Alternatives. Tea: equal parts – Agnus Castus, Ladysmantle, Motherwort, Raspberry leaves, 1-2 teaspoon to each cup boiling water; infuse 5-10 minutes; 1 cup 2-3 times daily.

Tablets/capsules. Cramp bark, Helonias.

Powders. Formula. Combine Blue Cohosh 1; Helonias 2; Black Haw 3. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Practitioner. Tincture Viburnum prunifolium BHP (1983), 20ml; Tincture Chamaelirium luteum BHP (1983) 20ml; Tincture Viburnum opulus BHP (1983), 20ml; Tincture Capsicum, fort, BPC 1934, 0.05ml. Distilled water to 100ml. Sig: 5ml tds pc c Aq cal.

Black Cohosh. Liquid Extract Cimicifuja BP 1898, 1:1 in 90 per cent alcohol. Dosage: 0.3-2ml. OR: Tincture Cimicifuja, BPC 1934, 1:10 in 60 per cent alcohol. Dosage: 2-4ml.

Squaw Vine (mother’s cordial) is specific for habitual abortion, beginning soon after becoming pregnant and continuing until the seventh month. Also the best remedy when abortion threatens. If attended by a physician for abortion, a hypodermic of morphine greatly assists; followed by Liquid Extract 1:1 Squaw Vine. Dosage: 2-4ml, 3 times daily.

Liquid extracts. Squaw Vine, 4 . . . Helonias, 1 . . . Black Haw bark, 1 . . . Blue Cohosh, 1. Mix. Dose: One teaspoon every 2 hours for 10 days. Thereafter: 2 teaspoons before meals, 3 times daily. Honey to sweeten, if necessary. (Dr Finlay Ellingwood)

Abortion, to prevent: Cramp bark, (Dr John Christopher)

Evening Primrose. Two 500mg capsules, at meals thrice daily.

Diet: High protein.

Vitamins. C. B6. Multivitamins. E (400iu daily).

Minerals. Calcium. Iodine. Iron. Selenium, Zinc. Magnesium deficiency is related to history of spontaneous abortion; magnesium to commence as soon as pregnant.

Enforced bed rest. ... Bartrams Encyclopedia of Herbal Medicine

• boil the dried roots of the plant ( 20 to 25 minutes)
• allow the mix to steep (5 minutes)
• drink it slowly

• fight kidney stones and bladder infections
• alleviate fever
• counter jaundice
• ease symptoms of arthritis and rheumatism
• fight gonorrhea
• treat anemia

– the hormone which provokes the adrenal cortex into action.

Symptoms The clinical symptoms appear slowly and depend upon the severity of the underlying disease process. The patient usually complains of appetite and weight loss, nausea, weakness and fatigue. The skin becomes pigmented due to the increased production of ACTH. Faintness, especially on standing, is due to postural HYPOTENSION secondary to aldosterone de?ciency. Women lose their axillary hair and both sexes are liable to develop mental symptoms such as DEPRESSION. Acute episodes – Addisonian crises – may occur, brought on by infection, injury or other stressful events; they are caused by a fall in aldosterone levels, leading to abnormal loss of sodium and water via the kidneys, dehydration, low blood pressure and confusion. Patients may develop increased tanning of the skin from extra pigmentation, with black or blue discoloration of the skin, lips, mouth, rectum and vagina occurring. ANOREXIA, nausea and vomiting are common and the sufferer may feel cold.

Diagnosis This depends on demonstrating impaired serum levels of cortisol and inability of these levels to rise after an injection of ACTH.

Treatment consists in replacement of the de?cient hormones. HYDROCORTISONE tablets are commonly used; some patients also require the salt-retaining hormone, ?udrocortisone. Treatment enables them to lead a completely normal life and to enjoy a normal life expectancy. Before surgery, or if the patient is pregnant and unable to take tablets, injectable hydrocortisone may be needed. Rarely, treated patients may have a crisis, perhaps because they have not been taking their medication or have been vomiting it. Emergency resuscitation is needed with ?uids, salt and sugar. Because of this, all patients should carry a card detailing their condition and necessary management. Treatment of any complicating infections such as tuberculosis is essential. Sometimes DIABETES MELLITUS coexists with Addison’s disease and must be treated.

Secondary adrenal insu?ciency may occur in panhypopituitarism (see PITUITARY GLAND), in patients treated with CORTICOSTEROIDS or after such patients have stopped treatment.... Medical Dictionary

• Take 1 or 2 teaspoons of dried Agrimony leaves and flowers, for each cup of boiling water
• Let it rest for 10 to 15 minutes
• Cool and strain

• fighting inflammations
• acting against viral infections
• treating kidney diseases and related bladder disorders
• aiding difficult digestions
• improving the liver function
• treating diarrhea both in adult and in child cases
• helping in cases of excess vaginal discharges
• fighting against rheumatism and arthritis
• curing mild coughs and sore throats

Both HIV-1 and HIV-2 are predominantly sexually transmitted and both are associated with secondary opportunistic infections. However, HIV-2 seems to result in slower damage to the immune system. HIV-1 is known to mutate rapidly and has given rise to other subtypes.

HIV is thought to have occurred in humans in the 1950s, but whether or not it infected humans from another primate species is uncertain. It became widespread in the 1970s but its latency in causing symptoms meant that the epidemic was not noticed until the following decade. Although it is a sexually transmitted disease, it can also be transmitted by intravenous drug use (through sharing an infected needle), blood transfusions with infected blood (hence the importance of e?ective national blood-screening programmes), organ donation, and occupationally (see health-care workers, below). Babies born of HIV-positive mothers can be infected before or during birth, or through breast feeding.

Although HIV is most likely to occur in blood, semen or vaginal ?uid, it has been found in saliva and tears (but not sweat); however, there is no evidence that the virus can be transmitted from these two body ?uids. There is also no evidence that HIV can be transmitted by biting insects (such as mosquitoes). HIV does not survive well in the environment and is rapidly destroyed through drying.

Prevalence At the end of 2003 an estimated 42 million people globally were infected with HIV – up from 40 million two years earlier. About one-third of those with HIV/AIDS are aged 15–24 and most are unaware that they are carrying the virus. During 2003 it is estimated that 5 million adults and children worldwide were newly infected with HIV, and that 3 million adults and children died. In Africa in 2003,

3.4 million people were newly infected and 2.3 million died, with more than 28 million carrying the virus. HIV/AIDS was the leading cause of death in sub-Saharan Africa where over half of the infections were in women and 90 per cent of cases resulted from heterosexual sex. In some southern African countries, one in three pregnant women had HIV.

In Asia and the Paci?c there were 1.2 million new infections and 435,000 deaths. The area with the fastest-growing epidemic is Eastern Europe, especially the Russian Federation where in 2002 around a million people had HIV and there were an estimated 250,000 new infections, with intravenous drug use a key contributor to this ?gure. Seventy-?ve per cent of cases occurred in men, with male-to-male sexual transmission an important cause of infection, though heterosexual activity is a rising cause of infection.

At the end of 2002 the UK had an estimated 55,900 HIV-infected adults aged between 15 and 59. More than 3,600 individuals were newly diagnosed with the infection in 2000, the highest annual ?gure since the epidemic started

– in 1998 the ?gure was 2,817 and in 1999 just over 3,000 (Department of Health and Communicable Disease Surveillance Centre). The incidence of AIDS in the UK has declined sharply since the introduction of highly active antiretroviral therapy (HAART) and HIV-related deaths have also fallen: in 2002 there were 777 reported new AIDS cases and 395 deaths, compared with 1,769 and 1,719 respectively in 1995. (Sources: UNAIDS and WHO, AIDS Epidemic Update, December 2001; Public Health Laboratory Services AIDS and STD Centre Communicable Disease Surveillance and Scottish Centre for Infection and Environmental Health, Quarterly Surveillance Tables.)

Poverty is strongly linked to the spread of AIDS, for various reasons including lack of health education; lack of e?ective public-health awareness; women having little control over sexual behaviour and contraception; and, by comparison with the developed world, little or no access to antiretroviral drugs.

Pathogenesis The cellular target of HIV infection is a subset of white blood cells called T-lymphocytes (see LYMPHOCYTE) which carry the CD4 surface receptor. These so-called ‘helper T-cells’ are vital to the function of cell-mediated immunity. Infection of these cells leads to their destruction (HIV replicates at an enormous rate – 109) and over the course of several years the body is unable to generate suf?cient new cells to keep pace. This leads to progressive destruction of the body’s immune capabilities, evidenced clinically by the development of opportunistic infection and unusual tumours.

Monitoring of clinical progression It is possible to measure the number of viral particles present in the plasma. This gives an accurate guide to the likely progression rate, which will be slow in those individuals with fewer than 10,000 particles per ml of plasma but progressively more rapid above this ?gure. The main clinical monitoring of the immune system is through the numbers of CD4 lymphocytes in the blood. The normal count is around 850 cells per ml and, without treatment, eventual progression to AIDS is likely in those individuals whose CD4 count falls below 500 per ml. Opportunistic infections occur most frequently when the count falls below 200 per ml: most such infections are treatable, and death is only likely when the CD4 count falls below 50 cells per ml when infection is developed with organisms that are di?cult to treat because of their low intrinsic virulence.

Simple, cheap and highly accurate tests are available to detect HIV antibodies in the serum. These normally occur within three months of infection and remain the cornerstone of the diagnosis.

Clinical features Most infected individuals have a viral illness some three weeks after contact with HIV. The clinical features are often non-speci?c and remain undiagnosed but include a ?ne red rash, large lymph nodes, an in?uenza-like illness, cerebral involvement and sometimes the development of opportunistic infections. The antibody test may be negative at this stage but there are usually high levels of virus particles in the blood. The antibody test is virtually always positive within three months of infection. HIV infection is often subsequently asymptomatic for a period of ten years or more, although in most patients progressive immune destruction is occurring during this time and a variety of minor opportunistic infections such as HERPES ZOSTER or oral thrush (see CANDIDA) do occur. In addition, generalised LYMPHADENOPATHY is present in a third of patients and some suffer from severe malaise, weight loss, night sweats, mild fever, ANAEMIA or easy bruising due to THROMBOCYTOPENIA.

The presentation of opportunistic infection is highly variable but usually involves either the CENTRAL NERVOUS SYSTEM, the gastrointestinal tract or the LUNGS. Patients may present with a sudden onset of a neurological de?cit or EPILEPSY due to a sudden onset of a STROKE-like syndrome, or epilepsy due to a space-occupying lesion in the brain – most commonly TOXOPLASMOSIS. In late disease, HIV infection of the central nervous system itself may produce progressive memory loss, impaired concentration and mental slowness called AIDS DEMENTIA. A wide variety of opportunistic PROTOZOA or viruses produces DYSPHAGIA, DIARRHOEA and wasting. In the respiratory system the commonest opportunistic infection associated with AIDS, pneumonia, produces severe shortness of breath and sometimes CYANOSIS, usually with a striking lack of clinical signs in the chest.

In very late HIV infection, when the CD4 count has fallen below 50 cells per ml, infection with CYTOMEGALOVIRUS may produce progressive retinal necrosis (see EYE, DISORDERS OF) which will lead to blindness if untreated, as well as a variety of gastrointestinal symptoms. At this stage, infection with atypical mycobacteria is also common, producing severe anaemia, wasting and fevers. The commonest tumour associated with HIV is Kaposi’s sarcoma which produces purplish skin lesions. This and nonHodgkin’s lymphoma (see LYMPHOMA), which is a hundred times more frequent among HIV-positive individuals than in the general population, are likely to be associated with or caused by opportunistic viral infections.

Prevention There is, as yet, no vaccine to prevent HIV infection. Vaccine development has been hampered

by the large number of new HIV strains generated through frequent mutation and recombination.

because HIV can be transmitted as free virus and in infected cells.

because HIV infects helper T-cells – the very cells involved in the immune response. There are, however, numerous research pro

grammes underway to develop vaccines that are either prophylactic or therapeutic. Vaccine-development strategies have included: recombinant-vector vaccines, in which a live bacterium or virus is genetically modi?ed to carry one or more of the HIV genes; subunit vaccines, consisting of small regions of the HIV genome designed to induce an immune response without infection; modi?ed live HIV, which has had its disease-promoting genes removed; and DNA vaccines – small loops of DNA (plasmids) containing viral genes – that make the host cells produce non-infectious viral proteins which, in turn, trigger an immune response and prime the immune system against future infection with real virus.

In the absence of an e?ective vaccine, preventing exposure remains the chief strategy in reducing the spread of HIV. Used properly, condoms are an extremely e?ective method of preventing exposure to HIV during sexual intercourse and remain the most important public-health approach to countering the further acceleration of the AIDS epidemic. The spermicide nonoxynol-9, which is often included with condoms, is known to kill HIV in vitro; however, its e?ectiveness in preventing HIV infection during intercourse is not known.

Public-health strategies must be focused on avoiding high-risk behaviour and, particularly in developing countries, empowering women to have more control over their lives, both economically and socially. In many of the poorer regions of the world, women are economically dependent on men and refusing sex, or insisting on condom use, even when they know their partners are HIV positive, is not a straightforward option. Poverty also forces many women into the sex industry where they are at greater risk of infection.

Cultural problems in gaining acceptance for universal condom-use by men in some developing countries suggests that other preventive strategies should also be considered. Microbicides used as vaginal sprays or ‘chemical condoms’ have the potential to give women more direct control over their exposure risk, and research is underway to develop suitable products.

Epidemiological studies suggest that male circumcision may o?er some protection against HIV infection, although more research is needed before this can be an established public-health strategy. Globally, about 70 per cent of infected men have acquired the virus through unprotected vaginal sex; in these men, infection is likely to have occurred through the penis with the mucosal epithelia of the inner surface of the foreskin and the frenulum considered the most likely sites for infection. It is suggested that in circumcised men, the glans may become keratinised and thus less likely to facilitate infection. Circumcision may also reduce the risk of lesions caused by other sexually transmitted disease.

Treatment AIDS/HIV treatment can be categorised as speci?c therapies for the individual opportunistic infections – which ultimately cause death – and highly active antiretroviral therapy (HAART) designed to reduce viral load and replication. HAART is also the most e?ective way of preventing opportunistic infections, and has had a signi?cant impact in delaying the onset of AIDS in HIV-positive individuals in developed countries.

Four classes of drugs are currently in use. Nucleoside analogues, including ZIDOVUDINE and DIDANOSINE, interfere with the activity of the unique enzyme of the retrovirus reverse transcriptase which is essential for replication. Nucleotide analogues, such as tenofovir, act in the same way but require no intracellular activation. Non-nucleoside reverse transcriptase inhibitors, such as nevirapine and EFAVIRENZ, act by a di?erent mechanism on the same enzyme. The most potent single agents against HIV are the protease inhibitors, such as lopinavir, which render a unique viral enzyme ineffective. These drugs are used in a variety of combinations in an attempt to reduce the plasma HIV viral load to below detectable limits, which is achieved in approximately 90 per cent of patients who have not previously received therapy. This usually also produces a profound rise in CD4 count. It is likely, however, that such treatments need to be lifelong – and since they are associated with toxicities, long-term adherence is di?cult. Thus the optimum time for treatment intervention remains controversial, with some clinicians believing that this should be governed by the viral load rising above 10,000 copies, and others that it should primarily be designed to prevent the development of opportunistic infections – thus, that initiation of therapy should be guided more by the CD4 count.

It should be noted that the drug regimens have been devised for infection with HIV-1; it is not known how e?ective they are at treating infection with HIV-2.

HIV and pregnancy An HIV-positive woman can transmit the virus to her fetus, with the risk of infection being particularly high during parturition; however, the risk of perinatal HIV transmission can be reduced by antiviral drug therapy. In the UK, HIV testing is available to all women as part of antenatal care. The bene?ts of antenatal HIV testing in countries where antiviral drugs are not available are questionable. An HIV-positive woman might be advised not to breast feed because of the risks of transmitting HIV via breastmilk, but there may be a greater risk associated with not breast feeding at all. Babies in many poor communities are thought to be at high risk of infectious diseases and malnutrition if they are not breast fed and may thus be at greater overall risk of death during infancy.

Counselling Con?dential counselling is an essential part of AIDS management, both in terms of supporting the psychological wellbeing of the individual and in dealing with issues such as family relations, sexual partners and implications for employment (e.g. for health-care workers). Counsellors must be particularly sensitive to culture and lifestyle issues. Counselling is essential both before an HIV test is taken and when the results are revealed.

Health-care workers Health-care workers may be at risk of occupational exposure to HIV, either through undertaking invasive procedures or through accidental exposure to infected blood from a contaminated needle (needlestick injury). Needlestick injuries are frequent in health care – as many as 600,000 to 800,000 are thought to occur annually in the United States. Transmission is much more likely where the worker has been exposed to HIV through a needlestick injury or deep cut with a contaminated instrument than through exposure of mucous membranes to contaminated blood or body ?uids. However, even where exposure occurs through a needlestick injury, the risk of seroconversion is much lower than with a similar exposure to hepatitis C or hepatitis B. A percutaneous exposure to HIV-infected blood in a health-care setting is thought to carry a risk of about one infection per 300 injuries (one in 1,000 for mucous-membrane exposure), compared with one in 30 for hepatitis C, and one in three for hepatitis B (when the source patient is e-antigen positive).

In the event of an injury, health-care workers are advised to report the incident immediately where, depending on a risk assessment, they may be o?ered post-exposure prophylaxis (PEP). They should also wash the contaminated area with soap and water (but without scrubbing) and, if appropriate, encourage bleeding at the site of injury. PEP, using a combination of antiretroviral drugs (in a similar regimen to HAART – see above), is thought to greatly reduce the chances of seroconversion; it should be commenced as soon as possible, preferably within one or two hours of the injury. Although PEP is available, safe systems of work are considered to o?er the greatest protection. Double-gloving (latex gloves remove much of the blood from the surface of the needle during a needlestick), correct use of sharps containers (for used needles and instruments), avoiding the resheathing of used needles, reduction in the number of blood samples taken from a patient, safer-needle devices (such as needles that self-blunt after use) and needleless drug administration are all thought to reduce the risk of exposure to HIV and other blood-borne viruses. Although there have been numerous cases of health-care workers developing HIV through occupational exposure, there is little evidence of health-care workers passing HIV to their patients through normal medical procedures.... Medical Dictionary

• steep the dried blossoms in a 12-gram cup of hot water (5 minutes)
• alternatively, place a teaspoon of dried Albizia herb powder in newly-boiled water and similarly steep for about 5 minutes
• drink the tea slowly

• fighting insomnia
• improving the mood, uplifting the spirit and fighting depression, melancholy and anxiety
• fighting irritability
• strengthening mental health
• relieving stress
• relieving tightness in the chest

Alcohol depresses the central nervous system and disturbs both mental and physical functioning. Even small doses of alcohol will slow a person’s re?exes and concentration; potentially dangerous effects when, for example, driving or operating machinery. Drunkenness causes slurred speech, muddled thinking, amnesia (memory loss), drowsiness, erectile IMPOTENCE, poor coordination and dulled reactions – thereby making driving or operating machinery especially dangerous. Disinhibition may lead to extreme euphoria, irritability, misery or aggression, depending on the underlying mood at the start of drinking. Severe intoxication may lead to COMA and respiratory failure.

Persistent alcohol misuse leads to physical, mental, social and occupational problems, as well as to a risk of DEPENDENCE (see also ALCOHOL DEPENDENCE). Misuse may follow several patterns: regular but controlled heavy intake, ‘binge’ drinking, and dependence (alcoholism). The ?rst pattern usually leads to mainly physical problems such as gastritis, peptic ulcer, liver disease, heart disease and impotence. The second is most common among young men and usually leads to mainly social and occupational problems – getting into ?ghts, jeopardising personal relationships, overspending on alcohol at weekends, and missing days o? work because of hangovers. The third pattern – alcohol dependence – is the most serious, and can severely disrupt health and social stability.

Many researchers consider alcohol dependence to be an illness that runs in families, with a genetic component which is probably passed on as a vulnerable personality. But it is hard to disentangle genetic, environmental and social factors in such families. In the UK there are estimated to be around a million people suffering from alcohol dependence and a similar number who have di?culty controlling their consumption (together about 1:30 of the population).

Alcohol causes tolerance and both physical and psychological dependence (see DEPENDENCE for de?nitions). Dependent drinkers classically drink early in the morning to relieve overnight withdrawal symptoms. These symptoms include anxiety, restlessness, nausea and vomiting, and tremor. Sudden withdrawal from regular heavy drinking can lead to life-threatening delirium tremens (DTs), with severe tremor, hallucinations (often visual – seeing spiders and monsters, rather than the pink elephants of romantic myth), and CONVULSIONS. This must be treated urgently with sedative drugs, preferably by intravenous drip. Similar symptoms, plus severe INCOORDINATION and double-vision, can occur in WERNICKE’S ENCEPHALOPATHY, a serious neurological condition due to lack of the B vitamin thiamine (whose absorption from the stomach is markedly reduced by alcohol). If not treated urgently with injections of thiamine and other vitamins, this can lead to an irreversible form of brain damage called Korsako?’s psychosis, with severe amnesia. Finally, prolonged alcohol misuse can cause a form of dementia.

In addition to these severe neurological disorders, the wide range of life-threatening problems caused by heavy drinking includes HEPATITIS, liver CIRRHOSIS, pancreatitis (see PANCREAS, DISEASES OF), gastrointestinal haemorrhage, suicide and FETAL ALCOHOL SYNDROME; pregnant women should not drink alcohol as this syndrome may occur with more than a glass of wine or half-pint of beer a day. The social effects of alcohol misuse – such as marital breakdown, family violence and severe debt – can be equally devastating.

Treatment of alcohol-related problems is only moderately successful. First, many of the physical problems are treated in the short term by doctors who fail to spot, or never ask about, heavy drinking. Second, attempts at treating alcohol dependence by detoxi?cation or ‘drying out’ (substituting a tranquillising drug for alcohol and withdrawing it gradually over about a week) are not always followed-up by adequate support at home, so that drinking starts again. Home support by community alcohol teams comprising doctors, nurses, social workers and, when appropriate, probation o?cers is a recent development that may have better results. Many drinkers ?nd the voluntary organisation Alcoholics Anonymous (AA) and its related groups for relatives (Al-Anon) and teenagers (Alateen) helpful because total abstinence from alcohol is encouraged by intensive psychological and social support from fellow ex-drinkers.

Useful contacts are: Alcoholics Anonymous; Al-Anon Family Groups UK and Eire (including Alateen); Alcohol Concern; Alcohol Focus Scotland; and Alcohol and Substance Misuse.

1 standard drink =1 unit

=••• pint of beer

=1 measure of spirits

=1 glass of sherry or vermouth

=1 glass of wine

Limits within which alcohol is believed not to cause long-term health risks:... Medical Dictionary

• take the dried leaves
• soak them in boiling water
• steep them for 10 to 15 minutes (depending on the quantity and flavor preferences)

• lower cholesterol levels
• help keep calcium in bones and out of artery linings
• help lower blood sugar levels
• help in treatment of upset stomach
• alleviate kidney and bladder woes
• stimulate the immune system
• purify the blood
• carry intestinal waste out of the body
• reduce cancer risks

• place 1 or 2 teaspoons of dried allspice fruit (or powder) in 1 cup of boiling water
• steep them for 10 to 20 minutes
• drink the tea (sugar or honey might be added)

• facilitate and promote good digestion
• help bloating, belching and flatulence
• help in preventing allergies
• help lower blood sugar
• help relieve toothache and muscle/joint pain
• help uplift the mood and relax the body

Alpha-fetoprotein (AFP) can be measured in the maternal blood from the latter part of the 1st trimester of pregnancy, and its concentration rises between the 15th and 20th weeks.

Raised levels of are associated with fetal neural tube defects, such as spina bifida or anencephaly, and certain kidney abnormalities. High levels of also occur in multiple pregnancies (see pregnancy, multiple) and threatened or actual miscarriage. levels may be unusually low if the fetus has Down’s syndrome. For this reason, measurement of blood is included in blood tests, which are used to screen pregnant women for an increased risk of Down’s syndrome.

levels are commonly raised in adults with hepatoma (see liver cancer), cancerous teratoma of the testes or ovaries, or cancer of the pancreas, stomach, or lung.

For this reason, is known as a tumour marker.

(AFP) levels can be used to monitor the results of treatment of certain cancers; increasing levels after surgery or chemotherapy may indicate tumour recurrence.

However, levels are also raised in some noncancerous conditions, including viral and alcoholic hepatitis and cirrhosis.... BMA Medical Dictionary

• Place about 30 grams of the dried anamu plant in one liter of boiling water
• Let it boil for about 15 minutes
• Take it out of the heat
• Let the mix steep for 7 minutes
• Drink it slowly

• lower the risk of developing tumors and cancer
• help fight inflammations that cause many different kinds of pain such as arthritis, rheumatism and headaches
• help strengthen the immune system by killing viruses, bacteria, candida and fungi
• help fight diabetes by lowering blood sugar levels
• help reduce fever and flu
• help sedate the nervous system
• fight anxiety
• help in detoxification by promoting urination, as well as perspiration
• help promote menstruation
• help fight congestion-related problems such as cough, colds and sinusitis
• help ease muscle spasms

Naturally occurring and synthetic androgens are used in replacement therapy (to treat such conditions as delayed puberty in adolescent boys, *hypogonadism, and impotence due to testicular insufficiency) and as *anabolic agents. Side-effects include salt and water retention, increased bone growth, and masculinization in women. Androgens should not be used in patients with cancer of the prostate gland or in pregnant women. —androgenic adj.... Oxford | Concise Colour Medical Dictionary

• place 1 teaspoon of dried andrographis in a tea infuser (10 grams of fresh leaves)
• place the infuser in a tea cup
• cover it with 1 cup of boiling water
• steep the tea for 10 minutes
• drink it slowly

• Treating gastrointestinal complains
• Treating throat infections
• Dispelling toxins
• Increasing biliary flow
• Treating coughs, headaches, edema
• Treating pain conditions, inflammation
• Treating arthritis, rheumatism
• Treating constipation
• Treating pneumonia, tuberculosis, leprosy, hepatitis, herpes, diabetes, bronchitis

• Boil 1 1/2 cups of water with anise seeds
• Boil 1 1/2 cups of water (in another pot)
• Add the tea bags
• Steep them both (10 minutes)
• Strain anise water into the pot containing tea
• Pour into serving cups

• the overall treatment of such respiratory ailments as colds, pneumonia, bronchitis and sinusitis
• an upset stomach and flatulence
• the treatment of colic
• loosen phlegm in the throat and lungs
• hiccups

Ultrasound scanning is carried out to identify abnormalities in the fetus. Chorionic villus sampling or amniocentesis may be performed if the baby is thought to be at increased risk of a chromosomal abnormality or a genetic disorder. The woman is also advised on general aspects of pregnancy, such as diet, exercise, techniques to help her with childbirth.

(See also childbirth, natural.)... BMA Medical Dictionary

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

Action: Oxytocic, abortifacient, emmenagogue.

