Nosebleeds

A nosebleed is characterized by bleeding from the interior of the nasal cavity. It can be caused by heat, dry air, trauma to the nose, certain medications, or a medical condition.

Description

Anterior nosebleeds, or bleeding of the nose that comes from near the nose opening, are the most common nosebleeds in children. Children are twice as likely to experience nosebleeds as adults are. Bleeding that originates from deep within the nasal cavity is known as a posterior nosebleed, the type usually experienced by adults.

Causes and symptoms

The most common causes of nosebleeds are:

• Low humidity. Hot and dry climates can dry out the nasal cavities.
• Nasal trauma. Injuries to the nose can cause bleeding. Excessive nose picking can also injure the interior of the nose.
• Cold, allergies, and sinus infections. Excessive nose blowing and irritation to the mucous membrane can cause bleeding.
• Medications. Bleeding can be triggered by Certain medications, particularly those with anticoagulant (or blood thinning) properties.

Nosebleeds can also be symptomatic of less common, but more serious, medical conditions. These include:

• nasal polyps
• high blood pressure
• blood clotting disorders (i.e., thrombocytopenia, liver disease)
• leukemia
• malaria

Diagnosis

A nosebleed is easily diagnosed by sight. Further examination of the nasal cavity may be necessary to determine the source of the bleeding, and a medical history should be taken if the cause of the nosebleed is not readily apparent.

Treatment

The first step in treating a nosebleed is to stop the bleeding. An individual experiencing a nosebleed should lightly blow his or her nose, and then pinch both nostrils to encourage clotting of the blood flow. The nose should be pinched close for five to 10 minutes, or until bleeding has stopped. In most cases, this will resolve the nosebleed.

If pinching does not stop blood flow completely, an astringent can also be used to dry up the blood flow. A piece of cotton soaked in witch hazel (Hamamelis virginiana) can be inserted into the bleeding nostril(s) to tighten and seal the blood vessels. Sniffing a small pinch of powdered yarrow (Achillea millefolium) can also stop bleeding.

Allopathic treatment

Use of a spray decongestant is sometimes recommended to shrink blood vessels and stop bleeding. In severe cases where bleeding from the nose does not stop after 20 minutes, professional emergency care should be sought.

Surgery to remove nasal polyps may be required in patients with this problem. In some cases of repeated, serious nosebleeds, cauterization of the blood vessels in the nasal passages is necessary.

Expected results

Most nosebleeds will resolve by themselves in 10–15 minutes. Nutritional and environmental measures can prevent further occurrences in many cases.

Prevention

The following precautions can prevent or lessen the frequency of nosebleeds:

• Vitamin C. An adequate supply of vitamin C is necessary to form collagen, the connective tissue that strengthens blood vessel walls.
• Humidify the air. Using a humidifier in the home and office can prevent nosebleeds caused by a dry environment.
• Vitamin E. Rubbing liquid vitamin E in the nose keeps the mucous membrane moist.

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Notoginseng root

Notoginseng root is a frequently prescribed herb in Chinese medicine. The scientific names for the plant are Panax notoginseng and Panax pseudoginseng. The herb is also referred to as pseudoginseng, and in Chinese it is called Tien qi ginseng, San qi, three-seven root, and Mountain paint.

Notoginseng belongs to the same scientific genus, Panax, as Asian ginseng. In Latin, the word panax means “cure-all,” and the family of ginseng plants is one of the most famous and frequently used of all families of herbs.

Notoginseng grows naturally in China and Japan. The Chinese refer to it as “three-seven root” because the plant has three leaves on one side and four leaves on the other.

The herb is a perennial with dark green leaves branching from a stem with a red cluster of berries in the middle. It is both cultivated and gathered from wild forests, with wild plants being the most expensive. The root of the plant is used medicinally, and tea is sometimes made from the leaves.

At the top of the root is a section called the “age root,” which has notches that indicate the age of the particular root. Chinese herbalists consider roots older than three years to be the most effective medicinally. Notoginseng root has a very bitter flavor.

Notoginseng root has been used in Chinese medicine for thousands of years. One of China’s most famous herbalists said that the root was “more valuable than gold.”

The herb is used as a general tonic, or a medicine to tone and strengthen the entire system. In particular, notoginseng is considered a blood and heart tonic. Chinese herbalists consider it to have a neutral energy, meaning it is neither heating nor cooling in the system.

In traditional Chinese medicine, notoginseng is believed to act on the Heart and Kidney meridians, which are the channels that contain the flow of qi (life energy) in the body. The herb was given the name “mountain paint” because a liquid solution of it is prescribed to reduce swelling and boils on the body.

Research has been performed on notoginseng root in China and Japan, although many findings have not been translated into English. From notoginseng, researchers have isolated chemicals called saponins and flavonoids, substances that are active biologically in the body.

Some of the saponins in notoginseng are believed to provide the raw materials for the creation of important hormones that regulate energy levels and sexual function. Notoginseng has also been reported to stimulate the immune system.

Other research has pointed to notoginseng’s benefits for the heart and circulatory system. Through actions not completely understood, notoginseng appears to increase blood flow to the coronary arteries, which are the blood vessels that supply blood to the heart muscle.

Heart disease usually results from blockages in the coronary arteries. Notoginseng also seems to increase the consumption of oxygen by the muscles in the heart. These actions have the effect of lowering blood pressure and regulating the rhythm of the heart.

Notoginseng also has been reported to have positive effects on the blood. It lowers cholesterol, and is believed to help dissolve clots. At the same time, it is reputed to stop bleeding both internally and externally.

Notoginseng root is one of the main herbs prescribed in Chinese medicine for traumatic injuries. In fact, the root has been distributed to members of armed forces in Asian countries to be used in case of traumatic injury and bleeding.

Possible newer uses for notoginseng root include treatment of HIV infection. A recently discovered xylanase, which is a type of enzyme found in plant roots, was isolated from the roots of are Panax notoginseng.

The new xylanase appears to inhibit HIV-1 reverse transcriptase, which is an enzyme that allows the human immunodeficiency virus to integrate itself into the chromosomes inside a cell.

General use

Notoginseng is used to treat external and internal bleeding, including nosebleeds and bloody stools and urine. According to an American herbalist, notoginseng has been used in the United States for some years to control postpartum bleeding in women and heavy bleeding associated with menopause. As of 2002, some herbalists are recommending notoginseng as an alternative to hormone replacement therapy.

Notoginseng is also used as a general tonic for the heart and circulatory system, and for such specific problems as coronary heart disease and high cholesterol. Notoginseng is prescribed by Chinese herbalists to relieve the pain of angina pectoris, a condition that results in sharp pain in the chest region. It is also used for painful menstruation and for swelling and boils on the skin.

Preparations

Notoginseng is available in Asian markets and some health food stores. It comes as dried roots, powder, and in capsules. The root is sometimes steamed and then powdered, which is believed to increase its healing effects for the blood. The powdered root can also be applied topically to wounds and swelling on the skin.

The dried root can be decocted into a tea by briefly boiling and then simmering it for over an hour, in a daily dosage of 3–9 g of root. For the powder, 1–3 g can be stirred into tea or juice as a daily serving. The dried root can be used in cooking as well. A common method of taking the herb in China is to prepare it with chicken or soups.

Precautions

Notoginseng root can be safely taken in large doses, but it should not be used during pregnancy, as it may contribute to miscarriage.

