Warfarin Health Dictionary

A medication or natural compound that slows or prevents the formation of blood clots. Examples: Heparin {endogenous), Dicumarol and warfarin (drugs), Melilotus (coumarin-containing).... anticoagulant

A synthetic anticoagulant (see ANTICOAGULANTS). Given by mouth, it is used to prevent the formation of clots in the blood in rheumatic heart disease and atrial ?brillation (see HEART, DISEASES OF); as prophylaxis after insertion of a prosthetic heart valve; and as prophylaxis and treatment of venous thrombosis and pulmonary embolism. It is slower in action than WARFARIN, not achieving its full anticoagulant e?ect until up to 48 hours after the initial dose. The drug should be avoided in patients with renal or hepatic impairment, and whenever severe hypersensitivity reactions have previously occurred. Adverse effects include rashes, fever, LEUCOPENIA, AGRANULOCYTOSIS, diarrhoea and pink urine; breast feeding should be avoided.... phenindione

Avocado (Persea americana).

Plant Part Used: Leaves, seed, fruit.

Dominican Medicinal Uses: The leaves are traditionally prepared as an infusion and taken orally for diabetes, diarrhea, inducing abortion, intestinal worms, menstrual cramps, parasites and vaginal infections, and the seed decoction is taken for contraception. The fruit is typically used for nutritional and culinary purposes.

Safety: No data on the safety of the leaf or the seed in humans has been identified in the available literature; animal toxicity studies have shown equivocal results. The fruit is commonly consumed as food and generally regarded as safe.

Contraindications: Oral use of the leaves is contraindicated during pregnancy (due to emmenagogue and uterine muscle stimulating effects) and lactation (due to potential for harmful effects based on case reports in goats). No information on the safety of the leaves in children has been identified in the available literature.

Drug Interactions: Warfarin: fruit may inhibit anticoagulant effect. Monoamine-oxidase inhibitors (MAOI): one case of hypertension crisis has been reported due to concomitant ingestion of the fruit and MAOI.

Clinical Data: The following effects of this plant have been investigated in human clinical trials: fruit: cholesterol and lipid-lowering, treatment of non-insulin dependent diabetes mellitus and triglyceride-lowering; avocado/soybean unsaponifiables: treatment of osteoarthritis; and oil: treatment of plaque psoriasis.

Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory and preclinical studies (in vitro or animal models): analgesic, anti-inflammatory, antihemorrhage, hepatoprotective, immuno-modulating, uterine muscle stimulant, trypanocidal, uterine stimulant and vasorelaxant.

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

Anise, anise burnet-saxifrage (Pimpinella anisum).

Plant Part Used: Fruit (seed).

Dominican Medicinal Uses: The seeds are traditionally prepared as a decoction and taken orally for colic (in children and adults), common cold, empacho, flatulence, flu, gastrointestinal disorders, headache, indigestion, nervous tension, pasmo and stress.

Safety: The seeds are generally regarded as safe for human consumption in moderation and widely used as a culinary spice. Caution is advised if this herbal remedy is combined with anís de estrella due to potential contamination with a toxic look-alike (see entry for “Anís de estrella”).

Contraindications: Studies show conflicting recommendations regarding safety of internal use during pregnancy and lactation. Use of this herb in combination with anís de estrella is contraindicated in children (due to potential for contamination with the toxic look-alike Illicium anisatum (see “Anís de estrella”); however, anís chiquito is considered safe for children when used appropriately.

Drug interactions: Anticoagulants, NSAIDS, antiplatelet drugs, warfarin: Avoid use of anís chiquito if taking any of these medications due to potential risk of excessive bleeding as a result of interaction with coumarin derivatives.

Clinical Data: No clinical trials of the oral use of this herb have been identified in the available literature. One open clinical trial has evaluated the pediculicidal effects of anise oil in combination with other ingredients.

Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory studies using in vitro or animal models: anticonvulsant, antidiuretic, antiflatulent, antifungal, antimicrobial, antispasmodic, estrogenic, expectorant, hypotensive, liver regeneration, muscle stimulant and mutagenic.

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

Anticoagulants are drugs which inhibit COAGULATION of the blood. They are used to prevent and treat abnormal clotting of the blood, to treat THROMBOSIS, and sometimes to prevent or treat STROKE or TRANSIENT ISCHAEMIC ATTACKS OR EPISODES (TIA, TIE). Anticoagulant drugs are also prescribed preventively in major surgery to stop abnormal clotting from occurring; HAEMODIALYSIS is another procedure during which these drugs are used. Anticoagulants are also prescribed to prevent thrombi (clots) forming on prosthetic heart valves after heart surgery.

The drugs are much more e?ective in the treatment and prevention of venous clotting – for example, deep vein thrombosis (DVT), see under VEINS, DISEASES OF – than in preventing thrombosis formation in arteries with their fast-?owing blood in which thrombi contain little ?brin (against which the anticoagulants work) and many PLATELETS.

The main anticoagulants now in use are the natural agent HEPARIN (a quick-acting variety and a low-molecular-weight long-acting type); synthetic oral anticoagulants such as WARFARIN and the less-often-used acenocoumarol and PHENINDIONE; and antiplatelet compounds such as ASPIRIN, clopidogrel dipyridamole and ticlopidines. Fondaparinux is an extract of heparin which can be given once daily by injection; ximelagatran, an inhibitor of thrombin, is being trialled as the ?rst new oral anticoagulant since heparin.

Patients taking anticoagulants need careful medical monitoring and they should carry an Anticoagulant Card with instructions about the use of whatever drug they may be receiving – essential information should the individual require treatment for other medical conditions as well as for thrombosis.... anticoagulants

(Ale)

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

  * t he first figure is t he %R DA for a man; t he second, for a woman Source: USDA Nut rient Database: w w w.nal.usda.gov/fnic/cgi-bin /nut _search.pl.

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: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: Moderate Fiber: Very high Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Calcium

About the Nutrients in This Food Broccoli is very high-fiber food, an excellent source of vitamin A, the B vitamin folate, and vitamin C. It also has some vitamin E and vitamin K, the blood-clotting vitamin manufactured primarily by bacteria living in our intestinal tract. One cooked, fresh broccoli spear has five grams of dietary fiber, 2,500 IU vitamin A (108 percent of the R DA for a woman, 85 percent of the R DA for a man), 90 mcg folate (23 percent of the R DA), and 130 mg vitamin C (178 percent of the R DA for a woman, 149 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food Raw. Studies at the USDA Agricultural Research Center in Beltsville, Maryland, show that raw broccoli has up to 40 percent more vitamin C than broccoli that has been cooked or frozen.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Broccoli with tightly closed buds. The stalk, leaves, and florets should be fresh, firm, and brightly colored. Broccoli is usually green; some varieties are tinged with purple. Avoid: Broccoli with woody stalk or florets that are open or turning yellow. When the green chlorophyll pigments fade enough to let the yellow carotenoids underneath show through, the buds are about to bloom and the broccoli is past its prime.

Storing This Food Pack broccoli in a plastic bag and store it in the refrigerator or in the vegetable crisper to protect its vitamin C. At 32°F, fresh broccoli can hold onto its vitamin C for as long as two weeks. Keep broccoli out of the light; like heat, light destroys vitamin C.

Preparing This Food First, rinse the broccoli under cool running water to wash off any dirt and debris clinging to the florets. Then put the broccoli, florets down, into a pan of salt water (1 tsp. salt to 1 qt. water) and soak for 15 to 30 minutes to drive out insects hiding in the florets. Then cut off the leaves and trim away woody section of stalks. For fast cooking, divide the broccoli up into small florets and cut the stalk into thin slices.