• Heat water in a teapot to about 208 degrees F (or bring the water to a boil)
• Remove from heat for a minute or two
• Pour water into your cup or mug
• Immerse the tea bag (in case of loose-leaf tea, use a tea strainer)
• Let it steep for four to five minutes (If you steep the tea longer, the flavor will be stronger, but the tea might taste bitter)
• Remove the tea from the mug and serve it
• Add milk and/or sugar to taste

• lower bad cholesterol levels
• lower the risks of cardiovascular diseases
• promote good digestion by helping relieve constipation, heartburn, diarrhea and bloating
• support the functions of the liver fighting against cirrhosis and other ailments of the liver
• help lower blood sugar levels
• help lower the risks for diabetes
• help in the treatment of problems affecting the kidney
• strengthen the immune system
• eliminate toxins
• clean the skin

• Place about 1 teaspoon of dried ashwagandha leaves in boiling water.
• Let the mix steep for about 15 minutes and cool.
• Strain and then drink.

• calm the nerves and treat severe stress and nervous exhaustion
• help in the treatment of hypertension
• clear the mind, as well as to improve memory and cognitive abilities
• help in fighting arthritis
• help in restoring sexual vitality, especially in males

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

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

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

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

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

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

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

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

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

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

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

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

This technique is used when normal methods of attempted CONCEPTION or ARTIFICIAL INSEMINATION with healthy SEMEN have failed. In the UK, assisted-conception procedures are governed by the Human Fertilisation & Embryology Act 1990, which set up the Human Fertilisation & Embryology Authority (HFEA).

Human Fertilisation & Embryology Act 1990 UK legislation was prompted by the report on in vitro fertilisation produced by a government-appointed committee chaired by Baroness Warnock. This followed the birth, in 1978, of the ?rst ‘test-tube’ baby.

This Act allows regulation monitoring of all treatment centres to ensure that they carry out treatment and research responsibly. It covers any fertilisation that uses donated eggs or sperm (called gametes) – for example, donor insemination or embryos (see EMBRYO) grown outside the human body (known as licensed treatment). The Act also covers research on human embryos with especial emphasis on foolproof labelling and immaculate data collection.

Human Fertilisation & EmbryologyAuthority (HFEA) Set up by the UK government following the Warnock report, the Authority’s 221 members inspect and license centres carrying out fertilisation treatments using donated eggs and sperm. It publishes a code of practice advising centres on how to conduct their activities and maintains a register of information on donors, patients and all treatments. It also reviews routinely progress and research in fertility treatment and the attempted development of human CLONING. Cloning to produce viable embryos (reproductive cloning) is forbidden, but limited licensing of the technique is allowed in specialist centres to enable them to produce cells for medical treatment (therapeutic cloning).

In vitro fertilisation (IVF) In this technique, the female partner receives drugs to enhance OVULATION. Just before the eggs are released from the ovary (see OVARIES), several ripe eggs are collected under ULTRASOUND guidance or through a LAPAROSCOPE. The eggs are incubated with the prepared sperm. About 40 hours later, once the eggs are fertilised, two eggs (three in special circumstances) are transferred into the mother’s UTERUS via the cervix (neck of the womb). Pregnancy should then proceed normally. About one in ?ve IVF pregnancies results in the birth of a child. The success rate is lower in women over 40.

Indications In women with severely damaged FALLOPIAN TUBES, IVF o?ers the only chance of pregnancy. The method is also used in couples with unexplained infertility or with male-factor infertility (where sperms are abnormal or their count low). Women who have had an early or surgically induced MENOPAUSE can become pregnant using donor eggs. A quarter of these pregnancies are multiple – that is, produce twins or more. Twins and triplets are more likely to be premature. The main danger of ovarian stimulation for IVF is hyperstimulation which can cause ovarian cysts. (See OVARIES, DISEASES OF.)... Medical Dictionary

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

About the Nutrients in This Food The avocado is an unusual fruit because about 16 percent of its total weight is fat, primarily monounsaturated fatty acids. Like many other fruits, avo- cados are high in fiber (the Florida avocado is very high in fiber), a good source of the B vitamin folate, vitamin C, and potassium. The edible part of half of one average size avocado (100 g/3.5 ounces) provides 6.7 g dietary fiber, 15 g fat (2.1 g saturated fat, 9.7 g monoun- saturated fat, 1.8 g polyunsaturated fat), 81 mcg folate (20 percent of the R DA), 20 mg vitamin C (26 percent of the R DA for a woman, 22 percent for a man), and 485 mg potassium (the equivalent of one eight-ounce cup of fresh orange juice). The edible part of one-half a Florida avocado (a.k.a. alligator pear) has eight grams dietary fiber, 13.5 g fat (2.65 g saturated fat), 81 mcg folate (41 percent of the R DA for a man, 45 percent of the R DA for a woman), 12 mg vitamin C (20 percent of the R DA), and 741 mg potassium, 50 percent more than one cup fresh orange juice.

Diets That May Exclude or Restrict This Food Controlled-potassium diet Low-fat diet

Buying This Food Look for: Fruit that feels heavy for its size. The avocados most commonly sold in the U.S. are the Hass—a purple-black bumpy fruit that accounts for 85 percent of the avocados shipped from California—and the smooth-skinned Florida avocado (“alligator pear”). The oval, midwinter Bacon; the pear-shaped, late-fall Fuerte; the Gwen, a slightly larger Hass; Pinkerton, pear-shaped with a smaller seed; the round summer Reed; and the yellow-green, pear-shaped Zutano. Avoid: Avocados with soft dark spots on the skin that indicate damage underneath.

Storing This Food Store hard, unripened avocados in a warm place; a bowl on top of the refrigerator will do. Avocados are shipped before they ripen, when the flesh is hard enough to resist bruising in transit, but they ripen off the tree and will soften nicely at home. Store soft, ripe avocados in the refrigerator to slow the natural enzyme action that turns their flesh brown as they mature even when the fruit has not been cut.

Preparing This Food When you peel or slice an avocado, you tear its cell walls, releasing polyphenoloxidase, an enzyme that converts phenols in the avocado to brownish compounds that darken the avocado’s naturally pale green flesh. You can slow this reaction (but not stop it completely) by brushing the exposed surface of the avocado with an acid (lemon juice or vinegar). To store a cut avocado, brush it with lemon juice or vinegar, wrap it tightly in plastic, and keep it in the refrigerator—where it will eventually turn brown. Or you can store the avocado as guacamole; mixing it with lemon juice, tomatoes, onions, and mayonnaise (all of which are acidic) is an efficient way to protect the color of the fruit.

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 healthy woman and 200 mcg for a healthy man, but the FDA now recommends 400 mcg for a woman who is or may become pregnant. Taking folate supple- ments before becoming pregnant and through the first two months of pregnancy reduces the risk of cleft palate; taking folate through the entire pregnancy reduces the risk of neural tube defects. Lower risk of heart attack. In the spring of 1998, an analysis of data from the records for more than 80,000 women enrolled in the long-running Nurses’ Health Study at Harvard School of Public Health/Brigham and Woman’s Hospital, in Boston, demonstrated that a diet providing more than 400 mcg folate and 3 mg vitamin B6 daily, from either food or supplements, more than twice the current R DA for each, may reduce a woman’s risk of heart attack by almost 50 percent. Although men were not included in the analysis, the results are assumed to apply to them as well. However, data from a meta-analysis published in the Journal of the American Medical Association in December 2006 called this theory into question. Researchers at Tulane Univer- sity examined the results of 12 controlled studies in which 16,958 patients with preexisting cardiovascular disease were given either folic acid supplements or placebos (“look-alike” pills with no folic acid) for at least six months. The scientists, who found no reduction in the risk of further heart disease or overall death rates among those taking folic acid, concluded that further studies will be required to ascertain whether taking folic acid supplements reduces the risk of cardiovascular disease. Lower levels of cholesterol. Avocados are rich in oleic acid, a monounsaturated fat believed to reduce cholesterol levels. 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 avocado—reduced the incidence of stroke by 60 percent.

Adverse Effects Associated with 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 rubber 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 pro- teins 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 aspar- tame. Persons sensitive to these foods are likely to be sensitive to latex as well. NOT E : The National Institute of Health Sciences, in Japan, also lists the following foods as suspect: A lmonds, apples, apricots, bamboo shoots, bell peppers, buckwheat, cantaloupe, carrots, celer y, cherries, chestnuts, coconut, figs, grapefruit, lettuce, loquat, mangoes, mushrooms, mustard, nectarines, oranges, passion fruit, papaya, peaches, peanuts, peppermint, pine- apples, potatoes, soybeans, strawberries, walnuts, and watermelon.

Food/Drug Interactions MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of enzymes that break down the amino acid tyramine so it can be eliminated from the body. Tyramine is a pressor amine, a chemical that constricts blood vessels and raises blood pressure. If you eat a food such as avocado that contains tyramine while you are taking an M AO inhibitor you cannot eliminate the pressor amine, and the result may be abnormally high blood pressure or a hypertensive crisis (sus- tained elevated blood pressure). False-positive test for tumors. Carcinoid tumors (which may arise from tissues in 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. Avocados 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 bananas, eggplant, pineapples, plums, tomatoes, and walnuts.)... A Nutritional, Medical and Culinary Guide

• 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

• 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

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

• 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

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.... A Nutritional, Medical and Culinary Guide

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.... A Nutritional, Medical and Culinary Guide

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.... A Nutritional, Medical and Culinary Guide

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.... A Nutritional, Medical and Culinary Guide

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).... A Nutritional, Medical and Culinary Guide

• 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.

Action: Antiseptic, Carminative, Expectorant.

Use s. Flatulence. Stomach cramp. Intestinal colic. Weak digestion. Nausea. Headache. menstruation.

Preparation. Tea. 1 teaspoon to each cup boiling water; infuse 5-10 minutes. Half-1 cup as necessary. Bergamot imparts the distinctive flavour to Earl Grey tea.

Aromatherapy. Diluted oil for shingles: 6 drops to 2 teaspoons Almond oil as a soothing lotion.

BERI BERI. A disease caused by a deficiency of thiamine (Vitamin B1) by eating polished rice from which the husk (in which the vitamin is found) is discarded. Others at risk from Vitamin B1 deficiency are alcoholics, hypothyroids, pregnant women and those with a high intake of refined sugar but a low intake of fresh fruits and vegetables. Heavy coffee drinkers suffer temporary wastage.

Symptoms: weight loss, poor appetite, loss of sensation in arms and legs. Polyneuritis, muscular atrophy. Mood changes.

Painful Of value. Slippery Elm. Dandelion. Alfalfa sprouts or tea. Psyllium husks.

Diet. Vitamin B1 is present in green vegetables, eggs, meat, nuts, yeast, natural unprocessed brown rice, cereal germ and husks, oatmeal, peas, beans, asparagus, brewer’s yeast, desiccated liver.

Supplements. Vitamin B-complex. Vitamins B1 and C. ... Bartrams Encyclopedia of Herbal Medicine

• 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.

• alleviate joint pain related to rheumatoid arthritis and osteoarthritis
• combat gout
• fight urinary disorders
• increase urination
• treat melanoma
• help fighting skin breakouts and other dermatological problems (applied topically as a wash or added to bath water)
• soothe sore muscles

• Place one teaspoonful of the dried bistort rhizome in a 250 ml cup of water and boil the mix.
• Let it steep for about 10 to 15 minutes.
• Strain the liquid.

• treat diarrhea, dysentery and irritable bowel syndrome
• aid in the treatment of diverticulitis
• help treating oral and tongue inflammations
• help fighting pharyngitis and sore throat
• help in the treatment of jaundice
• aid fighting measles and smallpox
• fight hemorrhoids
• ease menstrual bleeding
• help in the healing of wounds, skin ruptures and burstings (when applied topically)

• Place a handful of leaves in a pot of boiling water
• Boil the mix until the water turns green
• Let the mix steep for about 5 minutes

• abdominal gas and colic
• liver problems
• ulcers in different parts of the body
• digestion (It may also help ease symptoms of dyspepsia and constipation)

• Boil two teaspoonfuls of dried Black haw bark in a cup of water (Bring water to a gentle boil).
• Allowed it to simmer for ten minutes and then cool it and strain it.

• help in alleviating symptoms of menopause and menstrual cramps in women
• help prevent a miscarriage in women
• alleviate labor pains
• help in easing uterine disorders in women
• help in the treatment of migraine headaches
• help lower blood pressure

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.... Medical Dictionary

• stimulate the liver and thus, it is helpful in the treatment of jaundice and hepatitis
• fight impurities of the blood
• fight against skin problems like acne and psoriasis
• detoxify the body by increasing the production of bile, as well as frequency of urination
• help treat indigestion
• treat rheumatism
• help in weight loss

• Pour boiling water over 1 teaspoon of dried boldo leaves.
• Let the mix infuse for about 10 to 15 minutes.
• Drink it slowly.

• treating urinary tract and bladder infections
• helping in liver cleansing
• helping alleviate heartburn
• relieving discomfort in the gallbladder
• helping treat mild stomach cramps
• treating worm infections
• helping in the treatment of cystitis
• treating gonorrhea

• place two to three teaspoons of dried boneset herbs (leaves, flowers or the stem) into a cup of boiling water
• allow the mixture to steep for about 10 to 15 minutes

• treat colds, coughs and ailments in the upper respiratory tract
• help in the treatment of influenza, malaria and fever
• help relieve migraine headache
• relieve pain from arthritis and rheumatism
• help in the treatment of jaundice
• fight intestinal worms

• improving the memory and enhancing mental functions, agility and alertness (It is helpful in retention of new information)
• calming the mind and promoting relaxation
• improving motor learning ability
• promoting greater concentration and focus
• treating asthma
• treating epilepsy
• treating indigestion

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• Immerse 2 teaspoons of dried buchu leaves into 18 ounces of boiling water.
• Let the mixture soak for about 10 minutes.
• Drink it slowly.

• treat certain prostate disorders
• regulate blood sugar
• lower blood pressure
• help digestion
• eliminate flatulence and bloating
• reduce inflammation, tightness and swelling of the joints

• add one spoon of mashed buckthorn bark to a cup of boiling water
• cover it for 15 minutes
• boil it for another 15 minutes
• filter the brew while it is still hot
• drink it before bedtime

• assist in moving bowels and to relieve constipation (particularly those caused by insufficiency of bile)
• help in treating liver disorders
• treat rheumatism
• purge intestinal worms
• combat skin disorders associated with constipation (eczema, acne and psoriasis)

• add one teaspoonful of dried bugleweed herbs to a cup of boiling water
• allow the mixture to steep for 10-15 minutes

• treat hyperthyroidism
• alleviate cyclic breast pain in women by moderating estrogen levels
• sedate and calm the nerves
• suppress cough and fighting tuberculosis and other disorders of the lungs
• moderate a rapid heart rate
• remove excess fluid in the body and promote better circulation
• accelerate the healing of bruises and other wounds (when applied topically)

• treat liver problems like hepatitis, cirrhosis and cancer
• treat infections with fever
• relieve chest congestion
• treat indigestion
• treat hemorrhoids
• treat uterine and anal prolapse
• treat diarrhea
• help in overall efforts to treat HIV

• Pour boiling water over the desired amount of herbs.
• Cover and let them steep 10 to 20 minutes.
• Strain off the herbs using a tea strainer or coffee filter.

• soothe the skin and gastrointestinal tract
• improve appetite and digestion
• reduce liver damage
• mildly lower blood sugar (hypoglycemic effect)
• purify the blood
• fight the effects of rheumatism
• treat some kidney disorders
• counter bronchial cough and other irritations of the pulmonary tract

• boil a teaspoon of the bark in a cup of water
• let it steep for 3 to 5 minutes

• relieve constipation
• expel parasites
• help in the treatment of gallbladder disorders
• help in the treatment of hemorrhoids
• help against certain skin diseases
• protect the liver
• cleanse the blood
• cleanse the colon

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

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

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

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

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

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

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

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

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

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

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

Food/Drug Interactions Anticoagulants Cabbage contains vitamin K, the blood-clotting vitamin produced natu- rally by bacteria in the intestines. Consuming large quantities of this food may reduce the effectiveness of anticoagulants (blood thinners) such as warfarin (Coumadin). One cup of shredded common green cabbage contains 163 mcg vitamin K, nearly three times the R DA for a healthy adult; one cup of drained boiled common green cabbage contains 73 mcg vita- min K, slightly more than the R DA for a healthy adult. Monoamine oxidase (MAO) inhibitors. Monoamine oxidase inhibitors are drugs used to treat depression. They inactivate naturally occurring enzymes in your body that metabolize tyra- mine, a substance found in many fermented or aged foods. Tyramine constricts blood vessels and increases blood pressure. If you eat a food such as sauerkraut which is high in tyramine while you are taking an M AO inhibitor, you cannot effectively eliminate the tyramine from your body. The result may be a hypertensive crisis.... A Nutritional, Medical and Culinary Guide

The operation is usually performed through a low, horizontal ‘bikini line’ incision. A general anaesthetic in a heavily pregnant woman carries increased risks, so the operation is often performed under regional – epidural or spinal – ANAESTHESIA. This also allows the mother to see her baby as soon as it is born, and the baby is not exposed to agents used for general anaesthesia. If a general anaesthetic is needed (usually in an emergency), exposure to these agents may make the baby drowsy for some time afterwards.

Another problem with delivery by Caesarean section is, of course, that the mother must recover from the operation whilst coping with the demands of a small baby. (See PREGNANCY AND LABOUR.)... Medical Dictionary

• pour a cup of boiling water on 2 teaspoonfuls of the calamus root
• leave it to steep for about 10 to 15 minutes

• treat chest congestion
• treat digestive problems (flatulence and bloating)
• relieve stomach spasms
• enhance the appetite
• treat laryngitis
• fight the desire for tobacco
• fight fever

Calcium is a most important element in diet; the chief sources of it are milk and cheese. Calcium is especially needed by the growing child and the pregnant and nursing mother. The uptake of calcium by the baby is helped by vitamin D (see APPENDIX 5: VITAMINS). A de?ciency of calcium may cause TETANY, and an excess may result in the development of CALCULI (stones) in the KIDNEYS or gallbladder (see LIVER).

The recommended daily intakes of calcium are: 500 mg for children, 700 mg for adolescents, 500–900 mg for adults and 1,200 mg for pregnant or nursing mothers.... Medical Dictionary

• fight insomnia by ushering in restful sleep
• fight anxiety
• fight headaches
• fight toothaches and stomachaches
• fight skin sores and ulcers

Symptoms. A small lump comes to light while washing, a discharge from the nipple, change in nipple size and colour, irregular contour of the breast surface. Though tissue change is likely to be a cyst, speedy diagnosis and treatment are necessary. Some hospital physicians and surgeons are known to view favourably supportive herbal aids, and do not always think in terms of radical mastectomy. Dr Finlay Ellingwood, Chicago physician (1916) cured a case by injection of one dram Echinacea root extract twice a week into the surrounding tissues.

The condition is believed to be due to a number of causes including suppression of ovulation and oestrogen secretion in pregnant and lactating women. A high fat diet is suspected of interference with the production of oestrogen. Some women are constitutionally disposed to the condition which may be triggered by trauma or emotional shock. Increase in incidence in older women has been linked with excessive sugar consumption. “Consumption overwhelms the pancreas which has to ‘push it out’ to all parts of the body (when broken down by the digestive process) whether they need it or not. The vital organs are rationed according to their requirements of nutrients from the diet. What is left over has to ‘go into store elsewhere’. And the breast is forced to take its share and store it. If it gets too much, for too long, it may rebel!” (Stephen Seely, Department of Bacteriology and Virology, Manchester)

“Women who nurse their babies less than one month are at an increased risk for breast cancer. The longer a woman breast-feeds – no matter what her age – the more the risk decreases. (Marion Tompson, co-founder, The La Leche League, in the American Journal of Epidemiology)

Lactation reduces the risk of pre-menopausal breast cancer. (Newcomb P.A. et al New England Journal of Medicine, 330 1994)

There is currently no treatment to cure metastatic breast cancer. In spite of chemotherapy, surgery and radiotherapy survival rate has not diminished. Herbs not only have a palliative effect but, through their action on hormone function offer a positive contribution towards overcoming the condition. Their activity has been widely recorded in medical literature. Unlike cytotoxic drugs, few have been known to cause alopecia, nausea, vomiting or inflammation of the stomach.

Treatment by a general medical practitioner or oncologist.

Special investigations. Low radiation X-ray mammography to confirm diagnosis. Test for detection of oestrogen receptor protein.

Treatment. Surgery may be necessary. Some patients may opt out from strong personal conviction, choosing a rigid self-disciplined approach – the Gentle Way. Every effort is made to build up the body’s natural defences (immune system).

An older generation of herbalists believed tissue change could follow a bruise on the breast, which should not be neglected but immediately painted with Tincture Arnica or Tincture Bellis perennis.

Vincristine, an alkaloid from Vinca rosea (Catharanthus roseus) is used by the medical profession as an anti-neoplastic and anti-mitotic agent to inhibit cell division.

Of possible therapeutic value. Blue Flag root, Burdock root, Chaparral, Clivers, Comfrey root, Echinacea, Figwort, Gotu Kola, Marshmallow root, Mistletoe, Myrrh, Prickly Ash bark, Red Clover, Thuja, Wild Violet, Yellow Dock.

Tea. Equal parts: Red Clover, Clivers, Gotu Kola, Wild Violet. 1 heaped teaspoon to each cup boiling water; infuse 5-15 minutes. 3 or more cups daily.

Decoctions. Echinacea, Blue Flag root, Queen’s Delight, Yellow Dock.

Tablets/capsules. Blue Flag root, Echinacea, Poke root, Mistletoe.

Formula. Echinacea 2; Gotu Kola 1; Poke root 1; Mistletoe 1; Vinca rosea 1. Mix. Dose: Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 2 teaspoons. Thrice daily and at bedtime. According to progress of the disease, increase dosage as tolerated.

Maria Treben’s tea. Parts: Marigold (3), Yarrow 1; Nettles 1. Mix. 2 teaspoons to each cup boiling water. 1 cup as many times daily as tolerated.

William Boericke, M.D. recommends Houseleek. E.H. Ruddock M.D. favours Figwort.

Topical. Treatments believed to be of therapeutic value or for use as a soothing application.

(1) Cold poultice: Comfrey root.

(2) Poultice of fresh Marshmallow root pulped in juicer.

(3) Injection of Extract Greater Celandine (Chelidonium), locally, gained a reputation in the Eclectic school.

(4) The action of Blood root (Sanguinaria) is well known as a paint or injection.

(5) Ragwort poultice: 2oz Ragwort boiled in half a pint potato water for 15 minutes. See: POULTICE.

(6) Popular Russian traditional remedy: Badiaga (Spongilla fluviatilis), fresh water sponge gathered in the autumn; dried plant rubbed to a powder. Poultice.

(7) Maria Treben’s Poultice: Carefully washed fresh Plantain leaves, pulped, and applied direct to the lesion.

(8) If lymph glands are affected, apply Plantain poultice to glands.

(9) Dr Brandini’s treatment. Dr Brandini, Florence, used 4 grains Citric Acid (prepared from lemons) in 1oz (30ml) water for ulcerated cancer of the breast considered incurable. “The woman’s torments were so distressing that neither she nor other patients could get any rest. Applying lint soaked in the solution, relief was instantaneous. Repeated, it was successful.”

(10) Circuta leaves. Simmered till soft and mixed with Slippery Elm bark powder as a poultice morning and night.

(11) Decoction. Simmer gently Yellow Dock roots, fine cut or powdered, 1oz to 1 pint, 20 minutes. Saturate lint or suitable material and apply.

(12) Yellow Dock ointment. Half ounce Lobelia seed, half ounce Yellow Dock root powder. Baste into an ointment base. See: OINTMENT BASE.

(13) Infusion, for use as a wash. Equal parts: Horsetail, Red Clover, Raspberry leaves. 1oz to 1 pint boiling water infuse 15 minutes.

(14) Dr Christopher’s Ointment. Half an ounce White Oak, half an ounce Garden Sage, half an ounce Tormentil, half an ounce Horsetail, half an ounce Lemon Balm. Method: Boil gently half an hour in quart water, strain. Reduce to half a pint by simmering. Add half a pound honey. Bring to boil. Skim off scum. Allow cool. Apply: twice daily on sores.

(15) Dr Finlay Ellingwood. Poke root juice. “Fresh juice from the stems, leaves and roots applied directly to diseased tissue. Exercises a selective action; induces liquefaction and promotes removal, sometimes healing the open wound and encouraging scar formation. Masses of such tissue have been known to be destroyed in a few weeks with only a scar, with no other application but the fresh juice. Produces pain at first, but is otherwise harmless.”

(16) Lesion painted with Mandrake resin. (American Podophyllum)

(17) Dust affected parts with Comfrey powder. Mucilage from Comfrey powder or crushed root with the aid of a little milk. See: COMFREY.

(18) Dr Samuel Thomson’s Cancer Plaster. “Take heads of Red Clover and fill a kettle. Boil in water for one hour. Remove and fill kettle with fresh flower heads. Boil as before in the same liquor. Strain and press heads to express all the liquor. Simmer over a low fire till of the consistency of tar. It must not burn. Spread over a piece of suitable material.”

(19) Wipe affected area with cut Houseleek. (Dr Wm Boericke)

(20) Chinese Herbalism. Take 1-2 Liang pulverised liao-ko-wang (Wickstroemia indica), mix with cold boiled water or rice wine for local compress. Also good for mastitis.

(21) Italian women once used an old traditional remedy – Fenugreek tea.

(22) A clinical trial of Vitamin D provided encouraging results. Patients with locally advanced breast cancer were given a highly active Vitamin D analogue cream to rub on their tumours. “It was effective in one third of the tumours,” said Professor Charles Coombes, clinical oncologist, Charing Cross Hospital, London.

Diet. “A diet rich in cereal products (high in dietary fibre) and green leafy vegetables (antioxidants) would appear to offer women some protection against breast cancer due to the relation between fibre and oestrogen metabolism. Meat-free diet. In a study of 75 adolescent girls, vegetarians were found to have higher levels of a hormone that women suffering from breast cancer often lack. (Cancer Research) Supplements. Daily. Chromium. Selenium (600mcg). Zinc chelate (100mg morning and evening). Beta carotene. “Low levels of Selenium and Vitamins A and E are shown in breast cancer cases.” (British Journal of Cancer 49: 321-324, 1984).

Vitamins A and D inhibit virus penetration in healthy cell walls. Multivitamin combinations should not include Vitamin B12, production of which in the body is much increased in cancerous conditions. Vitamins B-complex and C especially required.

Note: A link between sugar consumption and breast cancer has been reported by some authorities who suggest that countries at the top of the mortality table are the highest also in sugar consumption; the operative factor believed to be insulin.

Screening. Breast screening should be annual from the age of forty.

General. Mothers are encouraged to breast-feed children for the protection it offers against mammary malignancy. (Am.J. Obstet. Gyn. 15/9/1984. 150.)

Avoidance of stress situations by singing, playing an instrument. Adopt relaxation techniques, spiritual healing and purposeful meditation to arouse the immune system; intensive visualisation. Avoid the carcinogens: smoking, alcohol.

Information. Breast Cancer Care. Free Help Line. UK Telephone: 0500 245345. ... Bartrams Encyclopedia of Herbal Medicine

• Infuse 1 teaspoon of crushed caraway seeds into a cup of boiling water.
• Allow this mix to steep for 10 to 15 minutes.

