The blood pressure is biphasic, being greatest (systolic pressure) at each heartbeat and falling (diastolic pressure) between beats. The average systolic pressure is around 100 mm Hg in children and 120 mm Hg in young adults, generally rising with age as the arteries get thicker and harder. Diastolic pressure in a healthy young adult is about 80 mm Hg, and a rise in diastolic pressure is often a surer indicator of HYPERTENSION than is a rise in systolic pressure; the latter is more sensitive to changes of body position and emotional mood. Hypertension has various causes, the most important of which are kidney disease (see KIDNEYS, DISEASES OF), genetic predisposition and, to some extent, mental stress. Systolic pressure may well be over 200 mm Hg. Abnormal hypertension is often accompanied by arterial disease (see ARTERIES, DISEASES OF) with an increased risk of STROKE, heart attack and heart failure (see HEART, DISEASES OF). Various ANTIHYPERTENSIVE DRUGS are available; these should be carefully evaluated, considering the patient’s full clinical history, before use.

HYPOTENSION may result from super?cial vasodilation (for example, after a bath, in fevers or as a side-e?ect of medication, particularly that prescribed for high blood pressure) and occur in weakening diseases or heart failure. The blood pressure generally falls on standing, leading to temporary postural hypotension – a particular danger in elderly people.... blood pressure

The toxin has two components, one having haemagglutinin activity and the other neurotoxic activity which produces most of the symptoms. It has a lethal dose of as little as 1 mg/kg and is highly selective for cholinergic nerves. Thus the symptoms are those of autonomic parasympathetic blockade (dry mouth, constipation, urinary retention, mydriasis, blurred vision) and progress to blockade of somatic cholinergic transmission (muscle weakness). Death results from respiratory muscle paralysis. Treatment consists of supportive measures and 4 aminopyridine and 3, 4 di-aminopyridine, which may antagonise the e?ect of the toxin.... botulism

Treatment consists of postural drainage of excessive lung secretions, and antibiotics.... bronchiectasis

Habitat: South Africa, from where the leaves are imported.

Action: Diuretic, diaphoretic, stimulant:

– they feed on dead organic matter. As well as infecting and spoiling food, some are pathogenic to humans, causing, for example, ANTHRAX, conjunctivitis (see EYE, DISORDERS OF) and DYSENTERY. They are also the source of some antibiotics (See under MICROBIOLOGY.)... bacillus

Patients found to have bacteriuria on SCREENING may never have consulted a doctor but nearly all have a few symptoms, such as frequency or urgency – so-called ‘covert bacteriuria’.

Men have longer urethras and fewer urinary tract infections (UTIs) than women. Risk factors include diabetes mellitus, pregnancy, impaired voiding and genito-urinary malformations. Over 70 per cent of UTIs are due to E. coli, but of UTIs in hospital patients, only 40 per cent are caused by E. coli.

Treatment Patients should be encouraged to drink plenty of water, with frequent urination. Speci?c antibiotic therapy with trimethoprim or amoxicillin may be needed.... bacteriuria

Habitat: Borders of woods and in hedges, particularly in south of England. Common in gardens.

Action: Carminative, diaphoretic, tonic.

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

About the Nutrients in This Food Barley is a high-carbohydrate food, rich in starch and dietary fiber, particu- larly pectins and soluble gums, including beta-glucans, the fiber that makes cooked oatmeal sticky. The proteins in barley are incomplete, limited in the essential amino acid lysine. Barley is a good source of the B vitamin folate. One-half cup cooked barley has 4.5 grams dietary fiber and 12.5 mg folate (3 percent of the R DA for healthy adults).

The Most Nutritious Way to Serve This Food With a calcium-rich food and with a food such as legumes or meat, milk, or eggs that supplies the lysine barley is missing.

Diets That May Restrict or Exclude This Food Gluten-free diet

Buying This Food Look for: Clean, tightly sealed boxes or plastic bags. Stains indicate that something has spilled on the box and may have seeped through to con- taminate the grain inside. * Values are for pearled barley.

Storing This Food Store barley in air- and moisture-proof containers in a cool, dark, dry cabinet. Well protected, it will keep for several months with no loss of nutrients.

Preparing This Food Pick over the barley and discard any damaged or darkened grains.

What Happens When You Cook This Food Starch consists of molecules of the complex carbohydrates amylose and amylopectin packed into a starch granule. When you cook barley in water, its starch granules absorb water mol- ecules, swell, and soften. When the temperature of the liquid reaches approximately 140°F, the amylose and amylopectin molecules inside the granules relax and unfold, breaking some of their internal bonds (bonds between atoms on the same molecule) and forming new bonds between atoms on different molecules. The result is a network that traps and holds water molecules. The starch granules swell and the barley becomes soft and bulky. If you continue to cook the barley, the starch granules will rupture, releasing some of the amylose and amylopectin molecules inside. These molecules will attract and immobilize some of the water molecules in the liquid, which is why a little barley added to a soup or stew will make the soup or stew thicker. The B vitamins in barley are water-soluble. You can save them by serving the barley with the liquid in which it was cooked.

How Other Kinds of Processing Affect This Food Pearling. Pearled barley is barley from which the outer layer has been removed. Milling, the process by which barley is turned into flour, also removes the outer coating (bran) of the grain. Since most of the B vitamins and fiber are concentrated in the bran, both pearled and milled barley are lower in nutrients and fiber than whole barley. Malting. After barley is harvested, the grain may be left to germinate, a natural chemical process during which complex carbohydrates in the grain (starches and beta-glucans) change into sugar. The grain, now called malted barley, is used as the base for several fermented and distilled alcohol beverages, including beer and whiskey.

Medical Uses and/or Benefits To reduce cholesterol levels. The soluble gums and pectins in barley appear to lower the amount of cholesterol circulating in your blood. There are currently two theories to explain how this might work. The first theory is that the pectins form a gel in your stomach that sops up fats and keeps them from being absorbed by your body. The second is that bacteria living in your gut may feed on the beta-glucans in the barley to produce short-chain fatty acids that slow the natural production of cholesterol in your liver. Barley is very rich in beta-glucans; some strains have three times as much as oats. It also has tocotrienol, another chemical that mops up cholesterol.... barley

To arrest excessive bleeding: Yarrow or Nettle tea. After the event; to restore – Alfalfa tea.

To heal the placenta: inserts of powdered Comfrey. ... birth

Habitat: Found growing in damp meadows in many parts of Britain, and is also distributed throughout Northern Europe, as well as Northern and Western Asia.

Action: There is no odour, and the taste is astringent, which is the chief therapeutic action of the root—indeed it is, perhaps, the most powerful astringent in the botanic practice.

The complication is frequently fatal, being associated with HAEMOGLOBINURIA, JAUNDICE, fever, vomiting and severe ANAEMIA. In an extreme case the patient’s urine appears black. Tender enlarged liver and spleen are usually present. The disease is triggered by quinine usage at subtherapeutic dosage in the presence of P. falciparum infection, especially in the non-immune individual. Now that quinine is rarely used for prevention of this infection (it is reserved for treatment), blackwater fever has become very unusual. Treatment is as for severe complicated P. falciparum infection with renal impairment; dialysis and blood transfusion are usually indicated. When inadequately treated, the mortality rate may be over 40 per cent but, with satisfactory intensive therapy, this should be reduced substantially.... blackwater fever

Any blind person, or his or her relatives, can obtain help and advice from the Royal National Institute for the Blind (www.rnib.org.uk).

Night blindness An inability to see in the dark. It can be associated with retinitis pigmentosa or vitamin A de?ciency (see EYE, DISORDERS OF).... blindness

Composition The cellular components are red cells or corpuscles (ERYTHROCYTES), white cells (LEUCOCYTES and lymphocytes – see LYMPHOCYTE), and platelets.

The red cells are biconcave discs with a diameter of 7.5µm. They contain haemoglobin

– an iron-containing porphyrin compound, which takes up oxygen in the lungs and releases it to the tissue.

The white cells are of various types, named according to their appearance. They can leave the circulation to wander through the tissues. They are involved in combating infection, wound healing, and rejection of foreign bodies. Pus consists of the bodies of dead white cells.

Platelets are the smallest cellular components and play an important role in blood clotting (see COAGULATION).

Erythrocytes are produced by the bone marrow in adults and have a life span of about 120 days. White cells are produced by the bone

marrow and lymphoid tissue. Plasma consists of water, ELECTROLYTES and plasma proteins; it comprises 48–58 per cent of blood volume. Plasma proteins are produced mainly by the liver and by certain types of white cells. Blood volume and electrolyte composition are closely regulated by complex mechanisms involving the KIDNEYS, ADRENAL GLANDS and HYPOTHALAMUS.... blood

Structure of bone Bone is composed partly of ?brous tissue, partly of bone matrix comprising phosphate and carbonate of lime, intimately mixed together. The bones of a child are about two-thirds ?brous tissue, whilst those of the aged contain one-third; the toughness of the former and the brittleness of the latter are therefore evident.

The shafts of the limb bones are composed of dense bone, the bone being a hard tube surrounded by a membrane (the periosteum) and enclosing a fatty substance (the BONE MARROW); and of cancellous bone, which forms the short bones and the ends of long bones, in which a ?ne lace-work of bone ?lls up the whole interior, enclosing marrow in its meshes. The marrow of the smaller bones is of great importance. It is red in colour, and in it red blood corpuscles are formed. Even the densest bone is tunnelled by ?ne canals (Haversian canals) in which run small blood vessels, nerves and lymphatics, for the maintenance and repair of the bone. Around these Haversian canals the bone is arranged in circular plates called lamellae, the lamellae being separated from one another by clefts, known as lacunae, in which single bone-cells are contained. Even the lamellae are pierced by ?ne tubes known as canaliculi lodging processes of these cells. Each lamella is composed of very ?ne interlacing ?bres.

GROWTH OF BONES Bones grow in thickness from the ?brous tissue and lime salts laid down by cells in their substance. The long bones grow in length from a plate of cartilage (epiphyseal cartilage) which runs across the bone about 1·5 cm or more from its ends, and which on one surface is also constantly forming bone until the bone ceases to lengthen at about the age of 16 or 18. Epiphyseal injury in children may lead to diminished growth of the limb.

REPAIR OF BONE is e?ected by cells of microscopic size, some called osteoblasts, elaborating the materials brought by the blood and laying down strands of ?brous tissue, between which bone earth is later deposited; while other cells, known as osteoclasts, dissolve and break up dead or damaged bone. When a fracture has occurred, and the broken ends have been brought into contact, these are surrounded by a mass of blood at ?rst; this is partly absorbed and partly organised by these cells, ?rst into ?brous tissue and later into bone. The mass surrounding the fractured ends is called the callus, and for some months it forms a distinct thickening which is gradually smoothed away, leaving the bone as before the fracture. If the ends have not been brought accurately into contact, a permanent thickening results.

VARIETIES OF BONES Apart from the structural varieties, bones fall into four classes: (a) long bones like those of the limbs; (b) short bones composed of cancellous tissue, like those of the wrist and the ankle; (c) ?at bones like those of the skull; (d) irregular bones like those of the face or the vertebrae of the spinal column (backbone).

The skeleton consists of more than 200 bones. It is divided into an axial part, comprising the skull, the vertebral column, the ribs with their cartilages, and the breastbone; and an appendicular portion comprising the four limbs. The hyoid bone in the neck, together with the cartilages protecting the larynx and windpipe, may be described as the visceral skeleton.

AXIAL SKELETON The skull consists of the cranium, which has eight bones, viz. occipital, two parietal, two temporal, one frontal, ethmoid, and sphenoid; and of the face, which has 14 bones, viz. two maxillae or upper jaw-bones, one mandible or lower jaw-bone, two malar or cheek bones, two nasal, two lacrimal, two turbinal, two palate bones, and one vomer bone. (For further details, see SKULL.) The vertebral column consists of seven vertebrae in the cervical or neck region, 12 dorsal vertebrae, ?ve vertebrae in the lumbar or loin region, the sacrum or sacral bone (a mass formed of ?ve vertebrae fused together and forming the back part of the pelvis, which is closed at the sides by the haunch-bones), and ?nally the coccyx (four small vertebrae representing the tail of lower animals). The vertebral column has four curves: the ?rst forwards in the neck, the second backwards in the dorsal region, the third forwards in the loins, and the lowest, involving the sacrum and coccyx, backwards. These are associated with the erect attitude, develop after a child learns to walk, and have the e?ect of diminishing jars and shocks before these reach internal organs. This is aided still further by discs of cartilage placed between each pair of vertebrae. Each vertebra has a solid part, the body in front, and behind this a ring of bone, the series of rings one above another forming a bony canal up which runs the spinal cord to pass through an opening in the skull at the upper end of the canal and there join the brain. (For further details, see SPINAL COLUMN.) The ribs – 12 in number, on each side – are attached behind to the 12 dorsal vertebrae, while in front they end a few inches away from the breastbone, but are continued forwards by cartilages. Of these the upper seven reach the breastbone, these ribs being called true ribs; the next three are joined each to the cartilage above it, while the last two have their ends free and are called ?oating ribs. The breastbone, or sternum, is shaped something like a short sword, about 15 cm (6 inches) long, and rather over 2·5 cm (1 inch) wide.

APPENDICULAR SKELETON The upper limb consists of the shoulder region and three segments – the upper arm, the forearm, and the wrist with the hand, separated from each other by joints. In the shoulder lie the clavicle or collar-bone (which is immediately beneath the skin, and forms a prominent object on the front of the neck), and the scapula or shoulder-blade behind the chest. In the upper arm is a single bone, the humerus. In the forearm are two bones, the radius and ulna; the radius, in the movements of alternately turning the hand palm up and back up (called supination and pronation respectively), rotating around the ulna, which remains ?xed. In the carpus or wrist are eight small bones: the scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate and hamate. In the hand proper are ?ve bones called metacarpals, upon which are set the four ?ngers, each containing the three bones known as phalanges, and the thumb with two phalanges.

The lower limb consists similarly of the region of the hip-bone and three segments – the thigh, the leg and the foot. The hip-bone is a large ?at bone made up of three – the ilium, the ischium and the pubis – fused together, and forms the side of the pelvis or basin which encloses some of the abdominal organs. The thigh contains the femur, and the leg contains two bones – the tibia and ?bula. In the tarsus are seven bones: the talus (which forms part of the ankle joint); the calcaneus or heel-bone; the navicular; the lateral, intermediate and medial cuneiforms; and the cuboid. These bones are so shaped as to form a distinct arch in the foot both from before back and from side to side. Finally, as in the hand, there are ?ve metatarsals and 14 phalanges, of which the great toe has two, the other toes three each.

