Drugs and other measures which have a calming e?ect, reducing tension and anxiety. They include ANXIOLYTICS and HYPNOTICS (usually given in smaller doses than is needed to induce sleep).
The most widely prescribed type of antidepressants are the tricyclics, so-called because their molecular structure includes three rings. The other commonly used types are named after the actions they have on chemicals in the brain: the SELECTIVE SEROTONIN-REUPTAKE INHIBITORS (SSRIS) and the MONOAMINE OXIDASE INHIBITORS (MAOIS) – see also below. All types of antidepressant work in similar ways. Tricyclic antidepressants have cured depression in millions of people, but they can cause unpleasant side-effects, particularly in the ?rst couple of weeks. These include SEDATION, dry mouth, excessive sweating, CONSTIPATION, urinary problems, and impotence (inability to get an erection). Up to half of all people prescribed tricyclic drugs cannot tolerate the side-effects and stop treatment before their depression is properly treated. More seriously, tricyclics can upset the rhythm of the heart in susceptible people and should never be given in the presence of heart disease.
The SSRIs are newer, coming into wide use in the late 1980s. They increase the levels in the brain of the chemical messenger SEROTONIN, which is thought to be depleted in depression. Indeed, the SSRIs are as e?ective as tricyclics and, although they can cause nausea and excessive sweating at ?rst, they generally have fewer side-effects. Their main disadvantage, however, is that they cost much more than the most commonly used tricyclic, amitriptyline. On the other hand, they are more acceptable to many patients and they cause fewer drop-outs from treatment – up to a quarter rather than a half. The money saved by completed, successful treatment may outweigh the prescribing costs. SSRIs have been reported as associated with an increased risk of suicide.
Another group of antidepressants, the MAOIs, have been in use since the late 1950s.
They are stimulants, rather than sedatives, and are particularly helpful for people who are physically and mentally slowed by depression. They work well but have one big disadvantage – a dangerous interaction with certain foods and other drugs, causing a sudden and very dangerous increase in blood pressure. People taking them must carry an information card explaining the risk and listing the things that they should avoid. Because of this risk, MAOIs are not used much now, except when other treatments have failed. A new MAOI, moclobemide, which is less likely to interact and so cause high blood pressure, is now available.
LITHIUM CARBONATE is a powerful antidepressant used for intractable depression. It should be used under specialist supervision as the gap between an e?ective dose and a toxic one is narrow.
St John’s Wort is a popular herbal remedy which may be e?ective, but which is handicapped by di?erences of strength between di?erent preparations or batches. It can interact with a number of conventional drugs and so needs to be used cautiously and with advice.
In general, antidepressants work by restoring the balance of chemicals in the brain. Improved sleep and reduced anxiety are usually the ?rst signs of improvement, particularly among people taking the more sedative tricyclic drugs. Improvement in other symptoms follow, with the mood starting to lift after about two weeks of treatment. Most people feel well by three months, although a few residual symptoms, such as slowness in the mornings, may take longer to clear up. People taking antidepressants usually want to stop them as soon as they feel better; however, the risk of relapse is high for up to a year and most doctors recommend continuing the drugs for around 4–6 months after recovery, with gradual reduction of the dose after that.
Withdrawal reactions may occur including nausea, vomiting, headache, giddiness, panic or anxiety and restlessness. The drugs should be withdrawn gradually over about a month or longer (up to six months in those who have been on maintenance treatment).
A wide range of antidepressant drugs is described in the British National Formulary. Examples include:
Tricyclics: amitryptyline, imipramine, doxepin.
MAOIs: phenelzine, isocarboxazid.
SSRIs: citalopram, ?uoxetine, paraxtene. (Antidepressant drugs not in these three
groups include ?upenthixol, mertazapine and venlafaxine.)... antidepressant drugs
Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: None Saturated fat: None Cholesterol: None Carbohydrates: High Fiber: None Sodium: Low Major vitamin contribution: B vitamins Major mineral contribution: Phosphorus
About the Nutrients in This Food Beer and ale are fermented beverages created by yeasts that convert the sugars in malted barley and grain to ethyl alcohol (a.k.a. “alcohol,” “drink- ing alcohol”).* The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits. One 12-ounce glass of beer has 140 calo- ries, 86 of them (61 percent) from alcohol. But the beverage—sometimes nicknamed “liquid bread”—is more than empty calories. Like wine, beer retains small amounts of some nutrients present in the food from which it was made. * Because yeasts cannot digest t he starches in grains, t he grains to be used in mak ing beer and ale are allowed to germinate ( “malt” ). When it is t ime to make t he beer or ale, t he malted grain is soaked in water, forming a mash in which t he starches are split into simple sugars t hat can be digested (fermented) by t he yeasts. If undisturbed, t he fermentat ion will cont inue unt il all t he sugars have been digested, but it can be halted at any t ime simply by raising or lowering t he temperature of t he liquid. Beer sold in bott les or cans is pasteurized to k ill t he yeasts and stop t he fermentat ion. Draft beer is not pasteurized and must be refrigerated unt il tapped so t hat it will not cont inue to ferment in t he container. The longer t he shipping t ime, t he more likely it is t hat draft beer will be exposed to temperature variat ions t hat may affect its qualit y—which is why draft beer almost always tastes best when consumed near t he place where it was brewed. The Nutrients in Beer (12-ounce glass)
| Nutrients | Beer | %R DA |
| Calcium | 17 mg | 1.7 |
| Magnesium | 28.51 mg | 7–9* |
| Phosphorus | 41.1 mg | 6 |
| Potassium | 85.7 mg | (na) |
| Zinc | 0.06 mg | 0.5– 0.8* |
| Thiamin | 0.02 mg | 1.6 –1.8* |
| R iboflavin | 0.09 mg | 7– 8* |
| Niacin | 1.55 mg | 10 |
| Vitamin B6 | 0.17 mg | 13 |
| Folate | 20.57 mcg | 5 |
Diets That May Restrict or Exclude This Food Bland diet Gluten-free diet Low-purine (antigout) diet
Buying This Food Look for: A popular brand that sells steadily and will be fresh when you buy it. Avoid: Dusty or warm bottles and cans.
Storing This Food Store beer in a cool place. Beer tastes best when consumed within two months of the day it is made. Since you cannot be certain how long it took to ship the beer to the store or how long it has been sitting on the grocery shelves, buy only as much beer as you plan to use within a week or two. Protect bottled beer and open bottles or cans of beer from direct sunlight, which can change sulfur compounds in beer into isopentyl mercaptan, the smelly chemical that gives stale beer its characteristic unpleasant odor.
When You Are Ready to Serve This Food Serve beer only in absolutely clean glasses or mugs. Even the slightest bit of grease on the side of the glass will kill the foam immediately. Wash beer glasses with detergent, not soap, and let them drain dry rather than drying them with a towel that might carry grease from your hands to the glass. If you like a long-lasting head on your beer, serve the brew in tall, tapering glasses to let the foam spread out and stabilize. For full flavor, serve beer and ales cool but not ice-cold. Very low temperatures immo- bilize the molecules that give beer and ale their flavor and aroma.
What Happens When You Cook This Food When beer is heated (in a stew or as a basting liquid), the alcohol evaporates but the flavor- ing agents remain intact. Alcohol, an acid, reacts with metal ions from an aluminum or iron pot to form dark compounds that discolor the pot or the dish you are cooking in. To prevent this, prepare dishes made with beer in glass or enameled pots.
Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moder- ate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How the alcohol prevents stroke is still unknown, but it is clear that moderate use of alcohol is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, can also reduce their risk of stroke. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low-density lipoproteins (LDLs), the protein and fat particles that carr y cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carr y cholesterol out of the body. The USDA /Health and Human Services Dietar y Guidelines for Americans defines moderation as two drinks a day for a man, one drink a day for a woman. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcohol dilates the capillaries (the tiny blood vessels just under the skin), and moderate amounts of alcoholic beverages produce a pleasant flush that temporar- ily warms the drinker. But drinking is not an effective way to warm up in cold weather since the warm blood that flows up to the capillaries will cool down on the surface of your skin and make you even colder when it circulates back into the center of your body. Then an alco- hol flush will make you perspire, so that you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the American Cancer Society’s warning that men and women who consume more than two drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Note: The Dietary Guidelines for Americans describes one drink as 12 ounces of beer, five ounces of wine, or 1.5 ounces of distilled spirits. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, and mental retardation—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who consume three to four drinks a day or five drinks on any one occasion while pregnant. To date, there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while pregnant, but two studies at Columbia University have suggested that as few as two drinks a week while preg- nant may raise a woman’s risk of miscarriage. (“One drink” means 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuse depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tissues. Although individuals vary widely in their capacity to metabolize alcohol, on average, normal healthy adults can metabolize the alcohol in one quart of beer in approximately five to six hours. If they drink more than that, they will have more alcohol than the body’s natural supply of ADH can handle. The unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, they will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining more irritating uric acid. The level of lactic acid in the body will increase, making them feel tired and out of sorts; their acid-base balance will be out of kilter; the blood vessels in their heads will swell and throb; and their stomachs, with linings irritated by the alcohol, will ache. The ultimate result is a “hangover” whose symptoms will disappear only when enough time has passed to allow their bodies to marshal the ADH needed to metabolize the extra alcohol in their blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. “Beer belly.” Data from a 1995, 12,000 person study at the University of North Carolina in Chapel Hill show that people who consume at least six beers a week have more rounded abdomens than people who do not drink beer. The question left to be answered is which came first: the tummy or the drinking.