What Happens When You Cook This Food The broccoli stem contains a lot of cellulose and will stay firm for a long time even through the most vigorous cooking, but the cell walls of the florets are not so strongly fortified and will soften, eventually turning to mush if you cook the broccoli long enough. Like other cruciferous vegetables, broccoli contains mustard oils (isothiocyanates), natural chemicals that break down into a variety of smelly sulfur compounds (including hydrogen sulfide and ammonia) when the broccoli is heated. The reaction is more intense in aluminum pots. The longer you cook broccoli, the more smelly compounds there will be, although broccoli will never be as odorous as cabbage or cauliflower. Keeping a lid on the pot will stop the smelly molecules from floating off into the air but will also accelerate the chemical reaction that turns green broccoli olive-drab. Chlorophyll, the pigment that makes green vegetables green, is sensitive to acids. When you heat broccoli, the chlorophyll in its florets and stalk reacts chemically with acids in the broccoli or in the cooking water to form pheophytin, which is brown. The pheophytin turns cooked broccoli olive-drab or (since broccoli contains some yellow carotenes) bronze. To keep broccoli green, you must reduce the interaction between the chlorophyll and the acids. One way to do this is to cook the broccoli in a large quantity of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the hydrogen atoms can float off into the air, but this allows the smelly sulfur compounds to escape, too. The best way is probably to steam the broccoli quickly with very little water, so it holds onto its vitamin C and cooks before there is time for reac- tion between chlorophyll and hydrogen atoms to occur.

How Other Kinds of Processing Affect This Food Freezing. Frozen broccoli usually contains less vitamin C than fresh broccoli. The vitamin is lost when the broccoli is blanched to inactivate catalase and peroxidase, enzymes that would otherwise continue to ripen the broccoli in the freezer. On the other hand, according to researchers at Cornell University, blanching broccoli in a microwave oven—two cups of broccoli in three tablespoons of water for three minutes at 600 –700 watts—nearly doubles the amount of vitamin C retained. In experiments at Cornell, frozen broccoli blanched in a microwave kept 90 percent of its vitamin C, compared to 56 percent for broccoli blanched in a pot of boiling water on top of a stove.

Medical Uses and/or Benefits Protection against some cancers. Naturally occurring chemicals (indoles, isothiocyanates, glucosinolates, dithiolethiones, and phenols) in Brussels sprouts, broccoli, cabbage, cauli- flower, and other cruciferous vegetables appear to reduce the risk of some forms of cancer, perhaps by preventing the formation of carcinogens in your body or by blocking cancer- causing substances from reaching or reacting with sensitive body tissues or by inhibiting the transformation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inacti- vate and help eliminate carcinogens. At the Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. To get a protective amount of sulforaphane from broccoli you would have to eat about two pounds a week. But in 1997, Johns Hopkins researchers discovered that broccoli seeds and three-day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old sprouts contain as much sulphoraphane as 150 grams of mature broccoli. * Broccoli will lose large amounts of vitamin C if you cook it in water t hat is cold when you start. As it boils, water releases ox ygen t hat would ot her wise dest roy vitamin C, so you can cut t he vitamin loss dramat ically simply by lett ing t he water boil for 60 seconds before adding t he broccoli. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss. Lower risk of some birth defects. Up to two or every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a woman, 200 mcg for a man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becoming pregnant and continuing through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Broccoli is a good source of folate. One raw broccoli spear has 107 mcg folate, more than 50 percent of the R DA for an adult. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to ascertain whether taking folic acid supplements reduces the risk of cardiovascular disease. Possible inhibition of the herpes virus. Indoles, another group of chemicals in broccoli, may inhibit the growth of some herpes viruses. In 2003, at the 43rd annual Interscience Confer- ence on Antimicrobial Agents and Chemotherapy, in Chicago, researchers from Stockholm’s Huddinge University Hospital, the University of Virginia, and Northeastern Ohio University reported that indole-3-carbinol (I3C) in broccoli stops cells, including those of the herpes sim- plex virus, from reproducing. In tests on monkey and human cells, I3C was nearly 100 percent effective in blocking reproduction of the HSV-1 (oral and genital herpes) and HSV-2 (genital herpes), including one strain known to be resistant to the antiviral drug acyclovir (Zovirax).

Adverse Effects Associated with This Food Enlarged thyroid gland. Cruciferous vegetables, including broccoli, contain goitrin, thio- cyanate, and isothiocyanate, chemical compounds that inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to produce more. These chemicals, known collectively as goitrogens, are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have thyroid problems or are taking thyroid medication. False-positive test for occult blood in the stool. The guaiac slide test for hidden blood in feces relies on alphaguaiaconic acid, a chemical that turns blue in the presence of blood. Broccoli contains peroxidase, a natural chemical that also turns alphaguaiaconic acid blue and may produce a positive test in people who do not actually have blood in the stool.

Food/Drug Interactions Anticoagulants Broccoli is rich in vitamin K, the blood-clotting vitamin produced natu- rally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of drained, boiled broccoli contains 220 mcg vitamin K, nearly four times the R DA for a healthy adult.... broccoli

Nutritional Profile Energy value (calories per serving): Low Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: High Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Potassium, iron

About the Nutrients in This Food Brussels sprouts are high in dietary fiber, especially insoluble cellulose and lignan in the leaf ribs. They are also a good source of vitamin A and vitamin C. One-half cup cooked fresh brussels sprouts has three grams of dietary fiber, 1,110 IU vitamin A (48 percent of the R DA for a woman, 37 percent of the R DA for a man), 47 mcg folate (16 percent of the R DA), and 48 mg vitamin C (64 percent of the R DA for a woman, 53 percent of the R DA for a man). Brussels sprouts also contain an antinutrient, a natural chemical that splits the thiamin (vitamin B1) molecule so that it is no longer nutritionally useful. This thiamin inhibitor is inactivated by cooking.

The Most Nutritious Way to Serve This Food Fresh, lightly steamed to preserve the vitamin C and inactivate the antinutrient.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Firm, compact heads with bright, dark-green leaves, sold loose so that you can choose the sprouts one at a time. Brussels sprouts are available all year round. Avoid: Puff y, soft sprouts with yellow or wilted leaves. The yellow carotenes in the leaves show through only when the leaves age and their green chlorophyll pigments fade. Wilting leaves and puff y, soft heads are also signs of aging. Avoid sprouts with tiny holes in the leaves through which insects have burrowed.

Storing This Food Store the brussels sprouts in the refrigerator. While they are most nutritious if used soon after harvesting, sprouts will keep their vitamins (including their heat-sensitive vitamin C) for several weeks in the refrigerator. Store the sprouts in a plastic bag or covered bowl to protect them from moisture loss.

Preparing This Food First, drop the sprouts into salted ice water to flush out any small bugs hiding inside. Next, trim them. Remove yellow leaves and leaves with dark spots or tiny holes, but keep as many of the darker, vitamin A–rich outer leaves as possible. Then, cut an X into the stem end of the sprouts to allow heat and water in so that the sprouts cook faster.