Besides these named bones there are others sometimes found in sinews, called sesamoid bones, while the numbers of the regular bones may be increased by extra ribs or diminished by the fusion together of two or more bones.... bone

Habitat: Damp places.

Action: Diaphoretic, febrifuge, tonic, laxative, expectorant.

The control centre of the whole nervous system is the brain, which is located in the skull or cranium. As well as controlling the nervous system it is the organ of thought, speech and emotion. The central nervous system controls the body’s essential functions such as breathing, body temperature (see HOMEOSTASIS) and the heartbeat. The body’s various sensations, including sight, hearing, touch, pain, positioning and taste, are communicated to the CNS by nerves distributed throughout the relevant tissues. The information is then sorted and interpreted by specialised areas in the brain. In response these initiate and coordinate the motor output, triggering such ‘voluntary’ activities as movement, speech, eating and swallowing. Other activities – for example, breathing, digestion, heart contractions, maintenance of BLOOD PRESSURE, and ?ltration of waste products from blood passing through the kidneys – are subject to involuntary control via the autonomic system. There is, however, some overlap between voluntary and involuntary controls.... brain

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

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

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

Anaemia is a frequent cause.

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

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

Habitat: Dry, hilly wastes.

Action: Powerfully diuretic.

Word deafness is an associated condition in which, although hearing remains perfect, the patient has lost the power of referring the names heard to the articles they denote. (See also DYSPHASIA.)... word blindness

(See also antibacterial drugs; antibiotic drugs.)... bactericidal

Aetiology. Injury, virus infection, cold, stroke. Recovery usually spontaneous. Herpes Simp. Alternatives. Chamomile, Wood Betony, Bryonia, Black Cohosh, Barberry, Asafoetida, Lobelia, Rosemary, Valerian, Sage. Echinacea has been used with convincing results internally and externally.

Tea. Equal parts. Chamomile, Wood Betony. Sage. 1 heaped teaspoon to each cup boiling water; infuse 15 minutes. 1 cup 3 times daily.

Decoctions. Black Cohosh, Rosemary, Valerian, Echinacea.

Tablets/capsules. Black Cohosh. Ginseng. Echinacea. Valerian.

Powders. Formula. Rosemary 1; Echinacea 2; Valerian 1. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Echinacea 2; Rosemary 1; Black Cohosh 1; Pinch Tincture Capsicum. 1-2 teaspoons 3 times daily.

Evening Primrose oil. 4 × 500mg capsules daily.

Aromatherapy. 10 drops Oil Juniper to eggcup Almond oil; gentle massage affected side of face. Diet. Lacto-vegetarian.

Vitamin E. (400iu daily). ... bell’s palsy

Scrapie. Notifiable disease. Fatal disease in the nervous system of cattle, unknown before 1985. Microscopic holes appear in the brain giving a spongiform appearance, but with little inflammation. Can spread from one animal to another: sheep, goats, deer, mules, mink, hamsters, mice, pigs and monkeys. Cause: not a virus. Animals itch and scrape themselves against trees or posts for relief. May spread from animals to humans, with brain infection after the character of polio.

Symptoms. (Human). Speech impairment, short-term-memory-loss, difficulty in controlling body movements. Zinc deficiency.

Treatment. Hospitalisation.

Suggested treatment for human infection, unproven.

Tinctures. Echinacea 5; Black Cohosh 3; Yarrow 2; Senna leaf 1.2-3 teaspoons in water (or cup hot Yarrow tea) 3-4 times daily. For headache: Gelsemium.

Supplement: Zinc.

To be treated by a general medical practitioner or hospital specialist. ... bovine spongiform encephalopathy

Causes: myocardial infarction, atherosclerosis, coronary thrombosis or other heart disorder.

Symptoms: slow feeble heart beats down to 36 beats per minute with fainting and collapse, breathlessness, Stoke Adams syndrome.

Treatment. Intensive care. Until the doctor comes: 1-5 drops Oil of Camphor in honey on the tongue or taken in a liquid if patient is able to drink. Freely inhale the oil. On recovery: Motherwort tea, freely. OR, Formula of tinctures: Lily of the Valley 2; Cactus 1; Motherwort 2. Mix. Dose – 30-60 drops in water thrice daily. A fitted pace-maker may be necessary.

Spartiol. 20 drops thrice daily. (Klein) ... heart block

The normal hydrogen ion concentration of the PLASMA is a constant pH 7·4, and the lungs and kidneys have a crucial function in maintaining this ?gure. Changes in pH value will cause ACIDOSIS or ALKALOSIS.... acid base balance

Non-speci?c back pain is probably the result of mechanical disorders in the muscles, ligaments and joints of the back: torn muscles, sprained LIGAMENTS, and FIBROSITIS. These disorders are not always easy to diagnose, but mild muscular and ligamentous injuries are usually relieved with symptomatic treatment – warmth, gentle massage, analgesics, etc. Sometimes back pain is caused or worsened by muscle spasms, which may call for the use of antispasmodic drugs. STRESS and DEPRESSION (see MENTAL ILLNESS) can sometimes result in chronic backache and should be considered if no clear physical diagnosis can be made.

If back pain is severe and/or recurrent, possibly radiating around to the abdomen or down the back of a leg (sciatica – see below), or is accompanied by weakness or loss of feeling in the leg(s), it may be caused by a prolapsed intervertebral disc (slipped disc) pressing on a nerve. The patient needs prompt investigation, including MRI. Resting on a ?rm bed or board can relieve the symptoms, but the patient may need a surgical operation to remove the disc and relieve pressure on the affected nerve.

The nucleus pulposus – the soft centre of the intervertebral disc – is at risk of prolapse under the age of 40 through an acquired defect in the ?brous cartilage ring surrounding it. Over 40 this nucleus is ?rmer and ‘slipped disc’ is less likely to occur. Once prolapse has taken place, however, that segment of the back is never quite the same again, as OSTEOARTHRITIS develops in the adjacent facet joints. Sti?ness and pain may develop, sometimes many years later. There may be accompanying pain in the legs: SCIATICA is pain in the line of the sciatic nerve, while its rarer analogue at the front of the leg is cruralgia, following the femoral nerve. Leg pain of this sort may not be true nerve pain but referred from arthritis in the spinal facet joints. Only about 5 per cent of patients with back pain have true sciatica, and spinal surgery is most successful (about 85 per cent) in this group.

When the complaint is of pain alone, surgery is much less successful. Manipulation by physiotherapists, doctors, osteopaths or chiropractors can relieve symptoms; it is important ?rst to make sure that there is not a serious disorder such as a fracture or cancer.

Other local causes of back pain are osteoarthritis of the vertebral joints, ankylosing spondylitis (an in?ammatory condition which can severely deform the spine), cancer (usually secondary cancer deposits spreading from a primary tumour elsewhere), osteomyelitis, osteoporosis, and PAGET’S DISEASE OF BONE. Fractures of the spine – compressed fracture of a vertebra or a break in one of its spinous processes – are painful and potentially dangerous. (See BONE, DISORDERS OF.)

Backache can also be caused by disease elsewhere, such as infection of the kidney or gall-bladder (see LIVER), in?ammation of the PANCREAS, disorders in the UTERUS and PELVIS or osteoarthritis of the HIP. Treatment is e?ected by tackling the underlying cause. Among the many known causes of back pain are:

Mechanical and traumatic causes

Congenital anomalies. Fractures of the spine. Muscular tenderness and ligament strain. Osteoarthritis. Prolapsed intervertebral disc. Spondylosis.

In?ammatory causes

Ankylosing spondylitis. Brucellosis. Osteomyelitis. Paravertebral abscess. Psoriatic arthropathy. Reiter’s syndrome. Spondyloarthropathy. Tuberculosis.

Neoplastic causes

Metastatic disease. Primary benign tumours. Primary malignant tumours.

Metabolic bone disease

Osteomalacia. Osteoporosis. Paget’s disease.

Referred pain

Carcinoma of the pancreas. Ovarian in?ammation and tumours. Pelvic disease. Posterior duodenal ulcer. Prolapse of the womb.

Psychogenic causes

Anxiety. Depression.

People with backache can obtain advice from www.backcare.org.uk... backache

Habitat: Common in North America.

Action: Anthelmintic, detergent, tonic.

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)

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

Treatment Oral steroids, if started early, increase the rate of recovery, which occurs in over 90 per cent of patients, usually starting after two or three weeks and complete within three months. Permanent loss of function with facial contractures occurs in about 5 per cent of patients. Recurrence of Bell’s palsy is unusual.... bell’s palsy

There are few signi?cant di?erences between the various antimuscarinic drugs available, but some patients may tolerate one drug better than another or ?nd that they need to adjust their drug regimen in relation to food.... benzhexol

Benzodiazepines act at a speci?c centralnervous-system receptor or by potentiating the action of inhibitory neuro-transmitters. They have advantages over other sedatives by having some selectivity for anxiety rather than general sedation. They are safer in overdose. Unfortunately they may cause aggression, amnesia, excessive sedation, or confusion in the elderly. Those with long half-lives or with metabolites having long half-lives may produce a hangover e?ect, and DEPENDENCE on these is now well recognised, so they should not be prescribed for more than a few weeks. Commonly used benzodiazepines include nitrazepam, ?unitrazepam (a controlled drug), loprazolam, temazepam (a controlled drug) and chlormethiazole, normally con?ned to the elderly. All benzodiazepines should be used sparingly because of the risk of dependence.... benzodiazepines

Habitat: Indigenous to North America.

Action: Cathartic, diuretic, detergent, emetic, tonic.

Habitat: Dry woods, throughout Central and Southern States of North America. Features ? A tree-like shrub, ten to twenty feet high. Fruit shiny black, sweet and

Action: Uterine tonic, nervine, anti-spasmodic.

In blood transfusion, the person giving and the person receiving the blood must belong to the same blood group, or a dangerous reaction will take place from the agglutination that occurs when blood of a di?erent group is present. One exception is that group O Rhesus-negative blood can be used in an emergency for anybody.

Rhesus factor In addition to the A and B agglutinogens (or antigens), there is another one known as the Rhesus (or Rh) factor – so named because there is a similar antigen in the red blood corpuscles of the Rhesus monkey. About 84 per cent of the population have this Rh factor in their blood and are therefore known as ‘Rh-positive’. The remaining 16 per cent who do not possess the factor are known as ‘Rh-negative’.

The practical importance of the Rh factor is that, unlike the A and B agglutinogens, there are no naturally occurring Rh antibodies. However, such antibodies may develop in a Rh-negative person if the Rh antigen is introduced into his or her circulation. This can occur (a) if a Rh-negative person is given a transfusion of Rh-positive blood, and (b) if a Rh-negative mother married to a Rh-positive husband becomes pregnant and the fetus is Rh-positive. If the latter happens, the mother develops Rh antibodies which can pass into the fetal circulation, where they react with the baby’s Rh antigen and cause HAEMOLYTIC DISEASE of the fetus and newborn. This means that, untreated, the child may be stillborn or become jaundiced shortly after birth.

As about one in six expectant mothers is Rh-negative, a blood-group examination is now considered an essential part of the antenatal examination of a pregnant woman. All such Rh-negative expectant mothers are now given a ‘Rhesus card’ showing that they belong to the rhesus-negative blood group. This card should always be carried with them. Rh-positive blood should never be transfused to a Rh-negative girl or woman.... blood groups

Habitat: Marshy places in Central America.

Action: Alterative, diuretic, cathartic.

Bluebelle, Blubell, Blubelle, Bluebella, Blubella... bluebell

Habitat: Widely distributed throughout North America.

Action: Stimulant, tonic, expectorant.

Bone fractures These occur when there is a break in the continuity of the bone. This happens either as a result of violence or because the bone is unhealthy and unable to withstand normal stresses.

SIMPLE FRACTURES Fractures where the skin remains intact or merely grazed. COMPOUND FRACTURES have at least one wound which is in communication with the fracture, meaning that bacteria can enter the fracture site and cause infection. A compound fracture is also more serious than a simple fracture because there is greater potential for blood loss. Compound fractures usually need hospital admission, antibiotics and careful reduction of the fracture. Debridement (cleaning and excising dead tissue) in a sterile theatre may also be necessary.

The type of fracture depends on the force which has caused it. Direct violence occurs when an object hits the bone, often causing a transverse break – which means the break runs horizontally across the bone. Indirect violence occurs when a twisting injury to the ankle, for example, breaks the calf-bone (the tibia) higher up. The break may be more oblique. A fall on the outstretched hand may cause a break at the wrist, in the humerus or at the collar-bone depending on the force of impact and age of the person. FATIGUE FRACTURES These occur after the bone has been under recurrent stress. A typical example is the march fracture of the second toe, from which army recruits suffer after long marches. PATHOLOGICAL FRACTURES These occur in bone which is already diseased – for example, by osteoporosis (see below) in post-menopausal women. Such fractures are typically crush fractures of the vertebrae, fractures of the neck of the femur, and COLLES’ FRACTURE (of the wrist). Pathological fractures also occur in bone which has secondary-tumour deposits. GREENSTICK FRACTURES These occur in young children whose bones are soft and bend, rather than break, in response to stress. The bone tends to buckle on the side opposite to the force. Greenstick fractures heal quickly but still need any deformity corrected and plaster of Paris to maintain the correction. COMPLICATED FRACTURES These involve damage to important soft tissue such as nerves, blood vessels or internal organs. In these cases the soft-tissue damage needs as much attention as the fracture site. COMMINUTED FRACTURES A fracture with more than two fragments. It usually means that the injury was more violent and that there is more risk of damage to vessels and nerves. These fractures are unstable and take longer to unite. Rehabilitation tends to be protracted. DEPRESSED FRACTURES Most commonly found in skull fractures. A fragment of bone is forced inwards so that it lies lower than the level of the bone surrounding it. It may damage the brain beneath it.

HAIR-LINE FRACTURES These occur when the bone is broken but the force has not been severe enough to cause visible displacement. These fractures may be easily missed. Symptoms and signs The fracture site is usually painful, swollen and deformed. There is asymmetry of contour between limbs. The limb is held uselessly. If the fracture is in the upper

limb, the arm is usually supported by the patient; if it is in the lower limb then the patient is not able to bear weight on it. The limb may appear short because of muscle spasm.