Food/Drug Interactions Acetaminophen (Tylenol, etc.). The FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetamino- phen combination may cause liver failure. Disulfiram (Antabuse). Taken with alcohol, disulfiram causes flushing, nausea, low blood pressure, faintness, respiratory problems, and confusion. The severity of the reaction gener- ally depends on how much alcohol you drink, how much disulfiram is in your body, and how long ago you took it. Disulfiram is used to help recovering alcoholics avoid alcohol. (If taken with alcohol, metronidazole [Flagyl], procarbazine [Matulane], quinacrine [Atabrine], chlorpropamide (Diabinase), and some species of mushrooms may produce a mild disulfi- ramlike reaction.) Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners) such as warfarin (Coumadin), intensif ying the effect of the drugs and increasing the risk of side effects such as spontaneous nosebleeds. Antidepressants. Alcohol may increase the sedative effects of antidepressants. Drinking alcohol while you are taking a monoamine oxidase (M AO) inhibitor is especially hazard- ous. M AO inhibitors inactivate naturally occurring enzymes in your body that metabolize tyramine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food containing 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. Ordinarily, fermentation of beer and ale does not produce tyramine, but some patients have reported tyramine reactions after drinking some imported beers. Beer and ale are usually prohibited to those using M AO inhibitors. Aspirin, ibuprofen, ketoprofen, naproxen, and nonsteroidal anti-inflammatory drugs. Like alcohol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Combining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antidepres- sants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol inten- sifies sedation and, depending on the dose, may cause drowsiness, respiratory depression, coma, or death.... beer
Nutritional Profile Energy value (calories per serving): Low Protein: Trace Fat: Trace Saturated fat: None Cholesterol: None Carbohydrates: Trace Fiber: Trace Sodium: Low Major vitamin contribution: None Major mineral contribution: None
About the Nutrients in This Food Coffee beans are roasted seeds from the fruit of the evergreen coffee tree. Like other nuts and seeds, they are high in proteins (11 percent), sucrose and other sugars (8 percent), oils (10 to 15 percent), assorted organic acids (6 percent), B vitamins, iron, and the central nervous system stimulant caffeine (1 to 2 percent). With the exceptions of caffeine, none of these nutrients is found in coffee. Like spinach, rhubarb, and tea, coffee contains oxalic acid (which binds calcium ions into insoluble compounds your body cannot absorb), but this is of no nutritional consequence as long as your diet contains adequate amounts of calcium-rich foods. Coffee’s best known constituent is the methylxanthine central ner- vous system stimulant caffeine. How much caffeine you get in a cup of coffee depends on how the coffee was processed and brewed. Caffeine is Caffeine Content/Coffee Servings Brewed coffee 60 mg/five-ounce cup Brewed/decaffeinated 5 mg/five-ounce cup Espresso 64 mg/one-ounce serving Instant 47 mg/rounded teaspoon
The Most Nutritious Way to Serve This Food In moderation, with high-calcium foods. Like spinach, rhubarb, and tea, coffee has oxalic acid, which binds calcium into insoluble compounds. This will have no important effect as long as you keep your consumption moderate (two to four cups of coffee a day) and your calcium consumption high.
Diets That May Restrict or Exclude This Food Bland diet Gout diet Diet for people with heart disease (regular coffee)
Buying This Food Look for: Ground coffee and coffee beans in tightly sealed, air- and moisture-proof containers. Avoid: Bulk coffees or coffee beans stored in open bins. When coffee is exposed to air, the volatile molecules that give it its distinctive flavor and richness escape, leaving the coffee flavorless and/or bitter.
Storing This Food Store unopened vacuum-packed cans of ground coffee or coffee beans in a cool, dark cabinet—where they will stay fresh for six months to a year. They will lose some flavor in storage, though, because it is impossible to can coffee without trapping some flavor- destroying air inside the can. Once the can or paper sack has been opened, the coffee or beans should be sealed as tight as possible and stored in the refrigerator. Tightly wrapped, refrigerated ground coffee will hold its freshness and flavor for about a week, whole beans for about three weeks. For longer storage, freeze the coffee or beans in an air- and moistureproof container. ( You can brew coffee directly from frozen ground coffee and you can grind frozen beans without thawing them.)
Preparing This Food If you make your coffee with tap water, let the water run for a while to add oxygen. Soft water makes “cleaner”-tasting coffee than mineral-rich hard water. Coffee made with chlorinated water will taste better if you refrigerate the water overnight in a glass (not plastic) bottle so that the chlorine evaporates. Never make coffee with hot tap water or water that has been boiled. Both lack oxygen, which means that your coffee will taste flat. Always brew coffee in a scrupulously clean pot. Each time you make coffee, oils are left on the inside of the pot. If you don’t scrub them off, they will turn rancid and the next pot of coffee you brew will taste bitter. To clean a coffee pot, wash it with detergent, rinse it with water in which you have dissolved a few teaspoons of baking soda, then rinse one more time with boiling water.
What Happens When You Cook This Food In making coffee, your aim is to extract flavorful solids (including coffee oils and sucrose and other sugars) from the ground beans without pulling bitter, astringent tannins along with them. How long you brew the coffee determines how much solid material you extract and how the coffee tastes. The longer the brewing time, the greater the amount of solids extracted. If you brew the coffee long enough to extract more than 30 percent of its solids, you will get bitter compounds along with the flavorful ones. (These will also develop by let- ting coffee sit for a long time after brewing it.) Ordinarily, drip coffee tastes less bitter than percolator coffee because the water in a drip coffeemaker goes through the coffee only once, while the water in the percolator pot is circulated through the coffee several times. To make strong but not bitter coffee, increase the amount of coffee—not the brewing time.
How Other Kinds of Processing Affect This Food Drying. Soluble coffees (freeze-dried, instant) are made by dehydrating concentrated brewed coffee. These coffees are often lower in caffeine than regular ground coffees because caffeine, which dissolves in water, is lost when the coffee is dehydrated. Decaffeinating. Decaffeinated coffee is made with beans from which the caffeine has been extracted, either with an organic solvent (methylene chloride) or with water. How the coffee is decaffeinated has no effect on its taste, but many people prefer water-processed decaf- feinated coffee because it is not a chemically treated food. (Methylene chloride is an animal carcinogen, but the amounts that remain in coffees decaffeinated with methylene chloride are so small that the FDA does not consider them hazardous. The carcinogenic organic sol- vent trichloroethylene [TCE], a chemical that causes liver cancer in laboratory animals, is no longer used to decaffeinate coffee.)
Medical Uses and/or Benefits As a stimulant and mood elevator. Caffeine is a stimulant. It increases alertness and concentra- tion, intensifies muscle responses, quickens heartbeat, and elevates mood. Its effects derive from the fact that its molecular structure is similar to that of adenosine, a natural chemical by-product of normal cell activity. Adenosine is a regular chemical that keeps nerve cell activ- ity within safe limits. When caffeine molecules hook up to sites in the brain when adenosine molecules normally dock, nerve cells continue to fire indiscriminately, producing the jangly feeling sometimes associated with drinking coffee, tea, and other caffeine products. As a rule, it takes five to six hours to metabolize and excrete caffeine from the body. During that time, its effects may vary widely from person to person. Some find its stimu- lation pleasant, even relaxing; others experience restlessness, nervousness, hyperactivity, insomnia, flushing, and upset stomach after as little as one cup a day. It is possible to develop a tolerance for caffeine, so people who drink coffee every day are likely to find it less imme- diately stimulating than those who drink it only once in a while. Changes in blood vessels. Caffeine’s effects on blood vessels depend on site: It dilates coronary and gastrointestinal vessels but constricts blood vessels in your head and may relieve headache, such as migraine, which symptoms include swollen cranial blood vessels. It may also increase pain-free exercise time in patients with angina. However, because it speeds up heartbeat, doc- tors often advise patients with heart disease to avoid caffeinated beverages entirely. As a diuretic. Caffeine is a mild diuretic sometimes included in over-the-counter remedies for premenstrual tension or menstrual discomfort.
