries, HYPERTENSION, gall-stones (see GALL-BLADDER, DISEASES OF), non-insulindependent DIABETES MELLITUS and certain cancers (e.g. of the breast, endometrium, intestine and stomach) seen in developed nations. Health-promotion strategies in these countries generally advocate a reduction in the intake of fat, particularly saturated fat, and salt, the avoidance of excessive intakes of alcohol and simple sugars, an increased consumption of starch and ?bre and the avoidance of obesity by taking appropriate physical exercise. A maximum level of dietary cholesterol is sometimes speci?ed.

Undernutrition, including protein-energy malnutrition and speci?c vitamin and mineral de?ciencies, is an important cause of poor health in underdeveloped countries. Priorities here centre on ensuring that the diet provides enough nutrients to maintain health.

In healthy people, dietary requirements depend on age, sex and level of physical activity. Pregnancy and lactation further alter requirements. The presence of infections, fever, burns, fractures and surgery all increase dietary energy and protein requirements and can precipitate undernutrition in previously well-nourished people.

In addition to disease prevention, diet has a role in the treatment of certain clinical disorders, for example, obesity, diabetes mellitus, HYPERLIPIDAEMIA, inborn errors of metabolism, food intolerances and hepatic and renal diseases. Therapeutic diets increase or restrict the amount and/or change the type of fat, carbohydrate, protein, ?bre, vitamins, minerals and/or water in the diet according to clinical indications. Additionally, the consistency of the food eaten may need to be altered. A commercially available or ‘homemade’ liquid diet can be used to provide all or some of a patient’s nutritional needs if necessary. Although the enteral (by mouth) route is the preferred route for feeding and can be used for most patients, parenteral or intravenous feeding is occasionally required in a minority of patients whose gastrointestinal tract is unavailable or unreliable over a period of time.

A wide variety of weight-reducing diets are well publicised. People should adopt them with caution and, if in doubt, seek expert advice.... diet

Flat-foot, or pes planus, is a deformity of the foot in which its arch sinks down so that the inner edge of the foot comes to rest upon the ground.

Causes The disorder may develop in infancy or occur in adult life, usually resulting from a combination of obesity and/or an occupation involving long periods of standing.

Symptoms Often none, but there may be pain along the instep and beneath the outer ankle. The foot is sti? and broad, walking is tiresome, and the toes turn far out.

Treatment A change of occupation may be necessary, to one which allows sitting. In early cases the leg muscles may be strengthened by tiptoe exercises performed for ten minutes night and morning. A pad to support the arch may have to be worn inside the shoe. Rarely, children may require surgery.... flat-foot

Linn.

Family: Fucaceae. (Laminaria sp.)

Habitat: On the shores of the United Kingdom, North Atlantic Ocean, North Pacific Coast of America; as a weed; found in Indian Ocean on the Manora Rocks. Allied species—F. distichus Linn., and F nodosus Linn. (Included in Glossary of Indian Medicinal Plants, CSIR, also in its second supplement.) F. nodosus is found in India along sea shores.

English: Bladderwrack, Black Tang, Rockweed, Kelp.

Action: Weed—one of the richest source of minerals, chiefly iodine, sodium, manganese, sulphur, silicon, zinc and copper. Effective against obesity, antirheumatic. Stimulates circulation of lymph. Endocrine gland stimulant. Allays onset of arteriosclerosis by maintaining elasticity of walls of blood vessels. Mild diuretic, bulk, laxative, antibiotic. High sodium content may reduce effectiveness of diuretics.

(The herb contains trace metal, particularly iodine from 0.03-1.0%. It may contain waste metals such as cadmium and strontium, when grown in a polluted environment. Variable iodine content and arsenic contamination make the herb unsafe.)

The herb should be used with caution in hyperthyroidism and hypothyroidism. Excess thyroid activity maybe aggravated by the iodine content of the herb; it may disrupt thyroid function. One gram of Bladderwrack might contain as much as 600 mcg iodine (Ingesting more than 150 mcg iodine per day may cause hyperthyroidism or exacerbate existing hyperthyroidism.) (Natural Medicines Comprehensive Database, 2007.)

Due to the antithrombin effects ofits fucan polysaccharides, consumption of the herb in cases of G1 bleeding disorders is contraindicated.

(Included among unapproved herbs by German Commission E.)... fucus vesiculosus

Immobilization of the jaws by means of metal wires to allow a fracture of the jaw to heal or as part of a treatment for obesity.

When a fracture is being treated, the jaws are kept wired in a fixed position for about 6 weeks. For promoting weight loss, the jaws are wired for as long as a year. In both cases, the person is unable to chew and can take only a liquid or semi-liquid diet. This form of diet treatment often fails because the person resumes previous eating habits following removal of the wires.... wiring of the jaws

n. an increase in the number of *prickle cells in the innermost layer of the epidermis, leading to thickening of the epidermis. Acanthosis nigricans is characterized by papillomatous growths, mainly in the armpits, neck, and groin, giving the skin a pigmented appearance and a velvety thickened texture. It may be associated with internal malignancy. Pseudoacanthosis nigricans is more common and is associated with obesity and *insulin resistance.... acanthosis

The term ‘eating disorders’ covers OBESITY, feeding problems in childhood, anorexia nervosa, and bulimia nervosa. The latter two are described here.

Anorexia nervosa Often called the slimmer’s disease, this is a syndrome characterised by the loss of at least a quarter of a person’s normal body weight; by fear of normal weight; and, in women, by AMENORRHOEA. An individual’s body image may be distorted so that the sufferer cannot judge real weight and wants to diet even when already very thin.