What Happens When You Cook This Food Brussels sprouts contain mustard oils (isothiocyanates), natural chemicals that break down into a variety of smelly sulfur compounds (including hydrogen sulfide and ammonia) when the sprouts are heated, a reaction that is intensified in aluminum pots. The longer you cook the sprouts, the more smelly compounds there will be. Adding a slice of bread to the cook- ing water may lessen the odor; keeping a lid on the pot will stop the smelly molecules from floating off into the air. But keeping the pot covered will also increase the chemical reaction that turns cooked brussels sprouts drab. Chlorophyll, the pigment that makes green vegetables green, is sensi- tive to acids. When you heat brussels sprouts, the chlorophyll in their green leaves reacts chemically with acids in the sprouts or in the cooking water to form pheophytin, which is brown. The pheophytin turns cooked brussels sprouts olive or, since they also contain yel- low carotenes, bronze. To keep cooked brussels sprouts green, you have to reduce the interaction between chlorophyll and acids. One way to do this is to cook the sprouts in a lot of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the hydrogen atoms can float off into the air, but this allows the smelly sulfur compounds to escape, too. The best solution is to steam the sprouts quickly in very little water, so they retain their vitamin C and cook before there is time for reaction between chlorophyll and hydrogen atoms to occur.

How Other Kinds of Processing Affect This Food Freezing. Frozen brussels sprouts contain virtually the same amounts of vitamins as fresh boiled sprouts.

Medical Uses and/or Benefits Protection against cancer. Naturally occurring chemicals (indoles, isothiocyanates, gluco- sinolates, dithiolethiones, and phenols) in brussels sprouts, broccoli, cabbage, cauliflower and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by pre- venting the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the transformation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inac- tivate and help eliminate carcinogens. At Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, the Johns Hopkins researchers discovered that broccoli seeds and three- day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Lower risk of some birth defects. Up to two or every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their mothers’ not having gotten adequate amounts of folate during pregnancy. NOTE : The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends * Brussels sprouts will lose as much as 25 percent of their vitamin C if you cook them in water that is cold when you start. As it boils, water releases oxygen that would otherwise destroy vitamin C. You can cut the vitamin loss dramatically simply by letting the water boil for 60 seconds before adding the sprouts. 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becoming pregnant and continuing through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including brussels sprouts, contain goitrin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to produce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condi- tion or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in brussels sprouts and produce gas that some people find distressing.

Food/Drug Interactions Anticoagulants Brussels sprouts are rich in vitamin K, the blood-clotting vitamin produced naturally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of drained, boiled brussels sprouts contains 219 mcg vitamin K, nearly three times the R DA for a healthy adult.... brussels sprouts

(Bok choy [Chinese cabbage], green cabbage, red cabbage, savoy cabbage) See also Broccoli, Brussels sprouts, Cabbage, Cauliflower, Lettuce, Radishes, Spinach, Turnips.

Nutritional Profile Energy value (calories per serving): Low Protein: Moderate Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Low Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Calcium (moderate)

About the Nutrients in This Food All cabbage has some dietary fiber food: insoluble cellulose and lignin in the ribs and structure of the leaves. Depending on the variety, it has a little vitamin A, moderate amounts of the B vitamin folate and vitamin C. One-half cup shredded raw bok choy has 0.1 g dietary fiber, 1,041 IU vitamin A (45 percent of the R DA for a woman, 35 percent of the R DA for a man), and 15.5 mg vitamin C (21 percent of the R DA for a woman, 17 percent of the R DA for a man). One-half cup shredded raw green cabbage has 0.5 g dietary fiber, 45 IU vitamin A (1.9 percent of the R DA for a woman, 1.5 percent of the R DA for a man), 15 mcg folate (4 percent of the R DA), and 11 mg vitamin C (15 percent of the R DA for a woman, 12 percent of the R DA for a man). One-half cup chopped raw red cabbage has 0.5 g dietary fiber, 7 mcg folate (2 percent of the R DA), and 20 mg vitamin C (27 percent of the R DA for a woman, 22 percent of the R DA for a man). One-half cup chopped raw savoy cabbage has one gram dietary fiber, 322 IU vitamin A (14 percent of the R DA for a woman, 11 percent of the R DA for a man), and 11 mg vitamin C (15 percent of the R DA for a woman, 12 percent of the R DA for a man). Raw red cabbage contains an antinutrient enzyme that splits the thiamin molecule so that the vitamin is no longer nutritionally useful. This thiamin in hibitor is inactivated by cooking.

The Most Nutritious Way to Serve This Food Raw or lightly steamed to protect the vitamin C.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Cabbages that feel heavy for their size. The leaves should be tightly closed and attached tightly at the stem end. The outer leaves on a savoy cabbage may curl back from the head, but the center leaves should still be relatively tightly closed. Also look for green cabbages that still have their dark-green, vitamin-rich outer leaves. Avoid: Green and savoy cabbage with yellow or wilted leaves. The yellow carotene pig- ments show through only when the cabbage has aged and its green chlorophyll pigments have faded. Wilted leaves mean a loss of moisture and vitamins.

Storing This Food Handle cabbage gently; bruising tears cells and activates ascorbic acid oxidase, an enzyme in the leaves that hastens the destruction of vitamin C. Store cabbage in a cool, dark place, preferably a refrigerator. In cold storage, cabbage can retain as much as 75 percent of its vitamin C for as long as six months. Cover the cabbage to keep it from drying out and losing vitamin A.

Preparing This Food Do not slice the cabbage until you are ready to use it; slicing tears cabbage cells and releases the enzyme that hastens the oxidation and destruction of vitamin C. If you plan to serve cooked green or red cabbage in wedges, don’t cut out the inner core that hold the leaves together. To separate the leaves for stuffing, immerse the entire head in boiling water for a few minutes, then lift it out and let it drain until it is cool enough to handle comfortably. The leaves should pull away easily. If not, put the cabbage back into the hot water for a few minutes.

What Happens When You Cook This Food Cabbage contains mustard oils (isothiocyanates) that break down into a variet y of smelly sulfur compounds (including hydrogen sulfide and ammon ia) when the cabbage is heated, a reaction that occurs more strongly in aluminum pots. The longer you cook the cabbage, the more smelly the compounds will be. Adding a slice of bread to the cooking water may lessen the odor. Keeping a lid on the pot will stop the smelly molecules from floating off into the air, but it will also accelerate the chemical reaction that turns cooked green cabbage drab. Chlorophyll, the pigment that makes green vegetables green, is sensitive to acids. When you heat green cabbage, the chlorophyll in its leaves reacts chemically with acids in the cabbage or in the cooking water to form pheophytin, which is brown. The pheophytin gives the cooked cabbage its olive color. To keep cooked green cabbage green, you have to reduce the interaction between the chlorophyll and the acids. One way to do this is to cook the cabbage in a large quantity of water, so the acids will be diluted, but this increases the loss of vitamin C.* Another alternative is to leave the lid off the pot so that the volatile acids can float off into the air, but this allows the smelly sulfur compounds to escape too. The best way may be to steam the cabbage ver y quickly in ver y little water so that it keeps its vitamin C and cooks before there is time for the chlorophyll/acid reaction to occur. Red cabbage is colored with red anthocyanins, pigments that turn redder in acids (lemon juice, vinegar) and blue purple in bases (alkaline chemicals such as baking soda). To keep the cabbage red, make sweet-and-sour cabbage. But be careful not to make it in an iron or aluminum pot, since vinegar (which contains tannins) will react with these metals to create dark pigments that discolor both the pot and the vegetable. Glass, stainless-steel, or enameled pots do not produce this reaction.