Examination may reveal crepitus – a bony grating – at the fracture site. The diagnosis is con?rmed by radiography.

Treatment Healing of fractures (union) begins with the bruise around the fracture being resorbed and new bone-producing cells and blood vessels migrating into the area. Within a couple of days they form a bridge of primitive bone across the fracture. This is called callus.

The callus is replaced by woven bone which gradually matures as the new bone remodels itself. Treatment of fractures is designed to ensure that this process occurs with minimal residual deformity to the bone involved.

Treatment is initially to relieve pain and may involve temporary splinting of the fracture site. Reducing the fracture means restoring the bones to their normal position; this is particularly important at the site of joints where any small displacement may limit movement considerably.

with plaster of Paris. If closed traction does not work, then open reduction of the fracture may

be needed. This may involve ?xing the fracture with internal-?xation methods, using metal plates, wires or screws to hold the fracture site in a rigid position with the two ends closely opposed. This allows early mobilisation after fractures and speeds return to normal use.

External ?xators are usually metal devices applied to the outside of the limb to support the fracture site. They are useful in compound fractures where internal ?xators are at risk of becoming infected.

Consolidation of a fracture means that repair is complete. The time taken for this depends on the age of the patient, the bone and the type of fracture. A wrist fracture may take six weeks, a femoral fracture three to six months in an adult.

Complications of fractures are fairly common. In non-union, the fracture does not unite

– usually because there has been too much mobility around the fracture site. Treatment may involve internal ?xation (see above). Malunion means that the bone has healed with a persistent deformity and the adjacent joint may then develop early osteoarthritis.

Myositis ossi?cans may occur at the elbow after a fracture. A big mass of calci?ed material develops around the fracture site which restricts elbow movements. Late surgical removal (after 6–12 months) is recommended.

Fractured neck of FEMUR typically affects elderly women after a trivial injury. The bone is usually osteoporotic. The leg appears short and is rotated outwards. Usually the patient is unable to put any weight on the affected leg and is in extreme pain. The fractures are classi?ed according to where they occur:

subcapital where the neck joins the head of the femur.

intertrochanteric through the trochanter.

subtrochanteric transversely through the upper end of the femur (rare). Most of these fractures of the neck of femur

need ?xing by metal plates or hip replacements, as immobility in this age group has a mortality of nearly 100 per cent. Fractures of the femur shaft are usually the result of severe trauma such as a road accident. Treatment may be conservative or operative.

In fractures of the SPINAL COLUMN, mere damage to the bone – as in the case of the so-called compression fracture, in which there is no damage to the spinal cord – is not necessarily serious. If, however, the spinal cord is damaged, as in the so-called fracture dislocation, the accident may be a very serious one, the usual result being paralysis of the parts of the body below the level of the injury. Therefore the higher up the spine is fractured, the more serious the consequences. The injured person should not be moved until skilled assistance is at hand; or, if he or she must be removed, this should be done on a rigid shutter or door, not on a canvas stretcher or rug, and there should be no lifting which necessitates bending of the back. In such an injury an operation designed to remove a displaced piece of bone and free the spinal cord from pressure is often necessary and successful in relieving the paralysis. DISLOCATIONS or SUBLUXATION of the spine are not uncommon in certain sports, particularly rugby. Anyone who has had such an injury in the cervical spine (i.e. in the neck) should be strongly advised not to return to any form of body-contact or vehicular sport.

Simple ?ssured fractures and depressed fractures of the skull often follow blows or falls on the head, and may not be serious, though there is always a risk of damage which is potentially serious to the brain at the same time.

Compound fractures may result in infection within the skull, and if the skull is extensively broken and depressed, surgery is usually required to check any intercranial bleeding or to relieve pressure on the brain.

The lower jaw is often fractured by a blow on the face. There is generally bleeding from the mouth, the gum being torn. Also there are pain and grating sensations on chewing, and unevenness in the line of the teeth. The treatment is simple, the line of teeth in the upper jaw forming a splint against which the lower jaw is bound, with the mouth closed.

Congenital diseases These are rare but may produce certain types of dwar?sm or a susceptibility to fractures (osteogenesis imperfecta).

Infection of bone (osteomyelitis) may occur after an open fracture, or in newborn babies with SEPTICAEMIA. Once established it is very di?cult to eradicate. The bacteria appear capable of lying dormant in the bone and are not easily destroyed with antibiotics so that prolonged treatment is required, as might be surgical drainage, exploration or removal of dead bone. The infection may become chronic or recur.

Osteomalacia (rickets) is the loss of mineralisation of the bone rather than simple loss of bone mass. It is caused by vitamin D de?ciency and is probably the most important bone disease in the developing world. In sunlight the skin can synthesise vitamin D (see APPENDIX 5: VITAMINS), but normally rickets is caused by a poor diet, or by a failure to absorb food normally (malabsorbtion). In rare cases vitamin D cannot be converted to its active state due to the congenital lack of the speci?c enzymes and the rickets will fail to respond to treatment with vitamin D. Malfunction of the parathyroid gland or of the kidneys can disturb the dynamic equilibrium of calcium and phosphate in the body and severely deplete the bone of its stores of both calcium and phosphate.

Osteoporosis A metabolic bone disease resulting from low bone mass (osteopenia) due to excessive bone resorption. Su?erers are prone to bone fractures from relatively minor trauma. With bone densitometry it is now possible to determine individuals’ risk of osteoporosis and monitor their response to treatment.

By the age of 90 one in two women and one in six men are likely to sustain an osteoporosis-related fracture. The incidence of fractures is increasing more than would be expected from the ageing of the population, which may re?ect changing patterns of exercise or diet.

Osteoporosis may be classi?ed as primary or secondary. Primary consists of type 1 osteoporosis, due to accelerated trabecular bone loss, probably as a result of OESTROGENS de?ciency. This typically leads to crush fractures of vertebral bodies and fractures of the distal forearm in women in their 60s and 70s. Type 2 osteoporosis, by contrast, results from the slower age-related cortical and travecular bone loss that occurs in both sexes. It typically leads to fractures of the proximal femur in elderly people.

Secondary osteoporosis accounts for about 20 per cent of cases in women and 40 per cent of cases in men. Subgroups include endocrine (thyrotoxicosis – see under THYROID GLAND, DISEASES OF, primary HYPERPARATHYROIDISM, CUSHING’S SYNDROME and HYPOGONADISM); gastrointestinal (malabsorption syndrome, e.g. COELIAC DISEASE, or liver disease, e.g. primary biliary CIRRHOSIS); rheumatological (RHEUMATOID ARTHRITIS or ANKYLOSING SPONDYLITIS); malignancy (multiple MYELOMA or metastatic CARCINOMA); and drugs (CORTICOSTEROIDS, HEPARIN). Additional risk factors for osteoporosis include smoking, high alcohol intake, physical inactivity, thin body-type and heredity.

Individuals at risk of osteopenia, or with an osteoporosis-related fracture, need investigation with spinal radiography and bone densitometry. A small fall in bone density results in a large increase in the risk of fracture, which has important implications for preventing and treating osteoporosis.

Treatment Antiresorptive drugs: hormone replacement therapy – also valuable in treating menopausal symptoms; treatment for at least ?ve years is necessary, and prolonged use may increase risk of breast cancer. Cyclical oral administration of disodium etidronate – one of the bisphosphonate group of drugs – with calcium carbonate is also used (poor absorption means the etidronate must be taken on an empty stomach). Calcitonin – currently available as a subcutaneous injection; a nasal preparation with better tolerance is being developed. Calcium (1,000 mg daily) seems useful in older patients, although probably ine?ective in perimenopausal women, and it is a safe preparation. Vitamin D and calcium – recent evidence suggests value for elderly patients. Anabolic steroids, though androgenic side-effects (masculinisation) make these unacceptable for most women.

With established osteoporosis, the aim of treatment is to relieve pain (with analgesics and physical measures, e.g. lumbar support) and reduce the risk of further fractures: improvement of bone mass, the prevention of falls, and general physiotherapy, encouraging a healthier lifestyle with more daily exercise.

Further information is available from the National Osteoporosis Society.

Paget’s disease (see also separate entry) is a common disease of bone in the elderly, caused by overactivity of the osteoclasts (cells concerned with removal of old bone, before new bone is laid down by osteoblasts). The bone affected thickens and bows and may become painful. Treatment with calcitonin and bisphosphonates may slow down the osteoclasts, and so hinder the course of the disease, but there is no cure.

If bone loses its blood supply (avascular necrosis) it eventually fractures or collapses. If the blood supply does not return, bone’s normal capacity for healing is severely impaired.

For the following diseases see separate articles: RICKETS; ACROMEGALY; OSTEOMALACIA; OSTEOGENESIS IMPERFECTA.

Tumours of bone These can be benign (non-cancerous) or malignant (cancerous). Primary bone tumours are rare, but secondaries from carcinoma of the breast, prostate and kidneys are relatively common. They may form cavities in a bone, weakening it until it breaks under normal load (a pathological fracture). The bone eroded away by the tumour may also cause problems by causing high levels of calcium in the plasma.

EWING’S TUMOUR is a malignant growth affecting long bones, particularly the tibia (calfbone). The presenting symptoms are a throbbing pain in the limb and a high temperature. Treatment is combined surgery, radiotherapy and chemotherapy.

MYELOMA is a generalised malignant disease of blood cells which produces tumours in bones which have red bone marrow, such as the skull and trunk bones. These tumours can cause pathological fractures.

OSTEOID OSTEOMA is a harmless small growth which can occur in any bone. Its pain is typically removed by aspirin.

OSTEOSARCOMA is a malignant tumour of bone with a peak incidence between the ages of ten and 20. It typically involves the knees, causing a warm tender swelling. Removal of the growth with bone conservation techniques can often replace amputation as the de?nitive treatment. Chemotherapy can improve long-term survival.... bone, disorders of

Disorders that can be helped or even cured include certain types of LEUKAEMIA and many inherited disorders of the immune system (see IMMUNITY).... bone marrow transplant

In severe injuries, there may be damage to both the upper and the lower nerve roots of the brachial plexus, producing complete paralysis of the arm.

Paralysis may be temporary if the stretching was not severe enough to tear nerve fibres.

Nerve roots that have been torn can be repaired by nerve grafting, a microsurgery procedure.

If a nerve root has become separated from the spinal cord, surgical repair will not be successful.

Apart from injuries, the brachial plexus may be compressed by the presence of a cervical rib (extra rib).... brachial plexus

The brainstem is composed of 3 main parts: the midbrain, pons, and medulla. The midbrain contains the nuclei (nervecell centres) of the 3rd and 4th cranial nerves. It also contains cell groups involved in smooth coordination of limb movements. The pons contains nerve fibres that connect with the cerebellum. It also houses the nuclei for the 5th–8th cranial nerves. The medulla contains the nuclei of the 9th–12th cranial nerves. It also contains the “vital centres” (groups of nerve cells that regulate the heartbeat, breathing, blood pressure, and digestion (information on which is relayed via the 10th cranial nerve (see vagus nerve). Nerve-cell groups in the brainstem, known collectively as the reticular formation, alert the higher brain centres to sensory stimuli that may require a conscious response. Our sleep/wake cycle is controlled by the reticular formation.

The brainstem is susceptible to the same disorders that afflict the rest of the central nervous system (see brain, disorders of). Damage to the medulla’s vital centres is rapidly fatal; damage to the reticular formation may cause coma. Damage to specific cranial nerve nuclei can sometimes lead to specific effects. For example, damage to the 7th cranial nerve (the facial nerve) leads to facial palsy. Degeneration of the substantia nigra in the midbrain is thought to be a cause of Parkinson’s disease.... brainstem

Symptoms include muscle weakness, loss of vision, or other sensory disturbances, speech difficulties, and epileptic seizures. Increased pressure within the skull can cause headache, visual disturbances, vomiting, and impaired mental functioning. Hydrocephalus may occur.

When possible, primary tumours are removed by surgery after opening the skull (see craniotomy).

In cases where a tumour cannot be completely removed, as much as possible of it will be cut away to relieve pressure.

For primary and secondary tumours, radiotherapy or anticancer drugs may also be given.

Corticosteroid drugs are often prescribed temporarily to reduce the size of a tumour and associated brain swelling.... brain tumour

... bracken

Breasts, or mammary glands, occur only in mammals and provide milk for feeding the young. These paired organs are usually fully developed only in adult females, but are present in rudimentary form in juveniles and males. In women, the two breasts over-lie the second to sixth ribs on the front of the chest. On the surface of each breast is a central pink disc called the areola, which surrounds the nipple. Inside, the breast consists of fat, supporting tissue and glandular tissue, which is the part that produces milk following childbirth. Each breast consists of 12–20 compartments arranged radially around the nipple: each compartment opens on to the tip of the nipple via its own duct through which the milk ?ows. The breast enlargement that occurs in pregnancy is due to development of the glandular part in preparation for lactation. In women beyond childbearing age, the glandular part of the breasts reduces (called involution) and the breasts become less ?rm and contain relatively more fat.

Habitat: Hedges and thickets.

Action: Cathartic, hydragogue.

Habitat: Throughout India.

Action: Seeds—anti-inflammatory, spasmolytic. Used for vaginal dysfunctions, as a fertility promoting drug. Powdered seeds, also roots, are given to help conception in women. Plant is also used in venereal diseases.... bryophyllum pinnatum

Habitat: Shady and damp places in the northern regions of U.S.A.

Action: Sedative, astringent.

Habitat: Ditches, by waterways, and in wet places generally; also cultivated in gardens.

Action: Astringent, diuretic, diaphoretic.

Verapamil, the longest-available, is used to treat angina and hypertension. It is the only calcium-channel blocker e?ective against cardiac ARRHYTHMIA and it is the drug of choice in terminating supraventricular tachycardia. It may precipitate heart failure, and cause HYPOTENSION at high doses. Nifedipine and diltiazem act more on the vessels and less on the myocardium than verapamil; they have no antiarrhythmic activity. They are used in the prophylaxis and treatment of angina, and in hypertension. Nicardipine and similar drugs act mainly on the vessels, but are valuable in the treatment of hypertension and angina. Important di?erences exist between di?erent calcium-channel blockers so their use must be carefully assessed. They should not be stopped suddenty, as this may precipitate angina. (See also HEART, DISEASES OF.)... calcium-channel blockers

Habitat: The dried rhizome and roots are imported from the U.S.A., to which country and Canada the plant is indigenous.

Action: Astringent, diuretic, emmenagogue and alterative.