Anorexia nervosa usually begins in adolescence, affecting about 1–2 per cent of teenagers and college students at any time. It is 20 times more common among women than men. Up to 10 per cent of sufferers’ sisters also have the syndrome. Anorexia may be linked with episodes of bulimia (see below).

The symptoms result from secretive self-starvation, usually with excessive exercise, self-induced vomiting, and misuse of laxatives. An anorexic (or anorectic) person may wear layers of baggy clothes to keep warm and to hide the ?gure. Starvation can cause serious problems such as ANAEMIA, low blood pressure, slow heart rate, swollen ankles, and osteoporosis. Sudden death from heart ARRHYTHMIA may occur, particularly if the sufferer misuses DIURETICS to lose weight and also depletes the body’s level of potassium.

There is probably no single cause of anorexia nervosa. Social pressure to be thin seems to be an important factor and has increased over the past 20–30 years, along with the incidence of the syndrome. Psychological theories include fear of adulthood and fear of losing parents’ attention.

Treatment should start with the general practitioner who should ?rst rule out other illnesses causing similar signs and symptoms. These include DEPRESSION and disorders of the bowel, PITUITARY GLAND, THYROID GLAND, and OVARIES.

If the diagnosis is clearly anorexia nervosa, the general practitioner may refer the sufferer to a psychiatrist or psychologist. Moderately ill sufferers can be treated by COGNITIVE BEHAVIOUR THERAPY. A simple form of this is to agree targets for daily calorie intake and for acceptable body weight. The sufferer and the therapist (the general practitioner or a member of the psychiatric team) then monitor progress towards both targets by keeping a diary of food intake and measuring weight regularly. Counselling or more intensely personal PSYCHOTHERAPY may help too. Severe life-threatening complications will need urgent medical treatment in hospital, including rehydration and feeding using a nasogastric tube or an intravenous drip.

About half of anorectic sufferers recover fully within four years, a quarter improve, and a quarter remain severely underweight with (in the case of women) menstrual abnormalities. Recovery after ten years is rare and about 3 per cent die within that period, half of them by suicide.

Bulimia nervosa is a syndrome characterised by binge eating, self-induced vomiting and laxative misuse, and fear of fatness. There is some overlap between anorexia nervosa and bulimia but, unlike the former, bulimia may start at any age from adolescence to 40 and is probably more directly linked with ordinary dieting. Bulimic sufferers say that, although they feel depressed and guilty after binges, the ‘buzz’ and relief after vomiting and purging are addictive. They often respond well to cognitive behaviour therapy.

Bulimia nervosa does not necessarily cause weight loss because the binges – for example of a loaf of bread, a packet of cereal, and several cans of cold baked beans at one sitting – are cancelled out by purging, by self-induced vomiting and by brief episodes of starvation. The full syndrome has been found in about 1 per cent of women but mild forms may be much more common. In one survey of female college students, 13 per cent admitted to having had bulimic symptoms.

Bulimia nervosa rarely leads to serious physical illness or death. However, repeated vomiting can cause oesophageal burns, salivary gland infections, small tears in the stomach, and occasionally dehydration and chemical imbalances in the blood. Inducing vomiting using ?ngers may produce two tell-tale signs – bite marks on the knuckles and rotten, pitted teeth.

Those suffering from this condition may obtain advice from the Eating Disorders Association.... eating disorders

Linn.

Family: Compositae; Asteraceae.

Habitat: Native to America. Cultivated in India.

English: Sunflower.

Ayurvedic: Suurajmukhi, Su- uryaavarta.

Siddha/Tamil: Suryakanti.

Action: Seeds—build up physical endurance and resistance against diseases; a decoction is used in coughs and colds, bronchial, laryngeal and pulmonary affections, whooping cough, also as a febrifuge and diuretic.

The seeds contain a fatty oil (3748%), rich in polyunsaturated acids (linoleic 70%, oleic 20%). The oil also contains tocopherols (alpha-type 92% of the total) and phytosterol (beta- sitosterol 154 mcg/100 g). In Europe and USA, several hybrids produce oils rich in oleic acid. Sunflower oil is reported to decrease the risk of coronary and arterial diseases.

Extracted oil from dehulled seeds (chlorogenic acid, present in hulls, interferes with lipid metabolism) reduced serum and hepatic cholesterol in healthy women.

The tubers of Helianthus tuberosus Linn., a related species, consists mainly of inulin. The dried tubers can be utilized in diabetic products. The tuber concentrate as food diminishes the risk of developing arteriosclerosis. It is advantageous in the diet of patients with gout, chronic renal diseases, and for obesity control.... helianthus annuus

(liposis) n. the presence of abnormally large accumulations of fat in the body. The condition may arise from overeating, hormone irregularities, or a metabolic disorder. In adiposis dolorosa, a condition affecting women more commonly than men, painful fatty swellings are associated with defects in the nervous system. See also obesity.... adiposis

pl. n. a group of *sympathomimetic drugs that have a marked *stimulant action on the central nervous system, alleviating fatigue and producing a feeling of mental alertness and wellbeing. Dexamfetamine (dexamphetamine) is used in the treatment of *narcolepsy and in selected cases of *attention-deficit/hyperactivity disorder in children. Side-effects include insomnia and restlessness. *Tolerance to amphetamines develops rapidly, and prolonged use may lead to *dependence; these drugs should not be used to treat depressive illness or obesity.... amphetamines

These are caused when there are mutations or other abnormalities which disrupt the code of a gene or set of GENES. These are divided into autosomal (one of the 44 CHROMOSOMES which are not sex-linked), dominant, autosomal recessive, sex-linked and polygenic disorders.