How Other Kinds of Processing Affect This Food Pickling. Sauerkraut is a fermented and pickled produce made by immersing cabbage in a salt solution strong enough to kill off pathological bacteria but allow beneficial ones to sur- vive, breaking down proteins in the cabbage and producing the acid that gives sauerkraut its distinctive flavor. Sauerkraut contains more than 37 times as much sodium as fresh cabbage (661 mg sodium/100 grams canned sauerkraut with liquid) but only one third the vitamin C and one-seventh the vitamin A. * According to USDA, if you cook t hree cups of cabbage in one cup of water you will lose only 10 percent of t he vitamin C; reverse t he rat io to four t imes as much water as cabbage and you will lose about 50 percent of t he vitamin C. Cabbage will lose as much as 25 percent of its vitamin C if you cook it in water t hat is cold when you start. As it boils, water releases ox ygen t hat would ot her wise dest roy vitamin C, so you can cut t he vitamin loss dramat ically simply by lett ing t he water boil for 60 seconds before adding t he cabbage.

Medical Uses and/or Benefits Protection against certain cancers. Naturally occurring chemicals (indoles, isothiocyanates, glucosinolates, dithiolethiones, and phenols) in cabbage, brussels sprouts, broccoli, cauli- flower, and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by preventing the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the trans- formation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inac- tivate and help eliminate carcinogens. At Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, Johns Hopkins researchers discovered that broccoli seeds and three-day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sulfora- phane to suggest that it may also protect cells in the eyes from damage due to ultraviolet light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss. Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The current R DA for folate is 180 mcg for a woman and 200 mcg for a man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking a folate supplement before becom- ing pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Possible lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Women’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, either from food or supple- ments, might reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the study, the results were assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verif y whether taking folic acid supplements reduces the risk of cardiovascular disease.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including cabbage, contain goitrin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to pro- duce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condition or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in cabbage, producing gas that some people find distressing.

Food/Drug Interactions Anticoagulants Cabbage contains vitamin K, the blood-clotting vitamin produced natu- rally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of shredded common green cabbage contains 163 mcg vitamin K, nearly three times the R DA for a healthy adult; one cup of drained boiled common green cabbage contains 73 mcg vita- min K, slightly more than the R DA for a healthy adult. 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. If you eat a food such as sauerkraut which is high in tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... cabbage

Powerful anti-coagulant plant chemicals (Di-coumarol). Used to prevent blood clotting. Adverse effects: nettlerash, hair loss, bleeding from the gums. Used in orthodox medicine for the manufacture of Warfarin against thrombosis. Aspirin enhances their action. Should not be used in pregnancy or when breast-feeding. Coumarins include: Tonka seed or Tonquin bean, Melilot, Ash, Bael, Black Haw, Rupturewort. ... coumarins

Celery (Apium graveolens variety dulce).

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

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

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

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

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

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

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

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

Squash, pumpkin (Cucurbita pepo & C. moschata).

Plant Part Used: Seeds, fruit pulp, oil.

Dominican Medicinal Uses: The seeds are traditionally prepared as an infusion and taken orally for diarrhea, intestinal parasites and worms. The fruit pulp is traditionally prepared as an infusion or juice for the common cold and flu.

Safety: The fruit and seeds are commonly consumed and generally regarded as safe. In animal studies the fruit was shown to be relatively nontoxic.

Drug Interactions: Warfarin (increased clotting time – 1 case; based on a study using the multi-herb supplement Cucurbicin®).

Clinical Data: The following effects of the seed or seed extracts have been investigated in human clinical trials: improved urinary symptoms of benign prostatic hyperplasia and inhibited urolithiasis.

Laboratory & Preclinical Data: In animal studies the plant or seed extract has shown antiallergenic and hepatoprotective effects. In vitro, isolated compounds from the seed have shown antiproliferative activity. Nutritionally the fruit and flower are a significant source of pro-vitamin A and the seeds are a source of L-tryptophan.

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

Cranberry (Scientific name).

Plant Part Used: Fruit.

Dominican Medicinal Uses: Fruit: juice, orally, urinary tract infection, kidney ailments, high cholesterol.

Safety: Juice is widely consumed and generally considered safe. In a clinical trail, ingestion of fruit extract tablets caused increase in urinary oxalate levels and may indicate risk of nephrolithiasis.

Drug Interactions: Warfarin (risk of bleeding).

Clinical Data: Human clinical trials: anti-inflammatory, anti-adhesion of urinary bacteria, antioxidant, heart disease prevention, urinary tract infection treatment and prevention (juice).

Laboratory & Preclinical Data: In vitro: antibacterial, anticancer, antifungal, antioxidant, antitumor, antiviral (fruit juice or constituents).

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

Unnecessary drugs during pregnancy should be avoided because of the adverse e?ect of some drugs on the fetus which have no harmful e?ect on the mother. Drugs may pass through the PLACENTA and damage the fetus because their pharmacological effects are enhanced as the enzyme systems responsible for their degradation are undeveloped in the fetus. Thus, if the drug can pass through the placenta, the pharmacological e?ect on the fetus may be great whilst that on the mother is minimal. WARFARIN may thus induce fetal and placental haemorrhage and the administration of THIAZIDES may produce THROMBOCYTOPENIA in the newborn. Many progestogens have androgenic side-effects and their administration to a mother for the purpose of preventing recurrent abortion may produce VIRILISATION of the female fetus. Tetracycline administered during the last trimester commonly stains the deciduous teeth of the child yellow.

The other dangers of administering drugs in pregnancy are the teratogenic effects (see TERATOGENESIS). It is understandable that a drug may interfere with a mechanism essential for growth and result in arrested or distorted development of the fetus and yet cause no disturbance in the adult, in whom these di?erentiation and organisation processes have ceased to be relevant. Thus the e?ect of a drug upon a fetus may di?er qualitatively as well as quantitatively from its e?ect on the mother. The susceptibility of the embryo will depend on the stage of development it has reached when the drug is given. The stage of early di?erentiation – that is, from the beginning of the third week to the end of the tenth week of pregnancy – is the time of greatest susceptibility. After this time the risk of congenital malformation from drug treatment is less, although the death of the fetus can occur at any time.... drugs in pregnancy

A group of drugs used to treat and prevent abnormal blood clotting, to treat thrombosis, and to prevent and treat stroke and transient ischaemic attack. Anticoagulant drugs are also given to prevent abnormal blood clotting after major surgery (especially heart-valve replacement) or during haemodialysis (see dialysis). The most common anticoagulants are heparin and the newer heparin-derived drugs, such as tinzaparin, all of which have to be given by injection, and warfarin, which is taken orally.

Excessive doses of anticoagulant drugs increase the risk of unwanted bleeding, and regular monitoring is needed.... anticoagulant drugs

A drug that reduces the stickiness of platelets in the blood and thereby helps to prevent the formation of abnormal blood clots within arteries. Dipyridamole is used with aspirin or warfarin to prevent the formation of clots following heart-valve surgery. It may also be given to people who have had a recent myocardial infarction or undergone a coronary artery bypass. Dipyridamole may also reduce the frequency of transient ischaemic attacks. Possible adverse may include headache, flushing, and dizziness.... dipyridamole

(DOAC) a relatively recently introduced class of drugs that reduce coagulation of the blood by inhibition of one of the coagulation factors (Factor Xa). They may be used as an alternative to *warfarin in many (but not all) cases, their advantage being that regular blood tests are not required for dose adjustment. Examples include, apixaban, dabigatran, edoxaban, and rivaroxaban.... direct oral anticoagulant

Nutritional Profile Energy value (calories per serving): Low Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: Moderate Fiber: Moderate Sodium: Low Major vitamin contribution: Vitamin A, folate, vitamin C Major mineral contribution: Potassium, iron

About the Nutrients in This Food Asparagus has some dietary fiber, vitamin A, and vitamin C. It is an excel- lent source of the B vitamin folate. A serving of four cooked asparagus spears (½ inch wide at the base) has 1.2 g dietary fiber, 604 IU vitamin A (26 percent of the R DA for a woman, 20 percent of the R DA for a man), 4.5 mg vitamin C (6 percent of the R DA for a woman, 5 percent of the R DA for a man), and 89 mcg folate (22 percent of the R DA).