Habitat: Cultivated in shrubberies, etc., for decorative purposes.

Action: Antispasmodic, nervine.

Habitat: Native to China and Japan; cultivated in Indian gardens as an ornamental.

Action: Antagonizes bronchospasm, used as a circulatory stimulant, peripheral vasodilator.

Habitat: Hedgerows, waste ground.

Action: Stimulant, expectorant, diaphoretic, antispasmodic.

Common features of IBS include:

abdominal distension.

altered bowel habit.

colicky lower abdominal pain, eased by defaecation.

mucous discharge from rectum.

feelings of incomplete defaecation.

Investigations usually produce normal results. Positive diagnosis in people under 40 is usually straightforward. In older patients, however, barium ENEMA, X-rays and COLONOSCOPY should be done to exclude colorectal cancer.

Reassurance is the initial and often e?ective treatment. If this fails, treatment should be directed at the major symptoms. Several months of the antidepressant amitriptyline (see ANTIDEPRESSANT DRUGS) may bene?t patients with intractable symptoms, given at a dose lower than that used to treat depression. The majority of patients follow a relapsing/remitting course, with episodes provoked by stressful events in their daily lives. (See also INTESTINE, DISEASES OF.)... irritable bowel syndrome (ibs)

The bladder lies in the anterior half of the PELVIS, bordered in front by the pubis bone and laterally by the side wall of the pelvis. Superiorly the bladder is covered by the peritoneal lining of the abdomen. The bottom or base of the bladder lies against the PROSTATE GLAND in the male and the UTERUS and VAGINA in the female.... urinary bladder

– is conjugated or unconjugated. If conjugated, this indicates that HAEMOLYSIS is causing the jaundice; if unconjugated, disease of the LIVER or BILE DUCT is the likely diagnosis.... van den bergh test

Bad breath is often indicative of toxaemia or defective elimination via liver, kidneys and skin which should be the focus of treatment. Palliatives such as Papaya fruit (or tablets), Peppermint or Chlorophyll may not reach the heart of the trouble which could demand deeper-acting agents.

Liver disorders (Blue Flag root); hyperacidity (Meadowsweet); excessive smoking and alcohol (Wormwood); bad teeth and septic tonsils (Poke root); diverticulitis (Fenugreek seeds); gastro-intestinal catarrh (Senna, Agrimony, Avens); smell of acetone as of diabetes (Goat’s Rue); constipation (Senna, Psyllium seed).

May be necessary for serious ear, nose and throat problems to be resolved by surgery. For blockage of respiratory channels, Olbas oil, Tea Tree oil or Garlic drops relieve congestion. Many cases have chronic gingivitis and arise from dental problems improved by 1 part Tea Tree oil to 20 parts water used as a spray. Alfalfa sprouts have a sweetening effect upon the breath. Chew Parsley or Peppermint. Alternatives. Teas. Dill seeds, Fennel seeds, Sage, Nettles, Mint, Liquorice root, Alfalfa, Wormwood. Dandelion (coffee). Parsley.

Tablets/capsules. Blue Flag root, Goldenseal, Echinacea. Wild Yam. Chlorophyll. Calamus.

Powders. Mix, parts: Blue Flag root 1; Myrrh half; Liquorice half. Dose: 250mg (one 00 capsule or one- sixth teaspoon) thrice daily before meals.

Gargle. 5 drops Tincture Myrrh to glass water, frequently.

Diet. Lacto-vegetarian. Lemon juice.

Supplements. Vitamins A, B-complex, B6, Niacin, C (500mg). ... bad breath

The basal ganglia play a vital part in producing smooth, continuous muscular actions and in stopping and starting movement.

Any disease or degeneration affecting the basal ganglia and their connections may lead to the appearance of involuntary movements, trembling, and weakness, as occur in Parkinson’s disease.... basal ganglia

BEHÇET’S... behaviourism

Prevention is best. Wipe over possible areas with whisky or Vodka following with Oil of St John’s Wort. Bed patients are encouraged to spend at least 2 or 3 hours out of bed daily. Many kinds of bed-care aids exist: inflatable rings, water beds and padded protection. Vitamin C deficiency exists in most cases. Treatment. Herbal antibiotics: Wild Indigo, Myrrh, Milk Thistle, Goldenseal, Echinacea, Marigold. Supportives: Comfrey, Sarsaparilla, Vitamin E.

Tablets/capsules. Goldenseal, Echinacea, Sarsaparilla.

Powders. Parts: Echinacea 2; Goldenseal 1; Liquorice 1. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Wild Indigo 1; Echinacea 2; Goldenseal quarter. 1-2 teaspoons in water 3 times daily. Practitioner. Tincture Echinacea BHP (1983) 20ml; Tincture Goldenseal BPC (1949) 5ml; Tincture Marigold BPC (1934) 10ml. Low alcohol vodka to 100ml. Sig: 5ml (3i) tds aq. cal. AC. (Anonymous) Topical. Early stages: Comfrey poultice or ointment. Marshmallow and Slippery Elm ointment; Oil St John’s Wort, Rue tea. Fresh pulp of Aloe Vera. Later stages: Sunlight soap plaster. Official medicine at the turn of the century used Lassar’s paste or zinc and castor oil ointment which are still effective. Distilled extract of Witch Hazel. For threatened gangrene, skin breakdown with formation of slough: (1) Zinc and Castor oil ointment (or cream) plus a little powdered Myrrh. (2) Cold poultice of Comfrey powder. ... bedsores

(See also aneurysm.)... berry aneurysm

As a result, bile is unable to drain from the liver (see cholestasis).

Unless the atresia can be treated, secondary biliary cirrhosis will develop and may prove fatal.

Symptoms include deepening jaundice, usually beginning a week after birth, and the passing of dark urine and pale faeces.

Treatment is by surgery to bypass the ducts.

If this fails, or if the jaundice recurs, a liver transplant is the only possible treatment.... biliary atresia

Bowel and kidney function should be investigated, as body odour is not normally offensive when these organs are healthy. Zinc is a powerful deodorant – zinc and castor oil cream being a traditional combination of pharmacy. Key herbal agent is Thuja, but it is sometimes advisable to add to this an agent for liver and kidneys.

Alternatives. Teas: Sage, Pennyroyal, Thyme, Betony. Decoctions: Sarsaparilla, Wild Yam.

Tablets/capsules. Seaweed and Sarsaparilla. Wild Yam, Thuja.

Formula: equal parts: Dandelion Root, Clivers, Thuja. Dosage – Powders: One-third teaspoon. Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons in water, thrice daily.

Topical. Dilute oil of Sage, or Sage tea, to under-arms, hands, feet.

Diet. Lacto-vegetarian. Safflower oil.

Vitamins. B-complex.

Minerals. Zinc. Dolomite. ... body odour

The last 2 are types of haemangioma (malformation of blood vessels).

Strawberry marks often increase in size in the first year, but most disappear after the age of 9 years.

Port-wine stains seldom fade, but laser treatment performed in adulthood can make some of them fade.... birthmark

The area is not sensitive to light because it has no light receptors (nerve endings responsive to light).

The blind spot can also be used to describe the part of the visual field in which objects cannot be detected.... blind spot

Symptoms: short dry cough, catarrh, wheezing, sensation of soreness in chest; temperature may be raised. Most cases run to a favourable conclusion but care is necessary with young children and the elderly. Repeated attacks may lead to a chronic condition.

Alternatives. Teas – Angelica, Holy Thistle, Elecampane leaves, Fenugreek seeds (decoction), Hyssop, Iceland Moss, Mouse Ear, Mullein, Nasturtium, Plantain, Wild Violet, Thyme, White Horehound, Wild Cherry bark (decoction), Lobelia, Liquorice, Boneset. With fever, add Elderflowers.

Tea. Formula. Equal parts: Wild Cherry bark, Mullein, Thyme. Mix. 1 heaped teaspoon to cup water simmered 5 minutes in closed vessel. 1 cup 2-3 times daily. A pinch of Cayenne assists action.

Irish Moss (Carragheen) – 1 teaspoon to cup water gently simmered 20 minutes. It gels into a viscous mass. Cannot be strained. Add honey and eat with a spoon, as desired.

Tablets/capsules. Iceland Moss. Lobelia. Garlic. Slippery Elm.

Prescription No 1. Morning and evening and when necessary. Thyme 2; Lungwort 2; Lobelia 1. OR Prescription No 2. Morning and evening and when necessary. Iceland Moss 2; Wild Cherry bark 1; Thyme 2.

Doses:– Powders: one-third teaspoon (500mg) or two 00 capsules. Liquid Extracts: 30-60 drops. Tinctures: 1-2 teaspoons.

Practitioner. Alternatives:–

(1) Tincture Ipecacuanha BP (1973). Dose, 0.25-1ml.

(2) Tincture Grindelia BPC (1949). Dose, 0.6-1.2ml.

(3) Tincture Belladonna BP (1980). Dose, 0.5-2ml.

Black Forest Tea (traditional). Equal parts: White Horehound, Elderflowers and Vervain. One teaspoon to each cup boiling water; infuse 5-15 minutes; drink freely.

Topical. Chest rub: Olbas oil, Camphorated oil. Aromatherapy oils:– Angelica, Elecampane, Mullein, Cajeput, Lemon, Eucalyptus, Lavender, Mint, Onion, Pine, Thyme.

Aromatherapy inhalants: Oils of Pine, Peppermint and Hyssop. 5 drops of each to bowl of hot water.

Inhale: head covered with a towel to trap steam.

Diet: Low salt, low fat, high fibre. Halibut liver oil. Wholefoods. Avoid all dairy products. Supplements. Vitamins A, C, D, E. ... bronchitis, acute

be replaced by unrelated new ones.

(See also psychotherapy.)... blocking

A steady herbal regime is required including agents which may coax sluggish liver or kidneys into action (Dandelion, Barberry). Sheer physical exhaustion may require Ginseng. For purulent sputum – Boneset, Elecampane, Pleurisy root. To increase resistance – Echinacea. Where due to tuberculosis – Iceland Moss. For blood-streaked mucus – Blood root. For fever – Elderflowers, Yarrow. To conserve cardiac energies – Hawthorn, Motherwort. A profuse sweat affords relief – Elderflowers.

Alternatives. Capsicum, Ephedra, Fenugreek, Garlic, Grindelia, Holy Thistle, Iceland Moss, Lobelia, Mullein, Pleurisy Root, Wild Cherry.

Tea. Formula. Iceland Moss 2; Mullein 1; Wild Cherry bark 1. 1 heaped teaspoon to each cup water gently simmered 10 minutes. Dose: 1 cup 2-3 times daily.

Powders. Pleurisy root 2; Echinacea 1; Holy Thistle 1. Pinch Ginger. Mix. Dose: 500mg (two 00 capsules or one-third teaspoon) 2-3 times daily.

Tinctures. Formula. Iceland Moss 2; Lobelia 2; Grindelia quarter; Capsicum quarter. Dose: 1-2 teaspoons two or more times daily.

Practitioner. Liquid Extract Ephedra BHP (1983), dose 1-3ml. Or: Tincture Ephedra BHP (1983), dose 6-8ml.

Topical. Same as for acute bronchitis.

Note: In a test at Trafford General Hospital, Manchester, blowing-up balloons proved of benefit to those with chronic bronchitis. Fourteen patients were asked to inflate balloons and 14 refrained from doing so. After 8 weeks, the balloon-blowers showed considerable improvement in walking and a sense of well- being. Breathlessness was reduced. Condition of the others was either unchanged or worse. ... bronchitis, chronic

Symptoms. Intermittent claudication. Affected parts of the leg are much paler than others, the condition regressing to ulceration and possible gangrene. Inflammation of nerves, veins and arteries may lead to clot formation (thrombosis).

Treatment. Stop smoking. Vasodilator herbs.

Alternatives. Cayenne (minute doses), Bayberry, Lime flowers, Lobelia, Prickly Ash, Wahoo bark, Mistletoe, Skullcap, Cactus.

BHP (1983) recommends: Angelica root, Hawthorn berry, Wild Yam.

Decoction. Formula. Equal parts: Hawthorn, Mistletoe, Valerian. 2 teaspoons to two cups water gently simmered 10 minutes. Dose half-1 cup thrice daily, and when necessary.

Tablets/capsules. Alternatives. Prickly Ash 100mg. Hawthorn 200mg. Wild Yam 200mg. Dosage as on bottles.

Powders. Formula. Equal parts: Hawthorn, Wild Yam, Prickly Ash. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Bayberry, Hawthorn, Prickly Ash. Dose: 1-2 teaspoons thrice daily. Practitioner. Tincture Gelsemium BPC (1973). 0.3ml (5 drops) when necessary for relief of pain.

Diet. Low fat, low salt, high fibre.

Supplements. Daily. Vitamin E 1000-1500iu. Vitamin B-complex. Magnesium, Calcium.

Exercise. Physiotherapy exercise. From the sitting position raise legs to horizontal; rest for a few minutes. Lie down and raise legs to 45 degrees; rest for a few minutes. Reverse movements resting each time to equalise the circulation. (Brenda Cooke FNIMH) ... buerger’s disease

This is usually due to a structural defect of the heart or the major arteries leaving the heart.

Such defects may need to be corrected surgically (see heart disease, congenital).... blue baby

Action. Expectorant for chronic bronchitis, asthma and other respiratory disorders.

Use. An inhalant. One 5ml teaspoon of the balsam to 500ml boiling water; patient inhales the vapour with a towel over the head.

Still used as an alternative to pressurised devices that may evoke a diminished response by over-use. Children may develop an unhealthy dependence upon a nebuliser resulting in bronchitis, the area of aerosol mists being an area of controversy. Friar’s balsam may still be used with effect.

Formula: macerate Benzoin 10 per cent, prepared Storax 7.5 per cent, Tolu balsam 2.5 per cent and Aloes 2 per cent with alcohol 90 per cent. ... friar’s balsam

The child usually becomes red or even blue in the face after a few seconds, and may faint.

Breathing quickly resumes as a natural reflex, ending the attack.

Attacks cause no damage and are usually outgrown.... breath-holding attacks

Alternatives. External.

Tinctures: Arnica, Acid tincture of Lobelia, Echinacea, Marigold, Myrrh, St John’s Wort.

Fresh plants. Crush and apply: Comfrey, Garlic, Houseleek, Marigold, Onion, Plantain. St John’s Wort: specific – horsefly.

Witch Hazel Lotion.

Cider Vinegar: wasp bites.