Interactions

Notoginseng has been reported to interact with warfarin and heparin, which are medications to thin the blood, or anticoagulants; and with ticlopidine, a drug given to prevent blood platelets from clumping and to prolong bleeding time. Patients taking any of these medications should not take preparations containing notoginseng.

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Nutmeg

Nutmeg is known by many names, such Myristica fragrans, mace, magic, muscdier, muskatbaum, myristica, noz moscada, nuez moscada, and nux moschata. Nutmeg is most commonly used as a cooking spice, comes from the fruit of a 50 ft (15 m) tall tropical evergreen tree.

This tree grows in Indonesia, New Guinea, and the West Indies. The bark is smooth and grayish brown with green young branches and leaves. The oblong, fleshy fruit, called the nutmeg apple, contains a nut from which nutmeg is made. The dried nut and essential oil are both used as medicine.

Nutmeg is used in both Western and Chinese herbal medicine. It is most popular as a spice in food and drinks, and is also used in cosmetics and soaps. In ancient Greece and Rome, where nutmeg was rare and expensive, people thought it stimulated the brain. The Arabs have used nutmeg since the seventh century.

General use

Nutmeg relaxes the muscles, sedates the body, and helps remove gas from the digestive track. It is most commonly used for stomach problems such as indigestion. It is also used for chronic nervous disorders, kidney disorders, and to prevent nausea and vomiting.

In Chinese medicine, nutmeg is used to treat abdominal pain, diarrhea, inflammation, impotence, liver disease, and vomiting. In the Middle East, some cultures are said to use nutmeg in love potions as an aphrodisiac.

The essential oil of nutmeg is used for rheumatic pain, toothaches, and bad breath. In Germany, it is used for problems related to the stomach and intestines, but this use is controversial. In homeopathy, nutmeg is used to treat anxiety or depression.

Although nutmeg has been used to treat many ailments, it hasn’t been proven to be useful or effective for any and it can be harmful. Nutmeg is used in medicines such as Vicks Vaporub, Agua del Carmen, Aluminum Free Indigestion, Incontinurina, Klosterfrau Magentoniuum, Melisana, and Nervospur.

Preparation

Nutmeg is made from the nut of the nutmeg apple. It is removed from the fruit and slowly dried. As an herbal medicine, nutmeg is commonly used in capsules (200 mg), powders, and essential oil.

As a cooking spice, the nut is ground and cooked in food. The skin of the nuts is ground to produce another spice, called mace. Nutmeg butter, a mixture of fatty and essential oil, is made by chopping and steaming the nuts until they form a paste.

Some of the suggested doses of nutmeg can be harmful. For nausea, other stomach problems, and chronic diarrhea, one or two capsules or nutmeg kernel as a single dose or three to five drops of essential oil on a lump of sugar or on a teaspoon of honey is suggested.

For diarrhea, 4-6 tbsp of powder could be taken every day. For a toothache, one or two drops of essential oil can be applied to the gum around the toothache to relieve pain; a visit to the dentist care is still necessary.

In Chinese medicine, 250–500 mg of nutmeg mixed with other herbs is recommended, once or twice a day. It can be taken in powder plain, capsules, pills, or infusion, and should be taken on an empty stomach. When used as a digestive stimulant in Chinese medicine, it is said to work best when ground and cooked in food.

Precautions

Nutmeg is not recommended for use as a medicine because it is too risky. An overdose of nutmeg is harmful and sometimes deadly. There are more effective treatments for all of the ailments that nutmeg could be used for.

Pregnant women should not use nutmeg because it can cause a miscarriage. Women who are breast-feeding should not use nutmeg either. Nutmeg should be used with caution in patients with psychiatric illnesses, as it can cause feelings of anxiety. Touching the nuts can cause an allergic skin reaction. In the home, nutmeg should be kept out of the reach of children and pets.

Side effects

There are no known side effects from using nutmeg properly. Too much nutmeg, however, can cause serious health problems and even death. Early symptoms of an overdose of nutmeg (one to three nuts) are thirst, nausea, and feelings of urgency.

There may also be experiences of altered consciousness; this can range from mild to intensive hallucinations, and results in a stupor that lasts from two to three days. Sometimes shock and seizures occur. Immediate medical attention is necessary when someone has taken too much nutmeg.

Interactions

Recent studies of the anxiogenic, or anxiety-causing, effects of nutmeg indicate that it counteracts such tranquilizers as diazepam (Valium), ondansetron (Zofran), and buspirone (BuSpar).

The specific substance in nutmeg that is responsible for this effect is a compound called trimyristin. There are, however, no known medical conditions that contraindicate the use of nutmeg in small quantities.

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Nutrition

Good nutrition can help prevent disease and promote health. There are six categories of nutrients that the body needs to acquire from food: protein, carbohydrates, fat, fibers, vitamins and minerals, and water.

Proteins

Protein supplies amino acids to build and maintain healthy body tissue. There are 20 amino acids considered essential because the body must have all of them in the right amounts to function properly.

Twelve of these are manufactured in the body but the other eight amino acids must be provided by the diet. Foods from animal sources such as milk or eggs often contain all these essential amino acids while a variety of plant products must be taken together to provide all these necessary protein components.

Fat

Fat supplies energy and transports nutrients. There are two families of fatty acids considered essential for the body: the omega-3 and omega-6 fatty acids. Essential fatty acids are required by the body to function normally.

They can be obtained from canola oil, flaxseed oil, cold-water fish, or fish oil, all of which contain omega-3 fatty acids, and primrose or black currant seed oil, which contain omega-6 fatty acids.

The American diet often contains an excess of omega-6 fatty acids and insufficient amounts of omega-3 fats. Increased consumption of omega-3 oils is recommended to help reduce risk of cardiovascular diseases and cancer and alleviate symptoms of rheumatoid arthritis, premenstrual syndrome, dermatitis, and inflammatory bowel disease.

Carbohydrates

Carbohydrates are the body’s main source of energy and should be a major part of total daily caloric intake. There are two types of carbohydrates: simple carbohydrates (such as sugar or honey) or complex carbohydrates (such as grains, beans, peas, or potatoes).

Complex carbohydrates are preferred because these foods are more nutritious yet have fewer calories per gram compared to fat and cause fewer problems with overeating than fat or sugar. Complex carbohydrates also are preferred over simple carbohydrates for diabetics because they allow better blood glucose control.

Fiber

Fiber is the material that gives plant texture and support. Although it is primarily made up of carbohydrates, it does not have a lot of calories and usually is not broken down by the body for energy. Dietary fiber is found in plant foods such as fruits, vegetables, legumes, nuts, and whole grains.

There are two types of fiber: soluble and insoluble. Insoluble fiber, as the name implies, does not dissolve in water because it contains a high amount of cellulose.

Insoluble fiber can be found in the bran of grains, the pulp of fruit and the skin of vegetables. Soluble fiber is the type of fiber that dissolves in water. It can be found in a variety of fruits and vegetables such as apples, oatmeal and oat bran, rye flour, and dried beans.

Although they share some common characteristics such as being partially digested in the stomach and intestines and have few calories, each type of fiber has its own specific health benefits.

Insoluble fiber speeds up the transit of foods through the digestive system and adds bulk to the stools, therefore, it is the type of fiber that helps treat constipation or diarrhea and helps prevent colon cancer.

On the other hand, only soluble fiber can lower blood cholesterol levels. This type of fiber works by attaching itself to the cholesterol so that it can be eliminated from the body, preventing cholesterol from re-circulating and being reabsorbed into the bloodstream.