Adverse Effects Associated with This Food Stimulation of acid secretion in the stomach. Both regular and decaffeinated coffees increase the secretion of stomach acid, which suggests that the culprit is the oil in coffee, not its caffeine. Elevated blood levels of cholesterol and homocysteine. In the mid-1990s, several studies in the Netherlands and Norway suggested that drinking even moderate amounts of coffee (five cups a day or less) might raise blood levels of cholesterol and homocysteine (by-product of protein metabolism considered an independent risk factor for heart disease), thus increas- ing the risk of cardiovascular disease. Follow-up studies, however, showed the risk limited to drinking unfiltered coffees such as coffee made in a coffee press, or boiled coffees such as Greek, Turkish, or espresso coffee. The unfiltered coffees contain problematic amounts of cafestol and kahweol, two members of a chemical family called diterpenes, which are believed to affect cholesterol and homocysteine levels. Diterpenes are removed by filtering coffee, as in a drip-brew pot. Possible increased risk of miscarriage. Two studies released in 2008 arrived at different conclusions regarding a link between coffee consumption and an increased risk of miscar- riage. The first, at Kaiser Permanente (California), found a higher risk of miscarriage among women consuming even two eight-ounce cups of coffee a day. The second, at Mt. Sinai School of Medicine (New York), found no such link. However, although the authors of the Kaiser Permanente study described it as a “prospective study” (a study in which the research- ers report results that occur after the study begins), in fact nearly two-thirds of the women who suffered a miscarriage miscarried before the study began, thus confusing the results. Increased risk of heartburn /acid reflux. The natural oils in both regular and decaffeinated coffees loosen the lower esophageal sphincter (LES), a muscular valve between the esopha- gus and the stomach. When food is swallowed, the valve opens to let food into the stomach, then closes tightly to keep acidic stomach contents from refluxing (flowing backwards) into the esophagus. If the LES does not close efficiently, the stomach contents reflux and cause heartburn, a burning sensation. Repeated reflux is a risk factor for esophageal cancer. Masking of sleep disorders. Sleep deprivation is a serious problem associated not only with automobile accidents but also with health conditions such as depression and high blood pres- sure. People who rely on the caffeine in a morning cup of coffee to compensate for lack of sleep may put themselves at risk for these disorders. Withdrawal symptoms. Caffeine is a drug for which you develop a tolerance; the more often you use it, the more likely you are to require a larger dose to produce the same effects and the more likely you are to experience withdrawal symptoms (headache, irritation) if you stop using it. The symptoms of coffee-withdrawal can be relieved immediately by drinking a cup of coffee.
Food/Drug Interactions Drugs that make it harder to metabolize caffeine. Some medical drugs slow the body’s metabolism of caffeine, thus increasing its stimulating effect. The list of such drugs includes cimetidine (Tagamet), disulfiram (Antabuse), estrogens, fluoroquinolone antibiotics (e.g., ciprofloxacin, enoxacin, norfloxacin), fluconazole (Diflucan), fluvoxamine (Luvox), mexi- letine (Mexitil), riluzole (R ilutek), terbinafine (Lamisil), and verapamil (Calan). If you are taking one of these medicines, check with your doctor regarding your consumption of caf- feinated beverages. Drugs whose adverse effects increase due to consumption of large amounts of caffeine. This list includes such drugs as metaproterenol (Alupent), clozapine (Clozaril), ephedrine, epinephrine, monoamine oxidase inhibitors, phenylpropanolamine, and theophylline. In addition, suddenly decreasing your caffeine intake may increase blood levels of lithium, a drug used to control mood swings. If you are taking one of these medicines, check with your doctor regarding your consumption of caffeinated beverages. Allopurinol. Coffee and other beverages containing methylxanthine stimulants (caffeine, theophylline, and theobromine) reduce the effectiveness of the antigout drug allopurinol, which is designed to inhibit xanthines. Analgesics. Caffeine strengthens over-the-counter painkillers (acetaminophen, aspirin, and other nonsteroidal anti-inflammatories [NSAIDS] such as ibuprofen and naproxen). But it also makes it more likely that NSAIDS will irritate your stomach lining. Antibiotics. Coffee increases stomach acidity, which reduces the rate at which ampicillin, erythromycin, griseofulvin, penicillin, and tetracyclines are absorbed when they are taken by mouth. (There is no effect when the drugs are administered by injection.) Antiulcer medication. Coffee increases stomach acidity and reduces the effectiveness of nor- mal doses of cimetidine and other antiulcer medication. False-positive test for pheochromocytoma. Pheochromocytoma, a tumor of the adrenal glands, secretes adrenalin, which is converted to VM A (vanillylmandelic acid) by the body and excreted in the urine. Until recently, the test for this tumor measured the levels of VM A in the patient’s urine and coffee, which contains VM A, was eliminated from patients’ diets lest it elevate the level of VM A in the urine, producing a false-positive test result. Today, more finely drawn tests make this unnecessary. Iron supplements. Caffeine binds with iron to form insoluble compounds your body cannot absorb. Ideally, iron supplements and coffee should be taken at least two hours apart. Birth control pills. Using oral contraceptives appears to double the time it takes to eliminate caffeine from the body. Instead of five to six hours, the stimulation of one cup of coffee may last as long as 12 hours. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. Caffeine is a substance similar to tyramine. If you consume excessive amounts of a caffeinated beverage such as coffee while you are taking an M AO inhibitor, the result may be a hypertensive crisis. Nonprescription drugs containing caffeine. The caffeine in coffee may add to the stimulant effects of the caffeine in over-the-counter cold remedies, diuretics, pain relievers, stimulants, and weight-control products containing caffeine. Some cold pills contain 30 mg caffeine, some pain relievers 130 mg, and some weight-control products as much as 280 mg caffeine. There are 110 –150 mg caffeine in a five-ounce cup of drip-brewed coffee. Sedatives. The caffeine in coffee may counteract the drowsiness caused by sedative drugs; this may be a boon to people who get sleepy when they take antihistamines. Coffee will not, however, “sober up” people who are experiencing the inebriating effects of alcoholic beverages. Theophylline. Caffeine relaxes the smooth muscle of the bronchi and may intensif y the effects (and/or increase the risk of side effects) of this antiasthmatic drug.... coffee
Nutritional Profile Energy value (calories per serving): Moderate to high Protein: None Fat: None Saturated fat: None Cholesterol: None Carbohydrates: None (except for cordials which contain added sugar) Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: Phosphorus
About the Nutrients in This Food Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with 20 percent alcohol by volume is 40 proof. This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits. Gins, whiskies, cordials, and many vodkas are made with spirits American whiskeys (which include bourbon, rye, and distilled from grains. blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.) Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream. Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.) Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.
The Most Nutritious Way to Serve This Food The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.
Diets That May Restrict or Exclude This Food Bland diet Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet
Buying This Food Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor. Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.
Storing This Food Store sealed or opened bottles of spirits in a cool, dark cabinet.
Preparing This Food All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.
What Happens When You Cook This Food The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite. Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.
Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.
Adverse Effects Associated with This Food Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.
Food/Drug Interactions Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure. Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body. Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds. Antidepressants. Alcohol may strengthen the sedative effects of antidepressants. Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death. MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... distilled spirits
The difference between German (wild) and Roman:– German is stronger, acting beneficially on mucous surfaces. Roman Chamomile, is less bitter, more soothing to the lungs, and more directly hastens menstrual flow.
Externally as a compress of the pulped flowers (fresh), both kinds are used for lumbago, gouty joints, sciatica, neuralgia and local inflammation. ... chamomile
Of gastric flu: See, INFLUENZA.
Of intestinal obstruction: Wild Yam. Black Horehound.
Of pregnancy: (Hyperemesis Gravidarum). A serious form of morning sickness causing dehydration with rapid loss of fluids; should receive hospital treatment.
Treatment: herbal sedatives and antinauseant remedies. See: MORNING SICKNESS. ... hyperemesis
Benzodiazepines act at a speci?c centralnervous-system receptor or by potentiating the action of inhibitory neuro-transmitters. They have advantages over other sedatives by having some selectivity for anxiety rather than general sedation. They are safer in overdose. Unfortunately they may cause aggression, amnesia, excessive sedation, or confusion in the elderly. Those with long half-lives or with metabolites having long half-lives may produce a hangover e?ect, and DEPENDENCE on these is now well recognised, so they should not be prescribed for more than a few weeks. Commonly used benzodiazepines include nitrazepam, ?unitrazepam (a controlled drug), loprazolam, temazepam (a controlled drug) and chlormethiazole, normally con?ned to the elderly. All benzodiazepines should be used sparingly because of the risk of dependence.... benzodiazepines
Treatment Most important is prevention of the initial tapeworm infection, by ensuring that pork is well cooked before it is eaten. Nurses and others attending to a patient harbouring an adult tapeworm must be careful to avoid ingesting ova from contaminated hands. The tapeworm itself can be destroyed with NICLOSAMIDE. Brain infections are treated with sedatives and anti-convulsants, surgery rarely being necessary. Most patients make a good recovery.... cysticercosis
Symptoms Warning symptoms include dizziness, headache, oedema, vomiting, and the secretion of albumin (protein) in the urine. These are normally accompanied by a rise in blood pressure, which can be severe. Preeclamptic symptoms may be present for some days or weeks before the seizure takes place, and, if a woman is found to have these during antenatal care, preventive measures must be taken. Untreated, CONVULSIONS and unconsciousness are very likely, with serious migraine-like frontal headache and epigastric pain the symptoms.