Bee and ant bites: in absence of any of the above: bicarbonate of soda.

Aromatherapy. Any one oil – Eucalyptus, Clove, Lavender.

For shock: with faintness and pallor: few grains Cayenne pepper in honey or cup of tea. Supplements. Vitamin A and B-complex. ... insect bites

Bronchioles branch from larger airways (bronchi) and subdivide into progressively smaller tubes before reaching the alveoli (see alveolus, pulmonary), where gases are exchanged.... bronchiole

provoke an asthma attack. The effect can be reversed by a bronchodilator drug.... bronchoconstrictor

Brown fat is located between and around the scapulae (shoulderblades) on the back.

It is a source of energy and helps infants to maintain a constant body temperature.... brown fat

Barotrauma can be avoided by vigorous swallowing or by forcibly breathing out with the mouth closed and the nose pinched (the Valsalva manoeuvre). This action equalizes the internal and external pressures in the middle ear and sinuses. If the eustachian tubes are blocked, as commonly occurs with a cold, use of a nasal spray containing a decongestant drug is recommended shortly before the descent of the aircraft. Infants should be breast- or bottle-fed during descent to encourage swallowing. (See also aviation medicine.)... barotrauma

pressure inside the eyeball due to congenital glaucoma.

Treatment of the condition usually involves surgery to reduce the pressure, otherwise the child’s sight is progressively damaged.... buphthalmos

The bladder walls consist of muscle and an inner lining.

Two ureters carry urine to the bladder from the kidneys.

At the lowest point of the bladder is the opening into the urethra, which is known as the bladder neck.

This is normally kept tightly closed by a ring of muscle (the urethral sphincter).

The function of the bladder is to collect and store urine until it can be expelled.

Defective bladder function, leading to problems such as incontinence and urinary retention, can have a variety of causes.

(See also bladder, disorders of; enuresis).... bladder

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

The size and shape and general appearance of the breasts may vary during the menstrual cycle, during pregnancy and lactation, and after the menopause.

During pregnancy, oestrogen and progesterone, secreted by the ovary and placenta, cause the milkproducing glands to develop and become active and the nipple to become larger.

Just before and after

childbirth, the glands in the breast produce a watery fluid known as colostrum.

This fluid is replaced by milk a few days later.

Milk production and its release is stimulated by the hormone prolactin.... breast

The first sign of breast cancer may be a painless lump. Other symptoms may include a dark discharge from the nipple, retraction (indentation) of the nipple, and an area of dimpled, creased skin over the lump. In 90 per cent of the cases, only 1 breast is affected. The cancer may be suspected after discovering a lump during breast self-examination or mammography. If a lump is detected, cells will be collected from it by needle aspiration or surgical biopsy. If the lump is cancerous, the treatment given depends on the woman’s age, the size of the tumour, whether or not there are signs of spread to the lymph nodes, and the sensitivity of the tumour cells to hormones, as assessed in the laboratory. A small tumour, with no evidence of having spread outside the breast, is removed surgically. Lymph nodes in the armpit are also commonly removed at the same time. Surgery may be combined with radiotherapy and/or anticancer drugs.

Secondary tumours in other parts of the body are treated with anticancer drugs and hormones. Regular check-ups are required to detect recurrence or the development of a new cancer in the other breast. If the cancer recurs, it can be controlled, in some cases, for years by drugs and/or radiotherapy.... breast cancer

It is especially useful in the diagnosis of Crohn’s disease, coeliac disease, lymphoma, and other causes of malabsorption.

The biopsy is taken using an endoscope passed down the throat into the small intestine, via the stomach.... jejunal biopsy

’S

Buerger’s disease A rare disorder, also called thromboangiitis obliterans, in which the arteries, nerves, and veins in the legs, and sometimes those in the arms, become severely inflamed. Blood supply to the toes and fingers becomes cut off, eventually causing gangrene. The disease is most common in men under the age of 45 who smoke heavily. bulimia An illness that is characterized by bouts of overeating usually followed by self-induced vomiting or excessive laxative use. Most sufferers are girls or women between the ages of 15 and 30. In some cases, the symptoms coexist with those of anorexia nervosa. Repeated vomiting can lead to dehydration and loss of potassium, causing weakness and cramps, and tooth damage due to the gastric acid in vomit. Treatment includes supervision and regulation of eating habits, and sometimes, antidepressant drugs and/or psychotherapy. bulk-forming agent A substance that makes stools less liquid by absorbing water: a type of antidiarrhoeal drug. bulla A large air- or fluid-filled bubble, usually in the lungs or skin. Lung bullae in young adults are usually congenital. In later life, lung bullae develop in patients with emphysema. Skin bullae are large, fluid-filled blisters with a variety of causes, including the bullous disease pemphigus.... budesonide

The experience, which is thought to be due to disturbance of brain function, is reported by some patients following a general anaesthetic or a medical emergency.... out-of-body experience

rectal examination Examination of the anus and rectum, performed as part of a general physical examination, to assess symptoms of pain or changes in bowel habits, and to check for the presence of tumours of the rectum or prostate gland. rectal prolapse Protrusion outsid.

nent in elderly people. If the prolapse is large, leakage of faeces may occur.

Treatment is with a fibre-rich diet.

Surgery may also be performed.... rectal bleeding

It often causes belching and abdominal discomfort.

Long-term use may cause swollen ankles, muscle cramps, tiredness, and nausea.... sodium bicarbonate

spinal anaesthesia Injection of an anaesthetic into the cerebrospinal fluid in the spinal canal to block pain sensations before they reach the central nervous system. It is used mainly during surgery on the lower abdomen and legs.

(See also epidural anaesthesia.)... spina bifida

Habitat: The temperate and subtropical Himalayas from Kishtwar to Sikkim at 1,200-3,200 m, Khasi hills.

Action: Astringent, diuretic, spasmolytic. Plant is given in whooping cough, roots in hemicrania.

Habitat: The sub-Himalayan tract, plains of Punjab and the upper Gangetic plain.

Action: Astringent, febrifugal (given in intermittent fever), stimulant, aperient, diuretic. Used for the treatment of gout and rheumatism; also for amenorrhoea. Juice of the leaves—blood purifier. The powder is used for burns and boils. The leaves are used in fever as a substitute for cinchona.

Habitat: The plains and foothills, up to an altitude of 2,100 m.

Action: Bark and roots—sedative, anthelmintic.

Habitat: Cultivated throughout India, wild on coasts of Maharashtra, Gujarat and South India.

Action: Purgative (causes griping), emmenagogue. Gel—topically emollient, anti-inflammatory, antimicrobial (used for wound healing, sunburn).

Habitat: Throughout India.

Action: Cooling, stomachic, emollient. Used in biliousness, haemorrhagic diathesis.... amaranthus blitum

Habitat: Nepal, Sikkim and Bhutan, Khasi Hills.

Action: Stimulant, aphrodisiac, antipyretic, dyspeptic, expectorant.... aralia binnatifida

Habitat: Marshy areas throughout India, as a weed.

Action: Stomachic, laxative, antirheumatic, febrifuge. Leaves— used externally for ringworm, herpic eruptions and other skin diseases; rubefacient.

Habitat: Uttar Pradesh, Bengal, Madhya Pradesh and western peninsular India.

Action: Oxytocic, abortifacient, emmenagogue.

Habitat: The alpine Himalayas from Kashmir to Kumaon, at altitude of 3,000-3,900 m, and in Nepal.

Action: Stimulant, cardiac tonic, expectorant, diuretic (syrup and jam, used in diseases of the mouth and throat, also in the treatment of fevers and debility.) The roots possess antiseptic and antibiotic properties.... arnebia benthamii

Habitat: Native to Malaysia; cultivated throughout the country.

Action: A syrup made from the fruits is used in febrile excitement, haemorrhages and internal haemorrhoids; also in diarrhoea, bilious colic and hepatitis. The fruit is used for scurvy. An infusion of flowers is given for cough.... averrhoa bilimbi

Absent CORNEAL REFLEX

Absent VESTIBULO-OCULAR REFLEX

No cranial motor response to somatic (physical) stimulation

Absent gag and cough re?exes

No respiratory e?ort in response to APNOEA despite adequate concentrations of CARBON DIOXIDE in the arterial blood.... b nosed. the test for brain-stem death are:

Bara, Barah, Barra, Barrah ... baara

Babett, Babete, Babet, Babbet, Babbett, Babbette, Babbete, Babita, Babitta, Babbitta, Babs... babette

Babi, Babie, Babey, Babe, Bebe, Babea, Babeah... baby

Habitat: Throughout the plains of India in damp marshy areas.

Action: Adaptogenic, astringent, diuretic, sedative, potent nervine tonic, anti-anxiety agent (improves mental functions, used in insanity, epilepsy), antispasmodic (used in bronchitis, asthma and diarrhoea).

See www.cancerbacup.org.uk... bacup

Badiah, Badi’a, Badiya, Badea, Badya, Badeah... badia

Bahirah, Baheera, Bahyra, Bahiera, Baheira, Bahiya, Bahiyah, Baheerah, Bahyrah, Baheirah, Bahierah, Baheara, Bahearah... bahira

Habitat: Drier parts of India, particularly in Rajasthan, Gujarat, Madhya Pradesh and Deccan.

Action: Seed—expectorant, bechic. Oil—antibacterial, antifungal. Fruit—used in whooping cough; also in leucoderma and other skin diseases. Bark—spasmolytic.

Habitat: The Himalayas from Kashmir to Sikkim and Darjeeling at altitudes of 1,800-3,400 m

Action: Astringent. Used in piles, also in rheumatism.

Balhart, Baldhard, Balhard, Ballard, Balard, Balarde... baldhart

Balighah, Baleegha, Balygha, Baliegha, Baleagha, Baleigha... baligha

Habitat: The Himalayas, Assam, Khasi Hills, Bengal, Madhya Pradesh, Bihar and Peninsular India, ascending to 1,800 m.

Action: Seed—purgative. Leaves— purgative (also used in dropsy), antiasthmatic (decoction is given in asthma). Latex—used for body ache and pain of joints. Root and seed oil—cathartic, antidropsical.

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

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

Bambyna, Bambinna, Bambie, Bambi, Bambey, Bambee, Bamhi, Bambea, Bambeah... bambina

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

About the Nutrients in This Food A banana begins life with more starch than sugar, but as the fruit ripens its starches turn to sugar, which is why ripe bananas taste so much better than unripe ones.* The color of a banana’s skin is a fair guide to its starch/ sugar ratio. When the skin is yellow-green, 40 percent of its carbohydrates are starch; when the skin is fully yellow and the banana is ripe, only 8 per- cent of the carbohydrates are still starch. The rest (91 percent) have broken down into sugars—glucose, fructose, sucrose, the most plentiful sugar in the fruit. Its high sugar content makes the banana, in its self-contained packet, a handy energy source. Bananas are a high-fiber food with insoluble cellulose and lignin in the tiny seeds and soluble pectins in the flesh. They are also a good source of vitamin C and potassium. One small (six-inch) banana or a half-cup of sliced banana has 2.6 g dietary fiber and 8.8 mg vitamin C (12 percent of the R DA for a woman, 10 percent of the R DA for a man), plus 363 mg potassium.

The Most Nutritious Way to Serve This Food Fresh and ripe. Green bananas contain antinutrients, proteins that inhibit the actions of amylase, an enzyme that makes it possible for us to digest * They are also more healt hful. Green bananas contain proteins t hat inhibit amy- lase, an enzyme t hat makes it possible for us to digest complex carbohydrates. starch and other complex carbohydrates. Raw bananas are richer in potassium than cooked bananas; heating depletes potassium.

Buying This Food Look for: Bananas that will be good when you plan to eat them. Bananas with brown specks on the skin are ripe enough to eat immediately. Bananas with creamy yellow skin will be ready in a day or two. Bananas with mostly yellow skin and a touch of green at either end can be ripened at home and used in two or three days. Avoid: Overripe bananas whose skin has turned brown or split open. A grayish yellow skin means that the fruit has been damaged by cold storage. Bananas with soft spots under the skin may be rotten.

Storing This Food Store bananas that aren’t fully ripe at room temperature for a day or two. Like avocados, bananas are picked green, shipped hard to protect them from damage en route and then sprayed with ethylene gas to ripen them quickly. Untreated bananas release ethylene natu- rally to ripen the fruit and turn its starches to sugar, but natural ripening takes time. Artificial ripening happens so quickly that there is no time for the starches to turn into sugar. The bananas look ripe but they may taste bland and starchy. A few days at room temperature will give the starches a chance to change into sugars. Store ripe bananas in the refrigerator. The cold air will slow (but not stop) the natural enzyme action that ripens and eventually rots the fruit if you leave it at room temperature. Cold storage will darken the banana’s skin, since the chill damages cells in the peel and releases polyphenoloxidase, an enzyme that converts phenols in the banana peel to dark brown compounds, but the fruit inside will remain pale and tasty for several days.

Preparing This Food Do not slice or peel bananas until you are ready to use them. When you cut into the fruit, you tear its cell walls, releasing polyphenoloxidase, an enzyme that hastens the oxidation of phenols in the banana, producing brown pigments that darken the fruit. (Chilling a banana produces the same reaction because the cold damages cells in the banana peel.) You can slow the browning (but not stop it completely) by dipping raw sliced or peeled bananas into a solution of lemon juice or vinegar and water or by mixing the slices with citrus fruits in a fruit salad. Overripe, discolored bananas can be used in baking, where the color doesn’t matter and their intense sweetness is an asset.

What Happens When You Cook This Food When bananas are broiled or fried, they are cooked so quickly that there is very little change in color or texture. Even so, they will probably taste sweeter and have a more intense aroma than uncooked bananas. Heat liberates the volatile molecules that make the fruit taste and smell good.

How Other Kinds of Processing Affect This Food Drying. Drying removes water and concentrates the nutrients and calories in bananas. Bananas may be treated with compounds such as sulfur dioxide to inhibit polyphenoloxi- dase and keep the bananas from browning as they dry. People who are sensitive to sulfites may suffer severe allergic reactions, including anaphylactic shock, if they eat these treated bananas. Freezing. Fresh bananas freeze well but will brown if you try to thaw them at room tem- perature. To protect the creamy color, thaw frozen bananas in the refrigerator and use as quickly as possible.