Vitamins and minerals

Vitamins are organic substances present in food and required by the body in a minute amount for regulation of metabolism and maintenance of normal growth and functioning.

The most commonly known vitamins are A, B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid), B12 (cobalamin), C (ascorbic acid), D, E, and K. The B and C vitamins are water-soluble, excess amounts of which are excreted in the urine. The A, D, E, and K vitamins are fat-soluble and will be stored in the body fat.

Minerals are vital to our existence because they are the building blocks that make up muscles, tissues, and bones. They also are important components of many life-supporting systems, such as hormones, oxygen transport, and enzyme systems.

There are two kinds of minerals: the major (or macro) minerals and the trace minerals. Major minerals are the minerals that the body needs in large amounts. The following minerals are classified as major: calcium, phosphorus, magnesium, sodium, potassium, sulfur, and chloride.

They are needed to build muscles, blood, nerve cells, teeth, and bones. They also are essential electrolytes that the body requires to regulate blood volume and acid-base balance.

Unlike the major minerals, trace minerals are needed only in tiny amounts. Even though they can be found in the body in exceedingly small amounts, they are also very important to the human body.

These minerals participate in most chemical reactions in the body. They also are needed to manufacture important hormones. The following are classified as trace minerals: iron, zinc, iodine, copper, manganese, fluoride, chromium, selenium, molybdenum, and boron.

Many vitamins (such as vitamins A, C, and E) and minerals (such as zinc, copper, selenium, or manganese) act as antioxidants. They protect the body against the damaging effects of free radicals. They scavenge or mop up these highly reactive radicals and change them into inactive, less harmful compounds.

In so doing, these essential nutrients have been claimed to help prevent cancer and many degenerative diseases, such as premature aging, heart disease, autoimmune diseases, arthritis, cataracts, Alzheimer’s disease, and diabetes mellitus.

Water

Water helps to regulate body temperature, transport nutrients to cells, and rid the body of waste materials.

Origins

Unlike plants, human beings cannot manufacture most of the nutrients they need to function. They must eat plants and/or other animals. Although nutritional therapy came to the forefront of the public’s awareness in the late Twentieth century, the notion that food affects health is not new.

John Harvey Kellogg was an early health food pioneer and an advocate of a highfiber diet. An avowed vegetarian, he believed that meat products were particularly detrimental to the colon. In the 1870s, Kellogg founded the Battle Creek Sanitarium, where he developed a diet based on nut and vegetable products.

Benefits

Good nutrition helps individuals achieve general health and well-being. In addition, dietary modifications might be prescribed for a variety of complaints including allergies, anemia, arthritis, colds, depression, fatigue, gastrointestinal disorders, high or low blood pressure, insomnia, headaches, obesity, pregnancy, premenstrual syndrome (PMS), respiratory conditions, and stress.

Nutritional therapy also may be involved as a complement to the allopathic treatments of cancer, diabetes, and Parkinson’s disease. Other specific dietary measures include the elimination of food additives for attention deficit hyperactivity disorder (ADHD), gluten-free diets for schizophrenia, and dairy-free diets for chronic respiratory diseases.

A high-fiber diet helps prevent or treat the following health conditions:

• High cholesterol levels. Fiber effectively lowers blood cholesterol levels. It appears that soluble fiber binds to cholesterol and moves it down the digestive tract so that it can be excreted from the body. This prevents the cholesterol from being reabsorbed into the bloodstream.
• Constipation. A high-fiber diet is the preferred nondrug treatment for constipation. Fiber in the diet adds more bulk to the stools, making them softer and shortening the time foods stay in the digestive tract.
• Hemorrhoids. Fiber in the diet adds more bulk and softens the stool, thus reducing painful hemorrhoidal symptoms.
• Diabetes. Soluble fiber in the diet slows down the rise of blood sugar levels following a meal and helps control diabetes.
• Obesity. Dietary fiber makes a person feel full faster.
• Cancer. Insoluble fiber in the diet speeds up the movement of the stools through the gastrointestinal tract. The faster food travels through the digestive tract, the less time there is for potential cancer-causing substances to work. Therefore, diets high in insoluble fiber help prevent the accumulation of toxic substances that cause cancer of the colon. New studies released in 2003 seemed to confirm these findings. Because fiber reduces fat absorption in the digestive tract, it also may prevent breast cancer.

A diet low in fat also promotes good health and prevents many diseases. Low-fat diets can help treat or control the following conditions:

• Obesity. High fat consumption often leads to excess caloric and fat intake, which increases body fat.
• Coronary artery disease. High consumption of saturated fats is associated with coronary artery disease.
• Diabetes. People who are overweight tend to develop or worsen existing diabetic conditions due to decreased insulin sensitivity.
• Breast cancer. A high dietary consumption of fat is associated with an increased risk of breast cancer.

Description

The four basic food groups, as outlined by the United States Department of Agriculture (USDA) are:

• dairy products (such as milk and cheese)
• meat and eggs (such as fish, poultry, pork, beef, and eggs)
• grains (such as bread, cereals, rice, and pasta)
• fruits and vegetables

The USDA recommendation for adults is that consumption of meat, eggs, and dairy products should not exceed 20% of total daily caloric intake. The rest (80%) should be devoted to vegetables, fruits, and grains.

For children age two or older, 55% of their caloric intake should be in the form of carbohydrates, 30% from fat, and 15% from proteins. In addition, saturated fat intake should not exceed 10% of total caloric intake. This low-fat, high-fiber diet is believed to promote health and help prevent many diseases, including heart disease, obesity, and cancer.

Allergenic and highly processed foods should be avoided. Highly processed foods do not contain significant amounts of essential trace minerals. Furthermore, they contain lots of fat and sugar as well as preservatives, artificial sweeteners and other additives.

High consumption of these foods causes buildup of these unwanted chemicals in the body and should be avoided. Food allergy causes a variety of symptoms including food cravings, weight gain, bloating, and water retention. It also may worsen chronic inflammatory conditions such as arthritis.

Preparations

An enormous body of research exists in the field of nutrition. Mainstream Western medical practitioners point to studies that show that a balanced diet, based on the USDA Food Guide Pyramid, provides all of the necessary nutrients.

However, the USDA is working to revise the pyramid for the first time in a decade. Other pyramids are suggested by various research agencies, many of which emphasize different nutrition areas. A Harvard University researcher emphasizes whole grains and plant oils over meat, dairy and refined carbohydrates.

Some nutritionists believe that the USDA will modify the Food Pyramid to reflect similar modifications. The basic pyramid will likely not change, but explanations about the types of fats, grains and carbohydrates that are best to choose are likely.

In the first revision of the Food Guide Pyramid in 2003, the USDA proposed new patterns about how much Americans eat. Calorie recommendations and vitamin intake will be based on a person’s age, sex, and activity level. The complete revision was proposed for final publishing in the winter of 2005.

As of early 2004, the Food Guide Pyramid recommends the following daily servings in six categories:

• grains: Six or more servings
• vegetables: Five servings
• fruits: Two to four servings
• meat: Two to three servings
• dairy: Two to three servings
• fats and oils: Use sparingly

A new food guide pyramid for various vegetarian diets has been released by the American Dietetic Association (ADA). The guide helps vegetarians obtain the vitamins and minerals they need from whole grains, vegetables, fruits, legumes, nuts and other protein-rich foods.