Treatment Prevention of eclampsia by dealing with pre-eclamptic symptoms is the best management, but even this may not prevent convulsions. Hospital treatment is essential if eclampsia develops, preferably in a specialist unit. The treatment of the seizures is that generally applicable to convulsions of any kind, with appropriate sedatives given such as intravenous DIAZEPAM. HYDRALLAZINE intravenously should also be administered to reduce the blood pressure. Magnesium sulphate given intramuscularly sometimes helps to control the ?ts. The baby’s condition should be monitored throughout.
Urgent delivery of the baby, if necessary by CAESAREAN SECTION, is the most e?ective ‘treatment’ for a mother with acute eclampsia. (See PREGNANCY AND LABOUR.)
Women who have suffered from eclampsia are liable to suffer a recurrence in a further preganancy. Careful monitoring is required. There is a self-help organisation, Action on Pre-eclampsia (APEC), to advise on the condition.... eclampsia
Teas. Cowslip flowers, St John’s Wort flowers, Passion flower, Valerian, Hops, Lime flowers, Balm, Motherwort, Woodruff, Skullcap, Oats.
Formula, tea: equal parts, Balm, Motherwort, Passion flower. 1 heaped teaspoon to each cup boiling water; infuse 5-10 minutes. 1 cup thrice daily.
Tablets. Valerian. Pulsatilla. Natracalm. (English Grains) 500mg Passion flower tablets: 1 tablet thrice daily.
See: SEDATIVES. ... nerve tension
Normally, a young child requires a smaller dose than an adult. There are, however, other factors than age to be taken into consideration. Thus, children are more susceptible than adults to some drugs such as MORPHINE, whilst they are less sensitive to others such as ATROPINE. The only correct way to calculate a child’s dose is by reference to texts supplying a recommended dose in milligrams per kilogram. However, many reference texts simply quote doses for certain age-ranges.
Old people, too, often show an increased susceptibility to drugs. This is probably due to a variety of factors, such as decreased weight; diminished activity of the tissues and therefore diminished rate at which a drug is utilised; and diminished activity of the KIDNEYS resulting in decreased rate of excretion of the drug.
Weight and sex have both to be taken into consideration. Women require slightly smaller doses than men, probably because they tend to be lighter in weight. The e?ect of weight on dosage is partly dependent on the fact that much of the extra weight of a heavy individual is made up of fatty tissue which is not as active as other tissues of the body. In practice, the question of weight seldom makes much di?erence unless the individual is grossly over- or underweight.
Idiosyncrasy occasionally causes drugs administered in the ordinary dose to produce unexpected effects. Thus, some people are but little affected by some drugs, whilst in others, certain drugs – for example, psychoactive preparations such as sedatives – produce excessive symptoms in normal or even small doses. In some cases this may be due to hypersensitivity, or an allergic reaction, to the drug, which is a possibility that must always be borne in mind
(e.g. with PENICILLIN). An individual who is known to be allergic to a certain medication is strongly advised to carry a card to this e?ect, and always to inform medical and dental practitioners and/or a pharmacist before accepting a new prescription or buying an over-the-counter preparation.
Habitual use of a drug is perhaps the in?uence that causes the greatest increase in the dose necessary to produce the requisite e?ect. The classical example of this is with OPIUM and its derivatives.
Disease may modify the dose of medicines. This can occur in several ways. Thus, in serious illnesses the patient may be more susceptible to drugs, such as narcotics, that depress tissue activity, and therefore smaller doses must be given. Again, absorption of the drug from the gut may be slowed up by disease of the gut, or its e?ect may be enhanced if there is disease of the kidneys, interfering with the excretion of the drug.
Fasting aids the rapidity of absorption of drugs, and also makes the body more susceptible to their action. Partly for this reason, as well as to avoid irritation of the stomach, it is usual to prescribe drugs to be taken after meals, and diluted with water.
Combination of drugs is to be avoided if possible as it is often di?cult to assess what their combined e?ect may be. In some cases they may have a mutually antagonistic e?ect, which means that the patient will not obtain full bene?t. Sometimes a combination may have a deleterious e?ect.
Form, route and frequency of administration Drugs are now produced in many forms, though tablets are the most common and, usually, convenient. In Britain, medicines are given by mouth whenever possible, unless there is some degree of urgency, or because the drug is either destroyed in, or is not absorbed from, the gut. In these circumstances, it is given intravenously, intra-muscularly or subcutaneously. In some cases, as in cases of ASTHMA or BRONCHITIS, the drug may be given in the form of an inhalant (see INHALANTS), in order to get the maximum concentration at the point where it is wanted: that is, in the lungs. If a local e?ect is wanted, as in cases of diseases of the skin, the drug is applied topically to the skin. In some countries there is a tendency to give medicines in the form of a suppository which is inserted in the rectum.
Recent years have seen developments whereby the assimilation of drugs into the body can be more carefully controlled. These include, for example, what are known as transdermals, in which drugs are built into a plaster that is stuck on the skin, and the drug is then absorbed into the body at a controlled rate. This method is now being used for the administration of GLYCERYL TRINITRATE in the treatment of ANGINA PECTORIS, and of hyoscine hydrobromide in the treatment of MOTION (TRAVEL) SICKNESS. Another is a new class of implantable devices. These are tiny polymers infused with a drug and implanted just under the skin by injection. They can be tailored so as to deliver drugs at virtually any rate – from minutes to years. A modi?cation of these polymers now being investigated is the incorporation of magnetic particles which allow an extra burst of the incorporated drug to be released in response to an oscillating magnetic ?eld which is induced by a magnetic ‘watch’ worn by the patient. In this way the patient can switch on an extra dose of drug when this is needed: insulin, for instance, in the case of diabetics. In yet another new development, a core of drug is enclosed in a semi-permeable membrane and is released in the stomach at a given rate. (See also LIPOSOMES.)... dosage
Treatment: to sustain the nervous system and help reduce pain. By medical practitioner. Hospitalisation. Sedatives. Antispasmodics. Anti-neoplastics.
Passion flower, Black Cohosh, Lobelia, Asafoetida, Mistletoe.
Formula. Periwinkle (Madagascar) 2; Black Cohosh 1; Passion flower 1. Liquid Extracts: 1-2 teaspoons. Tinctures: 2-3 teaspoons. Powders: 750mg. Three or more times daily.
Vinchristine. Response to vinca alkaloids. ... neuroblastoma
(See anxiety; anxiety disorders.)... generalized anxiety disorder
If required in states of chronic distress, whether induced by disease or environment, it is especially important to limit the drugs to a short time to prevent undue reliance on them, and to prevent the use of hypnotics and sedatives from becoming a means of avoiding the patient’s real problem. In many cases, such as chronic depression, overwork, and alcohol abuse, hypnotics are quite inappropriate; some form of counselling and relaxation therapy is preferable.
Hypnotics should always be chosen and prescribed with care, bearing in mind the patient’s full circumstances. They are generally best avoided in the elderly (confusion is a common problem), and in children – apart from special cases. Barbiturates should not now be used as they tend to be addictive. The most commonly used hypnotics are the BENZODIAZEPINES such as nitrazepam and temazepam; chloral derivatives, while safer for the few children who merit them, are generally second choice and should be used in the lowest possible dose for the minimum period.
Side-effects include daytime drowsiness – which may interfere with driving and other skilled tasks – and insomnia following withdrawal, especially after prolonged use, is a hazard. Occasionally benzodiazepines will trigger hostility and aggression. Zolpidem and zopiclone are two drugs similar to the benzodiazepines, indicated for short-term treatment of insomnia in the elderly. Adverse effects include confusion, incoordination and unsteadiness, and falls have been reported.
FLUNITRAZEPAM is a tranquilliser/hypnotic that has been misused as a recreational drug.... hypnotics
Viral infections by any of hepatitis A, B, C, D, or E viruses and also CYTOMEGALOVIRUS (CMV), EPSTEIN BARR VIRUS, and HERPES SIMPLEX.
Autoimmune disorders such as autoimmune chronic hepatitis, toxins, alcohol and certain drugs – ISONIAZID, RIFAMPICIN, HALOTHANE and CHLORPROMAZINE.
WILSON’S DISEASE.
Acute viral hepatitis causes damage throughout the liver and in severe infections may destroy whole lobules (see below).