Dominant genes A dominant characteristic is an e?ect which is produced whenever a gene or gene defect is present. If a disease is due to a dominant gene, those affected are heterozygous – that is, they only carry a fault in the gene on one of the pair of chromosomes concerned. A?ected people married to normal individuals transmit the gene directly to one-half of the children, although this is a random event just like tossing a coin. HUNTINGTON’S CHOREA is due to the inheritance of a dominant gene, as is neuro?bromatosis (see VON RECKLINGHAUSEN’S DISEASE) and familial adenomatous POLYPOSIS of the COLON. ACHONDROPLASIA is an example of a disorder in which there is a high frequency of a new dominant mutation, for the majority of affected people have normal parents and siblings. However, the chances of the children of a parent with the condition being affected are one in two, as with any other dominant characteristic. Other diseases inherited as dominant characteristics include spherocytosis, haemorrhagic telangiectasia and adult polycystic kidney disease.

Recessive genes If a disease is due to a recessive gene, those affected must have the faulty gene on both copies of the chromosome pair (i.e. be homozygous). The possession of a single recessive gene does not result in overt disease, and the bearer usually carries this potentially unfavourable gene without knowing it. If that person marries another carrier of the same recessive gene, there is a one-in-four chance that their children will receive the gene in a double dose, and so have the disease. If an individual sufferer from a recessive disease marries an apparently normal person who is a heterozygous carrier of the same gene, one-half of the children will be affected and the other half will be carriers of the disease. The commonest of such recessive conditions in Britain is CYSTIC FIBROSIS, which affects about one child in 2,000. Approximately 5 per cent of the population carry a faulty copy of the gene. Most of the inborn errors of metabolism, such as PHENYLKETONURIA, GALACTOSAEMIA and congenital adrenal hyperplasia (see ADRENOGENITAL SYNDROME), are due to recessive genes.

There are characteristics which may be incompletely recessive – that is, neither completely dominant nor completely recessive – and the heterozygotus person, who bears the gene in a single dose, may have a slight defect whilst the homozygotus, with a double dose of the gene, has a severe illness. The sickle-cell trait is a result of the sickle-cell gene in single dose, and sickle-cell ANAEMIA is the consequence of a double dose.

Sex-linked genes If a condition is sex-linked, affected males are homozygous for the mutated gene as they carry it on their single X chromosome. The X chromosome carries many genes, while the Y chromosome bears few genes, if any, other than those determining masculinity. The genes on the X chromosome of the male are thus not matched by corresponding genes on the Y chromosome, so that there is no chance of the Y chromosome neutralising any recessive trait on the X chromosome. A recessive gene can therefore produce disease, since it will not be suppressed by the normal gene of the homologous chromosome. The same recessive gene on the X chromosome of the female will be suppressed by the normal gene on the other X chromosome. Such sex-linked conditions include HAEMOPHILIA, CHRISTMAS DISEASE, DUCHENNE MUSCULAR

DYSTROPHY (see also MUSCLES, DISORDERS OF – Myopathy) and nephrogenic DIABETES INSIPIDUS.

If the mother of an affected child has another male relative affected, she is a heterozygote carrier; half her sons will have the disease and half her daughters will be carriers. The sister of a haemophiliac thus has a 50 per cent chance of being a carrier. An affected male cannot transmit the gene to his son because the X chromosome of the son must come from the mother; all his daughters, however, will be carriers as the X chromosome for the father must be transmitted to all his daughters. Hence sex-linked recessive characteristics cannot be passed from father to son. Sporadic cases may be the result of a new mutation, in which case the mother is not the carrier and is not likely to have further affected children. It is probable that one-third of haemophiliacs arise as a result of fresh mutations, and these patients will be the ?rst in the families to be affected. Sometimes the carrier of a sex-linked recessive gene can be identi?ed. The sex-linked variety of retinitis pigmentosa (see EYE, DISORDERS OF) can often be detected by ophthalmoscopic examination.

A few rare disorders are due to dominant genes carried on the X chromosome. An example of such a condition is familial hypophosphataemia with vitamin-D-resistant RICKETS.

Polygenic inheritance In many inherited conditions, the disease is due to the combined action of several genes; the genetic element is then called multi-factorial or polygenic. In this situation there would be an increased incidence of the disease in the families concerned, but it will not follow the Mendelian (see MENDELISM; GENETIC CODE) ratio. The greater the number of independent genes involved in determining a certain disease, the more complicated will be the pattern of inheritance. Furthermore, many inherited disorders are the result of a combination of genetic and environmental in?uences. DIABETES MELLITUS is the most familiar of such multi-factorial inheritance. The predisposition to develop diabetes is an inherited characteristic, although the gene is not always able to express itself: this is called incomplete penetrance. Whether or not the individual with a genetic predisposition towards the disease actually develops diabetes will also depend on environmental factors. Diabetes is more common in the relatives of diabetic patients, and even more so amongst identical twins. Non-genetic factors which are important in precipitating overt disease are obesity, excessive intake of carbohydrate foods, and pregnancy.