The Most Nutritious Way to Serve This Food Fresh, boiled and drained. Canned asparagus may have less than half the nutrients found in freshly cooked spears.

Diets That May Restrict or Exclude This Food Low-sodium diet (canned asparagus)

Buying This Food Look for: Bright green stalks. The tips should be purplish and tightly closed; the stalks should be firm. Asparagus is in season from March through August. Avoid: Wilted stalks and asparagus whose buds have opened.

Storing This Food Store fresh asparagus in the refrigerator. To keep it as crisp as possible, wrap it in a damp paper towel and then put the whole package into a plastic bag. Keeping asparagus cool helps it hold onto its vitamins. At 32°F, asparagus will retain all its folic acid for at least two weeks and nearly 80 percent of its vitamin C for up to five days; at room temperature, it would lose up to 75 percent of its folic acid in three days and 50 percent of the vitamin C in 24 hours.

Preparing This Food The white part of the fresh green asparagus stalk is woody and tasteless, so you can bend the stalk and snap it right at the line where the green begins to turn white. If the skin is very thick, peel it, but save the parings for soup stock.

What Happens When You Cook This Food Chlorophyll, the pigment that makes green vegetables green, is sensitive to acids. When you heat asparagus, its chlorophyll will react chemically with acids in the asparagus or in the cooking water to form pheophytin, which is brown. As a result, cooked asparagus is olive-drab. You can prevent this chemical reaction by cooking the asparagus so quickly that there is no time for the chlorophyll to react with acids, or by cooking it in lots of water (which will dilute the acids), or by leaving the lid off the pot so that the volatile acids can float off into the air. Cooking also changes the texture of asparagus: water escapes from its cells and they collapse. Adding salt to the cooking liquid slows the loss of moisture.

How Other Kinds of Processing Affect This Food Canning. The intense heat of can ning makes asparagus soft, robs it of its bright green color, and reduces the vitamin A, B, and C content by at least half. ( White asparagus, which is bleached to remove the green color, contains about 5 percent of the vitamin A in fresh asparagus.) With its liquid, can ned asparagus, green or white, contains about 90 times the sodium in fresh asparagus ( 348 mg in 3.5 oz. can ned against 4 mg in 3.5 oz. fresh boiled asparagus).

Medical Uses and/or Benefits Lower risk of some birth defects. As many as two of every 1,000 babies born in the United States each year may have cleft palate or a neural tube (spinal cord) defect due to their moth- ers’ not having gotten adequate amounts of folate during pregnancy. The R DA for folate is 400 mcg for healthy adult men and women, 600 mcg for pregnant women, and 500 mcg for women who are nursing. Taking folate supplements before becoming pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to verify whether taking folic acid supplements reduces the risk of cardiovascular disease.

Adverse Effects Associated with This Food Odorous urine. After eating asparagus, we all excrete the sulfur compound methyl mercap- tan, a smelly waste product, in our urine.

Food/Drug Interactions Anticoagulants. Asparagus is high in vitamin K, a vitamin manufactured naturally by bac- teria in our intestines, an adequate supply of which enables blood to clot normally. Eating foods that contain this vitamin may interfere with the effectiveness of anticoagulants such as heparin and warfarin (Coumadin, Dicumarol, Panwarfin) whose job is to thin blood and dissolve clots.... asparagus

International Normalized Ratio: the ratio of a patient’s *prothrombin time (PT; i.e. the time taken for the patient’s blood to clot) to a standardized ‘normal’ PT. It is used to monitor anticoagulant (usually warfarin) dosage. A normal INR is up to 1.2. Treatment usually aims to keep the ratio 2.0–3.0.... inr

(PT) the time taken for blood clotting to occur in a sample of blood to which calcium and thromboplastin have been added. A prolonged PT (compared with a control sample) indicates a deficiency of *coagulation factors, which – with calcium and thromboplastin – are required for the conversion of prothrombin to thrombin to occur in the final stages of blood coagulation. Measurement of PT is used to control anticoagulant therapy (e.g. with warfarin). See INR.... prothrombin time

obstruction of the *pulmonary artery or one of its branches by an *embolus, usually a blood clot derived from *phlebothrombosis of the leg veins (deep vein thrombosis). Large pulmonary emboli result in acute heart failure or sudden death. Smaller emboli cause death of sections of lung tissue, pleurisy, and haemoptysis (coughing of blood). Minor pulmonary emboli respond to the *anticoagulant drugs heparin and warfarin. Major pulmonary embolism is treated by *embolectomy or by dissolution of the blood clot with an infusion of *streptokinase. Recurrent pulmonary embolism may result in *pulmonary hypertension.... pulmonary embolism

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

About the Nutrients in This Food Cauliflower is an excellent source of vitamin C and a moderately good source of folate, a member of the B vitamin family. One-half cup cooked fresh cauliflower florets (the top of the plant) has one gram dietary fiber, 13.5 mcg folate (3 percent of the R DA), and 35 mg vitamin C (50 percent of the R DA for a woman, 39 percent of the R DA for a man).

The Most Nutritious Way to Serve This Food Raw or lightly steamed to protect the vitamin C. Cooked or frozen cauli-flower may have up to 50 percent less vitamin C than raw cauliflower.

Diets That May Restrict or Exclude This Food Antiflatulence diet Low-fiber diet

Buying This Food Look for: Creamy white heads with tight, compact florets and fresh green leaves. The size of the cauliflower has no bearing on its nutritional value or its taste. Avoid: Cauliflower with brown spots or patches.

Storing This Food Keep cauliflower in a cool, humid place to safeguard its vitamin C content.

Preparing This Food Pull off and discard any green leaves still attached to the cauliflower and slice off the woody stem and core. Then plunge the cauliflower, head down, into a bowl of salted ice water to flush out any insects hiding in the head. To keep the cauliflower crisp when cooked, add a teaspoon of vinegar to the water. You can steam or bake the cauliflower head whole or break it up into florets for faster cooking.

What Happens When You Cook This Food Cauliflower contains mustard oils (isothiocyanates), natural chemicals that give the vegeta- ble its taste but break down into a variety of smelly sulfur compounds (including hydrogen sulfide and ammonia) when the cauliflower is heated. The longer you cook the cauliflower, the better it will taste but the worse it will smell. Adding a slice of bread to the cooking water may lessen the odor; keeping a lid on the pot will stop the smelly molecules from floating off into the air. Cooking cauliflower in an aluminum pot will intensif y its odor and turn its creamy white anthoxanthin pigments yellow; iron pots will turn anthoxanthins blue green or brown. Like red and blue anthocyanin pigments (see beets, black ber r ies, blueber r ies), antho- xanthins hold their color best in acids. To keep cauliflower white, add a tablespoon of lemon juice, lime juice, vinegar, or milk to the cooking water. Steaming or stir-frying cauliflower preserves the vitamin C that would be lost if the vegetable were cooked for a long time or in a lot of water.