• soothe the digestive tract and relieve colic, cramps and flatulence
• promote gastric secretion and improve the appetite
• fight diarrhea
• ease menstrual cramps, as well as gallbladder spasms
• fight bronchitis and cough
• increase the production of breast milk
• freshen the breath

Each year around 50 people in the United Kingdom are reported as dying from carbon monoxide poisoning, and experts have suggested that as many as 25,000 people a year are exposed to its effects within the home, but most cases are unrecognised, unreported and untreated, even though victims may suffer from long-term effects. This is regrettable, given that Napoleon’s surgeon, Larrey, recognised in the 18th century that soldiers were being poisoned by carbon monoxide when billeted in huts heated by woodburning stoves. In the USA it is estimated that 40,000 people a year attend emergency departments suffering from carbon monoxide poisoning. So prevention is clearly an important element in dealing with what is sometimes termed the ‘silent killer’. Safer designs of houses and heating systems, as well as wider public education on the dangers of carbon monoxide and its sources, are important.

Clinical effects of acute exposure resemble those of atmospheric HYPOXIA. Tissues and organs with high oxygen consumption are affected to a great extent. Common effects include headaches, weakness, fatigue, ?ushing, nausea, vomiting, irritability, dizziness, drowsiness, disorientation, incoordination, visual disturbances, TACHYCARDIA and HYPERVENTILATION. In severe cases drowsiness may progress rapidly to COMA. There may also be metabolic ACIDOSIS, HYPOKALAEMIA, CONVULSIONS, HYPOTENSION, respiratory depression, ECG changes and cardiovascular collapse. Cerebral OEDEMA is common and will lead to severe brain damage and focal neurological signs. Signi?cant abnormalities on physical examination include impaired short-term memory, abnormal Rhomberg’s test (standing unsupported with eyes closed) and unsteadiness of gait including heel-toe walking. Any one of these signs would classify the episode as severe. Victims’ skin may be coloured pink, though this is very rarely seen even in severe incidents. The venous blood may look ‘arterial’. Patients recovering from acute CO poisoning may suffer neurological sequelae including TREMOR, personality changes, memory impairment, visual loss, inability to concentrate and PARKINSONISM. Chronic low-level exposures may result in nausea, fatigue, headache, confusion, VOMITING, DIARRHOEA, abdominal pain and general malaise. They are often misdiagnosed as in?uenza or food poisoning.

First-aid treatment is to remove the victim from the source of exposure, ensure an e?ective airway and give 100-per-cent oxygen by tight-?tting mask. In hospital, management is largely suppportive, with oxygen administration. A blood sample for COHb level determination should be taken as soon as practicable and, if possible, before oxygen is given. Ideally, oxygen therapy should continue until the COHb level falls below 5 per cent. Patients with any history of unconsciousness, a COHb level greater than 20 per cent on arrival, any neurological signs, any cardiac arrhythmias or anyone who is pregnant should be referred for an expert opinion about possible treatment with hyperbaric oxygen, though this remains a controversial therapy. Hyperbaric oxygen therapy shortens the half-life of COHb, increases plasma oxygen transport and reverses the clinical effects resulting from acute exposures. Carbon monoxide is also an environmental poison and a component of cigarette smoke. Normal body COHb levels due to ENDOGENOUS CO production are 0.4 to

0.7 per cent. Non-smokers in urban areas may have level of 1–2 per cent as a result of environmental exposure. Smokers may have a COHb level of 5 to 6 per cent.... Medical Dictionary

• Water
• Chamomile flowers
• Honey (Optional)
• Mint (Optional)

• Chamomile tea is most known for its relaxing properties and it is often taken before bed by people with sleeping problems for a restful sleep. Use it with discretion if you are already taking medications that have a sedative effect!
• Chamomile tea soothes stomach aches and helps overall digestion.
• Some studies have found that Chamomile tea has a compound that calms muscle spasm, researchers believing that due to this fact, the tea helps soothe menstrual cramps.
• Due to its antibacterial properties, Chamomile tea has resulted efficient in fighting colds, straightening the immune system.
• Chamomile tea has also resulted beneficial in healing wounds and other skin problems such as burns, allergies, bites or acne. In case of treating a wound, put a cold compress of Chamomile tea on it and let it action for a few minutes.

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

About the Nutrients in This Food Cheese making begins when Lactobacilli and/or Streptococci bacteria are added to milk. The bacteria digest lactose (milk sugar) and release lactic acid, which coagulates casein (milk protein) into curds. Rennet (gastric enzymes extracted from the stomach of calves) is added, and the mixture is put aside to set. The longer the curds are left to set, the firmer the cheese will be. When the curds are properly firm, they are pressed to squeeze out the whey (liquid) and cooked. Cooking evaporates even more liquid and makes the cheese even firmer.* At this point, the product is “fresh” or “green” cheese: cottage cheese, cream cheese, farmer cheese. Making “ripe” cheese requires the addition of salt to pull out more moisture and specific organisms, such as Penicil- lium roquefort for Roquefort cheese, blue cheese, and Stilton, or Penicillium cambembert for Camembert and Brie. The nutritional value of cheese is similar to the milk from which it is made. All cheese is a good source of high quality proteins with sufficient amounts of all the essential amino acids. Cheese is low to high in fat, mod- erate to high in cholesterol. * Natural cheese is cheese made direct ly from milk. Processed cheese is natural cheese melted and combined wit h emulsifiers. Pasteurized process cheese foods contain ingredients t hat allow t hem to spread smoot hly; t hey are lower in fat and higher in moisture t han processed cheese. Cholesterol and Saturated Fat Content of Selected Cheeses Mozzarella Source: USDA, Nutritive Value of Foods, Home and Garden Bullet in No. 72 (USDA, 1989). All cheeses, except cottage cheese, are good sources of vitamin A. Orange and yellow cheeses are colored with carotenoid pigments, including bixin (the carotenoid pigment in annatto) and synthetic beta-carotene. Hard cheeses are an excellent source of calcium; softer cheeses are a good source; cream cheese and cottage cheese are poor sources. The R DA for calcium is 1,000 mg for a woman, 1,200 mg for a man, and 1,500 mg for an older woman who is not on hormone- replacement therapy. All cheese, unless otherwise labeled, is high in sodium.

The Most Nutritious Way to Serve This Food With grains, bread, noodles, beans, nuts, or vegetables to add the essential amino acids miss- ing from these foods, “complete” their proteins, and make them more nutritionally valuable.

Diets That May Restrict or Exclude This Food Antiflatulence diet Controlled-fat, low-cholesterol diet Lactose- and galactose-free diet (lactose, a disaccharide [double sugar] is composed of one unit of galactose and one unit of glucose) Low-calcium diet (for patients with kidney disease) Sucrose-free diet (processed cheese)

Buying This Food Look for: Cheese stored in a refrigerated case. Check the date on the package. Avoid: Any cheese with mold that is not an integral part of the food.

Storing This Food Refrigerate all cheese except unopened canned cheeses (such as Camembert in tins) or grated cheeses treated with preservatives and labeled to show that they can be kept outside the refrigerator. Some sealed packages of processed cheeses can be stored at room temperature but must be refrigerated once the package is opened. Wrap cheeses tightly to protect them from contamination by other microorganisms in the air and to keep them from drying out. Well-wrapped, refrigerated hard cheeses that have not been cut or sliced will keep for up to six months; sliced hard cheeses will keep for about two weeks. Soft cheeses (cottage cheese, ricotta, cream cheese, and Neufchatel) should be used within five to seven days. Use all packaged or processed cheeses by the date stamped on the package. Throw out moldy cheese (unless the mold is an integral part of the cheese, as with blue cheese or Stilton).

Preparing This Food To grate cheese, chill the cheese so it won’t stick to the grater. The molecules that give cheese its taste and aroma are largely immobilized when the cheese is cold. When serving cheese with fruit or crackers, bring it to room temperature to activate these molecules.

What Happens When You Cook This Food Heat changes the structure of proteins. The molecules are denatured, which means that they may be broken into smaller fragments or change shape or clump together. All of these changes may force moisture out of the protein tissue, which is why overcooked cheese is often stringy. Whey proteins, which do not clump or string at low temperatures, contain the sulfur atoms that give hot or burned cheese an unpleasant “cooked” odor. To avoid both strings and an unpleasant odor, add cheese to sauces at the last minute and cook just long enough to melt the cheese.

How Other Kinds of Processing Affect This Food Freezing. All cheese loses moisture when frozen, so semisoft cheeses will freeze and thaw better than hard cheeses, which may be crumbly when defrosted. Drying. The less moisture cheese contains, the less able it is to support the growth of organ- isms like mold. Dried cheeses keep significantly longer than ordinary cheeses.

Medical Uses and/or Benefits To strengthen bones and reduce age-related loss of bone density. High-calcium foods protect bone density. The current recommended dietary allowance (R DA) for calcium is still 800 mg for adults 25 and older, but a 1984 National Institutes of Health (NIH) Conference advisory stated that lifelong protection for bones requires an R DA of 1,000 mg for healthy men and women age 25 to 50 ; 1,000 mg for older women using hormone replacement therapy; and 1,500 mg for older women who are not using hormones, and these recommendations have been confirmed in a 1994 NIH Consensus Statement on optimal calcium intake. A diet with adequate amounts of calcium-rich foods helps protect bone density. Low-fat and no-fat cheeses provide calcium without excess fat and cholesterol. Protection against tooth decay. Studies at the University of Iowa (Iowa City) Dental School confirm that a wide variety of cheeses, including aged cheddar, Edam, Gouda, Monterey Jack, Muenster, mozzarella, Port Salut, Roquefort, Romano, Stilton, Swiss, and Tilsit—limit the tooth decay ordinarily expected when sugar becomes trapped in plaque, the sticky film on tooth surfaces where cavity-causing bacteria flourish. In a related experiment using only cheddar cheese, people who ate cheddar four times a day over a two-week period showed a 20 percent buildup of strengthening minerals on the surface of synthetic toothlike material attached to the root surfaces of natural teeth. Protection against periodontal disease. A report in the January 2008 issue of the Journal of Periodontology suggests that consuming adequate amounts of dairy products may reduce the risk of developing periodontal disease. Examining the dental health of 942 subjects ages 40 to 79, researchers at Kyushu University, in Japan, discovered that those whose diets regularly included two ounces (55 g) of foods containing lactic acid (milk, cheese, and yogurt) were significantly less likely to have deep “pockets” (loss of attachment of tooth to gum) than those who consumed fewer dairy products.

Adverse Effects Associated with This Food Increased risk of heart disease. Like other foods from animals, cheese is a source of choles- terol and saturated fats, which increase the amount of cholesterol circulating in your blood and raise your risk of heart disease. To reduce the risk of heart disease, the USDA /Health and Human Services Dietary Guidelines for Americans recommends limiting the amount of cholesterol in your diet to no more than 300 mg a day. The guidelines also recommend limit- ing the amount of fat you consume to no more than 30 percent of your total calories, while holding your consumption of saturated fats to more than 10 percent of your total calories (the calories from saturated fats are counted as part of the total calories from fat). Food poisoning. Cheese made from raw (unpasteurized) milk may contain hazardous microorganisms, including Salmonella and Listeria. Salmonella causes serious gastric upset; Lis- teria, a flulike infection, encephalitis, or blood infection. Both may be life-threatening to the very young, the very old, pregnant women, and those whose immune systems are weakened either by illness (such as AIDS) or drugs (such as cancer chemotherapy). In 1998, the Federal Centers for Disease Control (CDC) released data identif ying Listeria as the cause of nearly half the reported deaths from food poisoning. Allergy to milk proteins. Milk is one of the foods most frequently implicated as a cause of allergic reactions, particularly upset stomach. However, in many cases the reaction is not a true allergy but the result of lactose intolerance (see below). Lactose intolerance. Lactose intolerance—the inability to digest the sugar in milk—is an inherited metabolic deficiency that affects two thirds of all adults, including 90 to 95 percent of all Orientals, 70 to 75 percent of all blacks, and 6 to 8 percent of Caucasians. These people do not have sufficient amounts of lactase, the enzyme that breaks the disaccharide lactose into its easily digested components, galactose and glucose. When they drink milk, the undi- gested sugar is fermented by bacteria in the gut, causing bloating, diarrhea, flatulence, and intestinal discomfort. Some milk is now sold with added lactase to digest the lactose and make the milk usable for lactase-deficient people. In making cheese, most of the lactose in milk is broken down into glucose and galactose. There is very little lactose in cheeses other than the fresh ones—cottage cheese, cream cheese, and farmer cheese. Galactosemia. Galactosemia is an inherited metabolic disorder in which the body lacks the enzymes needed to metabolize galactose, a component of lactose. Galactosemia is a reces- sive trait; you must receive the gene from both parents to develop the condition. Babies born with galactosemia will fail to thrive and may develop brain damage or cataracts if they are given milk. To prevent this, children with galactosemia are usually kept on a protective milk- free diet for several years, until their bodies have developed alternative pathways by which to metabolize galactose. Pregnant women who are known carriers of galactosemia may be advised to give up milk and milk products while pregnant lest the unmetabolized galactose in their bodies cause brain damage to the fetus (damage not detectable by amniocentesis). Genetic counseling is available to identif y galactosemia carriers and assess their chances of producing a baby with the disorder. Penicillin sensitivity. People who experience a sensitivity reaction the first time they take penicillin may have been sensitized by exposure to the Penicillium molds in the environment, including the Penicillium molds used to make brie, blue, camembert, roquefort, Stilton, and other “blue” cheeses.

Food/Drug Interactions Tetracycline. The calcium ions in milk products, including cheese, bind tetracyclines into insoluble compounds. If you take tetracyclines with cheese, your body may not be able to absorb and use the drug efficiently. 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 ves- sels and increases blood pressure. If you eat a food such as aged or fermented cheese which is high in tyramine while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine. The result may be a hypertensive crisis.

Tyramine Content of Cheeses High Boursault, Camembert, Cheddar, Emmenthaler, Stilton Medium to high Blue, brick, Brie, Gruyère, mozzarella, Parmesan, Romano, Roquefort Low Processed American cheese Very little or none Cottage and cream cheese Sources: The Medical Letter Handbook of Adverse Drug Interactions (1985); Handbook of Clinical Dietetics ( The A merican Dietet ic Associat ion, 1981). False-positive test for pheochromocytoma. Pheochromocytomas (tumors of the adrenal glands) secrete adrenalin that is converted by the body to vanillyl-mandelic acid ( VM A) and excreted in the urine. Tests for this tumor measure the level of VM A in the urine. Since cheese contains VM A, taking the test after eating cheese may result in a false-positive result. Ordinarily, cheese is prohibited for at least 72 hours before this diagnostic test.... A Nutritional, Medical and Culinary Guide

chest X-ray One of the most frequently performed medical tests, usually carried out to examine the heart or lungs to confirm diagnoses of heart disorders and lung diseases. (See also X-rays.)... BMA Medical Dictionary

Incubation period varies from a few hours to ?ve days. Watery diarrhoea may be torrential and the resultant dehydration and electrolyte imbalance, complicated by cardiac failure, commonly causes death. The victim’s skin elasticity is lost, the eyes are sunken, and the radial pulse may be barely perceptible. Urine production may be completely suppressed. Diagnosis is by detection of V. cholerae in a faecal sample. Treatment consists of rapid rehydration. Whereas the intravenous route may be required in a severe case, in the vast majority of patients oral rehydration (using an appropriate solution containing sodium chloride, glucose, sodium bicarbonate, and potassium) gives satisfactory results. Proprietary rehydration ?uids do not always contain adequate sodium for rehydration in a severe case. ANTIBIOTICS, for example, tetracycline and doxycycline, reduce the period during which V. cholerae is excreted (in children and pregnant women, furazolidone is safer); in an epidemic, rapid resistance to these, and other antibiotics, has been clearly demonstrated. Prevention consists of improving public health infrastructure – in particular, the quality of drinking water. When supplies of the latter are satisfactory, the infection fails to thrive. Though there have recently been large epidemics of cholera in much of South America and parts of central Africa and the Indian subcontinent, the risk of tourists and travellers contracting the disease is low if they take simple precautions. These include eating safe food (avoid raw or undercooked seafood, and wash vegetables in clean water) and drinking clean water. There is no cholera vaccine at present available in the UK as it provides little protection and cannot control spread of the disease. Those travelling to countries where it exists should pay scrupulous attention to food and water cleanliness and to personal hygiene.... Medicinal Plants Glossary

Deficiency. Rare. Hypoglycaemia, arteriosclerosis, heart disease. Depression, irritability, sudden mood swings. A lack of Chromium may result in diabetes in young adults, and a craving for sweet foods (sugar, chocolate).

Body effects. Metabolism of sugars and fats. Blood sugar regulator. Builds up muscle. Lowers cholesterol levels. Encourages the body’s insulin to perform effectively. Suppresses appetite – especially craving for sugar, chocolate etc. Sportsperson’s mineral to build muscle and reduce fat.

Sources. Red meat, liver, kidney, cheese, mushrooms, wholegrain cereals, brewer’s yeast, fresh fruits, nuts, honey, molasses, corn oil, raisins, grapes, beets, peppers, shellfish. ... Bartrams Encyclopedia of Herbal Medicine

• reducing cholesterol
• stabilizing blood glucose levels
• reducing weight
• decreasing excess deposits of fat
• aiding digestion processes
• promoting skin health
• promoting good oral hygiene
• aiding in the relief of anxiety due to emotional and physical stress

1. It is illegal for anyone not a registered medical practitioner to attempt to procure an abortion: a member must not knowingly administer an abortifacient or known uterine muscle stimulant remedies to a pregnant patient, nor instruments for the purpose of procuring an abortion, nor assist in any illegal operation.

2. It is required that any intimate examinations on a patient of the opposite sex be conducted in the presence of a relative of the patient or a suitable assistant.

3. A member must not treat or prescribe any remedy for gonorrhoea, syphilis, or urinary affections of a venereal nature.

4. It is the duty of the practitioner to notify the District Medical Officer regarding any disease on the current list of notifiable diseases. In cases of industrial poisoning or accident the local district branch of the Health and Safety Executive should be notified.

5. A member must consider very carefully the implications of recommending a course of treatment contrary to the advice of the patient’s registered medical practitioner or of not recommending referral to a registered medical practitioner in the case of serious disease or uncertain diagnosis. Members must be aware of their vulnerability in law on this issue and must ensure in such a case that all available information is given to the patient and that the patient makes the final decision without coercion.

6. A parent or supervising adult must be present at any treatment or examination of a child under the age of 16, or of a mentally-retarded patient.

7. The Data Protection Act means that any practitioner keeping patient’s data on computer file must register under the terms of the Act.

8. A member must become familiar with the terms of the Medicine’s Act 1968 and subsequent statutory instruments, notably the Medicines (Retail Sale or Supply of Herbal Remedies) Order 1977. Particular care should be taken to become familiar with the statutory maximum doses of those remedies listed in Schedule III of the latter order. Detailed records of prescriptions and dispensing must also be kept.

9. The Medicines Act further states that to claim exemptions from the restrictions on the supply of certain herbal remedies, the practitioner should supply said remedies from premises occupied by the practitioner and able to be closed so as to exclude the public.

10. The Medicines Act adds that to claim the said exemptions, the person supplying the remedy “sells or supplies it for administration to a particular person after being requested by or on behalf of that person and in that person’s presence to use his own judgement as to the treatment required”. The member should avoid treatment through telephone or postal contact, although repeat prescriptions may be supplied on this basis for a limited period.

11. Dispensing and labelling of medicines should at least comply with the terms of the Medicines Act. All medicines should be labelled to clearly indicate the correct dosage or other directions for use (especially for those remedies subject to a statutory maximum dose), and with the name and address of the practitioner and the date of dispensing.

12. A member should never claim verbally or in print to be able to cure any life-threatening or serious disease.

13. The distribution or display of letter headings, business cards or practice information should be compatible with the highest professional medical standards. ... Bartrams Encyclopedia of Herbal Medicine

Barrier methods These involve a physical barrier which prevents sperm (see SPERMATOZOON) from reaching the cervix (see CERVIX UTERI). Barrier methods reduce the risk of spreading sexually transmitted diseases, and the sheath is the best protection against HIV infection (see AIDS/HIV) for sexually active people. The e?ciency of barrier methods is improved if they are used in conjunction with a spermicidal foam or jelly, but care is needed to ensure that the preparation chosen does not damage the rubber barrier or cause an allergic reaction in the users. CONDOM OR SHEATH This is the most commonly used barrier contraceptive. It consists of a rubber sheath which is placed over the erect penis before intromission and removed after ejaculation. The failure rate, if properly used, is about 4 per cent. DIAPHRAGM OR CAP A rubber dome that is inserted into the vagina before intercourse and ?ts snugly over the cervix. It should be used with an appropriate spermicide and is removed six hours after intercourse. A woman must be measured to ensure that she is supplied with the correct size of diaphragm, and the ?t should be checked annually or after more than about 7 lbs. change in weight. The failure rate, if properly used, is about 2 per cent.

Non-barrier methods These do not provide a physical barrier between sperm and cervix and so do not protect against sexually transmitted diseases, including HIV. COITUS INTERRUPTUS This involves the man’s withdrawing his penis from the vagina before ejaculation. Because some sperm may leak before full ejaculation, the method is not very reliable. SAFE PERIOD This involves avoiding intercourse around the time when the woman ovulates and is at risk of pregnancy. The safe times can be predicted using temperature charts to identify the rise in temperature before ovulation, or by careful assessment of the quality of the cervical mucus. This method works best if the woman has regular menstrual cycles. If used carefully it can be very e?ective but requires a highly disciplined couple to succeed. It is approved by the Catholic church.

SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.

These are supposed to prevent pregnancy by killing sperm before they reach the cervix, but they are unreliable and should be used only in conjunction with a barrier method.

INTRAUTERINE CONTRACEPTIVE DEVICE (COIL) This is a small metal or plastic shape, placed inside the uterus, which prevents pregnancy by disrupting implantation. Some people regard it as a form of abortion, so it is not acceptable to all religious groups. There is a risk of pelvic infection and eventual infertility in women who have used coils, and in many countries their use has declined substantially. Coils must be inserted by a specially trained health worker, but once in place they permit intercourse at any time with no prior planning. Increased pain and bleeding may be caused during menstruation. If severe, such symptoms may indicate that the coil is incorrectly sited, and that its position should be checked. HORMONAL METHODS Steroid hormones have dominated contraceptive developments during the past 40 years, with more than 200 million women worldwide taking or having taken ‘the pill’. In the past 20 years, new developments have included modifying existing methods and devising more e?ective ways of delivering the drugs, such as implants and hormone-releasing devices in the uterus. Established hormonal contraception includes the combined oestrogen and progesterone and progesterone-only contraceptive pills, as well as longer-acting depot preparations. They modify the woman’s hormonal environment and prevent pregnancy by disrupting various stages of the menstrual cycle, especially ovulation. The combined oestrogen and progesterone pills are very e?ective and are the most popular form of contraception. Biphasic and triphasic pills contain di?erent quantities of oestrogen and progesterone taken in two or three phases of the menstrual cycle. A wide range of preparations is available and the British National Formulary contains details of the commonly used varieties.

The main side-e?ect is an increased risk of cardiovascular disease. The lowest possible dose of oestrogen should be used, and many preparations are phasic, with the dose of oestrogen varying with the time of the cycle. The progesterone-only, or ‘mini’, pill does not contain any oestrogen and must be taken at the same time every day. It is not as e?ective as the combined pill, but failure rates of less than 1-per-100 woman years can be achieved. It has few serious side-effects, but may cause menstrual irregularities. It is suitable for use by mothers who are breast feeding.

Depot preparations include intramuscular injections, subcutaneous implants, and intravaginal rings. They are useful in cases where the woman cannot be relied on to take a pill regularly but needs e?ective contraception. Their main side-e?ect is their prolonged action, which means that users cannot suddenly decide that they would like to become pregnant. Skin patches containing a contraceptive that is absorbed through the skin have recently been launched.

HORMONAL CONTRACEPTION FOR MEN There is a growing demand by men worldwide for hormonal contraception. Development of a ‘male pill’, however, has been slow because of the potentially dangerous side-effects of using high doses of TESTOSTERONE (the male hormone) to suppress spermatogenesis. Progress in research to develop a suitable ANDROGEN-based combination product is promising, including the possibility of long-term STEROID implants. STERILISATION See also STERILISATION – Reproductive sterilisation. The operation is easier and safer to perform on men than on women. Although sterilisation can sometimes be reversed, this cannot be guaranteed and couples should be counselled in advance that the method is irreversible. There is a small but definite failure rate with sterilisation, and this should also be made clear before the operation is performed. POSTCOITAL CONTRACEPTION Also known as emergency contraception or the ‘morning after pill’, postcoital contraception can be e?ected by two di?erent hormonal methods. Levonorgesterol (a synthetic hormone similar to the natural female sex hormone PROGESTERONE) can be used alone, with one pill being taken within 72 hours of unprotected intercourse, but preferably as soon as possible, and a second one 12 hours after the ?rst. Alternatively, a combined preparation comprising ETHINYLESTRADIOL and levonorgesterol can be taken, also within 72 hours of unprotected intercourse. The single constituent pill has fewer side-effects than the combined version. Neither version should be taken by women with severe liver disease or acute PORPHYRIAS, but the ethinylestradiol/levonorgesterol combination is unsuitable for women with a history of THROMBOSIS.

In the UK the law allows women over the age of 16 to buy the morning-after pill ‘over the counter’ from a registered pharmacist.... Medical Dictionary

• Use water that is free of chlorine, iron, salt and other type of impurities, because otherwise it can completely ruin the taste orDarjeeling tea.
• An important detail that most people ignore is using the right teapot. That is why it is recommended the use of China porcelain teapots and cups.
• For proper infusion, the Darjeeling tea leaves should be placed into the pot and then pour hot water on it.
• And last, Darjeeling tea connoisseurs advise not to put any kind of milk, honey or sugar in it since they change the aromatic flavor of Darjeeling tea. Also, milk reduces the benefits of this tea.

• Darjeeling tea strengthens your immune system, lowers cholesterol, fights dental plaque and maintains a healthy heart.
• Provides relaxation because of the L-theanine (amino - acid) that reduces mental and physical stress. That is why, people who suffer from depression or have anxiety attacks are advised to drink Darjeeling tea since it offers a feeling of well-being.
• It gives you energy, even though it has a small amount of caffeine. The L-theanine amino- acid softens caffeine’s speedy and uneven effects so that a person who is consuming Darjeeling tea feels relaxed and energized in the same time.
• Darjeeling tea contains antioxidants called flavonoids that protect cells from free radical damage.
• Reduces stroke risks and improves the function of blood vessels.

• People with anemia and iron deficiency should avoid drinking Darjeeling black tea.
• In cases of diabetes, even though Darjeeling tea’s caffeine content is softened by the the L-theanine amino - acid, still might affect blood sugar.
• People who present calcium deficit shouldn’t drink black tea, including Darjeeling tea, since it could produce dizziness and the sensation of fainting.
• Also, pregnant women are advised not to drink black tea.

Liver causation: Dandelion (Coffee), Wild Yam, Goldenseal.

In the elderly: Skullcap, Sage.