SCHIZOPHRENIA is another example of the combined effects of genetic and environmental in?uences in precipitating disease. The risk of schizophrenia in a child, one of whose parents has the disease, is one in ten, but this ?gure is modi?ed by the early environment of the child.... genetic disorders

a form of fat in adipose tissue that is a rich source of energy and can be converted rapidly to heat. It accounts for 5% of body weight in human infants; adults have little or no brown fat. The main form of adipose tissue in adults, white fat (accounting for 20–25% body weight), stores energy; infants have little or no white fat. Some forms of obesity may be linked to lack of – or inability to synthesize – brown fat.... brown fat

enlargement of the right ventricle of the heart due to excessive pressure loading that results from diseases of the lungs or the pulmonary arteries. Such diseases include those affecting the structure of the lungs (e.g. emphysema) or their function (e.g. obesity) except when these changes result from congenital heart disease or diseases primarily affecting the left side of the heart.... cor pulmonale

Alpinia galanga

Zingiberaceae

San:Sugandhamula, Rasna;

Hin:Kulainjan; Mal:Aratta, Chittaratha;

Tam:Arattai;

Guj: Kolinjan;

Kan: Dumba-rasmi; Mar: Kosht-Kulinjan;

Tel: Pedda-dumparash-tram

Importance: The greater galangal, Java galangal or Siamese ginger is a perennial aromatic rhizomatous herb. This plant is cultivated for its rhizome in tropical areas of south and East India. Because of the presence of essential oil, the rhizomes are used in bronchial troubles and as a carminative. They are also useful in vitiated conditions of vata and kapha, rheumatoid arthritis, inflammations, stomatopathy, pharyngopathy, cough, asthma, hiccough, dyspepsia, stomachalgia, obesity, diabetes, cephalagia, tubercular glands and intermittent fevers. It is one of the ingredients of medicated “Pan” used for removing the foul smell of the mouth and getting relief in throat inflammation. In Ayurveda, “Rasna-saptak-kwath” and “Rasna-adikamath” are used as antiinflammatory decoctions. In Unani, it is an ingredient of aphrodisiac preparations, “Majun Mugawivi ma Mumsik”, “Majun Samagh”, and antispasmodic nervine tonic “Majun Chobchine” and “Lubab Motadil”. It is also used in “Arq Pan” as a cardiac stimulant and carminative.

Distribution: The Java galangal is mainly distributed in Eastern Himalayas and South-West India. This is very common in West Bengal, Bihar, Assam, Kerala, Karnataka and throughout the Western Ghats. It is cultivated also in these places. They are also found in countries like Sri Lanka and Malaya.

Botany: Alpinia galanga (Linn.) Willd. belongs to the family Zingiberaceae. It is a perennial herb, about 2m high with lower portion covered with smooth leaf sheaths. The leaves are broadly lanceolate, 30-60cm long and 10-15cm broad. The flowers are arranged in erect, terminal panicles. composed of numerous spreading dichotomous branches each with two to six, pale greenish-white faintly fragrant flowers. Fruits 1.25 cm long, oblong, constricted in the middle or even pear shaped, three sided and deep orange red in colour. Seeds are ash coloured, three angled, finely striated towards the hilum. Both the seeds and rhizomes have pungent aroma.

Apinia calcarata (Linn.) Willd is another species of the genus with much medicinal importance. It is shorter in stature but stronger in aroma than Alpinia galanga.

Agrotechnology: Siamese Ginger comes up well in tropical climate. It grows on a wide range of climates and soils. Well drained hilly areas and places of 1400m high altitude are good for its cultivation. This is commercially propagated vegetatively by rhizomes. The field should be ploughed to a good tilth. All the stones and pebbles should be removed. Organic manures at 10t/ha are applied during land preparation. Seedbeds are prepared with 1m breadth, 2m length and 15cm height. Small pits are made at 25cm spacing above the seedbeds and 5cm long rhizomes are planted. Seedbeds are covered with dried leaves. It is irrigated immediately after planting. Regular weeding is needed during the initial stages of crop growth. This is cultivated also as an intercrop in coconut or rubber plantations. Rhizomes are dug out after cutting the top portions when the crop reaches 1.5-2 years of maturity. The average yield is 10-15 tonnes of fresh rhizomes/ha and the driage is 25-30%. The collected rhizomes are washed and cut into pieces of 5cm long and dried in sun for 4 days before sale.

Properties and activity: The rhizome contains tannins and flavonoids, some of which have been identified as kaempferide, galangin and alpinin. Seeds contain 1’-acetoxychavicol acetate and 1’-acetoxy eugenol acetate, antiulcer principles caryophyllenols I and II, n-pentadecane, 7-heptadecane and fatty acid methyl esters. Rhizomes yield essential oil containing methyl cinnamate, cineole and d-pinene and sesquiterpenoids. Fresh rhizome yielded 18 monoterpenoids of which -pinene, -pinene and limonene as major compounds and 17 oxygen containing monoterpenoids with cineol, terpinen-4-o1, and -terpineol as minor compounds.