How Other Kinds of Processing Affect This Food Freezing. Before it is frozen, cauliflower must be blanched to inactivate catalase and per- oxidase, enzymes that would otherwise continue to ripen and eventually deteriorate the vegetable. According to researchers at Cornell University, cauliflower will lose less vitamin C if it is blanched in very little water (two cups cauliflower in two tbsp. water) in a microwave- safe plastic bag in a microwave oven for four minutes at 600 –700 watts. Leave the bag open an inch at the top so steam can escape and the bag does not explode.

Medical Uses and/or Benefits Protection against certain cancers. Naturally occurring chemicals (indoles, isothiocyanates, glucosinolates, dithiolethiones, and phenols) in cauliflower, Brussels sprouts, broccoli, cab- bage, and other cruciferous vegetables appear to reduce the risk of some cancers, perhaps by preventing the formation of carcinogens in your body or by blocking cancer-causing substances from reaching or reacting with sensitive body tissues or by inhibiting the trans- formation of healthy cells to malignant ones. All cruciferous vegetables contain sulforaphane, a member of a family of chemicals known as isothiocyanates. In experiments with laboratory rats, sulforaphane appears to increase the body’s production of phase-2 enzymes, naturally occurring substances that inacti- vate and help eliminate carcinogens. At the Johns Hopkins University in Baltimore, Maryland, 69 percent of the rats injected with a chemical known to cause mammary cancer developed tumors vs. only 26 percent of the rats given the carcinogenic chemical plus sulforaphane. In 1997, Johns Hopkins researchers discovered that broccoli seeds and three-day-old broccoli sprouts contain a compound converted to sulforaphane when the seed and sprout cells are crushed. Five grams of three-day-old broccoli sprouts contain as much sulforaphane as 150 grams of mature broccoli. The sulforaphane levels in other cruciferous vegetables have not yet been calculated. Vision protection. In 2004, the Johns Hopkins researchers updated their findings on sul- foraphane to suggest that it may also protect cells in the eyes from damage due to UV (ultraviolet) light, thus reducing the risk of macular degeneration, the most common cause of age-related vision loss.

Adverse Effects Associated with This Food Enlarged thyroid gland (goiter). Cruciferous vegetables, including cauliflower, contain goi- trin, thiocyanate, and isothiocyanate. These chemicals, known collectively as goitrogens, inhibit the formation of thyroid hormones and cause the thyroid to enlarge in an attempt to produce more. Goitrogens are not hazardous for healthy people who eat moderate amounts of cruciferous vegetables, but they may pose problems for people who have a thyroid condi- tion or are taking thyroid medication. Intestinal gas. Bacteria that live naturally in the gut degrade the indigestible carbohydrates (food fiber) in cauliflower, producing intestinal gas that some people find distressing.

Food/Drug Interactions Anticoagulants (blood thinners). All cruciferous vegetables (broccoli, brussels sprouts, cab- bages, cauliflower, greens, radishes, and turnips) are high in vitamin K, a nutrient that decreases the anticoagulant effect of medicine such as warfarin (Coumadin). Multiple serv- ings of this vegetable, i.e., several days a week, may interfere with the anticoagulant effect of the drug. False-positive test for occult blood in the stool. The active ingredient in the guaiac slide test for hid- den blood in feces is alphaguaiaconic acid, a chemical that turns blue in the presence of blood. Cauliflower contains peroxidase, a natural chemical that also turns alphaguaiaconic acid blue and may produce a positive test in people who do not actually have blood in the stool.... cauliflower

a fat-soluble vitamin occurring in two main forms: phytomenadione (of plant origin) and menaquinone (synthesized by bacteria in the large intestine; deficiency is rare). It is necessary for the formation of *prothrombin in the liver, which is essential for blood clotting, and it also regulates the synthesis of other clotting factors. Good dietary sources are green leafy vegetables and meat. Large changes in the dietary intake of vitamin K should be avoided by people taking *warfarin.... vitamin k

Get a taste of South America by drinking pau d’arco tea. It has a pleasant, earthy taste, astringent and just a bit bitter. Find out more about its health benefits and side effects! About Pau D’Arco Tea Pau D’Arco tea uses the inner bark of the Pink Ipê tree, also known as Pink Lapacho. The tree can be found in many South American countries. The Pink Lapacho is a large tree which can grow up to 30m tall. Usually, the trunk represents a third of that height, while the rest is used by the tree’s branches. The bark is dark brown, tough and hard to peel, and its branches spring up with opposite and petiolate leaves, and large, tubular-shaped pink flowers which bloom between July and September. How to make Pau D’Arco Tea To enjoy some pau d’arco tea, add 3 tablespoons to a pot containing 1 liter of water and bring it to boiling point. Once it reaches boiling point, lower the heat to medium-low and leave it like this for about 20 minutes. Once that’s done, strain the tea and pour it into cups. Pau d’arco tea can be served both hot and cold. If you want to, you can sweeten it with honey, stevia or fruit juice. Pau D’Arco Tea Benefits The inner bark of the Pink Lapacho tea has important active constituents, such as lapachol, lapachone and isolapachone, as well as various flavonoids and tannins. They are transferred to the pau d’arco tea; this way, the beverage helps us stay healthy. Pau d’arco tea plays an important role in the help against cancer. Cancer patients who have consumed this tea have shown progress, from alleviation of chemotherapy symptoms to complete remission of the cancerous tumors. Pau d’arco tea is also useful in the treatment of other diseases, such as diabetes, fibromyalgia, and lupus. Drinking pau d’arco tea can help if you’ve got a cold or the flu. It is also useful as a remedy for smoker’s cough, and acts as an expectorant, stimulating coughing in order to get rid of mucus. It was also discovered that pau d’arco tea increases the production of red blood cells. Although researches are still being made in this area, it is recommended in the treatment for leukemia, anemia and other blood disorders. Pau d’arco tea is also useful in fighting fungi. It is used to treat yeast infection and candida, due to its antifungal nature. It can help in the treatment for stomach ulcers, tuberculosis, pneumonia, and dysentery. It also protects you against tropical diseases (malaria, schistosomiasis). Pau D’Arco Tea Side Effects Pau d’arco tea may act like a blood thinner. Don’t drink this tea at least two weeks before a surgery, otherwise it might increase the risk of bleeding both during and after the surgery, and can decrease the blood clotting speed. You also shouldn’t drink pau d’arco tea if you’ve got a bleeding disorder (hemophilia) or if you’re taking anticoagulants. If you’re taking any medication, talk to your doctor first before drinking pau d’arco tea. It may interfere with various medications, for example aspirin, enoxaparin, warfarin, and dalteparin. It is also recommended that you not drink pau d’arco tea if you’re pregnant or breastfeeding. During pregnancy, it can lead to child defects or even death of the baby. It can also affect the baby during breastfeeding. Be careful with the amount of pau d’arco tea you drink a day. The maximum amount of tea you can drink a day is 1 liter. If you drink more, it might lead to nausea, vomiting or bleeding (in which case you should consult a doctor). Other symptoms include headaches, dizziness and diarrhea. Pau d’arco tea has lots of important health benefits, but it also has a few side effects which you should remember. If you make sure it’s safe to drink this tea, you can enjoy it with no worries!... drink pau d’arco tea from south america