Precautions

Individuals should not change their diets without the advice of nutritional experts or health care professionals. Certain individuals, especially children, pregnant and lactating women, and chronically ill patients should only change their diets under professional supervision.

Side effects

It is best to obtain vitamins and minerals through food sources. Excessive intake of vitamins and mineral supplements can cause serious physiological problems. 2001 guidelines to help nutritionists counsel cancer patients in use of complementary and alternative medicine reported that 73% of cancer patients used these therapies in addition to their allopathic treatment. Of those, only about 38% discussed the alternative therapies with their physicians.

Patients using dietary supplements should document their use, discuss them with their doctor or nutritionist, and watch standard cautions like possible interactions with prescribed drugs, cumulative effects of several supplements containing the same vitamin or mineral, and to stop taking the supplements if adverse reactions occur.

The following is a list of possible side effects resulting from excessive doses of vitamins and minerals:

• vitamin A: Birth defects, irreversible bone and liver damage
• vitamin B1: Deficiencies in B2 and B6
• vitamin B6: Damage to the nervous system
• vitamin C: Effects on the absorption of copper; diarrhea
• vitamin D: Hypercalcemia (abnormally high concentration of calcium in the blood)
• phosphorus: affects the absorption of calcium
• zinc: affects absorption of copper and iron; suppression of the immune system

Research and general acceptance

Due to a large volume of scientific evidence demonstrating the benefits of the low-fat, high-fiber diet in disease prevention and treatment, this diet has been accepted and advocated by both complementary and allopathic practitioners.

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Nux vomica

Nux vomica is the homeopathic remedy that is created from the seeds of the strychnos nux vomica tree. Also known as poison nut or vomiting nut, this tree is an evergreen tree that is native to East India, Burma, Thailand, China, and Northern Australia.

The tree belongs to the Loganiaceae family and has small flowers and orange colored fruits that are the size of an apple or orange. Inside the fruit are five seeds surrounded by a jelly-like pulp.

The ash gray seeds are round and measure 1 in (2.5 cm) in diameter and are .25 in (0.6 cm) thick. The seeds are coated with downy hairs that give them a satiny appearance.

The main alkaloids in the seeds are strychnine and brucine. These alkaloids give the seeds their bitter taste. Strychnine by itself is extremely poisonous, but when given in small doses to humans it promotes appetite, aids digestion, and increases the frequency of urination. In the nineteenth century it was used as a central nervous stimulant.

In larger doses, however, strychnine produces a loss of appetite, hypersensitivity, depression, anxiety, and rigidity and stiffness of arms and legs. Toxic doses may cause convulsions and death. Some historians think that Alexander the Great died from drinking wine poisoned by strychnine.

Medicinal use of the nut dates back to the middle of the sixteenth century, where it was written about extensively by Valerius Cordus. Germans used the nut as a treatment for worms, rabies, hysteria, rheumatism, gout, and as an antidote for the plague.

General use

Nux vomica is one of the most frequently used homeopathic remedies, especially for acute conditions. Homeopaths prescribe this polychrest for hangovers, back pain, digestive problems, headaches, allergies, colds, flu, emotional stress, constipation, menstrual problems, and hemorrhoids.

Nux vomica affects the nervous system. When taken by a healthy person the remedy causes muscle spasms and cramps, and even convulsions. It affects all five senses and bodily reflexes and causes extreme sensitivity to light, touch, noise, and smells.

The remedy is primarily indicated in ailments that are caused by abuse of narcotic drugs, alcohol, coffee, or tobacco, overindulgence in rich food and drink, and mental strain brought about by too much work.

Nux vomica patients are typically thin and dark-complected workaholics who wear themselves down by working late, eating heavily, neglecting exercise, and overindulging in moodaltering foods such as coffee or alcohol.

They are hurried and have an overactive mind, even at night, which is why they often suffer from insomnia. Their digestive systems are weakened by the rich, spicy, stimulating food and drink they crave and consume.

As such, they suffer from diarrhea, constipation, hemorrhoids, digestive problems, and an overall weakened vitality. Nux vomica patients catch colds easily and are hypersensitive to light, touch, noise, smells, and the effect of medicines. They are also sensitive to the cold and dislike cold weather immensely. Patients may be tidy and fastidious.

Children who require nux vomica are mischievous, stubborn, sensitive, and easily offended. They like to get their own way and become difficult if they do not.

Mentally, nux vomica patients are irritable, impatient, jealous, suspicious, malicious, never satisfied or content, anxious, argumentative, critical, stubborn, and rude. They have a violent temper and are often suicidal. They also have a difficult time concentrating and their memory often fails them.

Physically they may suffer from muscle spasms and twitching of muscles, emaciation, anemia, internal muscle tension, numbness of the affected part, an ineffectual urge to urinate, cramping pains, and heat in the stomach, chest, uterus, head, face, and palms of the hands. The complaints are generally right-sided, especially in conditions of tonsillitis, hernias, and renal colic.

Symptoms are generally worse in the morning, at night (particularly after midnight or from 3:00 to 4:00 A.M.), in cold or open air, in dry weather, after eating, from cold food and drinks, from lying down or lying on the painful side, during the menstrual cycle, from mental strain, loss of sleep, and from use of alcohol, coffee, and tobacco. Symptoms are better with warmth, warm food and drinks, wet weather, and sleep.

Specific indications

The headaches indicative of nux vomica are concentrated in the forehead (over the eyes) or back of the head. The pains are sharp, bursting pains and the scalp may feel sore and bruised. Constipation and other gastric symptoms are often present. This headache is typical of a hangover headache.

It may be caused by alcohol, cold wind, damp weather, insomnia, mental strain, or overeating. The headache is aggravated by eating, cold air, moving the eyes, or shaking the head. Stillness and quiet relieves the headache, as does pressure, rising in the morning, or lying in bed at night.

The nux vomica cold occurs as a result of exposure to cold, dry wind or from indigestion. Colds generally settle in the nose, throat, chest, and ears.

Colds are accompanied by a hoarse voice, headache, sore throat, sneezing, chills, a tickling cough, fever, and bone pains. The voice sounds nasal from the stuffy nose, which is plugged in open air and at night. The nose emits a watery discharge during the day and in a warm room.

The patient has a desire for cold water and the eyes are watery. Colds are better from fresh air and worse upon rising in the morning and after eating. The earache that accompanies the cold is made worse by swallowing. The ear is itchy and painful.

Flus and hay fever both exhibit the nux vomica cold symptoms. The flu may be accompanied by an aching, sore sensation. The hay fever may last throughout the year.

The cough is a dry, tickling cough that comes about in violent fits. It is accompanied by headaches, a sore throat, and pain in the abdomen. Coughs are worse after midnight, from mental exertion, in cold air, and after eating. They are relieved by hot drinks and from fresh air.

Sore throat pains spread to the ears. The throat is raw and the patient may feel as though there is “a lump in his throat.” The sore throat is worse from swallowing and cold air.

Fever is accompanied by chills, shivering, and an aching of the back, arms and legs. The fever begins early in the morning around 6:00 or 7:00 A.M. The fever is hot and dry and is often one-sided.

The patient becomes chilled when he moves around in bed or when a limb becomes uncovered. He is thirsty and may perspire. The gastric symptoms typical of this remedy may occur with the fever.

Digestive complaints are brought about by overindulging in rich, spicy foods, alcohol, tobacco, or coffee. Disturbances include diarrhea, constipation, and abdominal pains and may be accompanied by nausea, vomiting, and indigestion.