The rhizomes are bitter, acrid, thermogenic, aromatic, nervine tonic, stimulant, revulsive, carminative, stomachic, disinfectant, aphrodisiac, expectorant, broncho-dilator, antifungal, febrifuge, antiinflammatory and tonic. Rhizome is CVS and CNS active, diuretic, hypothermic. Seed is antiulcerative. Rhizome spray in ether, over a space showed high knock down values against houseflies. Alcohol (50%) extract of rhizome is anti-amphetaminic. Unani physicians consider it good for impotence.... greater galangal

Heparin is one of the naturally produced ANTICOAGULANTS with a rapid e?ect, which is thought to act by neutralising thrombin (see COAGULATION). Inactive when taken orally, it is normally given intravenously – it may be given for a few days, combined with an oral anticoagulant such as warfarin, to initiate anticoagulation. Low-dose heparin may be given by subcutaneous injection for longer periods, for the prophylaxis of DEEP VEIN THROMBOSIS (DVT) or PULMONARY EMBOLISM in ‘high-risk’ patients, such as those with obesity or a history of thrombosis, or post-operatively. If haemorrhage occurs, withdrawal of heparin is usually su?cient, but protamine sulphate is a rapidly active and speci?c antidote. Prolonged treatment with heparin may cause osteoporosis (see under BONE, DISORDERS OF).... heparin

n. the separation or stretching of bodily structures. Rectus divarication is stretching of the *rectus abdominis muscle, a common condition associated with pregnancy or obesity.... divarication

(FSGS) a condition in which there is scarring in some (focal) glomeruli that affects only part (segmental) of the glomerular capillary tuft. Primary FSGS overlaps with *minimal change nephropathy and typically presents with the *nephrotic syndrome. Secondary FSGS has a wide range of causes, from viral infections, including HIV, to haemodynamic changes associated with reduced renal mass, hypertension, and obesity, and is usually associated with less severe proteinuria.... focal segmental glomerulosclerosis

n. surgical alteration of the shape of the stomach without removal of any part. The term was originally used for correction of an acquired deformity, e.g. narrowing due to a peptic ulcer, but has more recently been applied to techniques for reducing the size of the stomach in the treatment of morbid obesity, e.g. vertical banded gastroplasty (see stomach stapling) and *gastric banding.... gastroplasty

n. an operation in which part of the jejunum is joined to the distal ileum following the removal or bypass of diseased segments of small bowel. It was formerly used for the treatment of obesity but has been abandoned because of deleterious side-effects.... jejunoileostomy

Kurz.

Synonym: H. madablota Gaertn.

Family: Malpighiaceae.

Habitat: Throughout the warmer parts of Maharashtra, Konkan, Karnataka and other parts of India.

Ayurvedic: Atimukta, Atimuktaka, Maadhavi, Vaasanti, Pundrika, Mandaka, Vimukta, Kaamu- ka.

Siddha/Tamil: Madhavi, Vasanda- gala-malligai.

Action: Kernel of seeds is prescribed for reducing abdominal girth (obesity). Leaves—used in chronic rheumatism, asthma and skin diseases. Bark—used in bronchial asthma.

The stem and its bark contain friede- lin, epi-friedelinol, octacosanol, alpha- amyrin, beta-sitosterol and its beta-D- glucoside. The root bark gave a nitrogenous glucoside, hiptagin, identical with endecaphyllin and a glucosyl xanthone, mangiferin.

Dosage: Fruit, seed, root—powder 3-5 g; paste 5-10 g. (CCRAS.)... hiptage benghalensis

Planch.

Family: Ulmaceae.

Habitat: Throughout greater parts of India, also grown in gardens.

Ayurvedic: Chirbilva, Putika, Prakirya.

Siddha/Tamil: Avil thol, Ayil pattai (bark)

Action: Bark—internally and externally used in rheumatism. Stem bark paste—in scabies. Seeds—used topically on ringworm.

The Ayurvedic Pharmacopoeia of India recommends dried fruits in poly- uria and other urinary disorders.

The stem bark contains the triter- penoidal fatty acid esters, holoptelin-A (epi-friedelinol palmitate) and holop- telin-B (epi-friedelinol stearate), frie- delin and epi-friedelinol.

The powdered bark exhibited lipoly- tic action and mobilized fat from adipose tissues in rats and consequently helped in the reduction of obesity.

Dosage: Dried fruit—1-3 g. (API Vol. III.)... holoptelea integrifolia

Linn.

Family: Gramineae; Poaceae.

Habitat: Cultivated as food crop in Uttar Pradesh, West Bengal, Bihar, Madhya Pradesh, Rajasthan, Haryana, Punjab, Himachal Pradesh and Jammu and Kashmir.

English: Barley

Ayurvedic: Yava, Hayeshtha, Hayapriya, Shuka-dhaanya, Tiksh- nashuka.

Unani: Barley, Jao Shaeer.

Siddha: Yavam. Saambaluppu (ash).

Action: Barley—nutritive and demulcent during convalescence and in cases of bowel inflammation and diarrhoea. Protects immune system.

The Ayurvedic Pharmacopoeia ofIn- dia recommends barley in urinary disorders, muscular rigidity, chronic sinusitis, cough, asthma, lipid disorder and obesity.

Juice of young barley leaves—7 times richer in vitamin C than oranges, 5 times richer in iron than spinach, 25 times richer in potassium than wheat; high in SOD (superoxide dismutase), an enzyme that slows ageing of cells.

The nutritional quality of the barley depends on beta-glucan fraction of the grain. Beta-glucan-enriched fraction produced cholesterol-lowering effect in hamsters.

Naked barley extracts have been found to selectively inhibit cyclohex- anase activity and may be useful as a therapeutic drug for treating thrombosis and atherosclerosis.

Ethanol extract of young green leaves exhibits antioxidant activity attributed to a flavonoid, 2"-O-glucosyl- isovitexin. It also exhibits antiinflammatory and antiallergic activities. The leaves contain an indole alkaloid, gramine, which exhibits antibacterial properties.