If you feel like drinking an herbal tea with plenty of health benefits, you should try prickly ash tea. Even if the taste is bitter, the tea is bound to help you stay healthy. Find out more about it in this article! About Prickly Ash Tea Prickly ash tea is made from the bark of the prickly ash. The plant is also known as Devil’s Walkingstick, Hercules’s Club or Prickly Elder. The plant grows in the eastern parts of North America. Prickly ash is a tall shrub, usually reaching 6m in height. It has a stem with large leaves, 70-120cm long. The flowers bloom in late summer; they’re small and creamy-white. Also, the fruits are a small, purple-black berry. How to make Prickly Ash Tea It’s easy to make prickly ash tea. Boil the necessary amount of water and add a teaspoon of chopped bark for each cup of tea. Let it steep for 5-7 minutes; then, strain in order to remove the herbs. If it tastes too bitter for you, you can sweeten the tea with milk, honey or fruit juices. Prickly Ash Tea Benefits Prickly ash tea gets important active constituents from the bark of its plant. These include chelerythin alkaloids, tannins, lignans, resins, and volatile oils. You can drink prickly ash tea if you’ve got toothaches, abdominal pains (or any other chronic pains) or diarrhea. It is also used in killing intestinal parasites, and treating arthritis and rheumatism. It is also useful in treating circulation problems and lowering blood pressure. You can drink it if you’ve got a cold or a sore throat. Prickly ash tea can also be combined with other ingredients, for different health benefits. Combined with ginger, it alleviates chronic abdominal pains, and treats nausea and vomiting caused by long-term illnesses. It can also be combined with coptis or Oregon grape root in order to treat symptoms caused by roundworms. Prickly Ash Tea side Effects It is best not to drink prickly ash tea if you’re pregnant or breast feeding. It’s not quite sure how it can affect the baby, but it might, so it’s better to stop drinking it during these periods. Be careful with the amount of tea you drink if you’ve got low blood pressure. Prickly ash tea helps lower the blood pressure, so it might end up causing some harm (hypotension). Also, if you drink this tea while taking medication (aspirin, warfarin, heparin, tinzaparin), the combination might lead to bleeding and bruising. Also, don’t drink prickly ash tea if you’ve got stomach or intestinal problems: ulcerative colitis, peptic ulcer disease, gastroesophageal reflux, Crohn’s disease, irritable bowel syndrome, infections, and other digestive tract conditions. It’s bound to make your stomach and intestinal problems worse. Also, dopn’t drink this tea if you’ve got a fever with profuse sweating. Despite its bitter taste, you should give prickly ash tea a chance, especially thanks to its health benefits. As an herbal tea, it’s bound to keep you healthy!... enjoy prickly ash tea

If you haven’t tried reishi tea until now, you should get some. Made from a “cure-all” herb, reishi tea has plenty of health benefits and helps you stay healthy with every gulp. About Reishi Tea Reishi tea is made form reishi, which is considered the best and most superior of all Chinese herbs. Reishi is a polypore mushroom which can be found growing in dark forests, on deciduous trees and logs. It is soft, corky, and flat, and has a conspicuous red-varnished cap, kidney-shaped, and with pores underneath it. It is classified based on its color and shape, and each variety protects and nourishes a different body organ. The classification is the following: white (lungs and skin), purple (joints), red (heart), green (liver), black (brain and kidney), and yellow (spleen). How to prepare Reishi Tea For a cup of reishi tea, you need about 5 grams of dried reishi mushroom herbs. Add them to the necessary amount of water for one cup and boil for about 10 minutes. Then, let the mixture steep for 2-3 hours, before you strain it to remove the herbs. If you don’t like the taste too much or you think it’s too bitter, you can add honey or fruit juice to sweeten it. Reishi Tea Constituents Reishi tea gets many of its health benefits thanks to the active constituents found in the reishi mushroom - the tea’s main ingredient. Some of them include triterpenes (ganoderic acids), polysaccharides, alkaloids, lactones, mannitol and coumarin. Also, reishi tea has various vitamins, proteins, and minerals. Reishi Tea Benefits Reishi tea is an important element in the fight against cancer. It helps by enhancing the human ability to fight abnormal cells and, consequently, it can improve the synthesis of proteins and nucleic acid. It also protects the cells against further damage, and it helps alleviate the pain and discomfort caused by chemotherapy. Drinking reishi tea will keep the heart diseases away, as it lowers bad cholesterol levels and blood pressure. It helps strengthen the immune system, and it will also slow down the aging process by nurturing the cells in your body. Not only is reishi tea good for your immune system, but it also helps your nervous system. This tea is bound to help you relax, by soothing the mind and sedating the nerves. It will also help you sleep properly during the night. You can drink reishi tea if you’ve got problems with coughing or asthma. It protects your liver, therefore it is recommended to persons who suffer from acute and chronic hepatitis. Besides this, it also helps with diabetes, skin allergy, and duodenal ulcers. Reishi Tea Side Effects You might have an allergic reaction to reishi tea. If you end up with an upset stomach, or you feel your mouth, nose and/or throat dry, you might have an allergic reaction. Stop drinking reishi tea and contact your doctor, just in case. Other side effects you might get when drinking reishi tea include dizziness, nosebleeds, sore bones, gastrointestinal distress, or irritated skin. It is best not to drink reishi tea if you’re taking blood thinning medication (aspirin, warfarin). The tea might intensify the effects of the medicine. It is also considered that this tea may interfere with immunosuppressive drugs or even organ transplants.   According to the Chinese, the reishi mushroom is a plant which can bring “the dying back to life”. Reishi tea has quite similar properties too, as it comes with many health benefits. This should encourage you to drink reishi tea every day!... enjoy a cup of reishi tea!

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

Papaya (Carica papaya).

Plant Part Used: Fruit (ripe and unripe), papain enzymes.

Dominican Medicinal Uses: Fruit: eaten for digestive ailments, flatulence, stomachache, intestinal pain, heartburn, heart disease, hypertension, menopausal hot flashes, urinary tract infection, skin infection.

Safety: Ripe fruit is widely consumed and generally considered safe; topical application of the unripe fruit did not show toxicity in rabbits; other plant preparations have shown mixed results in animal toxicity studies.

Contraindications: Pregnancy and lactation (unripe fruit and papain); children under 12 years (due to lack of clinical data); history of hypersensitivity to fruit.

Drug Interactions: Warfarin (w/papain may cause excessive bleeding).

Clinical Data: Human clinical trials: guinea worm infection (leaves), immunomodulation (papain enzymes), burn wound-healing (fruit).

Laboratory & Preclinical Data: In vivo: abortifacient (unripe fruit constituents), anthelmintic (latex), antifertility—inhibits sperm motility (seed extract), antihypertensive (unripe fruit ethanolic extract); anti-ulcer (unripe fruit latex); diuretic (root); reversible azoospermia (seed extract).

In vitro: antiamoebic (seed extract), antihypertensive (unripe fruit ethanolic extract), antimicrobial, antioxidant (unripe fruit and seed), anti-salmonella (leaf and root extracts), immunomodulatory, immunostimulatory (seed extract), uterine stimulatory (fruit latex extract).

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

The formation of a thrombus (BLOOD CLOT) in one part of the circulatory system from which a portion becomes detached and lodges in another blood vessel, partially or completely obstructing the blood ?ow (an EMBOLISM). Most commonly a thrombus is formed in the veins of the leg – DEEP VEIN THROMBOSIS (DVT)

– and the embolism lodges in the pulmonary (lung) circulation. PULMONARY EMBOLISM is a potentially fatal condition and requires urgent anticoagulant treatment (see ANTICOAGULANTS) and sometimes surgery. Extended periods lying in bed or prolonged sitting in a con?ned position such as a car or aeroplane can cause DVT; venous thromboses in the legs may occur after surgery and preventive anticoagulant treatment with HEPARIN and warfarin is often used. Similar treatment is needed if a thrombus develops. STREPTOKINASE is also used to treat thromboembolism.... thromboembolism

Veins are the blood vessels that convey blood back from the tissues towards the heart. Two common conditions that affect them are THROMBOSIS and varicosities (see below).