The patient feels bloated and full. The abdomen is painful and cramped and the patient may be doubled over. He may strain to urinate, defecate, or vomit. The pains are relieved by passing gas or passing a stool, from hot drinks, loose clothing, and warmth.

Menstrual difficulties occur throughout the cycle. The period is early, late, or too long. The menses may be heavy and clotted and accompanied by back pain and violent cramps that are aggravated by air or the cold and relieved by warmth and pressure.

Insomnia is caused by excitement, mental exertion, or the effects of alcohol. The patient is sleepy but as soon as her head hits the pillow she is awake. She often wakes up early in the morning, around 3:00 A.M., and cannot get back to sleep.

Recent research

Because nux vomica is prescribed so frequently in homeopathic treatment, it has figured in several different areas of research into homeopathic remedies:

• Gastritis. Studies were done as early as 1966 comparing patients who received nux vomica 4X for gastritis compared with a group that received a placebo. While one study showed that twice as many patients responded to the homeopathic remedy as responded to the placebo, other studies found no difference in the rate of response.
• Alcoholism. A study published in 2001 reported that nux vomica reduced alcohol intake in rats that had been conditioned to crave alcohol. The rise in the number of animal studies using nux vomica, however, has led to some debate among homeopaths regarding the morality of experimentation on animals.
• Abnormal psychology. The compilation of the Constitutional Type Questionnaire, or CTQ, as a homeopathic psychological research instrument has led to studies comparing its findings to those of mainstream psychological measures. One group of researchers reported that subjects who fit the nux vomica profile on the CTQ scored high in neurotic traits as well as high in chemical intolerance.

Preparations

The seeds of the tree are ground until powdered then mixed with milk sugar. This solution is then diluted and succussed to create the final preparation.

Nux vomica is available at health food and drug stores in various potencies in the form of tinctures, tablets, and pellets.

Precautions

If symptoms do not improve after the recommended time period, a homeopath or healthcare practitioner should be consulted.

The recommended dose should not be exceeded, as the strychnine in nux vomica is poisonous. People should be careful to use only preparations made by established manufacturers, as cases of accidental strychnine poisoning from non-homeopathic herbal preparations containing nux vomica have been reported.

Side effects

There are no known side effects at recommended dosages, but individual aggravations may occur.

Interactions

When taking any homeopathic remedy, use of peppermint products, coffee, or alcohol should be avoided. These products may cause the remedy to be ineffective.

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Oak

Oak is the common name for many acorn-producing trees and shrubs that are members of the beech, or Fagaceae, family. Oak trees are classified as members of the genus Quercus, a Latin word said to be derived from a Celtic word meaning “fine tree.”

Worldwide there are more than 600 different species of oak. They thrive across the Northern Hemisphere in China, Japan, Europe, the British Isles, and in all of the continental United States except for Alaska.

More than half of the 600 species are native to North America. Yet only about 60 varieties grow north of Mexico. In the forests of northern areas that have short summer growing seasons and long winters, such as Canada, northern Europe, and Siberia, varieties of oak are very scarce.

The oak family is a diverse group of trees and shrubs, influenced by climatic and environmental changes. Recent studies indicate that global warming contributes to oak dieback by speeding up the reproduction of beetles and fungi that attack oak trees.

There are oaks that grow to heights of about 100 ft (30.5 m), while other types never grow larger than a small shrub. In warmer climates, oaks are evergreens, keep their leaves all year long, and are often used as ornamental trees in parks. In colder climates, they usually drop their leaves in autumn.

Many of these deciduous oaks have leaves that turn brilliant gold or scarlet in the autumn. In spring small, yellow green flowers appear. The male flowers hang in clusters called catkins and have profuse amounts of pollen.

This oak pollen is carried by the wind to fertilize female flowers that produce acorns. Oak trees grow very slowly. In 80 years, it’s estimated that one will grow to no more than 2 ft (0.6 m) in diameter.

Oaks do not even produce acorns for their first 20 years, but they live a very long time. Average life expectancy for most oaks is between 200 and 400 years, and there are oak trees over 800 years old that are still alive.

Oaks are divided into two basic categories: white and red. The leaves of most of these are characteristically lobed, and depending upon the variety, can have anywhere from five to 11 lobes.

Historically, the oak has been considered sacred by many civilizations. Abraham’s Oak, the Oak of Mamre, is thought to be on the spot where the bible states Abraham pitched his tent. Legend states that anyone defacing this tree will lose their firstborn son.

Both the ancient Greeks and Romans revered the oak, but its longest association has been with the British Isles. The Druids considered it to have both medicinal and mystical significance. For centuries, an oak sprig was inscribed on English coins.

Legend states that King Arthur’s round table was made from one gigantic slice of a very ancient oak tree. Oak has been used as a medicine since the ancient Greek and Roman times. The famous Roman doctor Galen first used oak leaves to heal wounds.

The American white oak, Quercus alba, and the English oak, Quercus robur, have bark with similar healing qualities. Oak bark contains saponins, tannins, calcium oxalate, starch, glycosides, oak-red, resin, pectin, levulin, and quercitol.


General use

Oak wood as timber is prized for its strength, elasticity, and durability. It is ideal for making furniture, barrels, railroad ties, and in the past, ships. Oak acorns are a source of food for wildlife and have been used as fodder for farm animals in the past.

A flour made from ground acorns was also a part of the diet of Native Americans. The tannin in oak bark is used in leather preparation. Cork is made from the bark of some species that grow only in Spain and Portugal.

Recent advances in molecular genetics have shown that DNA from samples of oak can be isolated and analyzed. This type of analysis has a variety of potential applications in archaeology and forensic investigations.

Oak used to make wine barrels has been found to increase the antioxidant activity of wines aged in the barrels as well as adding a distinctive aroma to the wine. The increase in antioxidant activity can be measured by a new technique known as electron paramagnetic resonance, or EPR.

Oak bark is used in medicine as a bowel astringent to treat diarrhea and as an anti-inflammatory gargle for soothing sore throats. It can be used topically for such skin inflammations as dermatitis, as an enema for hemorrhoids, or as a douche for vaginal infections and leukorrhea.

A study in 1980 showed some evidence that oak bark may prevent kidney stone formation and act as a diuretic. A 1990 Russian study demonstrated that oak bark had antibacterial activity against Staphylococcus. One study in 1994 showed that oak bark could reduce serum cholesterol levels in animals.

Preparations

One teaspoonful of pulverized oak bark powder can be added to 1 cup of water, boiled, and then simmered at a reduced heat for 15 minutes to make an oak bark tea. This tea can be taken internally as an intestinal astringent up to three times per day.

Oak bark is also available in both an extract and a tincture. For rinses, compresses, and gargles, 20 g of pulverized bark should be dissolved in 1 qt (1 L) of water, and prepared in the same manner as the tea. Oak bark is also available as snuff, tablets, and capsules.


Precautions

Oak bark should not be used externally over large areas of skin damage or used as a full bath. Oak bark for gargles, enemas, or douches should not be used for more than two weeks before consulting a doctor. A doctor should also be consulted for any episode of diarrhea that lasts longer than three days despite treatment with oak bark.


Side effects

No side effects have been reported when oak preparations are used at recommended dosage levels. Patients occasionally experience mild stomach upset or constipation if the dosage is exceeded.