Dosage: Dried fruit—100-200 g. (API Vol. II); dried plant—10-20 g. (API Vol. IV.)... hordeum vulgare

In?ammation between two skin surfaces in contact, typically in the toe clefts, axillae, under the breasts or in the anogenital folds. Heat, friction and obesity are aggravating factors. Secondary fungal or bacterial infection with CANDIDA or bacteria is common.

Interventional Radiology

The use of radiology (see X-RAYS) to enable doctors to carry out diagnostic or treatment procedures under direct radiological vision. This X-ray procedure is used in MINIMALLY INVASIVE SURGERY (MIS) – for example, ANGIOPLASTY, the removal of stones from the kidney (see KIDNEYS, DISEASES OF), and the observation of obstructions in the bile ducts (percutaneous CHOLANGIOGRAPHY). (See also magnetic resonance imaging – MRI.)... intertrigo

a familial condition that is the most common form of isolated *gonadotrophin deficiency; it is combined with underdevelopment of the olfactory lobes, causing *anosmia. The syndrome is caused by a gene *deletion on the short arm of the X chromosome. Patients often present with delayed puberty. There is an association with *ichthyosis, learning disabilities, obesity, renal and skeletal abnormalities, and undescended testes, but these features are very variable. [F. J. Kallmann (1897–1965), US geneticist]... kallmann’s syndrome

an autosomal *recessive condition characterized by obesity, short stature, learning disabilities, *retinitis pigmentosa, *hypogonadism, and delayed puberty. [J. Z. Laurence (1830–74), British ophthalmologist; R. C. Moon (1844–1914), US ophthalmologist; A. Biedl (1869–1933), Austrian physician]... laurence–moon–biedl syndrome

n. a protein that is produced and secreted by adipose tissue (especially white fat) and has a role in the regulation of eating (leptin receptors are concentrated in the hypothalamus). Increased amounts of adipose tissue result in higher concentrations of leptin and a reduction in appetite. A deficiency of leptin is responsible for a few cases of obesity.... leptin

A STROKE that occurs when the ?ow of blood to a part of the brain is interrupted by a partial or complete THROMBOSIS of the supplying artery or ARTERIES, or by a clot of blood that has detached itself from elsewhere in the circulatory system – for instance, a deep vein thrombosis (DVT) – and blocked a cerebral artery. Stroke is the second most common cause of death worldwide. Its treatment is di?cult and prevention is best targeted at those who are at the highest absolute risk of stroke, because such people are likely to derive the greatest bene?t. They generally have a history of occlusive vascular diseases such as previous ischaemic stroke or a transient ischaemic attack (TIA), coronary heart disease (see HEART, DISEASES OF) or PERIPHERAL VASCULAR DISEASE. In the UK strokes affect about 200 people per 100,000 population annually, with the incidence rising sharply after the age of 55. At the age of 70 the incidence is around 15 people per 1,000 of population; at 80 the ?gure is double that.

About 80 per cent of patients survive an acute stroke and they are at risk of a further episode within a few weeks and months; about 10 per cent in the ?rst year and 5 per cent a year after that. HYPERTENSION, smoking, HYPERLIPIDAEMIA and raised concentration of blood sugar, along with OBESITY, are signi?cant pointers to further strokes and preventive steps to reduce these factors are worthwhile, although the reduction in risk is hard to assess. Even so, the affected person should stop smoking, greatly reduce alcohol intake, check for and have treated diabetes, reduce weight and exercise regularly. In any case, a diet rich in fresh fruit and vegetables and low in fat and salt, exercise and the avoidance of smoking may reduce the risk of having a ?rst stroke.

The evidence is inconclusive that patients with ischaemic stroke should be treated with antihypertensives. Furthermore, neither the starting blood pressure nor the best drug regimen or its starting time are generally agreed. Studies on the most e?ective methods of preventing and treating stroke are continuing; meanwhile available evidence suggests that an active approach to prevention of primary and secondary hypertension will bene?t patients and usually be cost-e?ective.... ischaemic stroke

A substance which is insoluble in water, but soluble in fat solvents such as alcohol and ether. The main lipid groups are the triglycerides, phospholipids, and glycolipids. They play an important role in nutrition, health (particularly in the functioning of the cell membranes, and the immune response), and disease (notably cardiovascular disease). There is a strong correlation between the concentration of CHOLESTEROL in the blood (transported as lipoproteins) and the risk of developing ATHEROMA and coronary heart disease (see HEART, DISEASES OF). Lipoproteins are classi?ed by their density and mobility, the chief groups being low-density (LDL) and high-density (HDL). High SERUM concentrations of LDL increase the risk of cardiovascular disease, while HDL is thought to protect the vessel wall by removing cholesterol, and has an inverse relationship to risk. The various serum lipid abnormalities have been classi?ed into ?ve groups, according to the cause and particular lipoprotein raised. Most important are type II (increased LDL, genetically determined) and type IV (increased VLDL, associated with obesity, diabetes, and excess alcohol). Various lipid-lowering drugs are available, but any drug treatment must be combined with a strict diet, reduction of blood pressure, and cessation of smoking.... lipid

(Linn.) M. J. Roem.

Synonym: L. aegyptiaca Mill. L. pentandra Roxb.

Family: Cucurbitaceae.

Habitat: Cultivated throughout greater parts of India.

English: Smooth Luffa, Sponge- gourd, sponge Cucumber.