Varicose veins are dilated tortuous veins occurring in about 15 per cent of adults – women more than men. They most commonly occur in the legs but may also occur in the anal canal (HAEMORRHOIDS) and in the oesophagus (due to liver disease).

Normally blood ?ows from the subcutaneous tissues to the super?cial veins which drain via perforating veins into the deep veins of the leg. This ?ow, back towards the heart, is aided by valves within the veins. When these valves fail, increased pressure is exerted on the blood vessels leading to dilatations known as varicose veins.

Treatment is needed to prevent complications such as ulceration and bleeding, or for

cosmetic purposes. Treatment alternatives include injection with sclerosing agents to obliterate the lumen of the veins (sclerotherapy), or surgery; in the elderly or un?t, an elastic stocking may su?ce. One operation is the Trendelenburg operation in which the saphenous vein is disconnected from the femoral vein and individual varicose veins are avulsed. (See also VASCULITIS.)

Thrombosis Thrombosis occurs when blood, which is normally a liquid, clots within the vein to form a semisolid thrombus (clot). This occurs through a combination of reduced blood ?ow and hypercoagulability (a reduced threshold for clotting). The most common site for this to occur is in the deep veins of the leg, where it is known as a deep-vein thrombosis (DVT).

Predisposing factors include immobility (leading to reduced blood ?ow), such as during long journeys (e.g. plane ?ights) where there is little opportunity to stretch one’s legs; surgery (leading to temporary post-operative immobility and hypercoagulability of blood); oestrogen administration (low-dose oestrogen oral contraceptives carry a very low relative risk); and several medical illnesses such as heart failure, stroke and malignancy.

Deep-vein thrombosis presents as a tender, warm, red swelling of the calf. Diagnosis may be con?rmed by venogram (an X-ray taken following injection of contrast medium into the foot veins) or by ultrasound scanning looking for ?ow within the veins.

Prevention is important. This is why patients are mobilised and/or given leg exercises very soon after an operation, even major surgery. People should avoid sitting for long periods, particularly if the edge of the seat is hard, thus impeding venous return from the legs. Car drivers should stop regularly on a long journey and walk around; airline travellers should, where possible, walk round the aisle(s) and also exercise and massage their leg muscles, as well as drinking ample non-alcoholic ?uids.

Diagnosis and treatment are important because there is a risk that the clotted blood within the vein becomes dislodged and travels up the venous system to become lodged in the pulmonary arteries. This is known as PULMONARY EMBOLISM.

Treatment is directed at thinning the blood with ANTICOAGULANTS, initially with heparin and subsequently with WARFARIN for a period of time while the clot resolves.

Blocked super?cial veins are described as super?cial thrombophlebitis, which produces in?ammation over the vein. It responds to antiin?ammatory analgesics. Occasionally heparin and ANTIBIOTICS are required to treat associated thrombosis and infection.... veins, diseases of

Sweet Clover. Melilotus officinalis, Willd. German: Steinklee. French: Couronne royale. Spanish and Italian: Meliloto. Arabian: Aklil-ul Malika. Indian: Iklil-ul-mulk. Chinese: Hsu?n-ts’ao. Dried flowering plant. Keynote: thrombosis.

Constituents: coumarin derivatives, flavonoids, tannin, dicoumarol (anticoagulant).

Practitioner use.

Action: aromatic, antispasmodic, anti-inflammatory, diuretic, expectorant, antibiotic (seeds). Contains Coumarin, an anticoagulant and antithrombotic. Sedative. Mild analgesic (leaves and flowers). Antiflatulent. Styptic, to arrest haemorrhage.

Uses: thrombosis, facial or intercostal neuralgia (compress), conjunctivitis (infusion as an eye douche), rheumatic aches and pains, wounds, externally, for the healing of, (compress). Swelling of lymph glands.

Flatulent colic. Phlebitis, heavy legs, varicose veins, menopausal disorders, insomnia, nervousness. Combines with Milk Thistle or Goldenseal.

Preparations: Tea: 1-2 teaspoons to each cup boiling water; infuse 15 minutes. Dose: half-1 cup, thrice daily. (Cold as an eye douche)

Powder. 375mg (quarter of a teaspoon).

Tincture. Dose: 3-5ml thrice daily.

Fomentation. Aches and pains.

Externally: herb pillow.

Contra-indications. Emetic in large doses. Should not be used without supplementation with Vitamin K. Not used in presence of Warfarin. ... melilot

The process of blood solidification. Clotting is important in stemming bleeding from damaged blood vessels. However, unwanted blood clotting can occur inside major blood vessels and cause a myocardial infarction (heart attack) or stroke (see thrombosis).

When a blood vessel is damaged, it constricts immediately to reduce blood flow to the area. The damage sets off a series of chemical reactions that lead to the formation of a clot to seal the injury. First, platelets around the injury site are activated, becoming sticky and adhering to the blood-vessel wall. Then, the activated platelets release chemicals, which, in turn, activate blood clotting factors. These factors, together with vitamin K, act on fibrinogen and convert it to fibrin. Strands of fibrin form a meshwork, which traps red blood cells to form a clot.

There are several anticlotting mechanisms to prevent the formation of unwanted clots. These include prostacyclin (a prostaglandin), which prevents platelet aggregation, and plasmin, which breaks down fibrin (see fibrinolysis). Blood flow washes away active coagulation factors; and the liver deactivates excess coagulation factors.

Defects in blood clotting may result in bleeding disorders.

Excessive clotting (thrombosis) may be due to an inherited increase or defect in a coagulation factor (see factor V), the use of oral contraceptives, a decrease in the level of enzymes that inhibit coagulation, or sluggish blood flow through a particular area.

Treatment is usually with anticoagulant drugs such as heparin or warfarin.... blood clotting

n. the condition in which an embolus becomes lodged in an artery and obstructs its blood flow. The most common form of embolism is *pulmonary embolism, in which a blood clot is carried in the circulation to lodge in the pulmonary artery. An embolus in any other artery constitutes a systemic embolism. In this case a common source of the embolus is a blood clot within the heart in mitral valve disease or following *myocardial infarction. The clinical features depend upon the site at which an embolus lodges (for example, a stroke may result from a cerebral embolism and gangrene caused by a limb embolism). Treatment is by *anticoagulant therapy with heparin and warfarin. Major embolism is treated by *embolectomy or *thrombolysis to remove or dissolve the embolus. See also air embolism.... embolism

n. obstruction of a vein by a blood clot, without preceding inflammation of its wall. It is most common within the deep veins of the calf of the leg – deep vein thrombosis (DVT) – in contrast to *thrombophlebitis, which affects superficial leg veins. Prolonged immobility, heart failure, pregnancy, injury, and surgery predispose to thrombosis by encouraging sluggish blood flow. Many of these conditions are associated with changes in the clotting factors in the blood that increase the tendency to thrombosis; these changes also occur in some women taking oral contraceptives.

The affected leg may become swollen and tender. The main danger is that the clot may become detached and give rise to *pulmonary embolism. Regular leg exercises help to prevent deep vein thrombosis, and anticoagulant drugs (such as heparin and warfarin) are used in prevention and treatment. Large clots may be removed surgically in the operation of thrombectomy to relieve leg swelling.... phlebothrombosis