With restlessness: Lemon balm, Californian Poppy.

With palpitations: Hawthorn, Motherwort.

From abuse of coffee: German Chamomile.

Unable to relax: Passion Flower.

Epileptic: Mistletoe. Vervain.

Parkinsonian: St John’s Wort, broad beans.

To correct hormone imbalance: Helonias, Raspberry leaves.

Pre-menstrual tension: Evening Primrose, St John’s Wort, Rosemary.

With painful menstruation: Black Cohosh.

Associated with glaucoma: Rutin tea.

The hidden alcoholic: Ginseng.

Pregnant depressive: Raspberry leaves.

Obese depressive: Cider vinegar.

Enuresis schoolchild: Liquorice.

With swollen prostate gland: Pulsatilla.

In heart cases, and to counter side effects of beta blockers: Hawthorn, Lily of the Valley.

Drug-induced: St John’s Wort, Californian Poppy, Ginseng.

General anti-depressives: Lemon balm, Celery, Chamomile, Borage, Ginkgo, Damiana, Kola, Mistletoe, Mugwort, Oats, Rosemary, Skullcap, Southernwood, Valerian, Vervain, Wormwood, St John’s Wort, Peppermint.

BHP (1983) combination: Kola nuts, Skullcap, Oats, Damiana.

Evening Primrose: 4 × 500mg capsules daily.

Temporary depression from physical and mental exhaustion: Life Drops (see entry). Pinch of Cayenne in cup of tea.

Old men. Low cholesterol levels are linked to depression among older men.

Practitioner: Persistent depression from shock: Tincture Arnica, 2-5 drops in water, thrice daily.

(Practice among German physicians.)

Aromatherapy. Inhalant: any one oil: Rose, Tangerine, Geranium.

Diet. Low caffeine. Oats: good for depression (oatmeal porridge, oatcakes, etc). Spinach for iron and calcium.

Supplementation. Vitamins: B-complex, B6, B12, C. Thiamine, Niacin. Minerals: Dolomite, Iron, Chromium, Iodine, Zinc.

Note: Depression may trigger mechanisms that introduce chronic disease by lowering immune response, hence need for conscientious patient compliance. ... Bartrams Encyclopedia of Herbal Medicine

Unsaturated fatty acids, as in vegetable oils, should replace animal fats (saturated fatty acids) that increase deposits of cholesterol on the inner coat of arteries and encourage hardening. Vegetable oils contain lecithin – a homogeniser which thins and separates the cholesterol, sweeping it along through the bloodstream and preventing deposits to form on walls of the arteries.

A study on the European population has shown a strong link between oily fish consumption and a reduced risk of heart disease. Populations that eat a lot of fish, such as Greenland Eskimos (about 400g a day) and Japanese fishermen (about 200g a day) have low rates of heart disease.

Another study, by the Leiden University of the Netherlands, has found that men who ate more than 30g of fish per day were less than half as likely to die from coronary heart disease as those who ate no fish. A diet high in fish lowers plasma cholesterol, triglyceride and very low density lipoprotein levels and is of value in the treatment of hyperlipidaemia (abnormally high concentration of fats in the blood).

Indicated: Magnesium-containing foods, lecithin, Evening Primrose oil for gamma linoleic acid which is converted into prostaglandin E1 in the body and helps reduce high blood pressure and prevents platelet clumping. Coffee carries a risk factor and should be taken sparingly – alternatives: herbal teas Rutin, Lime flowers and others as available in bulk or tea-bags. Green grapes.

Supplements, daily: Vitamin C 1g; Vitamin E 400iu; Magnesium 300mg – 450mg for pregnant women and nursing mothers. Iodine. Chromium, Selenium. Garlic tablets/capsules – 2-3 at night.

Flora margarine is high in essential polyunsaturated fats – made from sunflower seed oil. Hay diet: good results reported. ... Bartrams Encyclopedia of Herbal Medicine

Overconsumption of alcohol can lead to various alcohol-related disorders. A high salt intake predisposes a person towards hypertension. Some components of the diet protect against disease. For example, fibre protects against diverticular disease, chronic constipation, and haemorrhoids.

Many people’s diets contain too few natural vitamins. Pregnant women need high intakes of folic acid to reduce the risk of neural tube defects.

Although many illnesses are commonly ascribed to food allergy, it is only rarely that a definite link is proved. (See also nutritional disorders).... BMA Medical Dictionary

• Helps in the treatment of kidney and bladder problems.
• Prevents and treats rheumatism, arthritis and gout.
• It is a remedy for cold and cough.
• Helps disinfecting the urinary tract.
• It is a strong allied in the treatment of cystitis.
• Tears various gastrointestinal problems.

• You shouldn’t drink too much heather tea because it can cause liver damage.
• Heather tea can alter the effects of some medications, especially the ones related to the urinary and gastro intestinal tract, so make sure you consult your doctor before drinking it.
• Pregnant and breastfeeding women should avoid drinking heather tea.

• Helps relieve dry cough.
• May help in the treatment of epilepsy and rheumatism.
• Can be used as a remedy for asthma.
• Relieves indigestion and flatulence.
• Prevents spasm in the digestive tract.

• It is most commonly used as a diuretic since washes away the toxins, having a cleansing effect to the kidneys.
• Strengthens your lungs thanks to its main component - silica acid helps strengthen the walls of the air sacs in the lungs.
• Promotes healthy hair. You can add 4 oz. of cooled horsetail tea into your shampoo or you can use the tea as a hair rinse.
• Reduces swellings and gets rid of water retention.
• Treats urinary infections.
• Helps healing and treating burns and wounds thanks to its anti-inflammatory properties.

• Pregnant or breastfeeding women are advised not to drink horsetail tea.
• If you have kidney stones, try to stay away from this tea.
• You can experience nausea, muscle weakness, fever or certain skin problems if you drink too much horsetail tea.
• Before you start drinking horsetail tea, make sure you don’t have theamine deficiency or weak heart. In case you do, do not drink this tea.

Nutritional Profile Energy value (calories per serving): Moderate to high Protein: None Fat: None Saturated fat: None Cholesterol: None Carbohydrates: None (except for cordials which contain added sugar) Fiber: None Sodium: Low Major vitamin contribution: None Major mineral contribution: Phosphorus

About the Nutrients in This Food Spirits are the clear liquids produced by distilling the fermented sugars of grains, fruit, or vegetables. The yeasts that metabolize these sugars and convert them into alcohol stop growing when the concentration of alcohol rises above 12–15 percent. In the United States, the proof of an alcoholic beverage is defined as twice its alcohol content by volume: a beverage with 20 percent alcohol by volume is 40 proof. This is high enough for most wines, but not high enough for most whiskies, gins, vodkas, rums, brandies, and tequilas. To reach the concentra- tion of alcohol required in these beverages, the fermented sugars are heated and distilled. Ethyl alcohol (the alcohol in beer, wine, and spirits) boils at a lower temperature than water. When the fermented sugars are heated, the ethyl alcohol escapes from the distillation vat and condenses in tubes leading from the vat to a collection vessel. The clear liquid that collects in this vessel is called distilled spirits or, more technically, grain neutral spirits. Gins, whiskies, cordials, and many vodkas are made with spirits American whiskeys (which include bourbon, rye, and distilled from grains. blended whiskeys) and Canadian, Irish, and Scotch whiskies are all made from spirits aged in wood barrels. They get their flavor from the grains and their color from the barrels. (Some whiskies are also colored with caramel.) Vodka is made from spirits distilled and filtered to remove all flavor. By law, vodkas made in America must be made with spirits distilled from grains. Imported vodkas may be made with spirits distilled either from grains or potatoes and may contain additional flavoring agents such as citric acid or pepper. Aquavit, for example, is essentially vodka flavored with caraway seeds. Gin is a clear spirit flavored with an infusion of juniper berries and other herbs (botanicals). Cordials (also called liqueurs) and schnapps are flavored spirits; most are sweetened with added sugar. Some cordials contain cream. Rum is made with spirits distilled from sugar cane (molasses). Tequila is made with spirits distilled from the blue agave plant. Brandies are made with spirits distilled from fruit. (Arma- gnac and cognac are distilled from fermented grapes, calvados and applejack from fermented apples, kirsch from fermented cherries, slivovitz from fermented plums.) Unless they contain added sugar or cream, spirits have no nutrients other than alcohol. Unlike food, which has to be metabolized before your body can use it for energy, alcohol can be absorbed into the blood-stream directly from the gastrointestinal tract. Ethyl alcohol provides 7 calories per gram.

The Most Nutritious Way to Serve This Food The USDA /Health and Human Services Dietary Guidelines for Americans defines one drink as 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits, and “moderate drinking” as two drinks a day for a man, one drink a day for a woman.

Diets That May Restrict or Exclude This Food Bland diet Lactose-free diet (cream cordials made with cream or milk) Low-purine (antigout) diet

Buying This Food Look for: Tightly sealed bottles stored out of direct sunlight, whose energy might disrupt the structure of molecules in the beverage and alter its flavor. Choose spirits sold only by licensed dealers. Products sold in these stores are manufac- tured under the strict supervision of the federal government.

Storing This Food Store sealed or opened bottles of spirits in a cool, dark cabinet.

Preparing This Food All spirits except unflavored vodkas contain volatile molecules that give the beverage its characteristic taste and smell. Warming the liquid excites these molecules and intensifies the flavor and aroma, which is the reason we serve brandy in a round glass with a narrower top that captures the aromatic molecules as they rise toward the air when we warm the glass by holding it in our hands. Whiskies, too, though traditionally served with ice in America, will have a more intense flavor and aroma if served at room temperature.

What Happens When You Cook This Food The heat of cooking evaporates the alcohol in spirits but leaves the flavoring intact. Like other alcoholic beverages, spirits should be added to a recipe near the end of the cooking time to preserve the flavor while cooking away any alcohol bite. Alcohol is an acid. If you cook it in an aluminum or iron pot, it will combine with metal ions to form dark compounds that discolor the pot and the food you are cooking. Any recipe made with spirits should be prepared in an enameled, glass, or stainless-steel pot.

Medical Uses and/or Benefits Reduced risk of heart attack. Data from the American Cancer Society’s Cancer Prevention Study 1, a 12-year survey of more than 1 million Americans in 25 states, shows that men who take one drink a day have a 21 percent lower risk of heart attack and a 22 percent lower risk of stroke than men who do not drink at all. Women who have up to one drink a day also reduce their risk of heart attack. Numerous later studies have confirmed these findings. Lower cholesterol levels. Beverage alcohol decreases the body’s production and storage of low density lipoproteins (LDLs), the protein and fat particles that carry cholesterol into your arteries. As a result, people who drink moderately tend to have lower cholesterol levels and higher levels of high density lipoproteins (HDLs), the fat and protein particles that carry cholesterol out of the body. Numerous later studies have confirmed these findings. Lower risk of stroke. In January 1999, the results of a 677-person study published by researchers at New York Presbyterian Hospital-Columbia University showed that moderate alcohol consumption reduces the risk of stroke due to a blood clot in the brain among older people (average age: 70). How alcohol prevents stroke is still unknown, but it is clear that moderate use is a key. Heavy drinkers (those who consume more than seven drinks a day) have a higher risk of stroke. People who once drank heavily, but cut their consumption to moderate levels, reduce their risk of stroke. Stimulating the appetite. Alcoholic beverages stimulate the production of saliva and the gastric acids that cause the stomach contractions we call hunger pangs. Moderate amounts of alcoholic beverages, which may help stimulate appetite, are often prescribed for geriatric patients, convalescents, and people who do not have ulcers or other chronic gastric problems that might be exacerbated by the alcohol. Dilation of blood vessels. Alcoholic beverages dilate the tiny blood vessels just under the skin, bringing blood up to the surface. That’s why moderate amounts of alcoholic beverages (0.2–1 gram per kilogram of body weight, or two ounces of whiskey for a 150-pound adult) temporarily warm the drinker. But the warm blood that flows up to the surface of the skin will cool down there, making you even colder when it circulates back into the center of your body. Then an alcohol flush will make you perspire, so you lose more heat. Excessive amounts of beverage alcohol may depress the mechanism that regulates body temperature.

Adverse Effects Associated with This Food Alcoholism. Alcoholism is an addiction disease, the inability to control one’s alcohol consumption. It is a potentially life-threatening condition, with a higher risk of death by accident, suicide, malnutrition, or acute alcohol poisoning, a toxic reaction that kills by para- lyzing body organs, including the heart. Fetal alcohol syndrome. Fetal alcohol syndrome is a specific pattern of birth defects—low birth weight, heart defects, facial malformations, learning disabilities, and mental retarda- tion—first recognized in a study of babies born to alcoholic women who consumed more than six drinks a day while pregnant. Subsequent research has found a consistent pattern of milder defects in babies born to women who drink three to four drinks a day or five drinks on any one occasion while pregnant. To date there is no evidence of a consistent pattern of birth defects in babies born to women who consume less than one drink a day while preg- nant, but two studies at Columbia University have suggested that as few as two drinks a week while pregnant may raise a woman’s risk of miscarriage. (One drink is 12 ounces of beer, five ounces of wine, or 1.25 ounces of distilled spirits.) Increased risk of breast cancer. In 2008, scientists at the National Cancer Institute released data from a seven-year survey of more than 100,000 postmenopausal women showing that even moderate drinking (one to two drinks a day) may increase by 32 percent a woman’s risk of developing estrogen-receptor positive (ER+) and progesterone-receptor positive (PR+) breast cancer, tumors whose growth is stimulated by hormones. No such link was found between consuming alcohol and the risk of developing ER-/PR- tumors (not fueled by hor- mones). The finding applies to all types of alcohol: beer, wine, and distilled spirits. Increased risk of oral cancer (cancer of the mouth and throat). Numerous studies confirm the A merican Cancer Societ y’s warn ing that men and women who consume more than t wo drinks a day are at higher risk of oral cancer than are nondrinkers or people who drink less. Increased risk of cancer of the colon and rectum. In the mid-1990s, studies at the University of Oklahoma suggested that men who drink more than five beers a day are at increased risk of rectal cancer. Later studies suggested that men and women who are heavy beer or spirits drinkers (but not those who are heavy wine drinkers) have a higher risk of colorectal cancers. Further studies are required to confirm these findings. Malnutrition. While moderate alcohol consumption stimulates appetite, alcohol abuses depresses it. In addition, an alcoholic may drink instead of eating. When an alcoholic does eat, excess alcohol in his/her body prevents absorption of nutrients and reduces the ability to synthesize new tissue. Hangover. Alcohol is absorbed from the stomach and small intestine and carried by the bloodstream to the liver, where it is oxidized to acetaldehyde by alcohol dehydrogenase (ADH), the enzyme our bodies use every day to metabolize the alcohol we produce when we digest carbohydrates. The acetaldehyde is converted to acetyl coenzyme A and either eliminated from the body or used in the synthesis of cholesterol, fatty acids, and body tis- sues. Although individuals vary widely in their capacity to metabolize alcohol, an adult of average size can metabolize the alcohol in four ounces (120 ml) whiskey in approximately five to six hours. If he or she drinks more than that, the amount of alcohol in the body will exceed the available supply of ADH. The surplus, unmetabolized alcohol will pile up in the bloodstream, interfering with the liver’s metabolic functions. Since alcohol decreases the reabsorption of water from the kidneys and may inhibit the secretion of an antidiuretic hormone, the drinker will begin to urinate copiously, losing magnesium, calcium, and zinc but retaining uric acid, which is irritating. The level of lactic acid in the body will increase, making him or her feel tired and out of sorts; the acid-base balance will be out of kilter; the blood vessels in the head will swell and throb; and the stomach, its lining irritated by the alcohol, will ache. The ultimate result is a hangover whose symptoms will disappear only when enough time has passed to allow the body to marshal the ADH needed to metabolize the extra alcohol in the person’s blood. Changes in body temperature. Alcohol dilates capillaries, tiny blood vessels just under the skin, producing a “flush” that temporarily warms the drinker. But drinking is not an effective way to stay warm in cold weather. Warm blood flowing up from the body core to the surface capillaries is quickly chilled, making you even colder when it circulates back into your organs. In addition, an alcohol flush triggers perspiration, further cooling your skin. Finally, very large amounts of alcohol may actually depress the mechanism that regulates body temperature. Impotence. Excessive drinking decreases libido (sexual desire) and interferes with the ability to achieve or sustain an erection. Migraine headache. Some alcoholic beverages contain chemicals that inhibit PST, an enzyme that breaks down certain alcohols in spirits so that they can be eliminated from the body. If they are not broken down by PST, these alcohols will build up in the bloodstream and may trigger a migraine headache. Gin and vodka appear to be the distilled spirits least likely to trigger headaches, brandy the most likely.

Food/Drug Interactions Acetaminophen (Tylenol, etc.). FDA recommends that people who regularly have three or more drinks a day consult a doctor before using acetaminophen. The alcohol/acetaminophen combination may cause liver failure. Anti-alcohol abuse drugs (disulfiram [Antabuse]). Taken concurrently with alcohol, the anti- alcoholism drug disulfiram can cause flushing, nausea, a drop in blood pressure, breathing difficulty, and confusion. The severity of the symptoms, which may var y among individu- als, generally depends on the amount of alcohol consumed and the amount of disulfiram in the body. Anticoagulants. Alcohol slows the body’s metabolism of anticoagulants (blood thinners), intensif ying the effect of the drugs and increasing the risk of side effects such as spontane- ous nosebleeds. Antidepressants. Alcohol may strengthen the sedative effects of antidepressants. Aspirin, ibuprofen, ketoprofen, naproxen and nonsteroidal anti-inflammatory drugs. Like alco- hol, these analgesics irritate the lining of the stomach and may cause gastric bleeding. Com- bining the two intensifies the effect. Insulin and oral hypoglycemics. Alcohol lowers blood sugar and interferes with the metabo- lism of oral antidiabetics; the combination may cause severe hypoglycemia. Sedatives and other central nervous system depressants (tranquilizers, sleeping pills, antide- pressants, sinus and cold remedies, analgesics, and medication for motion sickness). Alcohol intensifies the sedative effects of these medications and, depending on the dose, may cause drowsiness, sedation, respiratory depression, coma, or death. MAO inhibitors. Monoamine oxidase (M AO) inhibitors are drugs used as antidepressants or antihypertensives. They inhibit the action of natural enzymes that break down tyramine, a substance formed naturally when proteins are metabolized. Tyramine is a pressor amine, a chemical that constricts blood vessel and raises blood pressure. If you eat a food that contains tyramine while you are taking an M AO inhibitor, the pressor amine cannot be eliminated from your body and the result may be a hypertensive crisis (sustained elevated blood pressure). Brandy, a distilled spirit made from wine (which is fermented) contains tyramine. All other distilled spirits may be excluded from your diet when you are taking an M AO inhibitor because the spirits and the drug, which are both sedatives, may be hazard- ous in combination.... A Nutritional, Medical and Culinary Guide

Symptoms Warning symptoms include dizziness, headache, oedema, vomiting, and the secretion of albumin (protein) in the urine. These are normally accompanied by a rise in blood pressure, which can be severe. Preeclamptic symptoms may be present for some days or weeks before the seizure takes place, and, if a woman is found to have these during antenatal care, preventive measures must be taken. Untreated, CONVULSIONS and unconsciousness are very likely, with serious migraine-like frontal headache and epigastric pain the symptoms.

Treatment Prevention of eclampsia by dealing with pre-eclamptic symptoms is the best management, but even this may not prevent convulsions. Hospital treatment is essential if eclampsia develops, preferably in a specialist unit. The treatment of the seizures is that generally applicable to convulsions of any kind, with appropriate sedatives given such as intravenous DIAZEPAM. HYDRALLAZINE intravenously should also be administered to reduce the blood pressure. Magnesium sulphate given intramuscularly sometimes helps to control the ?ts. The baby’s condition should be monitored throughout.

Urgent delivery of the baby, if necessary by CAESAREAN SECTION, is the most e?ective ‘treatment’ for a mother with acute eclampsia. (See PREGNANCY AND LABOUR.)

Women who have suffered from eclampsia are liable to suffer a recurrence in a further preganancy. Careful monitoring is required. There is a self-help organisation, Action on Pre-eclampsia (APEC), to advise on the condition.... Medicinal Plants Glossary

Ectopic pregnancy is more common in women who have had previous pelvic infections (see pelvic inflammatory disease) and with some types of IUD and progestogen-only oral contraceptives.

Most ectopic pregnancies are discovered in the first 2 months, often before the woman realizes she is pregnant. Symptoms usually include severe painin the lower abdomen and vaginal bleeding. Internal bleeding may cause symptoms of shock, such as pallor, sweating, and faintness.

Diagnosis is made by a transvaginal ultrasound examination and can be confirmed by ectopic laparoscopy. If the diagnosis is made early, medical treatment using the drug methotrexate may be considered. In most cases, surgery, usually minimally invasive surgery, to remove the pregnancy is carried out. If blood loss is severe, blood transfusions are needed. An affected fallopian tube is removed if it cannot be repaired.... BMA Medical Dictionary

Nutritional Profile Energy value (calories per serving): Moderate Protein: High Fat: Low to moderate Saturated fat: Low to moderate Cholesterol: Moderate Carbohydrates: Low Fiber: None Sodium: Low (fresh fish) High (some canned or salted fish) Major vitamin contribution: Vitamin A, vitamin D Major mineral contribution: Iodine, selenium, phosphorus, potassium, iron, calcium

About the Nutrients in This Food Like meat, poultry, milk, and eggs, fish are an excellent source of high- quality proteins with sufficient amount of all the essential amino acids. While some fish have as much or more fat per serving than some meats, the fat content of fish is always lower in saturated fat and higher in unsaturated fats. For example, 100 g/3.5 ounce cooked pink salmon (a fatty fish) has 4.4 g total fat, but only 0.7 g saturated fat, 1.2 g monounsaturated fat, and 1.7 g polyunsaturated fat; 100 g/3.5 ounce lean top sirloin has four grams fat but twice as much saturated fat (1.5 g), plus 1.6 g monounsatu- rated fat and only 0.2 g polyunsaturated fat. Omega-3 Fatty Acid Content of Various Fish (Continued) Fish  Grams/ounce Rainbow trout  0.30 Lake whitefish  0.25 Source: “Food for t he Heart,” American Health, April 1985. Fish oils are one of the few natural food sources of vitamin D. Salmon also has vita- min A derived from carotenoid pigments in the plants eaten by the fish. The soft bones in some canned salmon and sardines are an excellent source of calcium. CAUTION: do not eat the bones in r aw or cook ed fish. the only bones consider ed edible ar e those in the canned products.

The Most Nutritious Way to Serve This Food Cooked, to kill parasites and potentially pathological microorganisms living in raw fish. Broiled, to liquify fat and eliminate the fat-soluble environmental contaminants found in some freshwater fish. With the soft, mashed, calcium-rich bones (in canned salmon and canned sardines).

Diets That May Restrict or Exclude This Food Low-purine (antigout) diet Low-sodium diet (canned, salted, or smoked fish)

Buying This Food Look for: Fresh-smelling whole fish with shiny skin; reddish pink, moist gills; and clear, bulging eyes. The flesh should spring back when you press it lightly. Choose fish fillets that look moist, not dry. Choose tightly sealed, solidly frozen packages of frozen fish. In 1998, the FDA /National Center for Toxicological Research released for testing an inexpensive indicator called “Fresh Tag.” The indicator, to be packed with seafood, changes color if the product spoils. Avoid: Fresh whole fish whose eyes have sunk into the head (a clear sign of aging); fillets that look dry; and packages of frozen fish that are stained (whatever leaked on the package may have seeped through onto the fish) or are coated with ice crystals (the package may have defrosted and been refrozen).

Storing This Food Remove fish from plastic wrap as soon as you get it home. Plastic keeps out air, encouraging the growth of bacteria that make the fish smell bad. If the fish smells bad when you open the package, throw it out. Refrigerate all fresh and smoked fish immediately. Fish spoils quickly because it has a high proportion of polyunsaturated fatty acids (which pick up oxygen much more easily than saturated or monounsaturated fatty acids). Refrigeration also slows the action of microorgan- isms on the surface of the fish that convert proteins and other substances to mucopolysac- charides, leaving a slimy film on the fish. Keep fish frozen until you are ready to use it. Store canned fish in a cool cabinet or in a refrigerator (but not the freezer). The cooler the temperature, the longer the shelf life.

Preparing This Food Fresh fish. Rub the fish with lemon juice, then rinse it under cold running water. The lemon juice (an acid) will convert the nitrogen compounds that make fish smell “fishy” to compounds that break apart easily and can be rinsed off the fish with cool running water. R insing your hands in lemon juice and water will get rid of the fishy smell after you have been preparing fresh fish. Frozen fish. Defrost plain frozen fish in the refrigerator or under cold running water. Pre- pared frozen fish dishes should not be thawed before you cook them since defrosting will make the sauce or coating soggy. Salted dried fish. Salted dried fish should be soaked to remove the salt. How long you have to soak the fish depends on how much salt was added in processing. A reasonable average for salt cod, mackerel, haddock (finnan haddie), or herring is three to six hours, with two or three changes of water. When you are done, clean all utensils thoroughly with hot soap and hot water. Wash your cutting board, wood or plastic, with hot water, soap, and a bleach-and-water solution. For ultimate safety in preventing the transfer of microorganisms from the raw fish to other foods, keep one cutting board exclusively for raw fish, meats, and poultry, and a second one for everything else. Finally, don’t forget to wash your hands.

What Happens When You Cook This Food Heat changes the structure of proteins. It denatures the protein molecules so that they break apart into smaller fragments or change shape or clump together. These changes force moisture out of the tissues so that the fish turns opaque. The longer you cook fish, the more moisture it will lose. Cooked fish flakes because the connective tissue in fish “melts” at a relatively low temperature. Heating fish thoroughly destroys parasites and microorganisms that live in raw fish, making the fish safer to eat.

How Other Kinds of Processing Affect This Food Marinating. Like heat, acids coagulate the proteins in fish, squeezing out moisture. Fish marinated in citrus juices and other acids such as vinegar or wine has a firm texture and looks cooked, but the acid bath may not inactivate parasites in the fish. Canning. Fish is naturally low in sodium, but can ned fish often contains enough added salt to make it a high-sodium food. A 3.5-ounce ser ving of baked, fresh red salmon, for example, has 55 mg sodium, while an equal ser ving of regular can ned salmon has 443 mg. If the fish is can ned in oil it is also much higher in calories than fresh fish. Freezing. When fish is frozen, ice cr ystals form in the flesh and tear its cells so that mois- ture leaks out when the fish is defrosted. Commercial flash-freezing offers some protec- tion by freezing the fish so fast that the ice cr ystals stay small and do less damage, but all defrosted fish tastes drier and less palatable than fresh fish. Freezing slows but does not stop the oxidation of fats that causes fish to deteriorate. Curing. Fish can be cured (preser ved) by smoking, dr ying, salting, or pickling, all of which coagulate the muscle tissue and prevent microorganisms from growing. Each method has its own particular drawbacks. Smoking adds potentially carcinogenic chemicals. Dr ying reduces the water content, concentrates the solids and nutrients, increases the calories per ounce, and raises the amount of sodium.