Ayurvedic: Dhaamaargava, Ma- haakoshtaki, Mahaajaalini, Raa- jakoshataki.

Siddha/Tamil: Mozhukupeerankai, Pikku.

Action: Plant—used against pharyngitis, rhinitis, mastitis, oedema, swellings and burns. Leaves— used for chronic bronchitis. Leaf juice is given for amenorrhoea. Flowers—used for treating migraine. Seeds—alcoholic extract exhibited 9.80% fungitoxic activity.

German Commission E included Luffa aegyptiaca among unapproved herbs. Preparations of Luffa sponge, used as a preventive for infections or cold, as a remedy for colds, nasal catarrh as well as sinusitis and suppuration of the sinus, have been negatively evaluated.

The saponins isolated from aerial parts are effective in controlling obesity, also the side-effects of steroids.

The oleanane saponins, lucyoside AH (at least one component) is effective in preventing loss of hair.

Spongegourd extracts or saponins (ginsenosides and lucyosides) find application in topical medication for skin disorders and haemorrhoids. Lucyo- sides are also used as antitussive.

The roots of the mature plants contain an acidic pentacyclic triterpene, bryonolic acid. Bryonolic acid showed antiallergic and anti-inflammatory activity in experimental animals. An aqueous extract of seeds showed strong fibrinolytic activity. It also showed anticancer activity in transplanted tumours.

Dosage: Leaf, flower, fruit—10- 20 ml juice. (CCRAS.)... luffa cylindrica

n. abnormally large size. In fetal macrosomia the baby is large for its gestational age. This condition is associated with poorly controlled maternal diabetes, the increased size being due to excessive production of fetal insulin and thence to increased deposition of glycogen in the fetus, and maternal obesity.... macrosomia

large irregular masses abnormally located in the hepatocytes of the liver. They are found in patients with alcoholic hepatitis, alcoholic cirrhosis, Wilson’s disease, primary biliary cirrhosis, clinical obesity, and hepatoma. [F. B. Mallory (1862–1941), US pathologist]... mallory bodies

n. a condition in which there is an imbalance between the nutrients the body receives and the nutrients it requires. A deficiency (or undernutrition) results from a combination of a decreased dietary intake, a decreased uptake by the body (*malabsorption), an increase in bodily losses, and an increase in the body’s requirements. Overnutrition is the consequence of dietary excess and results in *obesity and other metabolic abnormalities, such as *diabetes and *hyperlipidaemia.... malnutrition

Mill.

Synonym: Solanum lycopersicum Linn.

Family: Solanaceae.

Habitat: Cultivated in many parts of India.

English: Tomato, Love Apple.

Unani: Tamaatar.

Action: Mild aperient, blood purifier, cholagogue, digestive. Used in homoeopathy for treating rheumatic conditions, colds, chills, digestive disorders, diabetes, obesity, leucorrhoea, metrorrhagia.

Tomato is a powerful deobstruent. It promotes flow of bile; mildly laxative, especially when taken raw. Tomato stimulates torpid liver and kidneys and helps to wash away toxins. Tomato is recommended for diabetics. It is a major dietary source of carotenoid lycopene.

Tomato juice inhibits carcinogenic N-nitrosocompound formation chiefly in the stomach. Most of the inhibition of formation of N-nitrosomorpholine by phenolic fraction of tomato juice was due to chlorogenic acids. The ascorbate fraction of the juice also contains compounds that inhibit ni- trosation.

Consumption of tomato juice can significantly increase serum lycopene levels. (Decreased serum lycopene concentrations are associated with an increase risk of prostate cancer.) (Natural Medicines Comprehensive Database, 2007.)

The alcoholic extract of tomato possesses CNS depressant and analgesic properties.... lycopersicon esculentum

Excess bleeding at menses, in duration or amount. Causes are many, although chronic menorrhagia and PMS is usually the result of deficient progesterone secretions (days-per-month) or constant adipose-released estradiol from obesity or recent substantial weight loss. Uterine fibroids can contribute, as can menopausal breakthrough bleeding or flooding, coagulation disorders, and most serious metabolic disease can produce menorrhagia as one of many symptoms. My rule of thumb as an herbalist is, if botanicals fail to control the bleeding directly (hemostatics) or attempting to reestablish a good folliculization for the next month’s corpus luteum does not help, there may be a metabolic problem or an overt reproductive pathology. In menopausal menorrhagia, however, the conditions are transitional and in flux...it is hard to use such absolute statements.... menorrhagia

Oolong tea, literally meaning “Black Dragon”, is a traditional Chinese beverage which undergoes a unique preparation process resulting in a reddish drink with a slightly sweet delicate flavour. Oolong tea is partially fermented, unlike black tea, which is fully fermented, or green tea, which is unfermented. Oolong Tea Brewing Oolong tea requires a higher brewingtemperature in order to extract the complex aromas of the tea leaves. It is recommended to use spring or filtered water heated at a temperature of approximately 90 degrees Celsius. The steeping process for most Oolong teas should last no longer than five minutes. If this period is extended for too long, it may ruin the delicate aromas and turn your cup of tea unpleasantly bitter. Oolong teas are best served plain, but you can add milk, sugar, honey or lemon according to your taste. Oolong Tea Health Benefits Oolong tea, a hybrid between black and green tea, has numerous health benefits, especially if consumed regularly. Drinking Oolong tea stimulates brain activity and relieves mental and physical stress. Oolong tea has the potential of reducing high blood pressure, lowering blood sugar levels and preventing serious afflictions like obesity, osteoporosis, tooth decay, cancer or heart disease. Oolong tea accelerates the metabolism and promotes weight loss. Another health benefit of Oolong tea is its effectiveness in treating skin problems such as eczema and rashes and combating skin aging. Oolong Tea Side Effects Although drinking Oolong tea is extremely beneficial for the body, it can also lead to unpleasant side effects when consumed in large quantities, therefore moderation is required. These side effects include sleeping difficulties, anxiety or irritability, most of them related to excessive caffeine intake. It is not recommended for pregnant women and people suffering from kidney disorders. Furthermore, oolong tea has been proven to interact with certain medications; therefore, people who undertake treatment are advised to consult a health care provider first. Oolong tea is extremely effective in keeping your energy levels up, due to its caffeine content, and it also increases brain function, helping you maintain active and aware throughout the day.... oolong tea health benefits, side effects and brewing