Chronic hepatitis is typi?ed by an invasion of the portal tract by white blood cells (mild hepatitis). If these mononuclear in?ammatory cells invade the body (parenchyma) of the liver tissue, ?brosis and then chronic disease or cirrhosis can develop. Cirrhosis may develop at any age and commonly results in prolonged ill health. It is an important cause of premature death, with excessive alcohol consumption commonly the triggering factor. Sometimes, cirrhosis may be asymptomatic, but common symptoms are weakness, tiredness, poor appetite, weight loss, nausea, vomiting, abdominal discomfort and production of abnormal amounts of wind. Initially, the liver may enlarge, but later it becomes hard and shrunken, though rarely causing pain. Skin pigmentation may occur along with jaundice, the result of failure to excrete the liver product BILIRUBIN. Routine liver-function tests on blood are used to help diagnose the disease and to monitor its progress. Spider telangiectasia (caused by damage to blood vessels – see TELANGIECTASIS) usually develop, and these are a signi?cant pointer to liver disease. ENDOCRINE changes occur, especially in men, who lose their typical hair distribution and suffer from atrophy of their testicles. Bruising and nosebleeds occur increasingly as the cirrhosis worsens, and portal hypertension (high pressure of venous blood circulation through the liver) develops due to abnormal vascular resistance. ASCITES and HEPATIC ENCEPHALOPATHY are indications of advanced cirrhosis.
Treatment of cirrhosis is to tackle the underlying cause, to maintain the patient’s nutrition (advising him or her to avoid alcohol), and to treat any complications. The disorder can also be treated by liver transplantation; indeed, 75 per cent of liver transplants are done for cirrhosis. The overall prognosis of cirrhosis, however, is not good, especially as many patients attend for medical care late in the course of the disease. Overall, only 25 per cent of patients live for ?ve years after diagnosis, though patients who have a liver transplant and survive for a year (80 per cent do) have a good prognosis.
Autoimmune hepatitis is a type that most commonly occurs in women between 20 and 40 years of age. The cause is unknown and it has been suggested that the disease has several immunological subtypes. Symptoms are similar to other viral hepatitis infections, with painful joints and AMENORRHOEA as additional symptoms. Jaundice and signs of chronic liver disease usually occur. Treatment with CORTICOSTEROIDS is life-saving in autoimmune hepatitis, and maintenance treatment may be needed for two years or more. Remissions and exacerbations are typical, and most patients eventually develop cirrhosis, with 50 per cent of victims dying of liver failure if not treated. This ?gure falls to 10 per cent in treated patients.
Viral hepatitis The ?ve hepatic viruses (A to E) all cause acute primary liver disease, though each belongs to a separate group of viruses.
•Hepatitis A virus (HAV) is an ENTEROVIRUS
which is very infectious, spreading by faecal contamination from patients suffering from (or incubating) the infection; victims excrete viruses into the faeces for around ?ve weeks during incubation and development of the disease. Overcrowding and poor sanitation help to spread hepatitis A, which fortunately usually causes only mild disease.
Hepatitis B (HBV) is caused by a hepadna virus, and humans are the only reservoir of infection, with blood the main agent for transferring it. Transfusions of infected blood or blood products, and injections using contaminated needles (common among habitual drug abusers), are common modes of transfer. Tattooing and ACUPUNCTURE may spread hepatitis B unless high standards of sterilisation are maintained. Sexual intercourse, particularly between male homosexuals, is a signi?cant infection route.
Hepatitis C (HCV) is a ?avivirus whose source of infection is usually via blood contacts. E?ective screening of blood donors and heat treatment of blood factors should prevent the spread of this infection, which becomes chronic in about 75 per cent of those infected, lasting for life. Although most carriers do not suffer an acute illness, they must practise life-long preventive measures.
Hepatitis D (HDV) cannot survive independently, needing HBV to replicate, so its sources and methods of spread are similar to the B virus. HDV can infect people at the same time as HBV, but it is capable of superinfecting those who are already chronic carriers of the B virus. Acute and chronic infection of HDV can occur, depending on individual circumstances, and parenteral drug abuse spreads the infection. The disease occurs worldwide, being endemic in Africa, South America and the Mediterranean littoral.
Hepatitis E virus (HEV) is excreted in the stools, spreading via the faeco-oral route. It causes large epidemics of water-borne hepatitis and ?ourishes wherever there is poor sanitation. It resembles acute HAV infection and the patient usually recovers. HEV does not cause chronic infection. The clinical characteristics of the ?ve hepatic
viruses are broadly similar. The initial symptoms last for up to two weeks (comprising temperature, headache and malaise), and JAUNDICE then develops, with anorexia, nausea, vomiting and diarrhoea common manifestations. Upper abdominal pain and a tender enlarged liver margin, accompanied by enlarged cervical lymph glands, are usual.
As well as blood tests to assess liver function, there are speci?c virological tests to identify the ?ve infective agents, and these are important contributions to diagnosis. However, there is no speci?c treatment of any of these infections. The more seriously ill patients may require hospital care, mainly to enable doctors to spot at an early stage those developing acute liver failure. If vomiting is a problem, intravenous ?uid and glucose can be given. Therapeutic drugs – especially sedatives and hypnotics – should be avoided, and alcohol must not be taken during the acute phase. Interferon is the only licensed drug for the treatment of chronic hepatitis B, but this is used with care.
Otherwise-?t patients under 40 with acute viral hepatitis have a mortality rate of around
0.5 per cent; for those over 60, this ?gure is around 3 per cent. Up to 95 per cent of adults with acute HBV infection recover fully but the rest may develop life-long chronic hepatitis, particularly those who are immunode?cient (see IMMUNODEFICIENCY).
Infection is best prevented by good living conditions. HVA and HVB can be prevented by active immunisation with vaccines. There is no vaccine available for viruses C, D and E, although HDV is e?ectively prevented by immunisation against HBV. At-risk groups who should be vaccinated against HBV include:
Parenteral drug abusers.
Close contacts of infected individuals such as regular sexual partners and infants of infected mothers.
Men who have sex with men.
Patients undergoing regular haemodialysis.
Selected health professionals, including laboratory sta? dealing with blood samples and products.... hepatitis
Breast feeding Unless there is a genuine contraindication, every baby should be breast fed. The nutritional components of human milk are in the ideal proportions to promote the healthy growth of the human newborn. The mother’s milk, especially colostrum (the ?uid secreted before full lactation is established) contains immune cells and antibodies that increase the baby’s resistance to infection. From the mother’s point of view, breast feeding helps the womb to return to its normal size and helps her to lose excess body fat gained during pregnancy. Most importantly, breast feeding promotes intimate contact between mother and baby. A ?nal point to be borne in mind, however, is that drugs taken by a mother can be excreted in her milk. These include antibiotics, sedatives, tranquillisers, alcohol, nicotine and high-dose steroids or vitamins. Fortunately this is rarely a cause of trouble. (See also main entry on BREAST FEEDING.)
Arti?cial feeding Unmodi?ed cows’ milk is not a satisfactory food for the human newborn and may cause dangerous metabolic imbalance. If breast feeding is not feasible, one of the many commerciallly available formula milks should be used. Most of these are made from cows’ milk which has been modi?ed to re?ect the composition of human milk as closely as possible. For the rare infant who develops cows’-milk-protein intolerance, a milk based on soya-bean protein is indicated.
Feeding and weight gain The main guide as to whether an infant is being adequately fed is the weight. During the ?rst days of life a healthy infant loses weight, but should by the end of the second week return to birth weight. From then on, weight gain should be approximately 6oz. (170g) each week.
The timing of feeds reffects social convention rather than natural feeding patterns. Among the most primitive hunter-gatherer tribes of South America, babies are carried next to the breast and allowed to suckle at will. Fortunately for developed society, however, babies can be conditioned to intermittent feedings.
As the timing of breast feeding is ?exible – little or no preparation time being required – mothers can choose to feed their babies on demand. Far from spoiling the baby, demand feeding is likely to lead to a contented infant, the only necessary caution being that a crying baby is not always a hungry baby.
In general, a newborn will require feeding every two to four hours and, if well, is unlikely to sleep for more than six hours. After the ?rst months, a few lucky parents will ?nd their infant sleeping through the night.
Weaning Weaning on to solid foods is again a matter of individuality. Most babies will become dissatis?ed with a milk-only diet at around six months and develop enthusiasm for cereal-based weaning foods. Also at about this time they enjoy holding objects and transferring them to their mouths – the mouth being an important sense organ in infants. It is logical to include food items that they can hold, as this clearly brings the baby pleasure at this time. Introduction of solids before the age of four months is unusual and best avoided. The usual reason given for early weaning is that the baby appears hungry, but this is unlikely to be the case; crying due to COLIC, for example, is more probable. Some mothers take the baby’s desire to suck – say, on their ?nger – as a sign of hunger when this is, in fact, re?ex activity.
Delaying the start of weaning beyond nine months is nutritionally undesirable. As weaning progresses, the infant’s diet requires less milk. Once established on a varied solid diet, breast and formula milks can be safely replaced with cows’ milk. There is, however, no nutritional contraindication to continued breast feeding until the mother wishes to stop.