Medical Uses and/or Benefits Lower risk of stroke. Various nutrition studies have attested to the power of adequate potassium to keep blood pressure within safe levels. For example, in the 1990s, data from the long-running Harvard School of Public Health/Health Professionals Follow-Up Study of male doctors showed that a diet rich in high-potassium foods such as bananas, oranges, and plantain may reduce the risk of stroke. In the study, the men who ate the higher number of potassium-rich foods (an average of nine servings a day) had a risk of stroke 38 percent lower than that of men who consumed fewer than four servings a day. In 2008, a similar survey at the Queen’s Medical Center (Honolulu) showed a similar protective effect among men and women using diuretic drugs (medicines that increase urination and thus the loss of potassium). Improved mood. Bananas and plantains are both rich in serotonin, dopamine, and other natural mood-elevating neurotransmitters—natural chemicals that facilitate the transmis- sion of impulses along nerve cells. Potassium benefits. Because potassium is excreted in urine, potassium-rich foods are often recommended for people taking diuretics. In addition, a diet rich in potassium (from food) is associated with a lower risk of stroke. A 1998 Harvard School of Public Health analysis of data from the long-running Health Professionals Study shows 38 percent fewer strokes among men who ate nine servings of high potassium foods a day vs. those who ate less than four servings. Among men with high blood pressure, taking a daily 1,000 mg potas- sium supplement—about the amount of potassium in one banana—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with This Food Digestive Problems. Unripe bananas contain proteins that inhibit the actions of amylase, an enzyme required to digest starch and other complex carbohydrates. Sulfite allergies. See How other kinds of processing affect this food. Latex-fruit syndrome. Latex is a milky fluid obtained from the rubber tree and used to make medical and surgical products such as condoms and protective latex gloves, as well as rub- ber bands, balloons, and toys; elastic used in clothing; pacifiers and baby bottle-nipples; chewing gum; and various adhesives. Some of the proteins in latex are allergenic, known to cause reactions ranging from mild to potentially life-threatening. Some of the proteins found naturally in latex also occur naturally in foods from plants such as avocados, bananas, chestnuts, kiwi fruit, tomatoes, and food and diet sodas sweetened with aspartame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOTE : The National Insti- tute of Health Sciences, in Japan, also lists the following foods as suspect: Almonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celery, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectar- ines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pineapples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions 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 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. There have been some reports in the past of such reactions in people who have eaten rotten bananas or bananas stewed with the peel. False-positive test for tumors. Carcinoid tumors—which may arise from tissues of the endo- crine system, the intestines, or the lungs—secrete serotonin, a natural chemical that makes blood vessels expand or contract. Because serotonin is excreted in urine, these tumors are diagnosed by measuring the levels of serotonin by-products in the urine. Bananas contain large amounts of serotonin; eating them in the three days before a test for an endocrine tumor might produce a false-positive result, suggesting that you have the tumor when in fact you don’t. (Other foods high in serotonin are avocados, eggplant, pineapple, plums, tomatoes, and walnuts.)... bananas

For more detailed information about bandaging, the reader is referred to First Aid Manual, the authorised manual of the St John’s Ambulance Association, St Andrew’s Ambulance Association and British Red Cross Society.... bandages

Bandanah, Bandanna, Bandannah... bandana

Bandel, Bandelle, Bandell, Bandela, Bandella... bandele

Habitat: Arabia, Somaliland.

Action: Oleo-gum-resin—em- menagogue (used for irregular menstruation and painful periods), anti-inflammatory (on pharyngitis and gingivitis), antiseptic, bacteriostatic, antiviral, astringent, stimulant, expectorant, stomachic, carminative (in dyspepsia), a leuco- cytogenic agent (increases number of white cells in the blood). Used externally for treating acne, boils and pressure sores, internally as a blood purifier.

Habitat: Found in countries on both sides of Red Sea.

Action: Used in diseases of the urinary tract. Balsams are diuretic and stimulate mucous tissues in small doses (nauseatic and purgative in large doses).

Habitat: Wild throughout India, especially in the hill forests of Western and Southern India.

Action: Leaf bud and young shoots—used in dysmenorrhoea; externally in ulcerations. Leaf—em- menagogue, antileprotic, febrifuge, bechic; used in haemoptysis. Stem and leaf—blood purifier (used in leucoderma and inflammatory conditions). Root—poisonous. Burnt root is applied to ringworm, bleeding gums, painful joints. Bark—used for eruptions. Leaf and Bamboo-manna—emmena- gogue. Bamboo-manna—pectoral, expectorant, carminative, cooling, aphrodisiac, tonic (used in debilitating diseases, urinary infections, chest diseases, cough, asthma).

• Bring 400 milliliters (1 and 1/2 cups or 12 ounces) water to a strong boil.
• Reduce heat to low and drop in a tea bag.
• Keep at or below a simmer for 15 minutes.
• Evaporation will leave about 250 milliliters (1 cup or 8 ounces) of tea.
• Pour fresh brewed tea into a cup and drink while it is still warm.
• Save the tea bag. You should reuse each tea bag up to four times to achieve effective results.

• fight against diabetes by helping control blood sugar levels
• control blood cholesterol levels
• lower blood pressure
• help urinary system related ailments
• help in the treatment of diarrhea
• help in the treatment of constipation
• help reducing the absorption of carbohydrates, aiding the weight loss efforts
• help in the treatment of gout
• help in lowering uric acid levels

Barbra, Barbarella, Barbarita, Baibin, Baibre, Bairbre, Barbary, Barb, Barbi, Barbie, Barby, Barbey, Bobbie, Barbro, Barabal, Barabell, Basha, Basham, Baubie, Bobbi, Bobby, Bora, Borbala, Borhala, Borka, Boriska, Borsca, Borska, Borsala, Brosca, Broska... barbara

Barikah, Baryka, Barikka, Barykka, Baricka, Barycka, Baricca, Barycca... barika

Habitat: Subalpine and temperate Himalayas, at altitudes of 1,8003,750 m.

Action: Diuretic, anthelmintic, stomachic, antiscorbutic, (leaves are rich in vitamin C 130 mg/100 g). Pulverised herb is used as an agent for stimulating spermatogenesis.

Habitat: Woods and hedges, also gardens.

Action: Tonic, antiseptic, purgative.

• inflammation due to bacterial ear, nose and throat infection
• bacterial and viral forms of diarrhea
• psoriasis
• the function of the gallbladder
• urinary tract infection
• heartburn
• candida
• epilepsy

Habitat: Peninsular India from Maharashtra southwards up to an altitude of 1,200 m. An ornamental hedge plant in gardens.

Action: Roots and leaves are used in cough, bronchitis, inflammations (applied to swellings).... barleria buxifolia

Barrane, Baran, Barane, Barrayne, Barayne, Baranne, Barann, Barrann... barran

Habitat: Subtropical Himalaya, Sikkim, Khasi Hills, Central and Southern India at 1,350 m.

Action: Extract of the plant— sasmogenic and hypoglycaemic. Root extract—given in anaemia. The leaves are chewed in toothache. Roots and leaves are applied to swellings. An infusion is given in cough.

Habitat: Throughout the hotter parts of India. Also, commonly grown as a hedge plant in gardens.

Action: Leaf—juicegiveninstomach disorders, urinary affections; mixed with honey and given to children with fever and catarrh; leaf juice is applied to lacerated soles of feet in the rainy season, mixed with coconut oil for pimples. Leaves and flowering tops—diuretic. Bark—diaphoretic and expectorant. Roots—paste is applied over boils and glandular swellings. Plant (Vajradanti)—antidontalgic, used for bleeding gums in Indian medicine. Ash, obtained from the whole plant, mixed with honey, is given in bronchial asthma.

Habitat: The Himalayas from Uttar Pradesh to West Bengal, up to an altitude of 1,200 m.

Action: Mild antiseptic, expectorant (given in spasmodic cough); also used as an antianaemic.

• certain forms of cancer
• digestion
• prostate
• sleep disorder

Barett, Barrette, Barette, Barrete, Barete, Barretta, Baretta, Barreta, Bareta... barrett

Habitat: Sub-Himalayan tracts from the Ganges eastwards to Assam and Madhya Pradesh.

Action: Leaf juice—given in diarrhoea. Fruit—bitter, acrid, anthelmintic, haemolytic, vulnerary; prescribed in gingivitis as an expectorant. Powdered seeds— emetic and expectorant. Bark— astringent, used in diarrhoea and blennorrhoea. Febrifuge. Wood— haemostatic (in metrorrhagia).

Habitat: Grown as a pot herb in almost every part of India, except hills.

Action: Demulcent, diuretic, laxative (a good substitute for spinach and purslane). Used as a cooling medicine in digestive disorders. Leaf juice is used in balanitis and catarrhal affections. Externally applied in urticaria, burns, scalds. Root—decoction is given to stop bilious vomiting and in intestinal complaints. Used as poultice to reduce local swellings; sap is used in acne.

• bring the water and the basil leaves to boil (in a small tea pan)
• lower the heat and allow it to brew for 3-4 minutes
• add the tea leaves or tea bags and sugar according to taste
• bring to boil
• turn off the heat
• strain it into cups and add milk according to taste

• treat intestinal colics, gastric ulcers and bloating/swelling of the abdomen
• treat anorexia
• fight urinary tract infections
• help against diarrhea
• help fight insomnia
• help treat lesions and inflammations in the mouth
• enhance the body’s ability to resist stress
• help to relieve pain

Habitat: South India; common in the monsoon forests of Western Ghats.

Action: Flowers—laxative, bechic (used in coughs, colds and bronchitis), stimulant and nervine tonic. Seed oil—galactogenic, anticephalalgic, laxative in cases of habitual constipation and piles; used externally in rheumatism and skin affections. Bark, seed oil and gum—antirheumatic.

Batulle, Batoole, Batool, Batula, Batulah, Betul, Betool, Betulle, Betula, Betoole... batul

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low Saturated fat: Low Cholesterol: None Carbohydrates: High Fiber: Very high Sodium: Low Major vitamin contribution: Vitamin B6, folate Major mineral contribution: Iron, magnesium, zinc

About the Nutrients in This Food Beans are seeds, high in complex carbohydrates including starch and dietary fiber. They have indigestible sugars (stachyose and raffinose), plus insoluble cellulose and lignin in the seed covering and soluble gums and pectins in the bean. The proteins in beans are limited in the essential amino acids methionine and cystine.* All beans are a good source of the B vitamin folate, and iron. One-half cup canned kidney beans has 7.5 g dietary fiber, 65 mcg folate (15 percent of the R DA), and 1.6 mg iron (11 percent of the R DA for a woman, 20 percent of the R DA for a man). Raw beans contain antinutrient chemicals that inactivate enzymes required to digest proteins and carbohydrates. They also contain factors that inactivate vitamin A and also hemagglutinins, substances that make red blood cells clump together. Cooking beans disarms the enzyme inhibi- tors and the anti-vitamin A factors, but not the hemagglutinins. However, the amount of hemagglutinins in the beans is so small that it has no mea- surable effect in your body. * Soybeans are t he only beans t hat contain proteins considered “complete” because t hey contain sufficient amounts of all t he essent ial amino acids. The Folate Content of ½ Cup Cooked Dried Beans

The Most Nutritious Way to Serve This Food Cooked, to destroy antinutrients. With grains. The proteins in grains are deficient in the essential amino acids lysine and isoleucine but contain sufficient tryptophan, methionine, and cystine; the proteins in beans are exactly the opposite. Together, these foods provide “complete” proteins. With an iron-rich food (meat) or with a vitamin C-rich food (tomatoes). Both enhance your body’s ability to use the iron in the beans. The meat makes your stomach more acid (acid favors iron absorption); the vitamin C may convert the ferric iron in beans into ferrous iron, which is more easily absorbed by the body.

Diets That May Restrict or Exclude This Food Low-calcium diet Low-fiber diet Low-purine (antigout) diet

Buying This Food Look for: Smooth-skinned, uniformly sized, evenly colored beans that are free of stones and debris. The good news about beans sold in plastic bags is that the transparent material gives you a chance to see the beans inside; the bad news is that pyridoxine and pyridoxal, the natural forms of vitamin B6, are very sensitive to light. Avoid: Beans sold in bulk. Some B vitamins, such as vitamin B6 (pyridoxine and pyridoxal), are very sensitive to light. In addition, open bins allow insects into the beans, indicated by tiny holes showing where the bug has burrowed into or through the bean. If you choose to buy in bulk, be sure to check for smooth skinned, uniformly sized, evenly colored beans free of holes, stones, and other debris.

Storing This Food Store beans in air- and moistureproof containers in a cool, dark cabinet where they are pro- tected from heat, light, and insects.

Preparing This Food Wash dried beans and pick them over carefully, discarding damaged or withered beans and any that float. (Only withered beans are light enough to float in water.) Cover the beans with water, bring them to a boil, and then set them aside to soak. When you are ready to use the beans, discard the water in which beans have been soaked. Some of the indigestible sugars in the beans that cause intestinal gas when you eat the beans will leach out into the water, making the beans less “gassy.”

What Happens When You Cook This Food When beans are cooked in liquid, their cells absorb water, swell, and eventually rupture, releasing the pectins and gums and nutrients inside. In addition, cooking destroys antinutri- ents in beans, making them more nutritious and safe to eat.

How Other Kinds of Processing Affect This Food Canning. The heat of canning destroys some of the B vitamins in the beans. Vitamin B is water-soluble. You can recover all the lost B vitamins simply by using the liquid in the can, but the liquid also contains the indigestible sugars that cause intestinal gas when you eat beans. Preprocessing. Preprocessed dried beans have already been soaked. They take less time to cook but are lower in B vitamins.

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 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 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. 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-run ning Nurses Health Study at Har vard 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 a day from either food or supple- ments, more than t wice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. A lthough men were not included in the analysis, the results are assumed to apply to them as well. NOT E : Beans are high in B6 as well as folate. Fruit, green leaf y vegetables, whole grains, meat, fish, poultr y, and shellfish are good sources of vitamin B6. To reduce the levels of serum cholesterol. The gums and pectins in dried beans and peas appear to lower blood levels of cholesterol. Currently there are two theories to explain how this may happen. The first theory is that the pectins in the beans form a gel in your stomach that sops up fats and keeps them from being absorbed by your body. The second is that bacteria in the gut feed on the bean fiber, producing short-chain fatty acids that inhibit the production of cholesterol in your liver. As a source of carbohydrates for people with diabetes. Beans are digested very slowly, produc- ing only a gradual rise in blood-sugar levels. As a result, the body needs less insulin to control blood sugar after eating beans than after eating some other high-carbohydrate foods (such as bread or potato). In studies at the University of Kentucky, a bean, whole-grain, vegetable, and fruit-rich diet developed at the University of Toronto enabled patients with type 1 dia- betes (who do not produce any insulin themselves) to cut their daily insulin intake by 38 percent. Patients with type 2 diabetes (who can produce some insulin) were able to reduce their insulin injections by 98 percent. This diet is in line with the nutritional guidelines of the American Diabetes Association, but people with diabetes should always consult with their doctors and/or dietitians before altering their diet. As a diet aid. Although beans are high in calories, they are also high in bulk (fiber); even a small serving can make you feel full. And, because they are insulin-sparing, they delay the rise in insulin levels that makes us feel hungry again soon after eating. Research at the University of Toronto suggests the insulin-sparing effect may last for several hours after you eat the beans, perhaps until after the next meal.