(insulin resistance syndrome, syndrome X) a very common condition in which impaired glucose tolerance, impaired fasting glucose, or type 2 diabetes (see glucose tolerance test) is combined with central obesity (increased fat within the abdomen), raised blood pressure (*hypertension), and *hyperlipidaemia. It is associated with a risk of premature vascular disease (heart attack and stroke). The principal underlying cause is *insulin resistance, which is genetically determined.... metabolic syndrome

adj. referring to an environment that predisposes to *obesity, generally because of factors that encourage over-consumption of food or low levels of physical activity.... obeseogenic

(Prader–Willi–Labhart syndrome) a congenital condition that is inherited as an autosomal *dominant trait and is due to an abnormality of chromosome 15 (see imprinting). It is marked by pathological overeating and resulting obesity (affected children often subsequently develop type 2 diabetes), lethargy, short stature, a characteristic facial expression, learning disabilities, and underactivity of the testes or ovaries (*hypogonadism) due to lack of pituitary gonadotrophins. It is a cause of delayed puberty. [A. Prader, H. Willi, and A. Labhart (20th century), Swiss paediatricians]... prader–willi syndrome

n. infiltration of *hepatocytes with fat. This may occur in alcoholism, obesity, metabolic syndrome, pregnancy, malnutrition, viral hepatitis, or certain drugs (such as oestrogens or steroids).... steatosis

Oöphoritis (infection of the ovaries) rarely occurs alone, except in viral infections such as mumps. Usually it is associated with infection of the FALLOPIAN TUBES (SALPINGITIS). It may occur as a complication of a miscarriage, a therapeutic abortion, or the birth of a baby. Cases not associated with pregnancy typically result from sexual activity: the most common organisms involved are Chlamydia, E. coli, and Neisseria gonorrhoea. Cervical swabs should be sent for culture and analgesics given, together with the appropriate antibiotics.

Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.

Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.

In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.

Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.

Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of

Roxb.

Family: Papilionaceae; Fabaceae.

Habitat: Throughout the tropical zones of India in the hilly regions.

English: Indian Kino tree, Malabar Kino tree.

Ayurvedic: Asana, Bijaka, Priyaka, Pitashaala.

Unani: Bijaysaar.

Siddha/Tamil: Vengai.

Action: Bark-kino—astringent, antihaemorrhagic, antidiarrhoeal. Flowers—febrifuge. Leaves—used externally for skin diseases.

Key application: Heartwood— in anaemia, worm infestation, skin diseases, urinary disorders, lipid disorders and obesity. Stem bark—in diabetes. (The Ayurvedic Pharmacopoeia of India.)

The heartwood and roots contain isoflavonoids, terpenoids and tannins. Tannins include the hypoglycaemic principle (-)-epicatechin. Stilbenes, such as pterostilbene; flavonoids, including liquiritigenin, isoliquiritige- nin, 7-hydroxyflavanone, 7,4-dihy- droxyflavanone, 5-deoxykaempferol and pterosupin; a benzofuranone mar- supsin and propterol, p-hydroxy-ben- zaldehyde are active principles of therapeutic importance.

The gum-kino from the bark provides a non-glucosidal tannin, Kino tannic acid (25-80%).

The (-)-epi-catechin increases the cAMP content of the islets which is associated with the increased insulin release, conversion of proinsulin to insulin and cathepsin B activity.

Oral administration of ethylacetate extract of the heartwood and its fla- vonoid constituents, marsupin, ptero- supin and liquiritigenin, for 14 consecutive days to rats exhibited a significant reduction of serum triglycerides, total cholesterol and LDL- and VLDL-cholesterol levels, but it did not exert any significant effect on HDL- cholesterol.

The ethanolic and methanolic extracts of the heartwood exhibited significant in vitro antimicrobial activity against Gram-positive and Gramnegative bacteria and some strains of fungi.

Kino is powerfully astringent. The therapeutic value of kino is due to Kino tannic acid.

Dosage: Heartwood—50-100 g for decoction. (API, Vol. I); stem bark—32-50 g for decoction (API, Vol. III).... pterocarpus marsupium

n. a carbohydrate consisting of glucose and fructose. Sucrose is the principal constituent of cane sugar and sugar beet; it is the sweetest of the natural dietary carbohydrates. The increasing consumption of sucrose in the last 50 years has coincided with an increase in the incidence of dental caries, diabetes, coronary heart disease, and obesity.... sucrose

(WHR) the ratio of the circumference of the waist to that of the hips. It is used as a measure of obesity and is a more reliable predictor of obesity-related mortality than *body mass index alone.... waist to hip ratio