It is during weaning that infants realise they can arouse extreme maternal anxiety by refusing to eat. This can lead to force-feeding and battles of will which may culminate in a breakdown of the mother-child relationship. To avoid this, parents must resist the temptation to coax the child to eat. If the child refuses solid food, the meal should be taken away with a minimum of fuss. Children’s appetites re?ect their individual genetic structure and a well child will eat enough to grow and maintain satisfactory weight gain. If a child is not eating properly, weight gain will be inadequate over a prolonged period and an underlying illness is the most likely cause. Indeed, failure to thrive is the paediatrician’s best clue to chronic illness.
Advice on feeding Many sources of con?icting advice are available to new parents. It is impossible to satisfy everyone, and ultimately it is the well-being of the mother and infant and the closeness of their relationship that matter. In general, mothers should be wary of rigid advice. An experienced midwife, health visitor or well-baby-clinic nursing sister are among the most reliable sources of information.
Protein Fat per Sugar Calories per cent cent per cent per cent
Human milk 1·1 4·2 7·0 70 Cows’ milk 3·5 3·9 4·6 66
Composition of human and cows’ milk... infant feeding
Cause The disease is caused by a VIRUS of the in?uenza group. There are at least three types of in?uenza virus, known respectively as A, B and
C. One of their most characteristic features is that infection with one type provides no protection against another. Equally important is the ease with which the in?uenza virus can change its character. It is these two characteristics which explain why one attack of in?uenza provides little, if any, protection against a subsequent attack, and why it is so di?cult to prepare an e?ective vaccine against the disease.
Epidemics of in?uenza due to virus A occur in Britain at two- to four-year intervals, and outbreaks of virus B in?uenza in less frequent cycles. Virus A in?uenza, for instance, was the prevalent infection in 1949, 1951, 1955 and 1956, whilst virus B in?uenza was epidemic in 1946, 1950, 1954 and, along with virus A, in 1958–59. The pandemic of 1957, which swept most of the world, although fortunately not in a severe form, was due to a new variant of virus A
– the so-called Asian virus – and it has been suggested that it was this variant that was responsible for the pandemics of 1889 and 1918. Since 1957, variants of virus A have been the predominating causes of in?uenza, accompanied on occasions by virus B.
In 1997 and 2004, outbreaks of Chinese avian in?uenza caused alarm. The in?uenza virus had apparently jumped species from birds
– probably chickens – to infect some people. Because no vaccine is available, there was a risk that this might start an epidemic.
Symptoms The incubation period of in?uenza A and B is 2–3 three days, and the disease is characterised by a sudden onset. In most cases this is followed by a short, sharp febrile illness of 2–4 days’ duration, associated with headache, prostration, generalised aching, and respiratory symptoms. In many cases the respiratory symptoms are restricted to the upper respiratory tract, and consist of signs of irritation of the nose, pharynx and larynx. There may be nosebleeds, and a dry, hacking cough is often a prominent and troublesome symptom. The fever is usually remittent and the temperature seldom exceeds 39·4 °C (103 °F), tending to ?uctuate between 38·3 and 39·4 °C (101 and 103 °F).
The most serious complication is infection of the lungs. This infection is usually due to organisms other than the in?uenza virus, and is a complication which can have serious results in elderly people.
The very severe form of ’?u which tends to occur during pandemics – and which was so common during the 1918–19 pandemic – is characterised by the rapid onset of bronchopneumonia and severe prostration. Because of the toxic e?ect on the heart, there is a particularly marked form of CYANOSIS, known as heliotrope cyanosis.
Convalescence following in?uenza tends to be prolonged. Even after an attack of average severity there tends to be a period of weakness and depression.
Treatment Expert opinion is still divided as to the real value of in?uenza vaccine in preventing the disease. Part of the trouble is that there is little value in giving any vaccine until it is known which particular virus is causing the infection. As this varies from winter to winter, and as the protection given by vaccine does not exceed one year, it is obviously not worthwhile attempting to vaccinate the whole community. The general rule therefore is that, unless there is any evidence that a particularly virulent type of virus is responsible, only the most vulnerable should be immunised – such as children in boarding schools, elderly people, and people who suffer from chronic bronchitis or asthma, chronic heart disease, renal failure, diabetes mellitus or immunosuppression (see under separate entries). In the face of an epidemic, people in key positions, such as doctors, nurses and those concerned with public safety, transport and other public utilities, should be vaccinated.
For an uncomplicated attack of in?uenza, treatment is symptomatic: that is, rest in bed, ANALGESICS to relieve the pain, sedatives, and a light diet. A linctus is useful to sooth a troublesome cough. The best analgesics are ASPIRIN or PARACETAMOL. None of the sulphonamides or the known antibiotics has any e?ect on the in?uenza virus; on the other hand, should the lungs become infected, antibiotics should be given immediately, because such an infection is usually due to other organisms. If possible, a sample of sputum should be examined to determine which organisms are responsible for the lung infection. The choice of antibiotic then depends upon which antibiotic the organism is most sensitive to.... influenza
The concept of the dose-response is important for understanding the risk of exposure to a particular substance. This is embodied in a statement by Paracelsus (c.1493–1541): ‘All substances are poisons; there is none which is not a poison. The right dose di?erentiates a poison and a remedy.’
Poisoning may occur in a variety of ways: deliberate – SUICIDE, substance abuse or murder; accidental – including accidental overdose of medicines; occupational; and environmental
– including exposure during ?re.
Ingestion is the most common route of exposure, but poisoning may also occur through inhalation, absorption through the skin, by injection and through bites and stings of venomous animals. Poisoning may be described as acute, where a single exposure produces clinical effects with a relatively rapid onset; or chronic, where prolonged or repeated exposures may produce clinical effects which may be insidious in onset, cumulative and in some cases permanent.
Diagnosis of poisoning is usually by circumstantial evidence or elimination of other causes of the clinical condition of the patient. Some substances (e.g. opioids) produce a characteristic clinical picture in overdose that can help with diagnosis. In some patients laboratory analysis of body ?uids or the substance taken may be useful to determine or con?rm the o?ending agent. Routine assays are not necessary. For a very small number of poisons, such as paracetamol, aspirin, iron and lead, the management of the patient may depend on measuring the amount of poison in the bloodstream.
Accurate statistics on the incidence of poisoning in the UK are lacking. Mortality ?gures are more reliable than morbidity statistics; annually, well over 100,000 cases of poisoning are admitted to hospital. The annual number of deaths from poisoning is relatively small – about 300 – and in most cases patients die before reaching hospital. Currently, CARBON MONOXIDE (CO) is by far the most common cause of death due to poisoning. The most common agents involved in intentional or accidental poisoning are drugs, particularly ANALGESICS, ANTIDEPRESSANT DRUGS and SEDATIVES. Alcohol is also commonly taken by adults, usually in combination with drugs. Children frequently swallow household cleaners, white spirit, plant material – such as belladonna (deadly nightshade) and certain mushrooms; for example, death cap and ?y agaric – aftershave and perfume as well as drugs. If possible, the suspect container, drug or plant should be taken with the victim to the hospital or doctor. The use of child-resistant containers has reduced the number of admissions of children to hospital for treatment. Bixtrex® is an intensely bitter-tasting agent which is often added to products to discourage ingestion; however, not everybody is able to taste it, nor has any bene?cial e?ect been proven.
Treatment of poisoning usually begins with decontamination procedures. For ingested substances this may involve making the patient sick or washing the stomach out (GASTRIC LAVAGE): this is usually only worthwhile if performed soon after ingestion. It should be emphasised that salt (sodium chloride) water must never be given to induce vomiting, since this procedure is dangerous and has caused death. For substances spilt on the skin, the affected area should immediately be thoroughly washed and all contaminated clothing removed. Following eye exposure, the affected eye/s should be thoroughly irrigated with saline or water.
Treatment thereafter is generally symptomatic and supportive, with maintenance of the victim’s respiratory, neurological and cardiovascular systems and, where appropriate, monitoring of their ?uid and electrolyte balance and hepatic and renal function. There are speci?c antidotes for a few substances: the most important of these are PARACETAMOL, iron, cyanide (see CYANIDE POISONING), opioids (see OPIOID), DIGOXIN, insecticides and some heavy metals. Heavy-metal poisoning is treated with CHELATING AGENTS – chemical compounds that form complexes by binding metal ions: desferrioxamine and pencillinamine are two such agents. The number of people presenting with paracetamol overdose – a common drug used for attempted suicide – has fallen sharply since restrictions were placed on its over-thecounter sales.
When a patient presents with an illness thought to be caused by exposure to substances at work, further exposure should be limited or prevented and investigations undertaken to determine the source and extent of the problem. Acutely poisoned workers will usually go to hospital, but those suffering from chronic exposure may attend their GP with non-speci?c symptoms (see OCCUPATIONAL HEALTH, MEDICINE AND DISEASES).
In recent years, legislation has been enacted in the UK to improve safety in the workplace and to ensure that data on the hazardous constituents and effects of chemicals are more readily available. These o?cial controls include the Control of Substances Hazardous to Health (COSHH) and the Chemicals (Hazard Information and Packaging) Regulations (CHIP) and are UK legislation in response to European Union directives.