Interactions

Oak bark preparations are believed to inhibit or reduce the absorption of such alkaline drugs as antacids. In addition, oak bark has been found to reduce the effectiveness of codeine and atropine.

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Obesity

Obesity is an abnormal accumulation of body fat, usually 20% or more over an individual’s ideal body weight. Obesity is associated with increased risk of illness, disability, and death.

The branch of medicine that deals with the study and treatment of obesity is known as bariatrics. As obesity has become a major health problem in the United States, bariatrics has become a separate medical and surgical specialty.

Description

Obesity traditionally has been defined as body weight at least 20% above the weight corresponding to the lowest death rate for individuals of a specific height, sex, and age (designated as the ideal weight).

Twenty to forty percent over ideal weight is considered mildly obese; 40–100% over ideal weight is considered moderately obese; and 100% over ideal weight is considered severely, or morbidly, obese.

According to some estimates, approximately 25% of the United States population can be considered obese, 4 million of whom are morbidly obese. Other studies state that over 50% of American adults are obese, based on body mass index (BMI) measurements.

Excessive weight can result in many serious, and potentially deadly, health problems, including hypertension, Type II diabetes mellitus (non-insulin dependent diabetes), increased risk for coronary disease, increased unexplained heart attack, hyperlipidemia, infertility, and a higher prevalence of colon, prostate, endometrial, and possibly, breast cancer.

Approximately 300,000 deaths a year are attributed to obesity, prompting leaders in public health, such as former Surgeon General C. Everett Koop to label obesity “the second leading cause of preventable deaths in the United States.”

Causes and symptoms

The mechanism for excessive weight gain is clear more calories are consumed than the body burns, and the excess calories are stored as fat (adipose) tissue.

However, the exact cause is not as clear and likely arises from a complex combination of factors. Genetic factors significantly influence how the body regulates appetite and the rate at which it turns food into energy (metabolic rate).

Studies of adoptees confirm this relationship. The majority of adoptees followed a pattern of weight gain that more closely resembled that of their birth parents than their adoptive parents.

A genetic predisposition to weight gain, however, does not automatically mean that a person will be obese. Eating habits and patterns of physical activity also play a significant role in the amount of weight a person gains.

Some recent studies have indicated that the amount of fat in a person’s diet may have a greater impact on weight than the number of calories the food contains.

Carbohydrates like cereals, breads, fruits and vegetables, and protein (fish, lean meat, turkey breast, skim milk) are converted to fuel almost as soon as they are consumed.

Most fat calories are immediately stored in fat cells, which add to the body’s weight and girth as they expand and multiply. There is continuing research on the theory that fat is metabolized as fuel and energy and that only excess carbohydrates are converted to stored fat.

Current evidence shows that weight gain comes mostly from total calories consumed, rather than from the amount of carbohydrates. A study published in 2002 found that low-fat diets are no more effective in weight reduction programs than low-calorie diets.

At any rate, a sedentary life-style, particularly prevalent in affluent societies like the United States, can contribute to weight gain. Psychological factors, such as depression and low self-esteem may, in some cases, also play a role in weight gain.

At what stage of life a person becomes obese can effect his or her ability to lose weight. In childhood, excess calories are converted into new fat cells (hyperplastic obesity), while excess calories consumed in adulthood only serve to expand existing fat cells (hypertrophic obesity).

Since dieting and exercise can only reduce the size of fat cells, not eliminate them, persons who were obese as children can have great difficulty losing weight, since they may have up to five times as many fat cells as someone who became overweight as an adult.

Obesity can also be a side effect of certain disorders and conditions, including:

• Cushing’s syndrome, a disorder involving the excessive release of the hormone cortisol
• high cholesterol levels
• high blood pressure
• menstrual irregularities or cessation of menstruation (amenorhhea)
• shortness of breath that can be incapacitating
• skin disorders, arising from the bacterial breakdown of sweat and cellular material in thick folds of skin or from increased friction between folds

Diagnosis

Dignosis of obesity is made by observation and by comparing the patient’s weight to ideal weight charts. Many doctors and obesity researchers refer to the body mass index (BMI), which uses a height-weight relationship to calculate an individual’s ideal weight and personal risk of developing obesity-related health problems.

Physicians may also obtain direct measurements of an individual’s body fat content by using calipers to measure skin-fold thickness at the back of the upper arm and other sites.

The most accurate means of measuring body fat content involves immersing a person in water and measuring relative displacement; however, this method is very impractical and is usually only used in scientific studies requiring very specific assessments. Women whose body fat exceeds 30% and men whose body fat exceeds 25% are generally considered obese.

Doctors may also note how a person carries excess weight on his or her body. Studies have shown that this factor may indicate whether or not an individual has a predisposition to develop certain diseases or conditions that may accompany obesity.

“Apple-shaped” individuals who store most of their weight around the waist and abdomen are at greater risk for cancer, heart disease, stroke, and diabetes than “pear-shaped” people whose extra pounds settle primarily in their hips and thighs.

Treatment

Treatment of obesity depends primarily on the degree of a person’s overweight and his or her overall health. However, to be successful, any treatment must affect life-long behavioral changes rather than short-term weight loss.

“Yo-yo” dieting, in which weight is repeatedly lost and regained, has been shown to increase a person’s likelihood of developing fatal health problems than if the weight had been lost gradually or not lost at all. Behavior-focused treatment should concentrate on:

• What a person eats and how much. This aspect may involve keeping a food diary and developing a better understanding of the nutritional value and fat content of foods. It may also involve changing grocery shopping habits (e.g. buying only what is on a prepared list and going only on a certain day), timing of meals (to prevent feelings of hunger, a person may plan frequent small meals), and actually slowing down the rate at which a person eats.
• How a person responds to food. This may involve understanding what psychological issues underlie a person’s eating habits. For example, one person may binge eat when under stress, while another may always use food as a reward. In recognizing these psychological triggers, an individual can develop alternate coping mechanisms that do not focus on food.
• How people spend their time. Making activity and exercise an integral part of everyday life is a key to achieving and maintaining weight loss. Starting slowly and building endurance keeps individuals from becoming discouraged. Varying routines and trying new activities also keeps interest high.

For most who are mildly obese, these behavior modifications entail lifestyle changes they can make independently while being supervised by a family physician.

Other mildly obese persons may seek the help of a commercial weight loss program (e.g. Weight Watchers). The effectiveness of these programs is difficult to assess, since programs vary widely, dropout rates are high, and few employ members of the medical community.

However, programs that emphasize realistic goals, gradual progress, sensible eating, and exercise can be very helpful and are recommended by many doctors. Programs that promise instant weight loss or feature severely restricted diets are not effective and, in some cases, can be dangerous.

For individuals who are moderately obese, medically supervised behavior modification and weight loss are required. While doctors will put most moderately obese patients on a balanced low-calorie diet (1200–1500 calories a day), they may recommend that certain individuals follow a very low-calorie liquid protein diet (400–700 calories) for as long as three months.

This therapy, however, should not be confused with commercial liquid-protein diets or commercial weight-loss shakes and drinks. Doctors tailor these diets to specific patients, monitor patients carefully, and use them for only a short period of time.

In addition to reducing the amount and type of calories consumed by the patient, doctors will recommend professional therapists or psychiatrists who can help the individual effectively change his or her behavior in regard to eating.