Medical Uses and/or Benefits Protection against cardiovascular disease. The most important fats in fish are the poly- unsaturated acids k nown as omega-3s. These fatt y acids appear to work their way into heart cells where they seem to help stabilize the heart muscle and prevent potentially fatal arrhythmia (irregular heartbeat). A mong 85,000 women in the long-run n ing Nurses’ Health Study, those who ate fatt y fish at least five times a week were nearly 50 percent less likely to die from heart disease than those who ate fish less frequently. Similar results appeared in men in the equally long-run n ing Physicians’ Health Study. Some studies suggest that people may get similar benefits from omega-3 capsules. Researchers at the Consorzio Mario Negri Sud in Santa Maria Imbaro ( Italy) say that men given a one-gram fish oil capsule once a day have a risk of sudden death 42 percent lower than men given placebos ( “look-alike” pills with no fish oil). However, most nutrition scientists recom- mend food over supplements. Omega-3 Content of Various Food Fish Fish* (3 oz.)  Omega-3 (grams) Salmon, Atlantic  1.8 Anchovy, canned* 1.7 Mackerel, Pacific 1.6 Salmon, pink, canned* 1.4 Sardine, Pacific, canned* 1.4 Trout, rainbow  1.0 Tuna, white, canned* 0.7 Mussels  0.7 * cooked, wit hout sauce * drained Source: Nat ional Fisheries Inst itute; USDA Nut rient Data Laborator y. Nat ional Nut ri- ent Database for Standard Reference. Available online. UR L : http://w w w.nal.usda. gov/fnic/foodcomp/search /.

Adverse Effects Associated with This Food Allergic reaction. According to the Merck Manual, fish is one of the 12 foods most likely to trigger classic food allergy symptoms: hives, swelling of the lips and eyes, and upset stom- ach. The others are berries (blackberries, blueberries, raspberries, strawberries), chocolate, corn, eggs, legumes (green peas, lima beans, peanuts, soybeans), milk, nuts, peaches, pork, shellfish, and wheat (see wheat cer ea ls). NOTE : Canned tuna products may contain sulfites in vegetable proteins used to enhance the tuna’s flavor. People sensitive to sulfites may suf- fer serious allergic reactions, including potentially fatal anaphylactic shock, if they eat tuna containing sulfites. In 1997, tuna manufacturers agreed to put warning labels on products with sulfites. Environmental contaminants. Some fish are contaminated with methylmercury, a compound produced by bacteria that chemically alters naturally occurring mercury (a metal found in rock and soil) or mercury released into water through industrial pollution. The methylmer- cury is absorbed by small fish, which are eaten by larger fish, which are then eaten by human beings. The larger the fish and the longer it lives the more methylmercury it absorbs. The measurement used to describe the amount of methylmercury in fish is ppm (parts per mil- lion). Newly-popular tilapia, a small fish, has an average 0.01 ppm, while shark, a big fish, may have up to 4.54 ppm, 450 times as much. That is a relatively small amount of methylmercur y; it will soon make its way harmlessly out of the body. But even small amounts may be hazardous during pregnancy because methylmercur y targets the developing fetal ner vous system. Repeated studies have shown that women who eat lots of high-mercur y fish while pregnant are more likely to deliver babies with developmental problems. As a result, the FDA and the Environ men- tal Protection Agency have now warned that women who may become pregnant, who are pregnant, or who are nursing should avoid shark, swordfish, king mackerel, and tilefish, the fish most likely to contain large amounts of methylmercur y. The same prohibition applies to ver y young children; although there are no studies of newborns and babies, the young brain continues to develop after birth and the logic is that the prohibition during pregnancy should extend into early life. That does not mean no fish at all should be eaten during pregnancy. In fact, a 2003 report in the Journal of Epidemiology and Community Health of data from an 11,585-woman study at the University of Bristol (England) shows that women who don’t eat any fish while pregnant are nearly 40 percent more likely to deliver low birth-weight infants than are women who eat about an ounce of fish a day, the equivalent of 1/3 of a small can of tuna. One theory is that omega-3 fatty acids in the fish may increase the flow of nutrient-rich blood through the placenta to the fetus. University of Southern California researchers say that omega-3s may also protect some children from asthma. Their study found that children born to asthmatic mothers who ate oily fish such as salmon at least once a month while pregnant were less likely to develop asthma before age five than children whose asthmatic pregnant mothers never ate oily fish. The following table lists the estimated levels of mercury in common food fish. For the complete list of mercury levels in fish, click onto www.cfsan.fda.gov/~frf/sea-mehg.html. Mercury Levels in Common Food Fish Low levels (0.01– 0.12 ppm* average) Anchovies, butterfish, catfish, clams, cod, crab (blue, king, snow), crawfish, croaker (Atlantic), flounder, haddock, hake, herring, lobster (spiny/Atlantic) mackerel, mul- let, ocean perch, oysters, pollock, salmon (canned/fresh frozen), sardines, scallops, shad (American), shrimp, sole, squid, tilapia, trout (freshwater), tuna (canned, light), whitefish, whiting Mid levels (0.14 – 0.54 ppm* average) Bass (salt water), bluefish, carp, croaker ( Pacific), freshwater perch, grouper, halibut, lobster (Northern A merican), mackerel (Spanish), marlin, monkfish, orange roughy, skate, snapper, tilefish (Atlantic), tuna (can ned albacore, fresh/frozen), weakfish/ sea trout High levels (0.73 –1.45 ppm* average) King mackerel, shark, swordfish, tilefish * ppm = parts per million, i.e. parts of mercur y to 1,000,000 parts fish Source: U.S. Food and Drug Administ rat ion, Center for Food Safet y and Applied Nut rit ion, “Mercur y Levels in Commercial Fish and Shellfish.” Available online. UR L : w w w.cfsan.fda. gov/~frf/sea-mehg.ht ml. Parasitical, viral, and bacterial infections. Like raw meat, raw fish may carry various pathogens, including fish tapeworm and flukes in freshwater fish and Salmonella or other microorganisms left on the fish by infected foodhandlers. Cooking the fish destroys these organisms. Scombroid poisoning. Bacterial decomposition that occurs after fish is caught produces a his- taminelike toxin in the flesh of mackerel, tuna, bonito, and albacore. This toxin may trigger a number of symptoms, including a flushed face immediately after you eat it. The other signs of scombroid poisoning—nausea, vomiting, stomach pain, and hives—show up a few minutes later. The symptoms usually last 24 hours or less.

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 such as pickled herring, which is high in tyramine, while you are taking an M AO inhibitor, your body may not be able to eliminate the tyramine and the result may be a hypertensive crisis.... A Nutritional, Medical and Culinary Guide

In order to prevent NEURAL TUBE defects and cleft lip or palate (see CLEFT PALATE), all women planning to become pregnant should be advised to have a diet rich in folic acid in the months before conception until 13 weeks’ gestation, or to take folic acid tablets.

Recent research has suggested that adequate levels of folic acid can prevent the build-up of homocysteine, a compound in the blood closely associated with heart attacks and strokes. It has been suggested that the o?cial recommendation of 200 micrograms a day in the diet should be doubled. (See APPENDIX 5: VITAMINS.)... Medical Dictionary

Lactation is initiated by a rise in the level of prolactin, a hormone produced by the pituitary gland. Galactorrhoea is caused by excessive secretion of prolactin due to a pituitary tumour or otherendocrine disease, such as hypothyroidism. Some antipsychotic drugs may also cause excessive secretion. Treatment with bromocriptine suppresses prolactin production, but the underlying cause may also need treatment. galactosaemia A rare, inherited condition in which the body is unable to convert the sugar galactose into glucose due to the absence of a liver enzyme. It causes no symptoms at birth, but jaundice, diarrhoea, and vomiting soon develop and the baby fails to gain weight. Untreated, the condition results in liver disease, cataract, and learning difficulties. The diagnosis is confirmed by urine and blood tests. The major source of galactose is the milk sugar lactose. Lactosefree milk must be used throughout life. gallbladder A small, pear-shaped sac situated under the liver that stores bile. Bile, produced by the liver, passes into the gallbladder via the hepatic and cystic ducts. It is released into the intestine via the common bile duct.... BMA Medical Dictionary

• Combats pains caused by headaches and rheumatoid arthritis.
• Helps fight dizziness and vertigo.
• Helpful against epilepsy and tetanus.
• Works as a sedative being used in treating insomnia.
• Reduces general fatigue.

• Can cause skin allergies.
• Pregnant and breastfeeding women should avoid drinking gastrodia tea.
• Gastrodia Tea may interact with the effects of some medications.

Symptoms. Mild fever, temperature rising to 101°F (38°C), headache, drowsiness, runny nose, sore throat, swelling of glands side of neck and behind ears; itchy rash of small pink spots spreads from face downwards to whole of the body, lasting 3 days.

Complication: inflammation of the brain (rare).

If patient is pregnant professional care is necessary as congenital defects, stillbirth or abortion may follow in early pregnancy. There is evidence of a link between the virus and juvenile joint disease and arthritis later in life.

Treatment. Bedrest. Plenty of fluids (herb teas, fruit juices). Should not be suppressed by drugs. Alternatives:– Teas. Any one. Balm, Chamomile flowers, Elderflowers and Peppermint, Hyssop, Wild Thyme, Marigold. Sage, Peppermint. Combination: equal parts, Marigold flowers, Elderflowers, Yarrow. Prepare: 2 teaspoons to each cup boiling water; infuse 15 minutes. Half-1 cup freely.

Tablets/capsules. Echinacea.

Tinctures. Echinacea: 5-30 drops in water every 2 hours. OR: Combine, equal parts Echinacea and Wild Indigo with few drops Tincture Capsicum; 5-30 drops every 2 hours.

Absence of urine: add 1 part Pleurisy root.

For swollen glands: add 1 part Clivers.

For nervousness: add 1 part Skullcap.

For sore throat: Cinnamon.

Diet. Commence 3-day fast with no solid food. Abundant Vitamin C drinks, fruit juices, etc.

To be treated by or in liaison with a qualified medical practitioner. ... Bartrams Encyclopedia of Herbal Medicine

Good oral hygiene is the main means of preventing and treating gingivitis.

Untreated, it may damage gum tissue, which may lead to chronic periodontitis.

Acute ulcerative gingivitis may develop in people with chronic gingivitis, especially those with lowered resistance to infection (see gingivitis, acute ulcerative).... BMA Medical Dictionary

• Bring cold water to a rolling boil.
• Place 1 teaspoon of tea for each cup into the teapot.
• Pour the boiling water into the teapot.
• Cover the teapot and let it steep between 3 and 7 minutes according to taste (the longer the soaking time the stronger the tea). Milk and sugar could be added.

• Place 6 teaspoons of tea into a teapot or heat resistant pitcher.
• Pour 1 1/4 cups of boiled water over the tea. Steep it for about 5 minutes.
• Quarter fill a serving pitcher with cold water.
• Pour the tea into the serving pitcher straining the leaves.
• Add ice and top up the pitcher with cold water.
• Sugar could be added.

• digestive system
• stressful moods
• senses
• metabolic processes

• Helpful in the treatment of kidney and bladder stones.
• Alleviates sore throat.
• Relieves inflammation of the urinary tract.
• Eases whooping cough.
• Helps in the treatment of arthritis and rheumatism.

• Pregnant and breastfeeding women should avoid drinking Goldenrod Tea.
• Can cause allergic reactions for people who are sensitive to some herbal plants.
• Can cause fluid retention.
• Might make the body accumulate more sodium, increasing blood pressure.
• May interact with the effects of some medications, so make sure you always consult your doctor before drinking goldenrod tea or any type of herbal teas.

• Enhances brain and memory functions.
• Being an antibacterial, helps the body fight bacteria.
• Overcomes stress and fatigue.
• Improves blood flow and prevents blood clots.
• Helps relieve hemorrhoids.
• Eases anxiety, acting as a sedative for the central nervous system.
• Can help in treating ulcers.
• Effective in treating common cold and flu.
• Gotu Kola Tea can be safe for pregnant women ONLY when applied on skin for treating stretch marks.

• Gotu Kola Tea might cause liver damage in some people.
• Although Gotu Kola Tea is safe to apply on skin for treating stretch marks associated with pregnancy, pregnant and breastfeeding women shouldn’t drink Gotu Kola Tea.
• Gotu Kola Tea may cause too much sleepiness if it is combined with medications used during a surgery. Make sure you don’t drink Gotu Kola Tea at least 2 weeks before a scheduled surgery.

• Helps remove toxins from the body.
• Clears the respiratory tract.
• Lowers bad cholesterol.
• Provides relaxation.
• Helps fight allergies.
• Strong allied in the treatment of some digestive and bladder problems.

• Pregnant or breastfeeding women should avoid drinking Grapefruit Peel Tea.
• Grapefruit peel tea may interact with the effects of some medications, so make sure you always consult your doctor before drinking grapefruit peel tea.
• Try not to drink excessive amounts of Grapefruit Peel Tea if you have breast cancer or a higher than usual risk of developing breast cancer.

• Helps prevent the formation of kidney and bladder stones.
• Effective in treating gout.
• Relieves fever by encouraging sweating.
• Treats various urinary problems.
• Helps relieve constipation.
• Reduces stomach acidity.
• In some cases, it can act as an anti-inflammatory, reducing swelling.

• Due to the fact that Gravel Root Tea contains chemicals called hepatotoxic pyrrolizidine alkaloids (PAs), it may block blood flow and cause liver damage.
• Pregnant women should avoid drinking Gravel Root Tea since it can produce birth defects. Also, if you are breastfeeding, do not drink gravel root tea, because the chemicals (PAs) can affect the breast-milk and harm the baby.
• Do not apply gravel root on wounds or broken skin. The chemicals can be absorbed quickly through broken skin and can lead to dangerous body-wide toxicity.

The term gravida is often combined with a prefix to indicate the total number of pregnancies a woman has undergone (including the present one).

For example, a primigravida is a woman who is pregnant for the first time.... BMA Medical Dictionary

• Slowing early aging;
• Diets;
• The treatment of physical or intellectual fatigue;
• Treating fast cold and flu recovery;
• Preventing allergenic reactions;
• Balancing body fluids;
• Improving the immune function of the epidermis;
• Preventing and mending arthritis;
• Improving bone structure

• Guarana tea may be effective in treating headaches, but only as a short-term treatment, according to the University of Colorado Denver College of Pharmacy.
• Enhances memory, alertness and other cognitive capacities.
• Boosts energy and alleviates depression.
• Treats chronic diarrhea.

• Anxiety
• Trembling
• Hyperactivity
• Frequent urination
• Palpitation

The traditional remedy is to wind the worm from the skin on to a small stick. Once the worm is out, the condition usually clears up. The drugs tiabendazole and niridazole are given to reduce inflammation, antibiotics are given to control secondary infection, and the patient is immunized against tetanus.... BMA Medical Dictionary

• Helps reducing blood sugar levels.
• Is a strong allied in the process of weight loss.
• May help treat swollen glands.
• Has anti-inflammatory properties.
• Helps treating snakebites.
• Reduces the craving for sugar.

• Pregnant and breastfeeding women should not drink gymnema tea. Not enough is known about consuming gymnema tea during pregnancy so, it is better to avoid it.
• Gymnema tea may interfere with blood sugar control during and after surgical procedures.

• Use good quality water to prepare a good Gyokuro tea
• The optimal brewing temperature is between 122 F and 140 F degrees.
• First, preheat the cups or the teapot, because pouring the moderately warm tea into a cold cup changes its temperature.
• Pour some of the boiled water into the tea kettle and wait one or two minutes.
• Add the leaves and the remaining water.
• Use 2 table spoons of tea to approx. 4-5 ounces of water.
• Brewing time is between two and three minutes. While brewing, don’t mix, stir or shake the tea. Try to leave enough room for the leaves to expand.

• stimulate the metabolism
• burn off  calories
• lower cholesterol
• protect against various cardiovascular diseases
• soothe and relax the mind
• enhance cognition and alertness
• improve concentration
• keep one energetic
• prevent dental plaque, bacterial infections and dental decay
• freshen your breathe
• protect against bacteria

In mild cases of haemolytic disease, the newborn baby becomes slightly jaundiced during the first 24 hours of life (due to excess bilirubin in the blood) and slightly anaemic. In more severe cases, the level of bilirubin in the blood may increase to a dangerous level, causing a risk of kernicterus (a type of brain damage). Severely affected babies have marked anaemia while still in the uterus. They become swollen (hydrops fetalis) and are often stillborn.

In mild cases, no treatment is necessary. In other cases, the aim is to deliver the baby before the anaemia becomes severe, usually by induction of labour at 35–39 weeks’ gestation. If the baby is too young to be delivered safely, fetal blood transfusions may be necessary. After birth, phototherapy (light treatment that converts bilirubin in the skin into a water-soluble form that is more easily excreted from the body) can help to reduce jaundice. An exchange blood transfusion may be needed.... BMA Medical Dictionary

• Improves digestion.
• Alleviates gastrointestinal spasms.
• Prevents atherosclerotic plaques.
• Helps in the treatment of rheumatism.
• Helps fight cystitis.
• Energy booster.
• Calms menstrual cramps.

• Pregnant and breastfeeding women should avoid drinking Helichrysum tea.
• Helichrysum tea may interact with the effects of certain medications or supplements, so make sure you always consult your doctor before drinking Helichrysum tea or any herbal teas.

Hepatitis B (formerly known as serum hepatitis) is transmitted by infected blood or blood products contaminating hypodermic needles, blood transfusions, or tattooing needles, by unprotected sexual contact, or (rarely) by contact with any other body fluid. It often occurs in drug users. Symptoms, which develop suddenly after an incubation period of 1–6 months, include headache, fever, chills, general weakness, and jaundice. Treatment includes *interferon alfa and other oral antivirals (e.g. *lamivudine, *adefovir dipivoxil, entecavir). Most patients make a gradual recovery but the mortality rate is 5–20%. A vaccine is available.

Hepatitis C (formerly known as non-A, non-B hepatitis) has a mode of transmission similar to that of hepatitis B (predominantly intravenous drug abuse). Treatment is with interferon alfa, peginterferon alfa, ribavirin, telaprevir, and boceprevir.

Hepatitis D is a defective virus that can only proliferate when there is infection with hepatitis B. Patients with D virus usually have severe chronic hepatitis.

Hepatitis E is transmitted by infected food or drink and can cause acute hepatitis; it is especially severe in a pregnant patient.

Chronic hepatitis continues for months or years, eventually leading to *cirrhosis and possibly to malignancy (see hepatoma). It is usually caused by chronic viral hepatitis, alcohol, or autoimmune disease.... Oxford | Concise Colour Medical Dictionary

Severe herpes gestationis is treated with corticosteroid drugs in tablet form and may require hospital admission.

The disorder usually clears up completely after birth of the baby, but tends to recur in subsequent pregnancies.... BMA Medical Dictionary

Genital herpes cannot be cured, but treatment can reduce the severity of symptoms. Antiviral drugs such as aciclovir make the ulcers less painful and also encourage healing. Other measures include taking analgesic drugs and bathing with a salt solution.

Once the virus enters the body, it stays there for the rest of the person’s life. Recurrent attacks may occur, usually during periods when the person is feeling run down, anxious, or depressed, before menstruation, or after sexual intercourse. The virus can be spread to others through sexual intercourse even when symptoms are absent. Recurrent attacks tend to become less frequent and less severe over time.Genital herpes may be passed from a pregnant woman to her baby during delivery.

If the virus can be detected in vaginal swabs, delivery by caesarean section is usually recommended.... BMA Medical Dictionary

• Lowers cholesterol
• Some studies revealed that people who suffer from type 2 diabetes may benefits from drinking this tea.
• In Eastern medicine, hibiscus tea is used to treat liver problems
• Due to the fact that hibiscus tea stops the body from absorbing too many carbohydrates, it is a string allied in the weight loss process.
• Since it contains Vitamin C, hibiscus tea helps preventing colds, flu and also, strengthens your immune system.

• Pregnant and breastfeeding women should avoid drinking hibiscus tea.
• People with low blood pressure are not advised to drink hibiscus tea.
• You should be careful if you want to drink hibiscus tea for the first time since it can (rarely) produce hallucinogenic effects or even cause a sensations similar to intoxication.
• If you are taking any type of anti-inflammatories and want to drink hibiscus tea, drink it two hours after taking the medicine.

• Hojicha tea helps fighting against diseases caused by viruses or bacteria and strengthens the immune system.
• Hojicha tea helps protect against cardiovascular diseases, tumors and it’s also an important element when it comes to cancer prevention.
• Hojicha tea is a strong allied in the process of weight loss.
• Hojicha tea gives an overall well-being and helps you relax.

• You should not drinkHojicha tea when you are pregnant or breastfeeding.
• If you suffer from anemia or iron deficiency. According to some studies, green tea extract reduces the absorption of iron by 25%.
• It is advised not to drink green tea on an empty stomach since it could cause liver damage.
• Avoid green tea if you have kidney disorders or stomach ulcers.

• Helps fight indigestion and ease constipation.
• Strong allied in the process of weight loss.
• Lowers blood cholesterol levels.
• May stimulate milk production in breastfeeding women.
• Expectorant.
• Helps ease insomnia.
• Strengthens your immune system.
• Eases menopausal symptoms.
• Helps in the treatment of asthma and certain allergies.

• Helps fight bladder infections.
• Alleviates sores and swellings of the eyes, breast and throat.
• Honeysuckle Tea alleviates fever.
• It is said that it inhibits the bacteria that causes salmonella, strep and tuberculosis.
• Treats nausea and vomiting caused by hepatitis C.
• Stops the pain caused by headaches.

• People who suffer from chronic diarrhea caused by treatment from chronic diseases should avoid drinking Honeysuckle Tea.
• Pregnant and breastfeeding women should not drink Honeysuckle Tea.
• Honeysuckle Tea may increase the risk of extra bleeding during and after a surgery. Make sure you stop consuming honeysuckle tea at least 2 weeks before a scheduled surgery.

• Horehound Tea helps fighting respiratory disorders such as cough or asthma.
• Calms headaches caused by sinus infection.
• Relieves pain caused by cough or indigestion.
• Fights sore throat.

• Pregnant and breastfeeding women should avoid drinking Horehound Tea.
• Black Horehound Tea contains certain chemicals that may affect treatment for Parkinson`s disease.
• Horehound Tea may interact with the effects of some medications, so avoid drinking this tea without medical advice.

Many hormones are produced by endocrine glands.

Hormones are also secreted by other organs, including the brain, kidneys, intestines, and, in pregnant women, the placenta.

They control many body functions, including metabolism of cells, growth, sexual development, and the body’s response to stress or illness.... BMA Medical Dictionary

• Strengthens varicose veins.
• Can help treat hemorrhoids.
• Helps treating arthritis and rheumatic pains.
• Helpful in treating various skin conditions such as: rashes, eczema or burns.

• Provides relaxation and a restful sleep.
• May help treat dysentery.
• Alleviates fever and malaria.
• Relieves menstrual cramps.

• Horse chestnut flower can cause allergic reactions.
• Pregnant and breastfeeding women should avoid drinking Horse Chestnut Tea.
• Horse Chestnut Tea may lower blood sugar levels, so avoid drinking this tea if you suffer from diabetes.
• Don’t drink horse chestnut tea if you have bowel or stomach disorders.
• If you have a liver condition, avoid drinking horse chestnut.
• Avoid drinking Horse Chestnut Tea if you suffer from kidney problems.

Causes. Injury, tumour, blood clot, meningitis, or congenital malformation obstructing the aqueduct. Symptoms. Headache on the crown of the head, enlarged pupils, double vision, eyes squint and appear abnormally small, convulsions, slow onset of fever, high blood pressure, delirium, flushed cheeks, patient shuns the light.

Treatment. As a supportive aid to conventional treatment by hospital specialist or general medical practitioner.

Formula. Yarrow 2; Lily of the Valley 2; Ginkgo 1. Dose: Powders – 750mg (three 00 capsules or half a teaspoon). Liquid extracts – 1 teaspoon. Tinctures – 1-2 teaspoons every 2 hours for acute cases, otherwise thrice daily.

Ivy. Dr John Clarke, homoeopathic physician, reports the case of a colleague, Dr L. Cooper, who cured a case with one single dose of 1 drop mother-tincture of Ivy (Hedera helix). “Clear fluid (cerebrospinal rhinorrhoea) dripped from his nostrils for three weeks; 20-30 handkerchiefs being used a day.” Evidence of efficacy of the traditional reputation of 1-2 drops Ivy juice for the condition is lacking.

Diet. 3-5 day fast on fruit juice only. Yarrow tea. No solid food until fever abates; then Slippery Elm and Complan.

Note: Pregnant mothers are advised by the Medical Research Council to take folic acid – part of the Vitamin B-group – to help protect against neural tube defects; severe birth defects of spina bifida and hydrocephalus. See: FOLIC ACID. ... Bartrams Encyclopedia of Herbal Medicine

• Helps treating bronchitis.
• Cough remedy.
• Helps combat irritable bowel infections, gastritis and dysentery.
• Prevents congestion.
• Fights infestation of intestinal worms.

• Over consumption can be unsafe, because the dried Iceland moss plant can be contaminated with lead.
• Pregnant and breastfeeding women should avoid drinking Iceland Moss Tea. During pregnancy, it can be harmful to the mother and to the unborn child.
• It can cause ulcers in the stomach or small intestine.
• Iceland Moss Tea may interact with the effects of some medications, so make sure you always consult your doctor before drinking Iceland Moss Tea or any kind of herbal tea.
• It can cause nausea and liver problems.

Treatment Crusts should be gently removed with SALINE. Mild cases respond to frequent application of mupiricin or NEOMYCIN/BACITRACIN ointment; more severe cases should be treated orally or, sometimes, intravenously with FLUCLOXACILLIN or one of the CEPHALOSPORINS. If the patient is allergic to penicillin, ERYTHROMYCIN can be used.

For severe, intractable cases, an oral retinoid drug called isotretinoin (commercially produced as Roaccutane®) can be used. It is given systemically but treatment must be supervised by a consultant dermatologist as serious side-effects, including possible psychiatric disturbance, can occur. The drug is also teratogenic (see TERATOGENESIS), so women who are, or who may become, pregnant must not take isotretinoin. It acts mainly by suppressing SEBUM production in the sebaceous glands and can be very e?ective. Recurrent bouts of impetigo should raise suspicion of underlying SCABIES or head lice. Bactericidal soaps and instilling an antibiotic into the nostrils may also help.... Medicinal Plants Glossary

• Strenghtens the immune system.
• Can speed recovery from the common cold.
• Helps heal wounds and cuts.
• Treats respiratory infections such as pharyngitis and tonsilitis.
• Heals sore thorat.
• Helps reduce fever.
• Helps in the treatment of chronic fatigue syndrome when combined with echinacea.

• Taking in large doses, Indigo Root Tea can cause nausea, diarrhea, voming or asphyxiation.
• Pregnant and breastfeeding women should avoid drinking Indigo Root Tea.
• People with auto-immune disorders should not drink Indigo Root Tea.

The improvement in the infant mortality rate has occurred mainly in the period from the second month of life. There has been much less improvement in the neonatal mortality rate – that is, the number of infants dying during the ?rst four weeks of life, expressed as a proportion of every 1,000 live births. During the ?rst week of life the main causes of death are asphyxia, prematurity, birth injuries and congenital abnormalities. After the ?rst week the main cause of death is infection.