The National Poisons Information Service is a 24-hour emergency telephone service available to the medical profession and provides information on the likely effects of numerous agents and advice on the management of the poisoned patient. The telephone numbers are available in the medical literature. In the UK this is not a public-access service. People who believe they, or their relatives, have been poisoned should seek medical advice from their GPs or attend their local hospital.
Toxbase The National Poisons Information Service provides a primary clinical toxicology database on the Internet: www.spib.axl.co.uk. This website provides information about routine diagnosis, treatment and management of people exposed to drugs, household products and industrial and agricultural products.
(See also APPENDIX 1: BASIC FIRST AID.)... poisons
Anxiety is a consequence of too much STRESS and may occur without being serious enough to need treatment. Clinically it arises when the balance between certain chemicals in the brain is disturbed: this increases activity in the sympathetic system, thus provoking physical symptoms such as breathlessness, tachycardia, headaches and indigestion. Anxiolytics help to alleviate these symptoms but do not necessarily cure the underlying cause. Two main classes of drug relieve anxiety: BENZODIAZEPINES and beta blockers (see BETA-ADRENOCEPTORBLOCKING DRUGS). The latter, which include atenolol and propanolol, reduce the physical symptoms such as tachycardia and are useful in circumstances – for example, examinations – known to cause anxiety attacks. They block the action of NORADRENALINE, a key chemical of the sympathetic nervous system. Benzodiazepines depress activity in that part of the brain controlling emotion by stimulating the action of a chemical called gammaaminobutyric acid (GABA). Among the benzodiazepines are chlordiazepoxide and diazepam. (See also MENTAL ILLNESS.)... tranquillisers
Causes The simplest cause of vertigo is some mechanical disturbance of the body affecting the ?uid in the internal ear; such as that produced by moving in a swing with the eyes shut, the motion of a boat causing sea-sickness, or a sudden fall. (See also MOTION (TRAVEL) SICKNESS.)
Another common positional variety is benign paroxysmal positional vertigo (BPPV) caused by sudden change in the position of the head; this causes small granular masses in the cupola of the posterior semicircular canal in the inner ear to be displaced. It may subside spontaneously within a few weeks but can recur. Sometimes altering the position of the head so as to facilitate return of the crystals to the cupola will stop the vertigo.
The cause which produces a severe and sudden giddiness is MENIÈRE’S DISEASE, a condition in which there is loss of function of the vestibular mechanism of the inner ear. An acute labyrinthitis – in?ammation of the labyrinth of the ear – may result from viral infection and produce a severe vertigo lasting 2–5 days. Because it often occurs in epidemics it is often called epidemic vertigo. Vertigo is sometimes produced by the removal of wax from the ear, or even by syringing out the ear. (See EAR, DISEASES OF.)
A severe upset in the gastrointestinal tract may cause vertigo. Refractive errors in the eyes, an attack of MIGRAINE, a mild attack of EPILEPSY, and gross diseases of the brain, such as tumours, are other causes acting more directly upon the central nervous system. Finally, giddiness may be due to some disorder of the circulation, for example, reduced blood supply to the brain produced by fainting, or by disease of the heart.
Treatment While the attack lasts, this requires the sufferer to lie down in a darkened, quiet room. SEDATIVES have most in?uence in diminishing giddiness when it is distressing. After the attack is over, the individual should be examined to establish the cause and, if necessary, to be given appropriate treatment.
Vertigo and nausea linked to Menière’s disease – or following surgery on the middle ear – can be hard to treat. HYOSCINE, ANTI HISTAMINE DRUGS and PHENOTHIAZINES – for example, prochlorperazine – are often e?ective in preventing and treating these disorders. Cinnarizine and betahistine have been marketed as e?ective drugs for Menière’s disease; for acute attacks, cyclizine or prochlorperazine given by intramuscular injection or rectally can be of value. Research in America is exploring the use of virtual-reality technology to change subjects’ visual perception of the outside world gradually during several 30-minute sessions, helping them to adjust to the abnormal sensations that occur during an attack. Early results are promising.... vertigo
Plant essences give plants their scent and were known to the ancient civilisations of Egypt and Greece as the ‘vital force’ or spirit of the plant. They were used for inhalation, rubbing on the skin or as a healthful addition to baths and foot-baths. The art is complementary to phytotherapy, acupuncture and other systems of alternative medicine.
The aromatherapist uses oils individually or in blends of different oils. The natural concentrated oil is usually diluted by adding a vegetable oil before direct application to the skin. A massage oil usually comprises 6 drops essential oil to 10ml (2 teaspoons) carrier oil – Almond, Peanut or other vegetable oil.
The skin is known to be an integral part of the immune system. T-cells are scattered throughout, primarily in the epidermis or outer layer. It has been demonstrated that oils rubbed on the skin are readily absorbed and borne to distant organs in the body via the bloodstream to soothe, relax and heal. Some oils should not be used during pregnancy or lactation.
An oil may be used as a natural perfume. As a bath oil, 5-6 drops of a favourite oil may be added to bathwater. Oils freshen a room; stimulate or relax as desired when added to water on a warm radiator. Oils are never used on the skin undiluted.
The aromatherapist never uses essential oils internally. Other carrier oils may be used: Sesame seed, Sunflower seed, Apricot kernel and Wheatgerm. Usual methods of applying essential oils: massage, inhalation and baths. When adding oils to baths water should not be too hot which causes oils to evaporate.
Remedies absorbed into the body via the skin avoid metabolism by the liver as when taken by mouth.
When the therapy was used in a geriatric ward in Oxford drug expenditure on laxatives and night sedatives fell. It was reported to have given profoundly deaf patients, many of whom had multiple sensory deficits, tranquillity. The results of a randomised trial in patients on an intensive care unit showed significantly greater psychological improvement (as demonstrated with anxiety and mood rating scales) in those given aromatherapy (1 per cent Lavender and Grapeseed oil) over those massaged with Grapeseed oil only or those prescribed rest alone. (The Lancet 1990 336 (8723) 1120)
The governing body of the therapy in the UK is the Aromatherapy Organisations Council (AOC) which represents the majority of professional practitioners. Enquiries: AOC, 3 Latymer Close, Braybrooke, Market Harborough. Leicester LE16 8LN. Tel/Fax 01858 434242. ... aromatherapy
A child may avoid looking a person in the face, occupying himself or herself elsewhere to avoid direct contact. Obsessional motions include erratic movements of the fingers or limbs or facial twitch or grimace. Corrective efforts by parents to educate into more civilised behaviour meet with instant hostility, even hysteria. Hyperactivity may give rise to tantrums when every degree of self-control is lost. For such times, harmless non habit-forming herbal sedatives are helpful (Skullcap, Valerian, Mistletoe).
A link has been discovered between a deficiency of magnesium and autism. Magnesium is essential for the body’s use of Vitamin B6. Nutritionists attribute the condition stemming from an inadequate intake of vitamins and minerals at pregnancy. Alcohol in the expectant mother is a common cause of such deficiencies. Personal requirements of autistic children will be higher than normal levels of Vitamin B complex (especially B6) C, E and Magnesium.
Such children grow up to be ‘temperamental’, of extreme sensibility, some with rare talents. Medicine is not required, but for crisis periods calm and poise can be restored by:–
Motherwort tea: equal parts, Motherwort, Balm and Valerian: 1-2 teaspoons to each cup boiling water; infuse 10-15 minutes; 1 cup 2-3 times daily. Honey renders it more palatable.
Alternatives:– Teas, tablets or other preparations: Hops, German Chamomile, Ginseng, Passion flower, Skullcap, Devil’s Claw, Vervain, Mistletoe, Ginkgo.
Diet. Lacto-vegetarian. 2-3 bananas (for potassium) daily.
Supplements. Daily. Vitamin B-complex, Vitamin B6 50mg, Calcium, Magnesium, Zinc. Aromatherapy. Inhalation of Lavender oil may act as a mood-lifter.
Note: A scientific study revealed a link with the yeast syndrome as associated with candidiasis. ... autism
Symptoms. Sudden drawing-up of knees, nausea, vomiting, pallor, shallow breathing, prostration, weak heart beat, irritability, amnesia.
Treatment. Bed rest. Protection of eyes against light. Admission to hospital in case of deep brain damage. Quietness. Tranquillisers, sedatives and alcohol aggravate symptoms. If patient can swallow, alternatives as follows:–
Teas. St John’s Wort (concussion of the spine). Skullcap (to ease headache). Ginkgo (cerebral damage). Powders. Formula. Combine, St John’s Wort 3; Skullcap 2; Oats 2; Trace of Cayenne. Dose: 750mg (three 00 capsules or half a teaspoon) two-hourly.
Tinctures. Formula as above, but with few drops Tincture Capsicum in place of Cayenne powder: 1-2 teaspoons in water hourly.