Adverse Effects Associated with This Food Intestinal gas. All legumes (beans and peas) contain raffinose and stachyose, complex sug- ars that human beings cannot digest. The sugars sit in the gut and are fermented by intestinal bacteria which then produce gas that distends the intestines and makes us uncomfortable. You can lessen this effect by covering the beans with water, bringing them to a boil for three to five minutes, and then setting them aside to soak for four to six hours so that the indigestible sugars leach out in the soaking water, which can be discarded. Alternatively, you may soak the beans for four hours in nine cups of water for every cup of beans, discard the soaking water, and add new water as your recipe directs. Then cook the beans; drain them before serving. Production of uric acid. Purines are the natural metabolic by-products of protein metabo- lism in the body. They eventually break down into uric acid, sharp cr ystals that may concentrate in joints, a condition known as gout. If uric acid cr ystals collect in the urine, the result may be kidney stones. Eating dried beans, which are rich in proteins, may raise the concentration of purines in your body. Although controlling the amount of purines in the diet does not significantly affect the course of gout (which is treated with allopurinol, a drug that prevents the formation of uric acid cr ystals), limiting these foods is still part of many gout regimens.

Food/Drug Interactions Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They 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. Some nutrition guides list dried beans as a food to avoid while using M AO inhibitors.... beans

Habitat: Central India.

Action: Bark and leaves—a decoction is given in biliousness, stone in bladder, venereal diseases, leprosy and asthma. Root—boiled with oil is applied to burns.... bauhinia acuminata

Habitat: South India, Assam and Bengal.

Action: Antidysenteric.

Habitat: The Himalayas, and distributed in Northern India, Assam, Khasi Hills. Also cultivated in gardens.

Action: Bark—astringent, antidiar- rhoeal. Flower buds and flowers, fried in purified butter, are given to patients suffering from dysentery. Extract of stems are used internally and externally for fractured bones. Plant is used in goitre. It exhibited antithyroid-like activity in experimental animals.

Habitat: Sub-Himalayan tracts from Ravi eastwards, ascending to 1,000 m. in the Uttar Pradesh, West Bengal and Central and South India.

Action: Bark—highly astringent, anti-inflammatory (used in glandular inflammations, skin diseases, ulcers), cholagogue. Leaves—anthelmintic; with onion for diarrhoea. Flowers—used in haemorrhages, piles; also in cough. Seed—antibacterial.

Habitat: Northwestern Himalayas up to 1500 m, also in Orissa, Madhya Pradesh and Andhra Pradesh.

Action: Gum—emmenagogue, diuretic. (Gum resembles Gum arabic; used as an external application for sores). Protein isolated from seeds—hypoglycaemic, hypoc- holesterolaemic in young, normal as well as alloxan-induced diabetic albino rats.

Habitat: Southern India, Assam and Bihar.

Action: Antidysenteric. Fruit— diuretic. Bark—astringent. Root bark—vermifuge. A decoction of the root bark is prescribed for liver diseases. Seed—used for wound healing.

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

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

Habitat: Near the sea in pastures and on stony soils.

Action: A powerful stimulant, astringent and tonic to the alimentary tract.

The result is that patients who need inpatient care cannot always be admitted. The term ‘bedblockers’ is derogatory and should not be used.... bed-blocking

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

About the Nutrients in This Food Because beans use stored starches and sugars to produce green shoots called sprouts, sprouted beans have less carbohydrate than the beans from which they grow. But bean sprouts are a good source of dietary fiber, including insoluble cellulose and lignin in leaf parts and soluble pectins and gums in the bean. The sprouts are also high in the B vitamin folate and vitamin C. One-half cup raw mung bean sprouts has 1.2 mg dietary fiber, 31.5 mcg folate (8 percent of the R DA), and 7 mg vitamin C (9 percent of the R DA for a woman, 7 percent of the R DA for a man). Raw beans contain anti-nutrient chemicals that inhibit the enzymes we use to digest proteins and starches; hemagglutinins (substances that make red blood cells clump together); and “factors” that may inactivate vita- min A. These chemicals are usually destroyed when the beans are heated. with the bean must be cooked before serving. Sprouted beans served

The Most Nutritious Way to Serve This Food Cooked (see Adverse effects associated with this food ).

Diets That May Restrict or Exclude This Food Low-fiber, low-residue diet

Buying This Food Look for: Fresh, crisp sprouts. The tips should be moist and tender. (The shorter the sprout, the more tender it will be.) It is sometimes difficult to judge bean sprouts packed in plastic bags, but you can see through to tell if the tip of the sprout looks fresh. Sprouts sold from water-filled bowls should be refrigerated, protected from dirt and debris, and served with a spoon or tongs, not scooped up by hands. Avoid: Mushy sprouts (they may be decayed) and soft ones (they have lost moisture and vitamin C).

Storing This Food Refrigerate sprouts in a plastic bag to keep them moist and crisp. If you bought them in a plastic bag, take them out and repack them in bags large enough that they do not crush each other. To get the most vitamin C, use the sprouts within a few days.

Preparing This Food R inse the sprouts thoroughly under cold running water to get rid of dirt and sand. Discard any soft or browned sprouts, then cut off the roots and cook the sprouts. Do not tear or cut the sprouts until you are ready to use them. When you slice into the sprouts, you tear cells, releasing enzymes that begin to destroy vitamin C.

What Happens When You Cook This Food Cooking destroys some of the heat-sensitive vitamin C in sprouts. To save it, steam the sprouts quickly, stir-fry them, or add them uncooked just before you serve the dish.

How Other Kinds of Processing Affect This Food Canning. Vitamin C is heat-sensitive, and heating the sprouts during the canning process reduces their vitamin C content.

Medical Uses and/or Benefits Lower risk of some birth defects. As many as t wo of ever y 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 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 continuing through the first t wo 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 provid- ing 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 University 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 Food poisoning: Reacting to an outbreak of Salmonella and E. coli O157:H7 food poisoning associated with eating raw alfalfa sprouts, the Food and Drug Administration issued a warn- ing in 1998 and again in summer 1999, cautioning those at high risk of food-borne illness not to eat any raw sprouts. The high-risk group includes children, older adults, and people with a weakened immune system (for example, those who are HIV-positive or undergoing cancer chemotherapy). Tests conducted by the U.S. Department of Agriculture in 1999 sug- gest that irradiating raw sprouts and bathing them in an antiseptic solution at the processing plant may eliminate disease organisms and prolong the vegetable’s shelf life; this remains to be proven.... bean sprouts

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

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

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

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

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

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

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

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

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

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

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

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

Habitat: Tropical and sub-tropical regions, especially in America. Found in Sikkim, Arunachal Pradesh, Assam, Meghalaya, Nagaland and Manipur, ascending to an altitude to 2,100 m.

Action: A decoction of the root is given for liver diseases and fever. The extract from succulent stalks is used for venereal diseases in folk medicine. Fresh shoots are chewed for tooth troubles. Aqueous extracts of the leaves and flowers of Begonia sp. are active against Gram-positive and Gram-negative bacteria.

Habitat: Introduced from China; cultivated all over India, up to an altitude of 1,800 m.

Action: Rhizomes—expectorant, deobstruent, resolvent, used in tonsillitis, chest and liver complaints (antiviral against pneumonia).

Beliciah, Beliciya, Belicya, Beleecia, Belycia, Belishia, Belisha, Belyshia, Beliecia, Belieciah, Beleicia, Beleiciah, Beleacia, Beleaciah... belicia

Belindah, Belynda, Balinda, Balynda, Belienda, Beliendah, Balyndah, Belyndah, Beleinda, Beleindah... belinda

Belisamah, Belisamma, Belysama, Belisma, Belysma, Belesama... belisama

Belle, Bela, Bell, Belita, Bellissa, Belva, Belladonna, Belia, Bellanca, Bellance, Bellini... bella

Bellonah, Belona, Bellonna, Belonna, Bellonia, Belonia... bellona

Benah, Benna, Bennah... bena

Deficiency. Sun sensitivity; exposure inducing itching, burning and swelling of the skin. Kidney, bladder, and gut infections. Severe earache in young children. Strokes, heart attacks.

It is claimed that those who eat a diet rich in beta-carotene are less likely to develop certain types of cancer.

Smokers usually have low levels of beta-carotene in the blood. Statistics suggest that people who eat a lot of beta-carotene foods are less likely to develop lung, mouth or stomach cancer. In existing cases a slow-down of the disease is possible.

Daily dose. Up to 300mg. Excess may manifest as yellow discoloration of the skin, giving appearance of sun-tan.

Sources. Mature ripe carrots of good colour. A Finland study suggests that four small carrots contain sufficient beta-carotene to satisfy the recommended daily amount of Vitamin A. Orange and dark green fruits and vegetables. Broccoli, Brussels sprouts, spinach, pumpkin, apricots, peaches, oranges, tomatoes. Harvard Medical School study. Among 333 subjects with a history of heart disease, those who received beta-carotene supplements of 50 milligrams every other day suffered half as many heart attacks as those taking placebos. (Dr Charles Hennekens, Harvard Medical School) ... beta-carotene

Uses: Used in American Indian medicine for excessive bleeding from the womb, and for easy childbirth. Bleeding from lungs, kidneys, bladder and uterine fibroids. Flooding of the menopause. Candida, leucorrhoea (decoction used as a vaginal douche).

To strengthen female constitution.

Preparations: Thrice daily.

Decoction. Half-2 grams to each cupful water simmered gently 10 minutes. Dose: half-1 cup. Liquid extract. 10-30 drops in water.

Tincture. BHP (1983) 1:5 in 40 per cent alcohol.

Dose: 1-4ml in water.

Powdered root. Half-2 grams in capsules.

Poultice: for bleeding ulcers: equal parts Beth root and Slippery Elm bark powder. Snuff: for nosebleed.

Douche (per vagina). 1oz to 2 pints water (decoction). Allow to cool; inject warm. ... beth root

Action: Affinity for liver and nervous system. General tonic (emphasis on circulation of the brain). Bitter. Stomachic, Sedative (mild).

Uses: Headache, nervous debility, lack of energy, loss of memory, weak digestion, sciatica, chronic rheumatism, sinus congestion, temporal arteritis (temporary relief), dizziness, hiatus hernia, low back pain (to reduce). Myalgic encephalomyelitis (ME). Nightmare.

Combinations. With Valerian for anxiety states. With equal parts Agrimony and Raspberry leaves as a substitute for domestic tea. With Vervain to enhance its relaxing properties.

Caution. Avoid over-dosing in pregnancy.

Preparations: Tea: 1-2 teaspoons to cup boiling water; infuse 5-10 minutes. 1 cup freely. Liquid Extract: 1 teaspoon in water.

Tincture BHP (1983) 1 in 5 in 45 per cent alcohol. Dose 30-90 drops (2-6ml). ... betony

Action. Anti-inflammatory, anti-diarrhoeal, antemetic, astringent, diuretic, refrigerant, strengthens blood vessels, vein tonic. Inhibits growth of certain bacteria. Contains Vitamins A, C, P. Gather before fruit ripens.

Uses: Dropsy, gravel, violent irritable bowel, diverticulosis, nausea or vomiting, sore throat (gargle), leucorrhoea (douche), scurvy, Vitamin C deficiency. Popular in Russian Folk Medicine for gastro- enteritis and to reduce insulin intake in diabetes. Cleansing wash for old ulcers (decoction). Pharyngitis (gargle). Leukoplakia of the mouth, vagina and urethra – improvement reported. Crohn’s disease. Bacillus Coli infections. By stimulating production of visual purple improves vision, especially night vision. Varicose veins. Piles. Cystitis.

Preparations: Thrice daily.

Decoction: 1oz to 1 pint water, remove vessel when boiling point is reached. Wineglass freely.

Liquid Extract, dose: 2-8ml.

Home tincture. Handful bilberries to 1 pint Vodka. Cork or cap. Shake daily for 1 week. Filter. Wineglass freely.

Formula. Combines well with Meadowsweet and Horsetail (equal parts).

Powder, capsules: 280mg. 2 capsules thrice daily between meals. (Arkocaps)

Diet. Cooked fresh berries are a popular dessert. Equal parts leaves of Wild Strawberry, Thyme and Bilberry substitute for domestic tea.

Fresh berries. Chew 1-3 teaspoons daily. ... bilberry

Alternatives. To stimulate flow, Boldo, Horsetail, Dandelion, Blue Flag root, Milk Thistle, Bogbean, Burdock. Teas, capsules, tablets, Liquid extracts, or Tinctures.

A. Vogel recommends: Barberry, Centuary, St John’s Wort, Sarsaparilla.

Combination tea. Equal parts: Peppermint leaves, Milk Thistle, Dandelion root. 1 teaspoon to each cup boiling water; infuse 15 minutes, 1 cup thrice daily for limited period (1 month).

Bile in the urine. (Bilviria)

Arthur Barker: Liquid Extract Black root 1oz (30ml). Liquid Extract Cornsilk 1oz (30ml). Essential Peppermint 30 drops (2ml). Water to 8oz (240ml). 2 teaspoons in water 3 times daily before meals.

Diet. Dandelion coffee. Artichokes.

See: CHOLAGOGUES. CHOLERETICS. ... bile secretion deficiency

Alternatives:– Tea. Mixture. Equal parts, Black Horehound and Wood Betony. 1-2 teaspoons to each cup boiling water infused 5-15 minutes. Drink freely.

Decoction. Mixture. Parts: Fringe Tree bark 2; Parsley root 1; Dandelion root 1. One teaspoon to each cup water gently simmered 20 minutes. Half a cup 3 times daily before meals.

Tablets/capsules. Devil’s Claw, Milk Thistle, Blue Flag, Wild Yam.