Social conditions also play an important role in infant mortality. In England and Wales the infant mortality rate in 1930–32 was: Social Class I (professional), 32·7; Social Class III (skilled workers), 57·6; Social Class V (unskilled workers), 77·1. Many factors come into play in producing these social variations, but overcrowding is undoubtedly one of the most important.

1838–9 146 1950–52 30 1851–60 154 1960–62 22 1900–02 142 1970–72 18 1910–12 110 1980–82 12 1920–22 82 1990–92 7 1930–32 67 1996 6·2 1940–42 59 1999 5.8 2000 5.6

It is thus evident that for a reduction of the infant mortality rate to the minimum ?gure, the following conditions must be met. Mothers and potential mothers must be housed adequately in healthy surroundings, particularly with regard to safe water supplies and sewage disposal. The pregnant and nursing mother must be ensured an adequate diet. E?ective antenatal supervision must be available to every mother, as well as skilled supervision during labour (see PREGNANCY AND LABOUR). The newborn infant must be adequately nursed and fed and mothers encouraged to breast feed. Environmental and public-health measures must be taken to ensure adequate housing, a clean milk supply and full availability of medical care including such protective measures as IMMUNISATION against diphtheria, measles, poliomyelitis and whooping-cough. (See also PERINATAL MORTALITY.)... Medical Dictionary

Causes (female). Absence of menses, dry vaginal entrance, tension, stress, tiredness, deformed or retroverted womb, cervical polyps, inflammation of the cervix or ovaries, fibroids, cystic ovaries, diabetes, drugs, steroids, psychogenic factors. Women who use intra-uterine devices may become infertile from tubal infection. The Pill affects fertility. Vitamin E deficiency. Professor Richard Morisset (World Health Organisation) asserts STD’s account for more than 50 per cent infertility in women. Alcohol is a factor.

Causes (male). Inadequate seman, testicular or prostate infection, orchitis (from past mumps), kidney failure, chronic lung disease from smoking, thyroid deficiency, liver and other infections, calcium or Vitamin E deficiency. Low sperm count is found in regular drinkers of alcohol. 30 per cent cases of infertility are found to be due to the male.

“Women who drink more than one cup of coffee a day may find it harder to become pregnant.” (American study reported in The Guardian, 28.12.88)

“Vegetarian women have lower levels of oestrogen. The amount of fibre women eat is believed to affect oestrogen levels in their blood.” (Dr Elwyn Hughes, University of Wales Institute of Science and Technology)

“Drinking more than four cups of coffee a day and smoking more than 20 cigarettes could be a dangerous combination for male fertility.” (Research study, North Carolina, USA)

Women whose mothers smoked when they were pregnant are only 50 per cent as fertile as women who were not exposed (when in the uterus) to a mother’s tobacco smoke. (C. Weinberg, “Reduced Fecundity in Women with Prenatal exposure to cigarette smoking.” American Journal of Epidemiology 1989; 129 p1072)

Margarine has been implicated in low sperm counts.

Alternatives. Endocrine balancers.

Female. Tea. Equal parts: herbs – Motherwort, Agnus Castus and Oats. Mix. 2 teaspoons to each cup boiling water; infuse 15 minutes. Dose, 1 cup 2-3 times daily.

Tablets: Agnus Castus, dosage as on bottle.

Liquid Extracts: equal parts Agnus Castus and Helonias: 1 teaspoon in water 2-3 times daily.

Maria Treben: 25 drops fresh Mistletoe juice in water, on empty stomach, night and morning.

External: Castor oil abdominal packs twice weekly.

Male. Ginseng, Gotu Kola, or the traditional combination of Damiana, Saw Palmetto and Kola. Tablets, liquid extracts, powders or tinctures. Tinctures (practitioner): Capsicum Fort BPC 5ml; Saw Palmetto (1:5) 10ml; Damiana (1:5) 50ml; Prickly Ash (1:5) 10ml. Aqua to 100ml. 1 teaspoon in water, thrice daily. (Arthur Hyde FNIMH)

An orange a day helps keep sperm OK. (Important role of Vitamin C – New Scientist 1992 NO.1812 p20)

Fasting. Mrs A. Rylin, Sweden, had been trying to conceive for 2 years. Conventional medicine proved ineffective until both she and her husband decided to fast for ten days. Within a month she conceived. Other successes reported.

Diet. (For both partners) Vitamin A foods. Wholefoods, oatmeal products (breakfast oats, etc). Regular raw food days. No alcohol. The key mineral for infertility is zinc, a deficiency of which may be made up with bran which is not only high in zinc but in soluble fibre. Not to eat any green peas, which are mildly contraceptive.

Supplements. Daily. Vitamin C (1 gram). Vitamin E (500iu). One B-complex tablet, including B6. The calcium ion is the key regulator of human sperm function – Calcium Lactate 300mg (2 tablets thrice daily at meals). Zinc – 2 tablets or capsules at night. Folic acid, 400mcg. Dolomite. Iron.

Notes. Consider Vitamin B12 and Iron deficiency when evaluating anaemia in infertile couples.

20 percent of men suffer infertility and produce high levels of superoxide radicals in their semen. Vitamin E, an antioxidant, is believed to mop up their superoxide radicals.

Observe sign of zinc deficiency: white flecks on nails. ... Bartrams Encyclopedia of Herbal Medicine

Deficiency. Iron-deficiency anaemia is the most common deficiency disease in the world. Children require adequate level for cell growth and healthy development. Senior citizens may have inability to absorb. Sportspeople carefully watch their iron levels.

Studies reveal that iron absorption is reduced by coffee consumption. A single cup of coffee can effect a reduction of 30 per cent when consumed at the same time iron or iron containing foods are taken. (American Journal of Clinical Medicine, 1983)

Sources. Red meat, liver, kidney, almonds, dried fruits (especially figs), All Bran, spinach, watercress. Herbs. All seaweeds. Burdock, Devil’s Claw, Couch Grass root, Meadowsweet, Mullein, Rest Harrow, Nettles, Toadflax, Wild Strawberry leaves, Yellow Dock, Gotu Kola, Parsley, Silverweed.

Floradix Herbal Iron Extract: absorbable iron in a yeast extract dietary supplement. Contents include Nettles, Fennel, Angelica root, Horsetail, Spinach, Yarrow, etc. ... Bartrams Encyclopedia of Herbal Medicine

An IUD is inserted through the vagina and cervix into the uterine cavity. Once in position, an IUD provides immediate protection. Most IUDs have a plastic string attached to make removal easier and also to indicate its presence when in place. IUDs usually need to be replaced every 3–8 years.

Women who have been pregnant are less likely to have complications than women who have never been pregnant. For example, they may experience less pain on insertion and have lighter menstrual flow and lower expulsion rates. IUDs are usually not recommended for women with fibroids or an irregular uterine cavity. If menstrual flow is heavy, or there is a history or increased risk of pelvic inflammatory disease (PID), a progestogen IUD may be recommended.

Rarely, pregnancy can occur, although IUDs seldom cause problems and can be removed. Nonprogestogen IUDs increase the risk of PID, which can lead to permanent infertility. A rare complication of IUD use is perforation of the uterus, which most commonly occurs at the time of insertion.... BMA Medical Dictionary

• Juniper Tea helps treating arthritis, rheumatism and gout.
• Stimulates the appetite.
• Stimulates menstrual flow.
• Supports the functions of the stomach.
• Helps treating colic, indigestion and flatulence.

• Diarrhea
• Kidney pain
• Intestinal pain
• Blood in the urine
• High blood pressure

• Keemun Gongfu or Congou which has thin, dark and tight shaped leaves.
• Keemun Mao Feng which has slightly twisted leaf buds and a smoother flavor. For a proper taste, it is recommended to brew a smaller quantity of this type of tea and let it steep for 7 minutes.
• Keemun Xin Ya - a type of tea with a less bitter taste.
• Keemun Hao Ya

• Accelerates your metabolism and allows you to burn fat much easier and faster. With a balanced diet and regular exercise,Keemun tea is a strong allied in the process of weight loss.
• Keemun tea can be a good alternative for coffee. The caffeine in the black tea will give you the energy that you need in the morning and will make you feel full of energy all day long.
• Improves your digestion by dissolving the excess acidity.
• Inhibits the growth of cancer cells and the development of rheumatoid arthritis.

• Boosts your mood.
• Fights depression.
• Improves male potency.
• Suppresses food appetite.
• Helps in the treatment of congestion problems such as asthma and whooping cough.

• Because of its caffeine content, pregnant and breastfeeding women shouldn’t drink Kola Nut Tea.
• People with hypertension and heart disease should also avoid Kola Nut Tea.
• Do not drink Kola Nut Tea before bed, since its caffeine content may stop you from having a restful sleep.

• Relieves menstrual cramps and discomfort during menopause.
• When applied on skin, it can heal wounds, cuts, burns or other skin conditions.
• Helps relieving nausea.
• Effective in treating diarrhea and gastroenteritis.
• May heal bleeding gums.

• Do not drink Lady’s Mantle Tea if you are pregnant or breastfeeding.
• Stop drinking Lady’s Mantle tea if you experience weakness or fatigue.
• It may interact with the effects of some medications, so always consult your doctor before drinking any herbal tea, including Lady’s Mantle Tea.

High mortality rate, (50 per cent) especially in pregnant women. Each case is a matter for an infectious disease consultant.

Treatment. Isolation. Bedrest.

Alternatives. Teas. Gotu Kola, Chaparral, Red Clover, Yarrow.

Formula. Equal parts: Mullein, Yarrow, Thyme. One heaped teaspoon to cup water slowly brought to boil; vessel removed on boiling. Infuse 15 minutes. 1 cup freely.

Tablets/capsules. Red Clover.

Formula. Yarrow 2; Guaiacum quarter; Gotu Kola 1; Liquorice quarter. Dose – Powders: 500mg (two 00 capsules or one-third teaspoon). Liquid Extracts: 30-60 drops. Tinctures: 60-120 drops (4-8ml). Every 3 hours.

Diet. 3-day fast on fruit juices and abundant herb teas.

To be treated by or in liaison with a qualified medical practitioner. ... Bartrams Encyclopedia of Herbal Medicine

• Peppermint with lemon balm - to calm stomach ache.
• Valerian and lemon balm - for insomnia and nerve pain.
• Bugleweed and lemon balm - for Graves disease.

• Helps fighting insomnia and sleeping difficulties.
• Treats nerve pain.
• Strengthens memory and other brain functions.
• Mood booster.
• Alleviates disorders of the digestive tract and gas problems.
• Helps you concentrate.
• Used in Europe for treating thyroid and chronic fatigue syndrome.

• Over consumption may cause nausea, vomiting, abdominal pain or even dizziness.
• It’s not safe for pregnant and breastfeeding women to drink Lemon Balm Tea.
• Lemon Balm Tea may interact with the effects of some medications, especially the ones that are given to you during or after a surgery. That is why you should taking lemon balm at least 2 weeks before a scheduled surgery!

• Helps fight asthma in children.
• Prevents infections caused by viruses, fungi or bacteria.
• Provides relaxation.
• It can be gargled and used as a deodorizing mouthwash.
• Facilitates good digestion.
• Boosts your immune system.

• If you suffer from allergies, avoid drinking Lemon Thyme Tea.
• Do not drink Lemon Thyme Tea if you are pregnant or breastfeeding.
• Avoid over-consumption

• Lemon VerbenaTea strengthens the nervous system.
• Alleviates colon and stomach spasms.
• Helps reduce fever.
• Acts as a cough remedy.
• Helps with digestion.
• Calms menstrual cramps.

• Make sure you do not suffer from any allergies, since Lemon Verbena Tea can cause skin irritation in some people.
• Pregnant and breastfeeding women must avoid drinking Lemon Verbena Tea and other herbal teas.
• Drinking large amounts of Lemon Verbena Tea may irritate the kidneys. Avoid drinking this tea if you suffer from kidney stones or any other kidney problems.

• Speeds the healing of stomach ulcers.
• Alleviates liver inflammations.
• Combats diarrhea.
• Helps treating headaches.
• Overcomes excessive thirst.
• Treats sore throat.

• Hypertension.
• High blood pressure.
• Headaches.
• Low potassium levels in the blood.
• It may interact with the effects of some medications.
• It should not be consumed by pregnant or breastfeeding women.

Limb defects are rare and may be inherited or form part of a syndrome.

In a condition called phocomelia, hands, feet, or tiny finger- or toe-buds are attached to limb stumps or grow directly from the trunk.

The sedative drug thalidomide, when taken by pregnant women, is known to have caused phocomelia in fetuses.... BMA Medical Dictionary

• The most common use of Linden Tea is to treat anxiety since the herb has a relaxing effect on the body.
• Helps clear up any problems with the digestive system, combating also diarrhea.
• Alleviates fever, colds and cough.
• Relieves sore throat.
• Lessens the effects of excessive flatulence.
• Helps you to sweat out the toxins from your body.
• Is a strong helper in fighting different infections.

• First of all, avoid over-consumption. Drinking too much linden tea can be harmful rather than helpful.
• Pregnant and breastfeeding women should not drink linden tea.
• Frequent use of linden tea has been linked with heart problems, so if you are experiencing heart diseases make sure you always consult your doctor before taking any herbal teas or supplements.

liquid paraffin A lubricant laxative drug obtained from petroleum. It can cause anal irritation, and prolonged use may impair the absorption of vitamins from the intestine into the blood. lisinopril An ACE inhibitor drug commonly used to treat hypertension. lisp A common speech disorder caused by protrusion of the tongue between the teeth so that the “s” sound is replaced by “th”. Sometimes the cause is a cleft palate (see cleft lip and palate). In most children, there is no physical defect and lisping disappears by the age of about 4. listeriosis An infection that is common in animals and may also affect humans. It is caused by the bacterium LISTERIA MONOCYTOGENES, which is widespread in the environment, especially in soil. Possible sources of human infection include soft cheese, ready-prepared coleslaw and salads, and improperly cooked meat.

In most adults, the only symptoms are fever and aching muscles. There may also be sore throat, conjunctivitis, diarrhoea, and abdominal pain. Pneumonia, septicaemia, and meningitis may develop in severe cases. However, listeriosis can be life-threatening, particularly in elderlypeople, those with reduced immunity, and newborn babies. In pregnant women, infection may cause a miscarriage.

The condition is diagnosed by blood tests and analysis of other body fluids, such as urine. Treatment is with antibiotic drugs, such as ampicillin.... BMA Medical Dictionary

At risk: pregnant females, babies, the elderly and immuno-suppressed groups. Notifiable disease.

There may be few gastrointestinal signs but it may lead to endocarditis and CNS disturbance: encephalitis and meningitis. When faced with a previously healthy person with acute diarrhoea and vomiting, food poisoning should be suspected.

Treatment. Dosage: thrice daily (chronic conditions); 2-hourly (acute conditions).

Formula. Equal parts: Wild Yam, Goldenseal, Valerian. Dose: Liquid Extracts: 30-60 drops in water. Powders: 500mg (two 00 capsules or one-third teaspoon). Tinctures: two 5ml teaspoons. Tablets: one tablet of each taken together.

Diet. Slippery Elm gruel. No tea, alcohol or caffeine drinks. Lemon balm tea freely. Listeria is inhibited by unsaturated fatty acids.

Prevention. 2 Garlic tablets/capsules at night.

Treatment by or in liaison with a general medical practitioner. ... Bartrams Encyclopedia of Herbal Medicine

A localised (focal) form of liver disease in all tropical/subtropical countries results from invasive Entamoeba histolytica infection (amoebic liver ‘abscess’); serology and imaging techniques assist in diagnosis. Hydatidosis also causes localised liver disease; one or more cysts usually involve the right lobe of the liver. Serological tests and imaging techniques are of value in diagnosis. Whilst surgery formerly constituted the sole method of management, prolonged courses of albendazole and/or praziquantel have now been shown to be e?ective; however, surgical intervention is still required in some cases.

Hepato-biliary disease is also a problem in many tropical/subtropical countries. In southeast Asia, Clonorchis sinensis and Opisthorchis viverini infections cause chronic biliary-tract infection, complicated by adenocarcinoma of the biliary system. Praziquantel is e?ective chemotherapy before advanced disease ensues. Fasciola hepatica (the liver ?uke) is a further hepato-biliary helminthic infection; treatment is with bithionol or triclabendazole, praziquantel being relatively ine?ective.... Medical Dictionary

• Lobelia Tea has been used for many years to beak the smoking habit and it is often used in many smoking cessation programs.
• Provides relaxation, easing tension and panic.
• Treats asthma and bronchitis. It is said that Native Americans used to smoke lobelia to treat these conditions.
• Clears toxins from your body, lobelia tea being able to induce vomiting.
• Have anti-spasmodic, diuretic and sedative properties.

• People who experience certain health conditions such as heart, liver or kidney disease, high blood pressure, seizure disorders, paralysis, shortness of breath should not drink Lobelia Tea.
• Pregnant and breastfeeding women should not drink Lobelia Tea.
• Lobelia Tea may interfere with the effects of certain medications, such as psychiatric medications or nicotine substitutes, so do not drink lobelia tea before consulting your doctor!

• It is very effective in treating intestinal problems such as diarrhea and abdominal cramps.
• Controls bleeding due to the quercetin and other flavonoids in the lotus plant.
• Lotus leaf tea has a general calming effect, providing relaxation.
• Helps fighting gastric ulcers and combating hemorrhoids.
• Lotus tea alleviates restlessness and insomnia.

• Alleviates menstrual cramps.
• Helps in the treatment of rheumatism.
• Treats urinary tract infections.
• Stimulates food appetite.
• Improves blood circulation.
• Alleviates migraine headache.
• Alleviates gas pains and flatulence.

• Pregnant and breastfeeding women should avoid drinking Lovage Tea since during pregnancy may cause contractions or even miscarriage.
• Lovage Tea may lead to fluid retention.
• Might increase blood pressure.
• Do not drink Lovage Tea if you have kidney problems.

Deficiency. May lead to disorders of arteries or kidneys; brittle bones, pre-menstrual tension, heart disease, muscle cramps, hypoglycaemia, insomnia, palpitation, tremor of hands or lower limbs; anorexia, anxiety, depression, tiredness, dizziness, confusion. Studies reveal that two-thirds of patients with peripheral vascular disease are magnesium-deficient. Absorption is blocked by the contraceptive pill, a high milk or high fat intake. Chronic fatigue syndrome.

Heart attack. “An imbalance in the Magnesium/Calcium ratio may contribute to myocardial infarction.” (Dr H.J. Holtmeier, University of Freiburg, Germany)

Body effects. Co-ordination of nerves and muscles. Healthy teeth and bones. This metal activates more enzymes in the body than any other mineral. Heart patients on Digoxin have less palpitation when magnesium level is normal.

Sources. Most foods. Meat, milk, eggs, seafood, nuts (peanuts etc), brown rice, wheatbran, cocoa, Soya beans and flour, almonds, walnuts, maize, oats.

Fruits: apples, avocado, bananas, black grapes, seeds.

Herbs: Bladderwrack, Black Willow bark, Broom, Carrot leaves, Devil’s Bit, Dulse, Dandelion, Gotu Kola, Kale, Kelp, Meadowsweet, Mistletoe, Mullein, Okra, Parsley, Peppermint, Primrose flowers, Rest Harrow, Silverweed, Skunk Cabbage, Toadflax, Walnut leaves, Watercress, Wintergreen. Teas made from any of this list can be effective for low-grade magnesium deficiency.

RDA 300mg: 450mg (pregnant women and nursing mothers). ... Bartrams Encyclopedia of Herbal Medicine

FAMILY: Rutaceae

SYNONYMS: C. nobilis, C. madurensis, C. unshiu, C. deliciosa, European mandarin, true mandarin, tangerine, satsuma.

GENERAL DESCRIPTION: A small evergreen tree up to 6 metres high with glossy leaves, fragrant flowers and bearing fleshy fruit. The tangerine is larger than the mandarin and rounder, with a yellower skin, more like the original Chinese type.

DISTRIBUTION: Native to southern China and the Far East. Brought to Europe in 1805 and to America forty years later, where it was renamed the tangerine. The mandarin is produced mainly in Italy, Spain, Algeria, Cyprus, Greece, the Middle East and Brazil; the tangerine in Texas, Florida, California and Guinea.

OTHER SPECIES: There are many cultivars within this species: the terms tangerine (C. reticulata) and mandarin are used somewhat interchangeably, as is the word satsuma. They could be said to represent different chemotypes since the oils are quite different; see the Botanical Classification section.

HERBAL/FOLK TRADITION: The name comes from the fruit which was a traditional gift to the Mandarins of China. In France it is regarded as a safe children’s remedy for indigestion, hiccoughs, etc, and also for the elderly since it helps strengthen the digestive function and liver.

EXTRACTION: Essential oil by cold expression from the outer peel. A mandarin petitgrain oil is also produced in small quantities by steam distillation from the leaves and twigs.

CHARACTERISTICS: Mandarin oil is a yellowy-orange mobile liquid with a blue-violet hint, having an intensely sweet, almost floral citrus scent. It blends well with other citrus oils, especially neroli, and spice oils such as nutmeg, cinnamon and clove. Tangerine oil is an orange mobile liquid with a fresh, sweet, orangelike aroma. It has less body than mandarin and is little used in perfumery work.

PRINCIPAL CONSTITUENTS: Limonene, methyl methylanthranilate, geraniol, citral, citronella!, among others.

SAFETY DATA: Non-toxic, non-irritant, nonsensitizing. Possibly phototoxic, although it has not been demonstrated decisively.

AROMATHERAPY/HOME: USE

Skin care: Acne, congested and oily skin, scars, spots, stretch marks, toner.

Circulation muscles and joints: Fluid retention, obesity.

Digestive system: Digestive problems, dyspepsia, hiccoughs, intestinal problems.

Nervous system: Insomnia, nervous tension, restlessness. It is often used for children and pregnant women and is recommended in synergistic combinations with other citrus oils.

OTHER USES: Mandarin oil is used in soaps, cosmetics and perfumes, especially colognes. It is employed as a flavouring agent especially in sweets, soft drinks and liqueurs.... The Encyclopedia of Essential Oils

• infuse 1 tablespoon per cup
• use boiling water
• infuse it for 3 minutes

•  Anemia
•  Stress
• Muscle cramps
• Digestion
• Weight Control
• Bone Growth
• Immune Functions
• Vision
• Wound Healing
• Protein Synthesis
• Dehydration

• It is used for thousands of years as an herbal remedy for sore throat, cough and other respiratory problems due to its large amounts of mucilage.
• It is a strong allied in the weight loss process since it can give you the feeling of fullness.
• It is helpful in treating almost all problems related to inflammation of the digestive tract.
• It can be formed into a mouthwash for treating teeth or gum inflammation. Fresh peeled root is also good for children to chew on in order to have healthy teeth.

• Drink this tea with caution if you suffer from diabetes or liver disease since marshmallow tea may include the use of sugar or alcohol.
• Pregnant and breastfeeding women should not drink marshmallow tea.
• Keep in mind that if you are taking medications, marshmallow tea can interfere with their absorption. So drink the tea at least two hours after taking the drugs.

Ovulation (release of an egg from the follicle) usually occurs in the middle of the menstrual cycle.

The empty follicle also produces progesterone hormone, which makes the endometrium become swollen and thick with retained fluid.

This enables a fertilized egg to implant in the endometrium.

If pregnancy fails to occur, the production of oestrogens and progesterone diminishes.

The endometrium is then shed about 14 days after ovulation.

Uterine contractions force the menstrual discharge to be expelled into the vagina, accompanied by bleeding, which may last for 1–8 days.... BMA Medical Dictionary

It may cause a DISULFIRAM-like reaction with alcohol; caution is similarly indicated in patients with impaired liver function or hepatic encephalopathy, and who are pregnant or breast feeding. Rare side-effects include nausea, vomiting, unpleasant taste, furred tongue and gastrointestinal disturbances; rashes, URTICARIA, and angio-oedema (see under URTICARIA); drowsiness, headache, dizziness, ATAXIA and ANAPHYLAXIS.... Medical Dictionary

(See also individual mineral entries.)... BMA Medical Dictionary

Structural defects of the nipple are rare. An inverted nipple is usually a harmless abnormality of development. Nipple inversion that develops in older women is mostly due to ageing, but mammography may be advisable to rule out the possibility of cancer.

Cracked nipples, common in the last months of pregnancy and during breastfeeding, may lead to infective mastitis. Washing, drying, and moisturizing the nipple daily can help to prevent cracking. Papilloma of the nipple is a noncancerous swelling attached to the skin by a stalk. Paget’s disease of the nipple appears initially as persistent eczema of the nipple and is due to a slow-growing cancer arising in a milk duct. Surgical treatment is required.Discharge from the nipple occurs for various reasons.

A clear, straw-coloured discharge may develop in early pregnancy; a milky discharge may occur after breast-feeding is over.

Galactorrhoea (milk discharge in someone who is not pregnant or breast-feeding) may be caused by a hormone imbalance, or, rarely, a galactocele (a cyst under the areola).

A discharge containing pus indicates a breast abscess.

A bloodstained discharge may be due to a noncancerous breast disorder or cancer.... BMA Medical Dictionary

Occupational health includes both mental and physical health. It is about compliance with health-and-safety-at-work legislation (and common law duties) and about best practice in providing work environments that reduce risks to health and safety to lowest practicable levels. It includes workers’ ?tness to work, as well as the management of the work environment to accommodate people with disabilities, and procedures to facilitate the return to work of those absent with long-term illness. Occupational health incorporates several professional groups, including occupational physicians, occupational health nurses, occupational hygienists, ergonomists, disability managers, workplace counsellors, health-and-safety practitioners, and workplace physiotherapists.

In the UK, two key statutes provide a framework for occupational health: the Health and Safety at Work, etc. Act 1974 (HSW Act); and the Disability Discrimination Act 1995 (DDA). The HSW Act states that employers have a duty to protect the health, safety and welfare of their employees and to conduct their business in a way that does not expose others to risks to their health and safety. Employees and self-employed people also have duties under the Act. Modern health-and-safety legislation focuses on assessing and controlling risk rather than prescribing speci?c actions in di?erent industrial settings. Various regulations made under the HSW Act, such as the Control of Substances Hazardous to Health Regulations, the Manual Handling Operations Regulations and the Noise at Work Regulations, set out duties with regard to di?erent risks, but apply to all employers and follow the general principles of risk assessment and control. Risks should be controlled principally by removing or reducing the hazard at source (for example, by substituting chemicals with safer alternatives, replacing noisy machinery, or automating tasks to avoid heavy lifting). Personal protective equipment, such as gloves and ear defenders, should be seen as a last line of defence after other control measures have been put in place.

The employment provisions of the DDA require employers to avoid discriminatory practice towards disabled people and to make reasonable adjustments to working arrangements where a disabled person is placed at a substantial disadvantage to a non-disabled person. Although the DDA does not require employers to provide access to rehabilitation services – even for those injured or made ill at work – occupational-health practitioners may become involved in programmes to help people get back to work after injury or long-term illness, and many businesses see the retention of valuable sta? as an attractive alternative to medical retirement or dismissal on health grounds.