Tincture Arnica. (European practise) 2-5 drops in hot water usually sufficient to hasten recovery.
Topical. Distilled Extract Witch Hazel saturated pad over eyes and to wipe forehead.
Supplements. Vitamin B-complex. B6, C. ... concussion
Treatment. Bedrest. Alteratives, analgesics, sedatives. Spreads via the lymphatic system (Poke root, Clivers). Sustain heart (Hawthorn or Lily of the Valley); kidneys (Buchu or Juniper); as appropriate. Yarrow – to reduce temperature. Echinacea to strengthen immune system.
Tea: Formula: Yarrow 1; Raspberry leaves 1; Red Clover 1; Clivers 1; Liquorice root half. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. Half-1 cup every 2 hours, or as tolerated. If ingredients not available: substitute Elderflowers, Boneset, or Balm.
Alternatives. Tablets/capsules. Echinacea, Lobelia.
Powders. Formula: Sarsaparilla 2; Poke root 1; Liquorice 1. Dose: 500mg (two 00 capsules or one-third teaspoon) every 2 hours or as tolerated.
Tinctures. Alternatives: (1) Echinacea 2; Fringe Tree 1. (2) Sarsaparilla 2; Queen’s Delight 1. (3) Clivers 2; Echinacea 2. 1-2 teaspoons in water every 2 hours, or as long as tolerated.
Topical. Ointments or creams: Marigold, Comfrey, Evening Primrose, Echinacea, Logwood, Aloe Vera gel.
Traditional: Equal parts Houseleek and dairy cream.
Early Florida settlers: Powdered Slippery Elm as a dusting powder or with a little milk to form a paste. Maria Treben. Application of crushed leaves of cabbage, Coltsfoot, Houseleek and Speedwell all have their successes in reducing pain and facilitating healing.
Cleansing wash: warm infusion of Yarrow or Marshmallow.
Diet. Lacto-vegetarian. Abundant Vitamin C in lemon and other fruit juices.
Supplements. Vitamin A, B-complex, C, D.
To be treated by or in liaison with a general medical practitioner. ... erysipelas
Causes: fatigue, poor physical condition, inadequate nutrition.
Symptoms: death-like cold on surface of abdomen and under armpits, arrested pulse, slow breathing, partial loss of consciousness, blue puffy skin, stumbling, hallucinations, function of vital organs slows down.
A Glasgow survey shows cases are usually due to “the person dying of something else, drinks or drugs, or low thyroid function”. Cold induces platelet agglutination which is a hazard for sufferers of thrombosis and heart disease. Even short exposures in the elderly with atheroma (see definition) are a hazard. Preventative: Garlic.
To thin down thick blood: Nettle tea. Lemons.
Treatment. Circulatory stimulants. Under no circumstances should sedatives, antidepressants or tranquillisers be given. More than a few drops of alcohol increases heat loss and worsens the condition. Alternatives. Life Drops: 5-10 drops in cup of tea.
Cayenne pepper on food. Composition powder or essence.
Camphor drops rapidly dispel the shivering reaction. All these open surface blood vessels and promote a vigorous circulation.
Teas: Chamomile, Balm, Yarrow.
Diet. Hot meals, hot drinks, adequate protein as well as carbohydrates. No alcohol. Oats warms the blood. Oatmeal porridge is indicated for people habitually cold. One teaspoon honey thrice daily in tea or other hot drink.
Wear a hat; nightcap at night. Electric blanket. Sleep in well-heated room. Wear thick wool underclothing. Serious cases admitted to Intensive Care Unit. ... hypothermia
FAMILY: Asteraceae
SYNONYMS: S. canadensis var. gilvocanescens, S. altissima, S. canadensis var. salebrosa, Canadian goldenrod, meadow goldenrod, common goldenrod, giant goldenrod, tall goldenrod, rough goldenrod.
GENERAL DESCRIPTION: Solidago canadensis is a herbaceous, perennial plant of the daisy family often found growing as a wildflower, commonly forming colonies. The stem is stiff and erect, growing up to 7 feet high with numerous branches and lance-shaped leaves. The attractive small yellow or golden flowers are held above the foliage in clusters, which bloom late in the season. Goldenrod is often unfairly blamed for causing hay fever in humans although the pollen causing these allergy problems is mainly produced by ragweed, another wild plant which blooms at the same time. Goldenrods have a reputation of being difficult to control due to their aggressive rhizomatous growth, which enables them to rapidly colonize large areas.
DISTRIBUTION: Native to North America, the herb occurs in most US states and Canadian provinces. It is found in a variety of habitats, and it typically is one of the first plants to colonize an area after disturbance (such as fire) but rarely persists once shrubs and trees become established and is found neither in very dry locations nor in waterlogged ones. In many parts of Europe, Japan and China, it is considered an invasive weed, often endangering local fauna.
OTHER SPECIES: The genus Solidago comprises over 140 varieties, many of which are very similar; it can even crossbreed with other plants! Nearly all are known simply as goldenrod, though some have specific folk names such as woundwort, Aaron’s rod and Blue Mountain tea. Most of the goldenrod species are native to North America although a few are native to Europe, Asia, North Africa and South America. The European goldenrod (S. virgaurea), was known as woundwort in England as it was used as an astringent remedy for treating wounds and bleeding. The sweet goldenrod (S. odora), a native of the US and Canada, is the species most frequently seen in herb gardens and is also used to produce an essential oil used by the perfumery industry. Sweet goldenrod also has a long history of medicinal use by Native Americans and was exported for tea in the nineteenth century.
HERBAL/FOLK TRADITION: The genus name Solidago derives from the Latin soldare, which means ‘to make whole’. Goldenrod has a long history of medicinal use especially by the Native Americans who used the plant for a wide range of conditions: infusions and compounds of the flowers and roots were used as emetics, sedatives and to counteract love potions, treat diarrhoea, fevers and the ’flu. The Shuswap used the plant in baths for women giving birth and the Zunis chewed crushed flowers to treat sore throats and drank infusions of the flowers for body pain. People of the Gosiute tribe ate the seeds and the Navajo people ate the roots. The Navajo also smoked the root with other plants and used the plant as a charm for success in gambling. The ground flowers were used on bee stings and a tea made to treat snakebite. During the Boston Tea Party, colonists drank goldenrod tea instead of English tea, which gave it the nick-name ‘Liberty Tea’. The tea is aromatic with a pleasing anise-like flavour as well as being a mildly astringent, carminative, diaphoretic, diuretic, febrifuge and stimulant.
Traditionally the herb has also been used for respiratory conditions and urinary tract infections. In the Swiss Pharmacopoeia, Goldenrod essential oil is indicated for supporting the circulatory system including cardiovascular problems like tachycardia as well as urinary tract and liver function. Goldenrod has also been approved by the German Commission as a natural anti-inflammatory, diuretic and antispasmodic in the treatment of urinary tract conditions. It is also reputed to be a lymphatic system conditioner, a regulator of the autonomic nervous system, with relaxing and calming effects valuable for hypertension.
According to the University of Montreal in Canada, goldenrod shows great potential in dealing with impotence. Although a little-known aromatherapy essential oil, it may have value due to its anti-allergy properties, for conditions like hay fever, allergic reactions, coughs and respiratory infections.
ACTIONS: Analgesic, anti-allergenic, antibacterial, antifungal, anti-infectious, anti-inflammatory, anti-oxidant, antihypertensive, antispasmodic, antiviral, astringent, diuretic, expectorant, febrifuge, immuno-stimulant, liver support/stimulant, mucolytic, sedative.
EXTRACTION: The essential oil is steam distilled from the goldenrod flower.
CHARACTERISTICS: A yellowish liquid with a strong fresh, balsamic-peppery and slightly bitter aroma with a woody undertone. It blends well with ravintsara, peru balsam, rosemary, pine, ginger, spruce and spice oils.
PRINCIPAL CONSTITUENTS: Mainly pinene, bornyl acetate, benzoates, myrcene, methyl chavicol, borneol and limonene. NB: Essential oil from a sample of S. odora contained up to 75 per cent methyl chavicol (estragole), which is known to be moderately toxic
SAFETY DATA: Generally considered non-toxic, non-irritating and non-sensitizing: possible skin sensitivity. Avoid during pregnancy and for children due to high levels of estragole in some chemotypes.
AROMATHERAPY/HOME: USE
Skin Care: Acne, cuts, inflammations of the skin, insect bites, sores, wounds.
Respiratory system: Catarrh, chills, coughs and colds, hay fever, allergies, laryngitis (as a gargle) and respiratory congestion, sinus infection, sore throat, ’flu.
Digestive system: Liver congestion, hepatitis and fatty liver.
Genito-urinary system: Urinary tract and bladder conditions.
Immune system: Boosts vitality.
Nervous system: Anxiety, depression, nervous tension, stress.
OTHER USES: The essential oil is used in pharmaceutical and in perfumery products, especially for scenting soaps. Mustard, orange and brown dyes can be obtained from the whole plant.... goldenrod
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