Powders. Formula. Equal parts: Milk Thistle and Peppermint. Dose: 750mg (three 00 capsules or half a teaspoon) thrice daily.

Tinctures. Formula. Equal parts: Wahoo and Barberry. 30-60 drops every 2 hours in water.

Barberry bark. One teaspoon shredded Barberry bark to each cup cold water allowed to infuse overnight. Half-1 cup twice daily.

Arthur Barker. Liquid Extract Black root 30ml; Liquid Extract Meadowsweet 30ml; Liquid Extract Agrimony 15ml; Emulsion Peppermint water (1 in 60) 2ml (optional). Water to 240ml (8oz). Dose: 2 teaspoons in water 3 times daily.

Prevention. Weekly dose Epsom’s salts.

Milk Thistle. Acquires a reputation for the complaint.

Diet. Low fat, Dandelion coffee, artichokes. Reject alcohol and strong caffeine drinks.

See also: ACIDOSIS. LIVER. ... bilousness

Candida utilis is a highly active wild yeast able to synthesise its own vitamins. More than 90 selected plant species from 14 countries are used in Biostrath preparations. The Company has pioneered an important advance in the preparation of herbal medicines. Results have in some instances led to completely new discoveries. ... biostrath a. g.

Live yeast Saccharomyces cerevisiae is cultivated on the herbs: Angelica, Balm, Basil, Caraway, Chamomile, Cinnamon, Elder, Fennel, Horseradish, Hyssop, Lavender, Liquorice, Parsley, Peppermint, Sage and Thyme. ... biostrath elixir

Action: Astringent. Bitter. Anti-inflammatory. Cholagogue. Diuretic. Contains salicylates which have an aspirin-like effect. Young leaves increase the flow of urine. Popular in Scandinavia.

Uses: Rheumatism and gout (dried leaf tea). Sore mouth (gargle). Kidney and bladder complaints. Sluggish kidney function. ‘Heart’ oedema. Cellulitis due to retention of metabolic wastes.

Preparations: Tea: 1 teaspoon dried leaves to each cup boiling water; infuse 15 minutes. Strain. Wineglass thrice daily.

Methyl salicylate, a rheumatism remedy, obtained by distillation of the twigs. (A. Vogel) Birch tar oil. (Ointment) External use only (UK). ... birch, european

Action: cholagogue, digestive, hepatic.

Uses: Indigestion. To increase bile production in liver disorders and to increase intestinal peristalsis. Dyskinesias. Gall bladder disorders. Constipation. Dyspepsia.

Preparations: Powder. 230mg capsules; 3 capsules midday and evening 15 minutes before meals. (Arkocaps)

Freshly pressed Juice: half-1 cup daily. If too pungent mix with a little Slippery Elm powder. ... black radish

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

About the Nutrients in This Food Beets are roots, high-carbohydrate foods that provide sugars, starch, and small amounts of dietary fiber, insoluble cellulose in the skin, and soluble pectins in the flesh. Beets are also a good source of the B vitamin folate. One-half cup cooked fresh beets has one gram of dietar y fiber and 68 mcg folate (17 percent of the R DA).

The Most Nutritious Way to Serve This Food Cooked, to dissolve the stiff cell walls and make the nutrients inside available.

Diets That May Restrict or Exclude This Food Anti-kidney-stone diet Low-sodium diet

Buying This Food Look for: Smooth round globes with fresh, crisp green leaves on top. Avoid: Beets with soft spots or blemishes that suggest decay underneath.

Storing This Food Protect the nutrients in beets by storing the vegetables in a cool place, such as the vegetable crisper in your refrigerator. When stored, the beet root converts its starch into sugars; the longer it is stored, the sweeter it becomes. Remove the green tops from beets before storing and store the beet greens like other leaf y vegetables, in plastic bags in the refrigerator to keep them from drying out and losing vitamins (also see gr eens). Use both beets and beet greens within a week.

Preparing This Food Scrub the globes with a vegetable brush under cold running water. You can cook them whole or slice them. Peel before (or after) cooking.

What Happens When You Cook This Food Betacyamin and betaxanthin, the red betalain pigments in beets, are water-soluble. (That’s why borscht is a scarlet soup.) Betacyanins and betaxanthins turn more intensely red when you add acids; think of scarlet sweet-and-sour beets in lemon juice or vinegar with sugar. They turn slightly blue in a basic (alkaline) solution such as baking soda and water. Like carrots, beets have such stiff cell walls that it is hard for the human digestive tract to extract the nutrients inside. Cooking will not soften the cellulose in the beet’s cell walls, but it will dissolve enough hemicellulose so that digestive juices are able to penetrate. Cook- ing also activates flavor molecules in beets, making them taste better.

How Other Kinds of Processing Affect This Food Canning. Beets lose neither their color nor their texture in canning.

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 continu- ing 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 of 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 diseases 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 Pigmented urine and feces. The ability to metabolize betacyanins and be taxanthins is a genetic trait. People with two recessive genes for this trait cannot break down these red pig- ments, which will be excreted, bright red, in urine. Eating beets can also turn feces red, but it will not cause a false-positive result in a test for occult blood in the stool. Nitrosamine formation. Beets, celery, eggplant, lettuce, radishes, spinach, and collard and turnip greens contain nitrates that convert naturally into nitrites in your stomach—where some of the nitrites combine with amines to form nitrosamines, some of which are known carcinogens. This natural chemical reaction presents no known problems for a healthy adult. However, when these vegetables are cooked and left standing for a while at room tempera- ture, microorganisms that convert nitrates to nitrites begin to multiply, and the amount of nitrites in the food rises. The resulting higher-nitrite foods may be dangerous for infants (see spinach).... beets

• Calms stomach ache and aids in better disgestion.
• Increases food appetite.
• Remedy for liver problems.
• Stimulates blood circulation.
• Alleviates fever and helps treating common cold and flu.

• Allergic reactions that include difficulty in breathing; swelled lips, tongue or face; hives.
• Stomach irritation.
• Nausea.
• Vomiting.
• Menstrual disorders.

Berangarie, Berangary, Berangarey, Berangarri, Berangaree, Berangaria, Berangariya, Berengari, Berengaria... berangari

Bernadina, Bernadette, Bernadetta, Berdina, Berdine, Berdyne, Berdyna, Beranger, Bernadea, Bernarda, Bernetta, Bernette, Bernita, Bernelle, Berna, Berneen, Bernardina, Bernardine, Berne, Bern... bernadine

... berthog

• Due to its antioxidant content, Red Tea may lower the risk of developing tumors and cancer.
• Helps treat allergies like eczema, fever or asthma.
• Keeps your skin healthy.
• Strengthens your immune system.
• Provides relaxation, calming the nervous system.
• Helps control blood pressure.

• Red tea is not recommended for pregnant or breastfeeding women. The herb can harm both infant or fetus.
• Young children should not drink red tea since the herb may have adverse reactions for young patients.
• People who suffer from diabetes should not consume red tea. The herb can drastically lower blood sugar levels.

Beryll, Berylle, Beril, Berill, Berille... beryl

Habitat: Cultivated largely in Uttar Pradesh, Punjab, Rajasthan and Bihar.

Action: Leaves—cooling, juice rubbed on bruises. Fruit decoction—laxative, diuretic, nutritious, styptic (given for internal haemorrhages and diseases of the respiratory tract.) Juice of fruit— used for treating epilepsy, insanity and other nervous diseases. The ash of fruit rind—applied on painful swellings. Seeds—anthelmintic.

Bethebara, Bethabarra, Bethebarra, Bethbara, Bethbarra... bethabara

Bethseda, Bethsaida... bethesda

Habitat: Northwestern Himalayas, Nilgiris, Kulu and Kumaon.

Action: Rasaut, Rasasranjana (extract)—bitter, cholagogue, antidiarrhoeal, stomachic, laxative, diaphoretic, antipyretic, antiseptic. Used externally in opthalmia,conjunctivitis, ulcers, sores, swollen gums. Root bark— anti-inflammatory, hypoglycaemic hypotensive, antiamoebic, anticoagulant, antibacterial. Bark— used in liver complaints, diarrhoea, dysentery, cholera, gastric disorders, enlargement of spleen and for regulating metabolism. Berries— antiscorbutic, laxative.

Habitat: The Himalayas from Kashmir to Nepal, at altitudes of 1,500-2,400 m.

Action: Same as that of Berberis aristata.

Habitat: Distributed in Northwestern Himalayas.

Action: Root and bark—used for ailments of gastrointestinal tract, liver, gallbladder, kidney and urinary tract, respiratory tract, also as a febrifuge and blood purifier.

Beula, Beulla, Bulah, Bula, Beullah... beulah

Habitat: Temperate Himalaya from Kashmir to Bhutan, between altitudes of 900 and 3,000 m.

Action: Leaf and root—antiscorbutic, astringent, spasmolytic, antidiarrhoeal. Used in dysuria, spleen enlargement, pulmonary affections as a cough remedy, menorrhagia, urinary tract infections. Alcoholic extract of roots— antilithic. Acetone extract of root- bark—cardiotoxic, CNS depressant and anti-inflammatory; in mild doses diuretic but antidiuretic in higher doses. Anti-inflammatory activity decreases with increasing dosage.

Habitat: Native to Mediterranean region; cultivated in North India, Maharashtra and South India.

Action: Leaf—used in burns and bruises, also for diseases of spleen and liver. Tuber and seed— expectorant. Leaf and seed— diuretic. Leaf, tuber and seed— anti-inflammatory. Seed oil— analgesic.

Beyoncay, Beyonsay, Beyonsai, Beyonsae, Beyonci, Beyoncie, Beyoncee, Beyoncea, Beyonceah... beyonce

Bharatie, Bharaty, Bharatey, Bharatee, Bharatea, Bharateah, Barati, Baratie, Baraty, Baratey, Baratee, Baratea, Barateah... bharati

They work by blocking the stimulation of beta adrenergic receptors by the neurotransmitters adrenaline and noradrenaline, which are produced at the nerve endings of that part of the SYMPATHETIC NERVOUS SYSTEM – the autonomous (involuntary) network

– which facilitates the body’s reaction to anxiety, stress and exercise – the ‘fear and ?ight’ response.

Beta1 blockers reduce the frequency and force of the heartbeat; beta2 blockers prevent vasodilation (increase in the diameter of blood vessels), thus in?uencing the patient’s blood pressure. Beta1 blockers also affect blood pressure, but the mechanism of their action is unclear. They can reduce to normal an abnormally fast heart rate so the power of the heart can be concomitantly controlled: this reduces the oxygen requirements of the heart with an advantageous knock-on e?ect on the respiratory system. These are valuable therapeutic effects in patients with ANGINA or who have had a myocardial infarction (heart attack – see HEART, DISEASES OF), or who suffer from HYPERTENSION. Beta2 blockers reduce tremors in muscles elsewhere in the body which are a feature of anxiety or the result of thyrotoxicosis (an overactive thyroid gland – see under THYROID GLAND, DISEASES OF). Noncardioselective blockers also reduce the abnormal pressure caused by the increase in the ?uid in the eyeball that characterises GLAUCOMA.

Many beta-blocking drugs are now available; minor therapeutic di?erences between them may in?uence the choice of a drug for a particular patient. Among the common drugs are:

These powerful drugs have various side-effects and should be prescribed and monitored with care. In particular, people who suffer from asthma, bronchitis or other respiratory problems may develop breathing diffculties. Long-term treatment with beta blockers should not be suddenly stopped, as this may precipitate a severe recurrence of the patient’s symptoms – including, possibly, a sharp rise in blood pressure. Gradual withdrawal of medication should mitigate untoward effects.... beta-adrenoceptor-blocking drugs

Habitat: The temperate and subtropical Himalayas, Khasi Hills and Manipur.

Action: Used in supportive therapy of rheumatic ailments.

Bhumi, Bhoomi, Bhu, Bhudevi... bhumidevi

Bianka, Byanca, Blanca, Blanche, Biana, Bianna, Biankeh, Byanka, Blanch, Blanka

... bianca

Habitat: Temperate Himalaya from Kashmir to Bhutan.

Action: Resin—laxative. Leaves— diuretic; used in the form of infusion in gout, rheumatism, dropsy, and as a solvent of stones in the kidneys; used in skin affections, especially eczema. Bark—used in convulsions. Oil—astringent, antiseptic.

Habitat: Throughout India in gardens, waste places and tea plantations.

Action: Plant—cytotoxic. Leaf— applied to ulcers and swollen glands.

Habitat: Throughout tropical India.

Action: Plant—used in insomnia, convulsions, cramps, chest-complaints, inflammations, tumours, chronic skin diseases. Ash—in stomachache. Leaves— diuretic, astringent, antiseptic. Paste is applied to burns, contusions and wounds. Decoction is given in strangury, asthma and phthisis. Roots—decoction is given in lithia- sis. Mature leaves are recommended in diabetes; contain an insulin-like principle.

Scientists have engineered appropriate genes from other organisms into BACTERIA, or sometimes plants, to accelerate this natural evolutionary process. For e?ective ‘digestion of waste’, a micro-organism must quickly and completely digest organic waste without producing unpleasant smells or noxious gases, be non-pathogenic and be able to reproduce in hostile conditions. For example, American researchers have discovered an anaerobic bacterium that neutralises dangerous chlorinated chemical compounds such as trichlorethane, which can pollute soil, into a harmless molecule called ethens. But the bacteria do not thrive in soil. So the dechlorinating genes in this bacterium are transferred to bacteria that are acclimatised to living in toxic areas and can more e?ciently carry out the required detoxi?cation. Other research has been aimed at detoxifying the byproducts of DDT, a troublesome and resistant pollutant. Bioremediation should prove to be an environmentally friendly and cost-e?ective alternative to waste incineration or chemically based processes for washing contaminated soils.... bioremediation

• fight headaches
• fight asthma, cough and bronchitis
• fight fever
• fight bacteria and viruses
• heal wounds, treat burns, as well as improve the growth of hair, when applied topically
• help in the treatment of excessive menstruation
• fight hemorrhages
• ease arthritic pain
• help in the treatment of premature baldness
• soothe and calm the nerves
• fight constipation among the elderly

• Place 2 to 3 teaspoonfuls in a cup and pour on boiling water.
• Cover the mix and allow it to steep for 10 minutes.
• Drink the tea about three times a day.

• Place a teaspoon of dried birch bark in a cup of boiling water.
• Allow it to steep for 15 minutes.
• Drink the tea twice or thrice a day.