Although a major part of occupational-health practice is concerned with statutory compliance, the workplace is also an important venue for health promotion. Many working people rarely see their general practitioner and, even when they do, there is little time to discuss wider health issues. Occupational-health advisers can ?ll in this gap by providing, for example, workplace initiatives on stopping smoking, cardiovascular health, diet and self-examination for breast and testicular cancers. Such initiatives are encouraged because of the perceived bene?ts to sta?, to the employing organisation and to the wider public-health agenda. Occupational psychologists recognise the need for the working population to achieve a ‘work-life balance’ and the promotion of this is an increasing part of occupational health strategies.

The law requires employers to consult with their sta? on health-and-safety matters. However, there is also a growing understanding that successful occupational-health management involves workers directly in the identi?cation of risks and in developing solutions in the workplace. Trade unions play an active role in promoting occupational health through local and national campaigns and by training and advising elected workplace safety representatives.

Occupational medicine The branch of medicine that deals with the control, prevention, diagnosis, treatment and management of ill-health and injuries caused or made worse by work, and with ensuring that workers are ?t for the work they do.

Occupational medicine includes: statutory surveillance of workers’ exposure to hazardous agents; advice to employers and employees on eliminating or reducing risks to health and safety at work; diagnosis and treatment/management of occupational illness; advice on adapting the working environment to suit the worker, particularly those with disabilities or long-term health problems; and advice on the return to work and, if necessary, rehabilitation of workers absent through illness. Occupational physicians may play a wider role in monitoring the health of workplace populations and in advising employers on controlling health hazards where ill-health trends are observed. They may also conduct epidemiological research (see EPIDEMIOLOGY) on workplace diseases.

Because of the occupational physician’s dual role as adviser to both employer and employee, he or she is required to be particularly diligent with regards to the individual worker’s medical CONFIDENTIALITY. Occupational physicians need to recognise in any given situation the context they are working in, and to make sure that all parties are aware of this.

Occupational medicine is a medical discipline and thus is only part of the broader ?eld of occupational health. Although there are some speci?c clinical duties associated with occupational medicine, such as diagnosis of occupational disease and medical screening, occupational physicians are frequently part of a multidisciplinary team that might include, for example, occupational-health nurses, healthand-safety advisers, ergonomists, counsellors and hygienists. Occupational physicians are medical practitioners with a post-registration quali?cation in occupational medicine. They will have completed a period of supervised in-post training. In the UK, the Faculty of Occupational Medicine of the Royal College of Physicians has three categories of membership, depending on quali?cations and experience: associateship (AFOM); membership (MFOM); and fellowship (FFOM).

Occupational diseases Occupational diseases are illnesses that are caused or made worse by work. In their widest sense, they include physical and mental ill-health conditions.

In diagnosing an occupational disease, the clinician will need to examine not just the signs and symptoms of ill-health, but also the occupational history of the patient. This is important not only in discovering the cause, or causes, of the disease (work may be one of a number of factors), but also in making recommendations on how the work should be modi?ed to prevent a recurrence – or, if necessary, in deciding whether or not the worker is able to return to that type of work. The occupational history will help in deciding whether or not other workers are also at risk of developing the condition. It will include information on:

the nature of the work.

how the tasks are performed in practice.

the likelihood of exposure to hazardous agents (physical, chemical, biological and psychosocial).

what control measures are in place and the extent to which these are adhered to.

previous occupational and non-occupational exposures.

whether or not others have reported similar symptoms in relation to the work. Some conditions – certain skin conditions,

for example – may show a close relationship to work, with symptoms appearing directly only after exposure to particular agents or possibly disappearing at weekends or with time away from work. Others, however, may be chronic and can have serious long-term implications for a person’s future health and employment.

Statistical information on the prevalence of occupational disease in the UK comes from a variety of sources, including o?cial ?gures from the Industrial Injuries Scheme (see below) and statutory reporting of occupational disease (also below). Neither of these o?cial schemes provides a representative picture, because the former is restricted to certain prescribed conditions and occupations, and the latter suffers from gross under-reporting. More useful are data from the various schemes that make up the Occupational Diseases Intelligence Network (ODIN) and from the Labour Force Survey (LFS). ODIN data is generated by the systematic reporting of work-related conditions by clinicians and includes several schemes. Under one scheme, more than 80 per cent of all reported diseases by occupational-health physicians fall into just six of the 42 clinical disease categories: upper-limb disorders; anxiety, depression and stress disorders; contact DERMATITIS; lower-back problems; hearing loss (see DEAFNESS); and ASTHMA. Information from the LFS yields a similar pattern in terms of disease frequency. Its most recent survey found that over 2 million people believed that, in the previous 12 months, they had suffered from an illness caused or made worse by work and that

19.5 million working days were lost as a result. The ten most frequently reported disease categories were:

stress and mental ill-health (see MENTAL ILLNESS): 515,000 cases.

back injuries: 508,000.

upper-limb and neck disorders: 375,000.

lower respiratory disease: 202,000.

deafness, TINNITUS or other ear conditions: 170,000.

lower-limb musculoskeletal conditions: 100,000.

skin disease: 66,000.

headache or ‘eyestrain’: 50,000.

traumatic injury (includes wounds and fractures from violent attacks at work): 34,000.

vibration white ?nger (hand-arm vibration syndrome): 36,000. A person who develops a chronic occu

pational disease may be able to sue his or her employer for damages if it can be shown that the employer was negligent in failing to take reasonable care of its employees, or had failed to provide a system of work that would have prevented harmful exposure to a known health hazard. There have been numerous successful claims (either awarded in court, or settled out of court) for damages for back and other musculoskeletal injuries, hand-arm vibration syndrome, noise-induced deafness, asthma, dermatitis, MESOTHELIOMA and ASBESTOSIS. Employers’ liability (workers’ compensation) insurers are predicting that the biggest future rise in damages claims will be for stress-related illness. In a recent study, funded by the Health and Safety Executive, about 20 per cent of all workers – more than 5 million people in the UK – claimed to be ‘very’ or ‘extremely’ stressed at work – a statistic that is likely to have a major impact on the long-term health of the working population.

While victims of occupational disease have the right to sue their employers for damages, many countries also operate a system of no-fault compensation for the victims of prescribed occupational diseases. In the UK, more than 60 diseases are prescribed under the Industrial Injuries Scheme and a person will automatically be entitled to state compensation for disability connected to one of these conditions, provided that he or she works in one of the occupations for which they are prescribed. The following short list gives an indication of the types of diseases and occupations prescribed under the scheme:

CARPAL TUNNEL SYNDROME connected to the use of hand-held vibrating tools.

hearing loss from (amongst others) use of pneumatic percussive tools and chainsaws, working in the vicinity of textile manufacturing or woodworking machines, and work in ships’ engine rooms.

LEPTOSPIROSIS – infection with Leptospira (various listed occupations).

viral HEPATITIS from contact with human blood, blood products or other sources of viral hepatitis.

LEAD POISONING, from any occupation causing exposure to fumes, dust and vapour from lead or lead products.

asthma caused by exposure to, among other listed substances, isocyanates, curing agents, solder ?ux fumes and insects reared for research.

mesothelioma from exposure to asbestos.

In the UK, employers and the self-employed have a duty to report all occupational injuries (if the employee is o? work for three days or more as a result), diseases or dangerous incidents to the relevant enforcing authority (the Health and Safety Executive or local-authority environmental-health department) under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR). Despite this statutory duty, comparatively few diseases are reported so that ?gures generated from RIDDOR reports do not give a useful indication of the scale of occupational diseases in the UK. The statutory reporting of injuries is much better, presumably because of the clear and acute relationship between a workplace accident and the resultant injury. More than 160,000 injuries are reported under RIDDOR every year compared with just 2,500 or so occupational diseases, a gross underestimate of the true ?gure.

There are no precise ?gures for the number of people who die prematurely because of work-related ill-health, and it would be impossible to gauge the exact contribution that work has on, for example, cardiovascular disease and cancers where the causes are multifactorial. The toll would, however, dwarf the number of deaths caused by accidents at work. Around 250 people are killed by accidents at work in the UK each year – mesothelioma, from exposure to asbestos at work, alone kills more than 1,300 people annually.

The following is a sample list of occupational diseases, with brief descriptions of their aetiologies.

Inhaled materials

PNEUMOCONIOSIS covers a group of diseases which cause ?brotic lung disease following the inhalation of dust. Around 250–300 new cases receive bene?t each year – mostly due to coal dust with or without silica contamination. SILICOSIS is the more severe disease. The contraction in the size of the coal-mining industry as well as improved dust suppression in the mines have diminished the importance of this disease, whereas asbestos-related diseases now exceed 1,000 per year. Asbestos ?bres cause a restrictive lung disease but also are responsible for certain malignant conditions such as pleural and peritoneal mesothelioma and lung cancer. The lung-cancer risk is exacerbated by cigarette-smoking.

Even though the use of asbestos is virtually banned in the UK, many workers remain at risk of exposure because of the vast quantities present in buildings (much of which is not listed in building plans). Carpenters, electricians, plumbers, builders and demolition workers are all liable to exposure from work that disturbs existing asbestos. OCCUPATIONAL ASTHMA is of increasing importance – not only because of the recognition of new allergic agents (see ALLERGY), but also in the number of reported cases. The following eight substances are most frequently linked to occupational asthma (key occupations in brackets): isocyanates (spray painters, electrical processors); ?our and grain (bakers and farmers); wood dust (wood workers); glutaraldehyde (nurses, darkroom technicians); solder/colophony (welders, electronic assembly workers); laboratory animals (technicians, scientists); resins and glues (metal and electrical workers, construction, chemical processors); and latex (nurses, auxiliaries, laboratory technicians).

The disease develops after a short, symptomless period of exposure; symptoms are temporally related to work exposures and relieved by absences from work. Removal of the worker from exposure does not necessarily lead to complete cessation of symptoms. For many agents, there is no relationship with a previous history of ATOPY. Occupational asthma accounts for about 10 per cent of all asthma cases. DERMATITIS The risk of dermatitis caused by an allergic or irritant reaction to substances used or handled at work is present in a wide variety of jobs. About three-quarters of cases are irritant contact dermatitis due to such agents as acids, alkalis and solvents. Allergic contact dermatitis is a more speci?c response by susceptible individuals to a range of allergens (see ALLERGEN). The main occupational contact allergens include chromates, nickel, epoxy resins, rubber additives, germicidal agents, dyes, topical anaesthetics and antibiotics as well as certain plants and woods. Latex gloves are a particular cause of occupational dermatitis among health-care and laboratory sta? and have resulted in many workers being forced to leave their profession through ill-health. (See also SKIN, DISEASES OF.)

Musculoskeletal disorders Musculoskeletal injuries are by far the most common conditions related to work (see LFS ?gures, above) and the biggest cause of disability. Although not all work-related, musculoskeletal disorders account for 36.5 per cent of all disabilities among working-age people (compared with less than 4 per cent for sight and hearing impairment). Back pain (all causes – see BACKACHE) has been estimated to cause more than 50 million days lost every year in sickness absence and costs the UK economy up to £5 billion annually as a result of incapacity or disability. Back pain is a particular problem in the health-care sector because of the risk of injury from lifting and moving patients. While the emphasis should be on preventing injuries from occurring, it is now well established that the best way to manage most lower-back injuries is to encourage the patient to continue as normally as possible and to remain at work, or to return as soon as possible even if the patient has some residual back pain. Those who remain o? work on long-term sick leave are far less likely ever to return to work.

Aside from back injuries, there are a whole range of conditions affecting the upper limbs, neck and lower limbs. Some have clear aetiologies and clinical signs, while others are less well de?ned and have multiple causation. Some conditions, such as carpal tunnel syndrome, are prescribed diseases in certain occupations; however, they are not always caused by work (pregnant and older women are more likely to report carpal tunnel syndrome irrespective of work) and clinicians need to be careful when assigning work as the cause without ?rst considering the evidence. Other conditions may be revealed or made worse by work – such as OSTEOARTHRITIS in the hand. Much attention has focused on injuries caused by repeated movement, excessive force, and awkward postures and these include tenosynovitis (in?ammation of a tendon) and epicondylitis. The greatest controversy surrounds upper-limb disorders that do not present obvious tissue or nerve damage but nevertheless give signi?cant pain and discomfort to the individual. These are sometimes referred to as ‘repetitive strain injury’ or ‘di?use RSI’. The diagnosis of such conditions is controversial, making it di?cult for sufferers to pursue claims for compensation through the courts. Psychosocial factors, such as high demands of the job, lack of control and poor social support at work, have been implicated in the development of many upper-limb disorders, and in prevention and management it is important to deal with the psychological as well as the physical risk factors. Occupations known to be at particular risk of work-related upper-limb disorders include poultry processors, packers, electronic assembly workers, data processors, supermarket check-out operators and telephonists. These jobs often contain a number of the relevant exposures of dynamic load, static load, a full or excessive range of movements and awkward postures. (See UPPER LIMB DISORDERS.)

Physical agents A number of physical agents cause occupational ill-health of which the most important is occupational deafness. Workplace noise exposures in excess of 85 decibels for a working day are likely to cause damage to hearing which is initially restricted to the vital frequencies associated with speech – around 3–4 kHz. Protection from such noise is imperative as hearing aids do nothing to ameliorate the neural damage once it has occurred.

Hand-arm vibration syndrome is a disorder of the vascular and/or neural endings in the hands leading to episodic blanching (‘white ?nger’) and numbness which is exacerbated by low temperature. The condition, which is caused by vibrating tools such as chain saws and pneumatic hammers, is akin to RAYNAUD’S DISEASE and can be disabling.

Decompression sickness is caused by a rapid change in ambient pressure and is a disease associated with deep-sea divers, tunnel workers and high-?ying aviators. Apart from the direct effects of pressure change such as ruptured tympanic membrane or sinus pain, the more serious damage is indirectly due to nitrogen bubbles appearing in the blood and blocking small vessels. Central and peripheral nervous-system damage and bone necrosis are the most dangerous sequelae.

Radiation Non-ionising radiation from lasers or microwaves can cause severe localised heating leading to tissue damage of which cataracts (see under EYE, DISORDERS OF) are a particular variety. Ionising radiation from radioactive sources can cause similar acute tissue damage to the eyes as well as cell damage to rapidly dividing cells in the gut and bone marrow. Longer-term effects include genetic damage and various malignant disorders of which LEUKAEMIA and aplastic ANAEMIA are notable. Particular radioactive isotopes may destroy or induce malignant change in target organs, for example, 131I (thyroid), 90Sr (bone). Outdoor workers may also be at risk of sunburn and skin cancers. OTHER OCCUPATIONAL CANCERS Occupation is directly responsible for about 5 per cent of all cancers and contributes to a further 5 per cent. Apart from the cancers caused by asbestos and ionising radiation, a number of other occupational exposures can cause human cancer. The International Agency for Research on Cancer regularly reviews the evidence for carcinogenicity of compounds and industrial processes, and its published list of carcinogens is widely accepted as the current state of knowledge. More than 50 agents and processes are listed as class 1 carcinogens. Important occupational carcinogens include asbestos (mesothelioma, lung cancer); polynuclear aromatic hydrocarbons such as mineral oils, soots, tars (skin and lung cancer); the aromatic amines in dyestu?s (bladder cancer); certain hexavalent chromates, arsenic and nickel re?ning (lung cancer); wood and leather dust (nasal sinus cancer); benzene (leukaemia); and vinyl chloride monomer (angiosarcoma of the liver). It has been estimated that elimination of all known occupational carcinogens, if possible, would lead to an annual saving of 5,000 premature deaths in Britain.

Infections Two broad categories of job carry an occupational risk. These are workers in contact with animals (farmers, veterinary surgeons and slaughtermen) and those in contact with human sources of infection (health-care sta? and sewage workers).

Occupational infections include various zoonoses (pathogens transmissible from animals to humans), such as ANTHRAX, Borrelia burgdorferi (LYME DISEASE), bovine TUBERCULOSIS, BRUCELLOSIS, Chlamydia psittaci, leptospirosis, ORF virus, Q fever, RINGWORM and Streptococcus suis. Human pathogens that may be transmissible at work include tuberculosis, and blood-borne pathogens such as viral hepatitis (B and C) and HIV (see AIDS/HIV). Health-care workers at risk of exposure to infected blood and body ?uids should be immunised against hapatitis B.

Poisoning The incidence of occupational poisonings has diminished with the substitution of noxious chemicals with safer alternatives, and with the advent of improved containment. However, poisonings owing to accidents at work are still reported, sometimes with fatal consequences. Workers involved in the application of pesticides are particularly at risk if safe procedures are not followed or if equipment is faulty. Exposure to organophosphate pesticides, for example, can lead to breathing diffculties, vomiting, diarrhoea and abdominal cramps, and to other neurological effects including confusion and dizziness. Severe poisonings can lead to death. Exposure can be through ingestion, inhalation and dermal (skin) contact.

Stress and mental health Stress is an adverse reaction to excessive pressures or demands and, in occupational-health terms, is di?erent from the motivational impact often associated with challenging work (some refer to this as ‘positive stress’). Stress at work is often linked to increasing demands on workers, although coping can often prevent the development of stress. The causes of occupational stress are multivariate and encompass job characteristics (e.g. long or unsocial working hours, high work demands, imbalance between e?ort and reward, poorly managed organisational change, lack of control over work, poor social support at work, fear of redundancy and bullying), as well as individual factors (such as personality type, personal circumstances, coping strategies, and availability of psychosocial support outside work). Stress may in?uence behaviours such as smoking, alcohol consumption, sleep and diet, which may in turn affect people’s health. Stress may also have direct effects on the immune system (see IMMUNITY) and lead to a decline in health. Stress may also alter the course and response to treatment of conditions such as cardiovascular disease. As well as these general effects of stress, speci?c types of disorder may be observed.

Exposure to extremely traumatic incidents at work – such as dealing with a major accident involving multiple loss of life and serious injury

(e.g. paramedics at the scene of an explosion or rail crash) – may result in a chronic condition known as post-traumatic stress disorder (PTSD). PTSD is an abnormal psychological reaction to a traumatic event and is characterised by extreme psychological discomfort, such as anxiety or panic when reminded of the causative event; sufferers may be plagued with uncontrollable memories and can feel as if they are going through the trauma again. PTSD is a clinically de?ned condition in terms of its symptoms and causes and should not be used to include normal short-term reactions to trauma.... Medical Dictionary

Side effects may include nausea, vomiting, diarrhoea, skin rash, and increased sensitivity of the skin to sunlight. Oxytetracycline may discolour developing teeth, and is not given to children under 12 or to pregnant women.... BMA Medical Dictionary

Uses: acidity, flatulence, incomplete digestion of meats. Patient preference: vegetarian hypoallergenic yeast-free, freeze-dried Papaya. For slimming diet.

Tablets/capsules. Popular combination. Papain BPC 1954 60mg; powdered Charcoal BP 100mg; powdered Slippery Elm BHP (1983) 60mg; powdered Goldenseal BHP (1983) 10mg. Digestive disorders.

External. Juice of the fresh plant used for wounds that refuse to heal. William Scharf, 31, became desperately ill after a kidney transplant. Strong antibiotics failed to heal the infected wound. The surgeon of the Transplant Department of Guy’s Hospital laid strips of fresh paw-paw fruit across the wound. After one week’s treatment Mr Scharf was cured.

Diet. Paw-paw fruit or juice, raw, at meals.

Note: The fruit has a contraceptive effect in its ability to halt pregnancy by attacking progesterone, the hormone essential to pregnancy. (Researchers: Sussex University)

The large green fruit is widely used as a contraceptive in India and Sri Lanka. If a woman wants to become pregnant, she simply avoids eating them. ... Bartrams Encyclopedia of Herbal Medicine

• Lowers the risk of developing cardiovascular diseases.
• Provides relaxation.
• Improves digestion.
• Due to its antioxidant content, Passionfruit Tea may help lowering the risk of developing tumors and cancer.
• Strengthens the immune system.
• Fights skin and tissue damage.

• Pregnant and breastfeeding women should avoid drinking Passionfruit Tea.
• Passionfruit Tea may interact with the effects of some medications, so consult your doctor before drinking passionfruit tea.
• People with blood sugar problems should also avoid drinking Passionfruit Tea.

The condition is usually evident from a physical examination, but ultrasound scanning may be needed.

In mild cases, only rest is needed.

In more severe cases, amniotic fluid may be withdrawn using a needle.

In late pregnancy, induction of labour may be performed.... BMA Medical Dictionary

Pregnancy lasts about 280 days and is calculated from the ?rst day of the last menstrual period – see MENSTRUATION. Pregnancy-testing kits rely on the presence of the hormone beta HUMAN CHORIONIC GONADOTROPHIN (b HCG) which is excreted in the woman’s urine as early as 30 days from the last menstrual period. The estimated date of delivery can be accurately estimated from the size of the developing fetus measured by ULTRASOUND (see also below) between seven and 24 weeks. ‘Term’ refers to the time that the baby is due; this can range from 38 weeks to 41 completed weeks.

Physical changes occur in early pregnancy – periods stop and the abdomen enlarges. The breasts swell, with the veins becoming prominent and the nipples darkening. About two in three women will have nausea with a few experiencing such severe vomiting as to require hospital admission for rehydration.

Antenatal care The aim of antenatal care is to ensure a safe outcome for both mother and child; it is provided by midwives (see MIDWIFE) and doctors. Formal antenatal care began in Edinburgh in the 1930s with the recognition that all aspects of pregnancy – normal and abnormal – warranted surveillance. Cooperation between general practitioners, midwives and obstetricians is now established, with pregnancies that are likely to progress normally being cared for in the community and only those needing special intervention being cared for in a hospital setting.

The initial visit (or booking) in the ?rst half of pregnancy will record the history of past events and the results of tests, with the aim of categorising the patients into normal or not. Screening tests including blood checks and ultrasound scans are a routine part of antenatal care. The ?rst ultrasound scan is done at about 11 weeks to date the pregnancy, with a further one done at 20 weeks – the anomaly scan – to assess the baby’s structure. Some obstetric units will check the growth of the baby with one further scan later in the pregnancy or, in the case of twin pregnancies (see below), many scans throughout. The routine blood tests include checks for ANAEMIA, DIABETES MELLITUS, sickle-cell disease and THALASSAEMIA, as well as for the blood group. Evidence of past infections is also looked for; tests for RUBELLA (German measles) and SYPHILIS are routine, whereas tests for human immunode?ciency virus (see AIDS/ HIV below) and HEPATITIS are being o?ered as optional, although there is compelling evidence that knowledge of the mother’s infection status is bene?cial to the baby.

Traditional antenatal care consists of regular appointments, initially every four weeks until 34 weeks, then fortnightly or weekly. At each visit the mother’s weight, urine and blood pressure are checked, and assessment of fetal growth and position is done by palpating the uterus. Around two-thirds of pregnancies and labours are normal: in the remainder, doctors and midwives need to increase the frequency of surveillance so as to prevent or deal with maternal and fetal problems.

Common complications of pregnancy

Some of the more common complications of pregnancy are listed below.

As well as early detection of medical complications, antenatal visits aim to be supportive and include emotional and educational care. Women with uncomplicated pregnancies are increasingly being managed by midwives and general practitioners in the community and only coming to the hospital doctors should they develop a problem. A small number will opt for a home delivery, but facilities for providing such a service are not always available in the UK.

Women requiring more intensive surveillance have their management targeted to the speci?c problems encountered. Cardiologists will see mothers-to-be with heart conditions, and those at risk of diabetes are cared for in designated clinics with specialist sta?. Those women needing more frequent surveillance than standard antenatal care can be looked after in maternity day centres. These typically include women with mildly raised blood pressure or those with small babies. Fetal medicine units have specialists who are highly skilled in ultrasound scanning and specialise in the diagnosis and management of abnormal babies still in the uterus. ECTOPIC PREGNANCY Chronic abdominal discomfort early in pregnancy may be caused by unruptured ectopic pregnancy, when, rarely, the fertilised OVUM starts developing in the Fallopian tube (see FALLOPIAN TUBES) instead of the uterus. The patient needs hospital treatment and LAPAROSCOPY. A ruptured ectopic pregnancy causes acute abdominal symptoms and collapse, and the woman will require urgent abdominal surgery. URINARY TRACT INFECTIONS These affect around 2 per cent of pregnant women and are detected by a laboratory test of a mid-stream specimen of urine. In pregnancy, symptoms of these infections do not necessarily resemble those experienced by non-pregnant women. As they can cause uterine irritability and possible premature labour (see below), it is important to ?nd and treat them appropriately. ANAEMIA is more prevalent in patients who are vegetarian or on a poor diet. Iron supplements are usually given to women who have low concentrations of HAEMOGLOBIN in their blood (less than 10.5 g/dl) or who are at risk of becoming low in iron, from bleeding, twin pregnancies and those with placenta previa (see below). ANTEPARTUM HAEMORRHAGE Early in pregnancy, vaginal bleedings may be due to a spontaneous or an incomplete therapeutic ABORTION. Bleeding from the genital tract between 24 completed weeks of pregnancy and the start of labour is called antepartum haemorrhage. The most common site is where the PLACENTA is attached to the wall of the uterus. If the placenta separates before delivery, bleeding occurs in the exposed ‘bed’. When the placenta is positioned in the upper part of the uterus it is called an abruption. PLACENTA PRAEVIA is sited in the lower part and blocks or partly blocks the cervix (neck of the womb); it can be identi?ed at about the 34th week. Ten per cent of episodes of antepartum bleeding are caused by placenta previa, and it may be associated with bleeding at delivery. This potentially serious complication is diagnosed by ultrasound scanning and may require a caesarean section (see below) at delivery. INCREASED BLOOD PRESSURE, associated with protein in the urine and swelling of the limbs, is part of a condition known as PRE-ECLAMPSIA. This occurs in the second half of pregnancy in about 1 in 10 women expecting their ?rst baby, and is mostly very mild and of no consequence to the pregnancy. However, some women can develop extremely high blood pressures which can adversely affect the fetus and cause epileptic-type seizures and bleeding disorders in the mother. This serious condition is called ECLAMPSIA. For this reason a pregnant woman with raised blood pressure or PROTEIN in her urine is carefully evaluated with blood tests, often in the maternity day assessment unit. The condition can be stopped by delivery of the baby, and this will be done if the mother’s or the fetus’s life is in danger. If the condition is milder, and the baby not mature enough for a safe delivery, then drugs can be used to control the blood pressure. MISCARRIAGE Also called spontaneous abortion, miscarriage is the loss of the fetus. There are several types:

threatened miscarriage is one in which some vaginal bleeding occurs, the uterus is enlarged, but the cervix remains closed and pregnancy usually proceeds.

inevitable miscarriage usually occurs before the 16th week and is typi?ed by extensive blood loss through an opened cervix and cramp-like abdominal pain; some products of conception are lost but the developing placental area (decidua) is retained and an operation may be necessary to clear the womb.

missed miscarriages, in which the embryo dies and is absorbed, but the decidua (placental area of uterine wall) remains and may cause abdominal discomfort and discharge of old blood.

THERAPEUTIC ABORTION is performed on more than 170,000 women annually in England and Wales. Sometimes the woman may not have arranged the procedure through the usual health-care channels, so that a doctor may see a patient with vaginal bleeding, abdominal discomfort or pain, and open cervix – symptoms which suggest that the decidua and a blood clot have been retained; these retained products will need to be removed by curettage.