The Chinese herb ephedra (Ephedra sinica, or ma huang), combined with exercise and a low-fat diet in physician-supervised weight-loss programs, can cause at least a temporary increase in weight loss. However, the large doses of ephedra required to achieve the desired result can also cause:

• anxiety
• heart arrhythmias
• heart attack
• high blood pressure
• insomnia
• irritability
• nervousness
• seizures
• strokes
• death

Ephedra should not be used by anyone with a history of diabetes, heart disease, or thyroid problems. It is not recommended for long-term use, and can cause serious medical or psychiatric problems if used too long. An article that appeared in the Journal of the American Medical Association in early 2003 advised against the use of ephedra.

Diuretic herbs, which increase urine production, can cause short-term weight loss but cannot help patients achieve lasting weight control. The body responds to heightened urine output by increasing thirst to replace lost fluids, and patients who use diuretics for an extended period of time eventually start retaining water again anyway.

In moderate doses, psyllium, a mucilaginous herb available in bulk-forming laxatives like Metamucil, absorbs fluid and makes patients feel as if they have eaten enough. Red peppers and mustard help patients lose weight more quickly by accelerating the metabolic rate.

They also make people more thirsty, so they crave water instead of food. Walnuts contain serotonin, the brain chemical that tells the body it has eaten enough. Dandelion (Taraxacum officinale) can raise metabolism and counter a desire for sugary foods.

The amino acid 5-hydroxytryptophan, or 5-HTP, which is extracted from the seeds of the Griffonia simplicifolia plant, is thought to increase serotonin levels in the brain.

Serotonin is a neurotransmitter, or brain chemical, that regulates mood and thus can be linked to mood-related eating behaviors. When physical and mental stress reduces serotonin levels in the body, 5-HTP may be helpful in regulating mood by boosting serotonin levels.

Individuals should consult with their healthcare professional before taking 5-HTP, as the amino acid may interact with other medications and can have potentially serious side effects.

Acupressure and acupuncture can also suppress food cravings. Visualization and meditation can create and reinforce a positive self-image that enhances the patient’s determination to lose weight.

By improving physical strength, mental concentration, and emotional serenity, yoga can provide the same benefits. Also, patients who play soft, slow music during meals often find that they eat less food but enjoy it more.

Eating the correct ratio of protein, carbohydrates, and good-quality fats can help in weight loss via enhancement of metabolism. Support groups and self-help groups such as Overeaters Anonymous and TOPS (Taking Off Pounds Sensibly) that are informed about healthy, nutritious, and balanced diets can offer an individual the support he or she needs to maintain this type of eating regimen.

Allopathic treatment

For individuals who are severely obese, dietary changes and behavior modification may be accompanied by surgery to reduce or bypass portions of the stomach or small intestine.

The risks of obesity surgery have declined in recent years, but it is still only performed on patients for whom other strategies have failed and whose obesity seriously threatens their health.

Other surgical procedures are not recommended, including liposuction, a purely cosmetic procedure in which a suction device is used to remove fat from beneath the skin, and jaw wiring, which can damage gums and teeth and cause painful muscle spasms.

A newer approach to weight loss is the development of functional foods, which are food products that incorporate natural compounds shown to help in weight loss programs.

These compounds include carbohydrates with a low glycemic index, which help to suppress appetite; green tea extract, which increases the body’s energy expenditure; and chromium, which encourages the body to burn stored fat rather than lean muscle tissue. Functional food products are currently undergoing clinical testing.

Appetite suppressant drugs are sometimes prescribed to aid in weight loss. These drugs work by increasing levels of serotonin or catecholamine, which are brain chemicals that control moods and feelings of fullness.

Appetite suppressants, though, are not considered truly effective, since most of the weight lost while taking them is usually regained after stopping.

Also, suppressants containing amphetamines can be potentially abused by patients. While most of the immediate side effects of these drugs are harmless, the long-term effects in many cases, are unknown.

Two drugs, dexfenfluramine hydrochloride (Redux) and fenfluramine (Pondimin) as well as a combination fenfluramine-phentermine (Fen/Phen) drug, were taken off the market when they were shown to cause potentially fatal heart defects. In 1999, the United States Food and Drug Administration (FDA) approved a new prescription weight loss drug, Orlistat.

Unlike other anti-obesity drugs that act as appetite suppressants, Orlistat encourages weight loss by inhibiting the body’s ability to absorb dietary fat. The drug can cause side effects of abdominal cramping, gas, and diarrhea.

Other weight-loss medications available with a doctor’s prescription include:

• Sibutramine (Meridia)
• Diethylpropion (Tenuate, Tenuate Dospan)
• Mazindol (Mazanor, Sanorex)
• Phendimetrazine (Bontril, Prelu-2)
• Phentermine (Adipex-P, Fastin, Ionamin, Oby-Cap)

Phenylpropanolamine (Acutrim, Dextarim) is the only nonprescription weight-loss drug approved by the FDA. These over-the-counter diet aids can boost weight loss by 5%.

Combined with diet and exercise and used only with a doctor’s approval, prescription anti-obesity medications enable some patients to lose 10% more weight than they otherwise would. Most patients regain lost weight after discontinuing use of either prescription medications or nonprescription weight-loss products.

Prescription medications or over-the-counter weight loss products can cause:

• constipation
• dry mouth
• headache
• irritability
• nausea
• nervousness
• sweating

None of the weight loss drugs should be used by patients taking monoamine oxidate inhibitors (MAO inhibitors).

Doctors sometimes prescribe fluoxetine (Prozac), an antidepressant that can increase weight loss by about 10%. Weight loss may be temporary and side effects of this medication include diarrhea, fatigue, insomnia, nausea, and thirst.

Weight loss drugs currently being developed or tested include ones that can prevent fat absorption or digestion, reduce the desire for food and prompt the body to burn calories more quickly, and regulate the activity of substances that control eating habits and stimulate overeating.

Expected results

As many as 85% of dieters who do not exercise on a regular basis regain their lost weight within two years. In five years, the figure rises to 90%. Repeatedly losing and regaining weight (yo-yo dieting) encourages the body to store fat and may increase a patient’s risk of developing heart disease.

The primary factor in achieving and maintaining weight loss is a lifelong commitment to regular exercise and sensible eating habits.


Prevention

Obesity experts suggest that a key to preventing excess weight gain is monitoring fat consumption rather than counting calories, and the National Cholesterol Education Program maintains that only 30% of calories should be derived from fat.

Only one-third of those calories should be contained in saturated fats (the kind of fat found in high concentrations in meat, poultry, and dairy products). Because most people eat more than they think they do, keeping a detailed food diary is a useful way to assess eating habits.

Eating three balanced, moderateportion meals a day—with the main meal at mid-day—is a more effective way to prevent obesity than fasting or crash diets. Exercise increases the metabolic rate by creating muscle, which burns more calories than fat.

When regular exercise is combined with regular, healthful meals, calories continue to burn at an accelerated rate for several hours. Finally, encouraging healthful habits in children is a key to preventing childhood obesity and the health problems that follow in adulthood.

New directions in obesity treatment

The rapid rise in the incidence of obesity in the United States since 1990 has prompted researchers to look for new treatments. One approach involves the application of antidiabetes drugs to the treatment of obesity.

Metformin (Glucophage), a drug that was approved by the Food and Dug Administration (FDA) in 1994 for the treatment of type 2 diabetes, shows promise in treating obesity associated with insulin resistance.

Another field of obesity research is the study of hormones, particularly leptin, which is produced by fat cells in the body, and ghrelin, which is secreted by cells in the lining of the stomach. Both hormones are known to affect appetite and the body’s energy balance.