Septic abortions are now much less common in Britain than before the Abortion Act (1967) permitted abortion in speci?ed circumstances. The cause is the passage of infective organisms from the vagina into the uterus, with Escherichia coli and Streptococcus faecalis the most common pathogenic agents. The woman has abdominal pain, heavy bleeding, usually fever and sometimes she is in shock. The cause is usually an incomplete abortion or one induced in unsterile circumstances. Antibiotics and curettage are the treatment. INTRAUTERINE GROWTH RETARDATION describes a slowing of the baby’s growth. This can be diagnosed by ultrasound scanning, although there is a considerable margin of error in estimates of fetal weight. Trends in growth are favoured over one-o? scan results alone. GESTATIONAL DIABETES is a condition that is more common in women who are overweight or have a family member with diabetes. If high concentrations of blood sugar are found, e?orts are made to correct it as the babies can become very fat (macrosomia), making delivery more di?cult. A low-sugar diet is usually enough to control the blood concentration of sugars; however some women need small doses of INSULIN to achieve control. FETAL ABNORMALITIES can be detected before birth using ultrasound. Some of these defects are obvious, such as the absence of kidneys, a condition incompatible with life outside the womb. These women can be o?ered a termination of their pregnancy. However, more commonly, the pattern of problems can only hint at an abnormality and closer examination is needed, particularly in the diagnosis of chromosomal deformities such as DOWN’S (DOWN) SYNDROME (trisomy 21 or presence of three 21 chromosomes instead of two).

Chromosomal abnormalities can be de?nitively diagnosed only by cell sampling such as amniocentesis (obtaining amniotic ?uid – see AMNION – from around the baby) done at 15 weeks onwards, and chorionic villus sampling (sampling a small part of the placenta) – another technique which can be done from 12 weeks onwards. Both have a small risk of miscarriage associated with them; consequently, they are con?ned to women at higher risk of having an abnormal fetus.

Biochemical markers present in the pregnant woman’s blood at di?erent stages of pregnancy may have undergone changes in those carrying an abnormal fetus. The ?rst such marker to be routinely used was a high concentration of alpha-fetol protein in babies with SPINA BIFIDA (defects in the covering of the spinal cord). Fuller research has identi?ed a range of diagnostic markers which are useful, and, in conjunction with other factors such as age, ethnic group and ultrasound ?ndings, can provide a predictive guide to the obstetrician – in consultation with the woman – as to whether or not to proceed to an invasive test. These tests include pregnancy-associated plasma protein assessed from a blood sample taken at 12 weeks and four blood tests at 15–22 weeks – alphafetol protein, beta human chorionic gonadotrophin, unconjugated oestriol and inhibin A. Ultrasound itself can reveal physical ?ndings in the fetus, which can be more common in certain abnormalities. Swelling in the neck region of an embryo in early pregnancy (increased nuchal thickness) has good predictive value on its own, although its accuracy is improved in combination with the biochemical markers. The e?ectiveness of prenatal diagnosis is rapidly evolving, the aim being to make the diagnosis as early in the pregnancy as possible to help the parents make more informed choices. MULTIPLE PREGNANCIES In the UK, one in 95 deliveries is of twins, while the prevalence of triplets is one in 10,000 and quadruplets around one in 500,000. Racial variations occur, with African women having a prevalence rate of one in 30 deliveries for twins and Japanese women a much lower rate than the UK ?gure. Multiple pregnancies occur more often in older women, and in the UK the prevalence of fertility treatments, many of these being given to older women, has raised the incidence. There is now an o?cial limit of three eggs being transferred to a woman undergoing ASSISTED CONCEPTION (gamete intrafallopian transfer, or GIFT).

Multiple pregnancies are now usually diagnosed as a result of routine ultrasound scans between 16 and 20 weeks of pregnancy. The increased size of the uterus results in the mother having more or worse pregnancy-related conditions such as nausea, abdominal discomfort, backache and varicose veins. Some congenital abnormalities in the fetus occur more frequently in twins: NEURAL TUBE defects, abnormalities of the heart and the incidence of TURNER’S SYNDROME and KLINEFELTER’S SYNDROME are examples. Such abnormalities may be detected by ultrasound scans or amniocentesis. High maternal blood pressure and anaemia are commoner in women with multiple pregnancies (see above).

The growth rates of multiple fetuses vary, but the di?erence between them and single fetuses are not that great until the later stages of pregnancy. Preterm labour is commoner in multiple pregnancies: the median length of pregnancy is 40 weeks for singletons, 37 for twins and 33 for triplets. Low birth-weights are usually the result of early delivery rather than abnormalities in growth rates. Women with multiple pregnancies require more frequent and vigilant antenatal assessments, with their carers being alert to the signs of preterm labour occurring. CEPHALOPELVIC DISPROPORTION Disparity between the size of the fetus and the mother’s pelvis is not common in the UK but is a signi?cant problem in the developing world. Disparity is classi?ed as absolute, when there is no possibility of delivery, and relative, when the baby is large but delivery (usually after a dif?cult labour) is possible. Causes of absolute disparity include: a large baby – heavier than 5 kg at birth; fetal HYDROCEPHALUS; and an abnormal maternal pelvis. The latter may be congenital, the result of trauma or a contraction in pelvic size because of OSTEOMALACIA early in life. Disproportion should be suspected if in late pregnancy the fetal head has not ‘engaged’ in the pelvis. Sometimes a closely supervised ‘trial of labour’ may result in a successful, if prolonged, delivery. Otherwise a caesarean section (see below) is necessary. UNUSUAL POSITIONS AND PRESENTATIONS OF THE BABY In most pregnant women the baby ?ts into the maternal pelvis head-?rst in what is called the occipito-anterior position, with the baby’s face pointing towards the back of the pelvis. Sometimes, however, the head may face the other way, or enter the pelvis transversely – or, rarely, the baby’s neck is ?exed backwards with the brow or face presenting to the neck of the womb. Some malpositions will correct naturally; others can be manipulated abdominally during pregnancy to a better position. If, however, the mother starts labour with the baby’s head badly positioned or with the buttocks instead of the head presenting (breech position), the labour will usually be longer and more di?cult and may require intervention using special obstetric forceps to assist in extracting the baby. If progress is poor and the fetus distressed, caesarean section may be necessary. HIV INFECTION Pregnant women who are HIV positive (see HIV; AIDS/HIV) should be taking antiviral drugs in the ?nal four to ?ve months of pregnancy, so as to reduce the risk of infecting the baby in utero and during birth by around 50 per cent. Additional antiviral treatment is given before delivery; the infection risk to the baby can be further reduced – by about 40 per cent – if delivery is by caesarean section. The mother may prefer to have the baby normally, in which case great care should be taken not to damage the baby’s skin during delivery. The infection risk to the baby is even further reduced if it is not breast fed. If all preventive precautions are taken, the overall risk of the infant becoming infected is cut to under 5 per cent.

Premature birth This is a birth that takes place before the end of the normal period of gestation, usually before 37 weeks. In practice, however, it is de?ned as a birth that takes place when the baby weighs less than 2·5 kilograms (5••• pounds). Between 5 and 10 per cent of babies are born prematurely, and in around 40 per cent of premature births the cause is unknown. Pre-eclampsia is the most common known cause; others include hypertension, chronic kidney disease, heart disease and diabetes mellitus. Multiple pregnancy is another cause. In the vast majority of cases the aim of management is to prolong the pregnancy and so improve the outlook for the unborn child. This consists essentially of rest in bed and sedation, but there are now several drugs, such as RITODRINE, that may be used to suppress the activity of the uterus and so help to delay premature labour. Prematurity was once a prime cause of infant mortality but modern medical care has greatly improved survival rates in developing countries.

Labour Also known by the traditional terms parturition, childbirth or delivery, this is the process by which the baby and subsequently the placenta are expelled from the mother’s body. The onset of labour is often preceded by a ‘show’ – the loss of the mucus and blood plug from the cervix, or neck of the womb; this passes down the vagina to the exterior. The time before the beginning of labour is called the ‘latent phase’ and characteristically lasts 24 hours or more in a ?rst pregnancy. Labour itself is de?ned by regular, painful contractions which cause dilation of the neck of the womb and descent of the fetal head. ‘Breaking of the waters’ is the loss of amniotic ?uid vaginally and can occur any time in the delivery process.

Labour itself is divided into three stages: the ?rst is from the onset of labour to full (10 cm) dilation of the neck of the womb. This stage varies in length, ideally taking no more than one hour per centimetre of dilation. Progress is monitored by regular vaginal examinations, usually every four hours. Fetal well-being is observed by intermittent or continuous monitoring of the fetal heart rate in relation to the timing and frequency of the contractions. The print-out is called a cardiotocograph. Abnormalities of the fetal heart rate may suggest fetal distress and may warrant intervention. In women having their ?rst baby (primigravidae), the common cause of a slow labour is uncoordinated contractions which can be overcome by giving either of the drugs PROSTAGLANDIN or OXYTOCIN, which provoke contractions of the uterine muscle, by an intravenous drip. Labours which progress slowly or not at all may be due to abnormal positioning of the fetus or too large a fetus, when prostaglandin or oxytocin is used much more cautiously.

The second stage of labour is from full cervical dilation to the delivery of the baby. At this stage the mother often experiences an irresistible urge to push the baby out, and a combination of strong coordinated uterine contractions and maternal e?ort gradually moves the baby down the birth canal. This stage usually lasts under an hour but can take longer. Delay, exhaustion of the mother or distress of the fetus may necessitate intervention by the midwife or doctor. This may mean enlarging the vaginal opening with an EPISIOTOMY (cutting of the perineal outlet – see below) or assisting the delivery with specially designed obstetric forceps or a vacuum extractor (ventouse). If the cervix is not completely dilated or open and the head not descended, then an emergency caesarean section may need to be done to deliver the baby. This procedure involves delivering the baby and placenta through an incision in the mother’s abdomen. It is sometimes necessary to deliver by planned or elective caesarean section: for example, if the placenta is low in the uterus – called placenta praevia – making a vaginal delivery dangerous.

The third stage occurs when the placenta (or afterbirth) is delivered, which is usually about 10–20 minutes after the baby. An injection of ergometrine and oxytocin is often given to women to prevent bleeding.

Pain relief in labour varies according to the mother’s needs. For uncomplicated labours, massage, reassurance by a birth attendant, and a warm bath and mobilisation may be enough for some women. However, some labours are painful, particularly if the woman is tired or anxious or is having her ?rst baby. In these cases other forms of analgesia are available, ranging from inhalation of NITROUS OXIDE GAS, injection of PETHIDINE HYDROCHLORIDE or similar narcotic, and regional local anaesthetic (see ANAESTHESIA).

Once a woman has delivered, care continues to ensure her and the baby’s safety. The midwives are involved in checking that the uterus returns to its normal size and that there is no infection or heavy bleeding, as well as caring for stitches if needed. The normal blood loss after birth is called lochia and generally is light, lasting up to six weeks. Midwives o?er support with breast feeding and care of the infant and will visit the parents at home routinely for up to two weeks.

Some complications of labour All operative deliveries in the UK are now done in hospitals, and are performed if a spontaneous birth is expected to pose a bigger risk to the mother or her child than a specialist-assisted one. Operative deliveries include caesarean section, forceps-assisted deliveries and those in which vacuum extraction (ventouse) is used. CAESAREAN SECTION Absolute indications for this procedure, which is used to deliver over 15 per cent of babies in Britain, are cephalopelvic disproportion and extensive placenta praevia, both discussed above. Otherwise the decision to undertake caesarean section depends on the clinical judgement of the specialist and the views of the mother. The rise in the proportion of this type of intervention (from 5 per cent in the 1930s to its present level of over 23 per cent

P

of the 600,000 or so annual deliveries in England) has been put down to defensive medicine

– namely, the doctor’s fear of litigation (initiated often because the parents believe that the baby’s health has suffered because the mother had an avoidably di?cult ‘natural’ labour). In Britain, over 60 per cent of women who have had a caesarean section try a vaginal delivery in a succeeding pregnancy, with about two-thirds of these being successful. Indications for the operation include:

absolute and relative cephalopelvic disproportion.

placenta previa.

fetal distress.

prolapsed umbilical cord – this endangers the viability of the fetus because the vital supply of oxygen and nutrients is interrupted.

malpresentation of the fetus such as breech or transverse lie in the womb.

unsatisfactory previous pregnancies or deliveries.

a request from the mother.

Caesarean sections are usually performed using regional block anaesthesia induced by a spinal or epidural injection. This results in loss of feeling in the lower part of the body; the mother is conscious and the baby not exposed to potential risks from volatile anaesthetic gases inhaled by the mother during general anaesthesia. Post-operative complications are higher with general anaesthesia, but maternal anxiety and the likelihood that the operation might be complicated and di?cult are indications for using it. A general anaesthetic may also be required for an acute obstetric emergency. At operation the mother’s lower abdomen is opened and then her uterus opened slowly with a transverse incision and the baby carefully extracted. A transverse incision is used in preference to the traditional vertical one as it enables the woman to have a vaginal delivery in any future pregnancy with a much smaller risk of uterine rupture. Women are usually allowed to get up within 24 hours and are discharged after four or ?ve days. FORCEPS AND VENTOUSE DELIVERIES Obstetric forceps are made in several forms, but all are basically a pair of curved blades shaped so that they can obtain a purchase on the baby’s head, thus enabling the operator to apply traction and (usually) speed up delivery. (Sometimes they are used to slow down progress of the head.) A ventouse or vacuum extractor comprises an egg-cup-shaped metal or plastic head, ranging from 40 to 60 mm in diameter with a hollow tube attached through which air is extracted by a foot-operated vacuum pump. The instrument is placed on the descending head, creating a negative pressure on the skin of the scalp and enabling the operator to pull the head down. In mainland Europe, vacuum extraction is generally preferred to forceps for assisting natural deliveries, being used in around 5 per cent of all deliveries. Forceps have a greater risk of causing damage to the baby’s scalp and brain than vacuum extraction, although properly used, both types should not cause any serious damage to the baby.

Episiotomy Normal and assisted deliveries put the tissues of the genital tract under strain. The PERINEUM is less elastic than the vagina and, if it seems to be splitting as the baby’s head

moves down the birth canal, it may be necessary to cut the perineal tissue – a procedure called an episiotomy – to limit damage. This is a simple operation done under local anaesthetic. It should be done only if there is a speci?c indication; these include:

to hasten the second stage of labour if the fetus is distressed.

to facilitate the use of forceps or vacuum extractor.

to enlarge a perineum that is restricted because of unyielding tissue, perhaps because of a scar from a previous labour. Midwives as well as obstetricians are trained

to undertake and repair (with sutures) episiotomies.

(For organisations which o?er advice and information on various aspects of childbirth, including eclampsia, breast feeding and multiple births, see APPENDIX 2: ADDRESSES: SOURCES OF INFORMATION, ADVICE, SUPPORT AND SELF-HELP.)... Medical Dictionary

4 weeks pregnancy

Your baby in 4 weeks pregnancy

Support system in formation

Your 4th week pregnancy

The results came

5-week pregnancy

Baby for 5 weeks gestation

Installation ready

Some basics

Heart start

Your 5th week pregnancy

Emotional ocean

Careful maintenance

The haemagglutination inhibition test This, and the subsequent tests to be mentioned, are known as immunological tests. They are based upon the e?ect of the urine from a pregnant woman upon the interaction of red blood cells, which have been sensitised to human gonadotrophin, and anti-gonadotrophin serum. They have the great practical advantage of being performed in a test-tube or even on a slide. Because of their ease and speed of performance, a result can be obtained in two hours.

Enzyme-linked immunosorbent assay (ELISA) This is the basis of many of the pregnancy-testing kits obtainable from pharmacies. It is a highly sensitive antibody test and can detect very low concentrations of human chorionic gonadotrophin. Positive results show up as early as ten days after fertilisation – namely, four days before the ?rst missed period.

Ultrasound The fetal sac can be detected by ULTRASOUND from ?ve weeks, and a fetal echo at around six or seven weeks (see also PRENATAL SCREENING OR DIAGNOSIS).... Medical Dictionary

Problems may also be caused in a developing baby if a pregnant woman drinks alcohol, smokes (see tobaccosmoking), or takes drugs of abuse. The babies of women who use heroin during pregnancy tend to have a low birthweight and a higher death rate than normal during the first few weeks of life. Babies of women who abuse drugs intravenously are at high risk of HIV infection.... BMA Medical Dictionary

may involve counselling or psychotherapy. (See also conversion disorder.)... BMA Medical Dictionary

ULTRASOUND scanning is probably the most widely used diagnostic tool in obstetric practice. It can detect structural abnormalities such as SPINA BIFIDA and CLEFT PALATE and even cardiac and renal problems. A series of scans can assess whether the baby is growing at a normal rate; ultrasound may also be used to assist with other diagnostic tests (e.g. AMNIOCENTESIS – see below).

Tests on the mother’s blood can also diagnose fetal abnormalities. Alphafetoprotein (AFP) is produced by babies and ‘leaks’ into the AMNIOTIC FLUID and is absorbed by the mother. In spina bi?da and other neural-tube defects there is increased leakage of AFP, and a blood test at 16 weeks’ gestation can detect a raised level which suggests the presence of these abnormalities.

The triple test, also performed at 16 weeks, measures AFP and two hormones – HUMAN CHORIONIC GONADOTROPHIN and unconjugated OESTRADIOL – and is used in diagnosing DOWN’S (DOWN) SYNDROME.

Amniocentesis involves inserting a needle through the mother’s abdominal wall into the uterus to remove a sample of amniotic ?uid at 16–18 weeks. Examination of the ?uid and the cells it contains is used in the diagnosis of Down’s syndrome and other inherited disorders. The test carries a small risk of miscarriage.

Chorionic villus sampling may be used to diagnose various inherited conditions. A small amount of tissue from the developing PLACENTA is removed for analysis: this test has the advantages of having a lower incidence of miscarriage than amniocentesis and is carried out at an earlier stage (9–13 weeks).

Analysis of a blood sample removed from the umbilical cord (cordocentesis) may diagnose infections in the uterus, blood disorders or inherited conditions.

Direct observation of the fetus via a viewing instrument called a fetoscope is also used diagnostically and will detect structural abnormalities.

Most tests have a recognised incidence of false positive and negative results and are therefore usually cross-checked with another test. Counselling of the parents about prenatal tests is important. This allows them to make an informed choice which may not necessarily involve terminating the pregnancy if an abnormality is found. (See PREGNANCY AND LABOUR.)... Medical Dictionary

Public health functions are covered by many people and agencies, such as Environmental Health Officers, Medical Officers of Environmental Health, and the Public Health Laboratory Service.... BMA Medical Dictionary

Chronic pyelonephritis may start in childhood, and the usual cause is back ?ow of urine from the bladder into one of the ureters – perhaps because of a congenital deformity of the valve where the ureter drains into the bladder. Constant urine re?ux results in recurrent infection of the kidney and damage to its tissue. Full investigation of the urinary tract is essential and, if an abnormality is detected, surgery may well be required to remedy it. HYPERTENSION and renal failure may be serious complications of pyelonephritis (see also KIDNEYS, DISEASES OF).... Medical Dictionary

They can assist people with anxiety symptoms, help to reduce hypertension, and relieve stress, and may help pregnant women to cope with labour pains (see childbirth, natural).

Active relaxation consists of tensing and relaxing each of the muscles in turn.

Passive relaxation involves clearing the mind and concentrating on a phrase or sound.

Breathing exercises help to prevent hyperventilation, which often brings on or worsens anxiety.

Traditional concentration methods, such as yoga and meditation, employ similar techniques.... BMA Medical Dictionary

The Rh system is based on the presence or absence in the blood of several factors, the most important of which is a substance called D antigen. Rh-positive blood contains D antigen, whereas Rhnegative blood does not. The blood type is determined by genes.Rhesus incompatibility results if a Rhnegative woman is exposed to the blood of her Rh-positive baby while it is being born. There are usually no problems during the first pregnancy with a Rh-positive baby. However, the woman may produce antibodies against the D antigen; in a subsequent pregnancy with a Rh-positive baby, these antibodies may cross the placenta and attack the red blood cells of the fetus. A Rhnegative woman can also be sensitized if she has had a miscarriage, abortion, or amniocentesis, in which the fetus’s Rhpositive blood enters her circulation.

Rhesus incompatibility is now uncommon because injections of anti-D(Rh0) immunoglobulin are given routinely to Rh-negative women during pregnancy and at delivery. They are also given after miscarriage, abortion, amniocentesis, or any procedure that might result in exposure of the mother to fetal blood cells.... BMA Medical Dictionary

• use spring water or filtered water
• brew Rooibos tea leaves in heartily boiling water: one heaping teaspoon of tea leaves per eight ounces (one cup) of water
• steep it five to ten minutes
• keep the water hot the entire time the leaves are steeping

• treat irritability,headaches, disturbed sleeping patterns, insomnia, nervous tension, mild depression or hypertension
• relieve stomach cramps
• relieve colic in infants
• relieve stomach and indigestive problems like nausea, vomiting, heartburn, stomach ulcers and constipation
• supplement the daily amounts of calcium, manganese and especially fluoride for the development of strong teeth and bones
• relieve itching and certain skin irritations like eczema, nappy rash and acne (when directly applied to the affected area)

Cause A virus spread by close contact with infected individuals. Rubella is infectious for a week before the rash appears and at least four days afterwards. It occurs in epidemics (see EPIDEMIC) every three years or so, predominantly in the winter and spring. Children are more likely to be affected than infants. One attack gives permanent IMMUNITY. The incubation period is usually 14–21 days.

Symptoms are very mild, and the disease is not at all serious. On the day of onset there may be shivering, headache, slight CATARRH with sneezing, coughing and sore throat, with very slight fever – not above 37·8 °C (100 °F). At the same time the glands of the neck become enlarged. Within 24 hours of the onset a pink, slightly raised eruption appears, ?rst on the face or neck, then on the chest, and the second day spreads all over the body. The clinical signs and symptoms of many other viral infections are indistinguishable from rubella so a precise diagnosis cannot be made without taking samples (such as saliva) for antibody testing, but this is rarely done in practice.

An attack of German measles during the early months of pregnancy may be responsible for CONGENITAL defects in the FETUS (for information on fetal abnormalities, see under PREGNANCY AND LABOUR). The incidence of such defects is not precisely known, but probably around 20 per cent of children whose mothers have had German measles in the ?rst three months of the pregnancy are born with congenital defects. These defects take a variety of forms, but the most important ones are: low birth weight with retarded physical development; malformations of the HEART; cataract (see under EYE, DISORDERS OF); and DEAFNESS.

Treatment There is no speci?c treatment. Children who develop the disease should not return to school until they have recovered, and in any case not before four days have passed from the onset of the rash.

In view of the possible dangerous e?ect of the disease upon the fetus, particular care should be taken to isolate pregnant mothers from contact with infected subjects. As the risk is particularly high during the ?rst 16 weeks of pregnancy, any pregnant mother exposed to infection during this period should be given an intramuscular injection of GAMMA-GLOBULIN. A vaccine is available to protect an individual against rubella (see IMMUNISATION).

In the United Kingdom it is NHS policy for all children to have the combined measles, mumps and rubella vaccine (see MMR VACCINE), subject to parental consent. All women of childbearing age, who have been shown by a simple laboratory test not to have had the disease, should be vaccinated, provided that the woman is not pregnant at the time and has not been exposed to the risk of pregnancy during the previous eight weeks.... Medical Dictionary

The rubella virus is spread by motherto-baby transmission and in airborne droplets; it has an incubation period of 2–3 weeks. Infection usually occurs in children aged 6–12. A rash appears on the face, spreads to the trunk and limbs, then disappears after a few days. There may be slight fever and enlarged lymph nodes at the back of the neck.

The virus may be transmitted from a few days before symptoms appear until one day after they disappear. An unborn baby is at risk if the mother is infected during the first 4 months of pregnancy. The earlier the infection occurs, the more likely the infant is to be affected, and the more serious the abnormalities tend to be. The most common abnormalities are deafness, congenital heart disease, learning difficulties, cataracts, purpura, cerebral palsy, and bone abnormalities. About 1 in 5 affected babies dies in early infancy.

There is no specific treatment, apart from paracetamol for fever.

Treatment of rubella syndrome depends on the defects.

Rubella vaccine provides longlasting immunity to the disease; it is given in the MMR vaccine to babies aged 12–15 months, with a booster at school entry.

Rubella infection also provides immunity.

If a nonimmune pregnant woman comes into contact with a person who has rubella, passive immunization by immunoglobulin injection may help prevent infection of the fetus.... BMA Medical Dictionary

In a highly signi?cant advance in research, a scienti?c team in the United States obtained stem cells from newly formed human embryos

– donated by women who had become pregnant after successful in vitro fertilisation – and successfully cultivated these cells in the laboratory. This achievement opened the way to replicating in the laboratory, the various specialised cells that develop naturally in the body. UK government legislation constrains the use of human embryos in research (see ETHICS) and the ethical aspects of taking this stem-cell culture technique forwards will have to be resolved. Nevertheless, this discovery points the biological way to the use of genetic engineering in selecting di?erentiated specialised cells from which replacement tissues could be grown for use as transplants to rectify absent or damaged tissues in the human body.

Research into potential use of stem cells has raised expectations that in the long term they may prove to be an e?ective regenerative treatment for a wide range of disorders including PARKINSONISM, ALZHEIMER’S DISEASE, type-2 diabetes (see under DIABETES MELLITUS), myocardial infarction (see HEART, DISEASES OF), severe burns, osteoporosis (see under BONE, DISORDERS OF) and the regeneration of blood to replace the need for BONE MARROW TRANSPLANT. Recent research has shown that adult stem cells may also be stimulated to produce new cell lines. If successful, this would eliminate the need to use embryos and thus resolve existing ethical dilemmas over the use of stem cells.... Medical Dictionary

Details of surrogacy at the Human Fertilisation and Embryology Authority website... Oxford | Concise Colour Medical Dictionary

Habitat: Throughout North and eastern India, extending southwards to Peninsular India.

Action: Bark—used as specific remedy for uterine complaints, vaginal diseases and menstrual disorders; menorrhagia, leucorrhoea (The Ayurvedic Pharmacopoeia of India); also used in diarrhoea, dysentery, vaginal ulcers, inflammatory affections and liver disorders.

The primary symptom – a hard painless ulcer (*chancre) at the site of infection – forms 2–4 weeks after exposure. Neighbouring lymph nodes enlarge about 2 weeks later. Secondary stage symptoms appear about two months after infection and include fever, malaise, general enlargement of lymph nodes, and a faint red rash on the chest that persists for 1–2 weeks. After months, or even years, the disease enters its tertiary stage with widespread formation of tumour-like masses (*gummas). Tertiary syphilis may cause serious damage to the heart and blood vessels (cardiovascular syphilis) or to the brain and spinal cord (neurosyphilis), resulting in *tabes dorsalis, blindness, and *general paralysis of the insane.

Treatment is with antibiotics, such as penicillin and doxycycline. Syphilis can be diagnosed by several blood tests. Compare bejel. —syphilitic adj.... Oxford | Concise Colour Medical Dictionary