Leptin is also related to reproductive function, while ghrelin stimulates the pituitary gland to release growth hormone. Further studies of these two hormones may lead to the development of new medications to control appetite and food intake.

A third approach to obesity treatment involves research into the social factors that encourage or reinforce weight gain in humans. Researchers are looking at such issues as the advertising and marketing of food products; media stereotypes of obesity; the development of eating disorders in adolescents and adults; and similar questions.

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Obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a type of anxiety disorder characterized by distressing repetitive thoughts, impulses, or images that are intense, frightening, absurd, or unusual. These thoughts are followed by ritualized actions that are usually bizarre and irrational.

These ritual actions, known as compulsions, help reduce anxiety caused by the individual’s obsessive thoughts. Often described as the “disease of doubt,” the sufferer usually knows the obsessive thoughts and compulsions are irrational but, on another level, fears they may be true.

Description

Almost one out of every 40 people will suffer from obsessive-compulsive disorder at some time in their lives. The condition is two to three times more common than either schizophrenia or manic depression, and strikes men and women of every ethnic group, age, and social level.

Because the symptoms are so distressing, sufferers often hide their fears and rituals but cannot avoid acting on them. OCD sufferers are often unable to decide if their fears are realistic and need to be acted upon.

Most people with obsessive-compulsive disorder have both obsessions and compulsions, but occasionally a person will have just one or the other. The degree to which this condition can interfere with daily living also varies.

Some people are barely bothered, while others find the obsessions and compulsions to be profoundly traumatic and spend a great deal of time each day in compulsive actions.

Obsessions are intrusive, irrational thoughts that keep popping up in a person’s mind, such as, “My hands are dirty, I must wash them again.” Typical obsessions include fears of dirt, germs, contamination, and violent or aggressive impulses.

Other obsessions include feeling responsible for others’ safety, or an irrational fear of hitting a pedestrian with a car. Additional obsessions may involve intrusive sexual thoughts.

The patient may fear acting out the strong sexual thoughts in a hostile way. People with obsessive-compulsive disorder may have an intense preoccupation with order and symmetry, or be unable to throw anything out.

Compulsions usually involve repetitive rituals such as excessive washing (especially handwashing or bathing), cleaning, checking and touching, counting, arranging, or hoarding. As the person performs these acts, he may feel temporarily better, but there is no long lasting sense of satisfaction or completion after the act is performed.

Often, a person with obsessive-compulsive disorder believes that if the ritual isn’t performed, something dreadful will happen. While these compulsions may temporarily ease stress, short-term comfort is purchased at a heavy price—time spent repeating compulsive actions and a long-term interference with life.

The difference between OCD and other compulsive behavior is that while people who have problems with gambling, overeating, or substance abuse may appear to be compulsive, these activities also provide pleasure to some degree. The compulsions of OCD, on the other hand, are never pleasurable.

OCD may be related to some other conditions, such as the continual urge to pull out body hair (trichotillomania); fear of having a serious disease (hypochondriasis), or preoccupation with imagined defects in personal appearance disorder (body dysmorphic disorder).

Some people with OCD also have Tourette syndrome, a condition featuring tics and unwanted vocalizations (such as swearing). OCD is often linked with depression and other anxiety disorders.

Causes and symptoms

The tendency to develop obsessive-compulsive disorder appears to be inherited. In the summer of 2002, researchers at the University of Michigan identified a segment of human chromosome 9p as containing genes for susceptibility to OCD. Other chromosomes that may also be linked to OCD are 19q and 6p.

There are several theories behind the cause of OCD. Some experts believe that OCD is related to a chemical imbalance within the brain that causes a communication problem between the front part of the brain (frontal lobe) and deeper parts of the brain responsible for the repetitive behavior.

Research has shown that the orbital cortex located on the underside of the brain’s frontal lobe is overactive in OCD patients. This may be one reason for the feeling of alarm that pushes the patient into compulsive, repetitive actions.

The higher-than-average rate of concurrent eating disorders in patients diagnosed with OCD has been attributed to the fact that hyperactivity in the orbital cortex is associated with both disorders.

It is possible that people with OCD experience overactivity deep within the brain that causes the cells to get “stuck,” much like a jammed transmission in a car damages the gears.

This could lead to the development of rigid thinking and repetitive movements common to the disorder. The fact that drugs which boost the levels of serotonin (a brain chemical linked to emotion) in the brain can reduce OCD symptoms may indicate that to some degree OCD is related to brain serotonin levels.

Recently, scientists have identified an intriguing link between childhood episodes of strep throat and the development of OCD. It appears that in some vulnerable children, strep antibodies attack a certain part of the brain.

Antibodies are cells that the body produces to fight specific diseases. That attack results in the development of excessive washing or germ phobias. A phobia is a strong but irrational fear. In this instance the phobia is fear of disease germs present on commonly handled objects.

These symptoms would normally disappear over time, but some children who have repeated infections may develop full-blown OCD. Treatment with antibiotics has resulted in lessening of the OCD symptoms in some of these children.

If one person in a family has obsessive-compulsive disorder, there is a 25% chance that another immediate family member has the condition. It also appears that stress and psychological factors may worsen symptoms, which usually begin during adolescence or early adulthood.

Some studies indicate that the nature of parent-child interactions is an important factor in the development of OCD. Observers have often remarked that parents and children in OCD families can be differentiated from members of other types of families on the basis of behavior.

One Australian study described the parents of children with OCD as “..less confident in their child’s ability, less rewarding of independence, and less likely to use positive problem solving.”

OCD has also sometimes been linked to religion, in that the symptoms of some persons diagnosed with OCD reflect religious beliefs or practices. Christian clergy have been trained since the Middle Ages to recognize a specific spiritual problem known as scrupulosity, in which a person is troubled by excessive fears of God’s punishment or fears of having sinned and offended God.

A new inventory for measuring scrupulosity in devout Jews as well as Protestants and Catholics has been tested at the University of Pennsylvania and appears to be a reliable instrument for evaluating OCD symptoms that take religious forms.

Scrupulosity has been traditionally treated in both Judaism and Christianity by consultation with a rabbi, priest, or pastor who is able to correct the distorted beliefs that underlie the obsessions or compulsions. In some cases the clergyperson may also use an appropriate religious ritual in treating scrupulosity.

Diagnosis

People with obsessive-compulsive disorder feel ashamed of their problem and often try to hide their symptoms. They may avoid seeking treatment. Because they can be very good at keeping their problem from friends and family, many sufferers do not get the help they need until the behaviors are deeply ingrained habits and harder to change.

As a result, the condition is often misdiagnosed or underdiagnosed. All too often, it can take more than a decade between the onset of symptoms and proper diagnosis and treatment.

While scientists seem to agree that OCD is related to a disruption in serotonin levels, there is no blood test for the condition. Instead, doctors diagnose OCD after evaluating a person’s symptoms and history.

Treatment

Because OCD sometimes responds to selective serotonin reuptake inhibitors (SSRI) antidepressants, herbalists believe a botanical medicine called St. John’s wort (Hypericum perforatum) might have some beneficial effect as well. Known popularly as “Nature’s Prozac,”

St. John’s wort is prescribed by herbalists for the treatment of anxiety and depression. They believe that this herb affects brain levels of serotonin in the same way that SSRI antidepressants do. Herbalists recommend a dose of 300 mg, three times per day.

In about one out of 400 people, St. John’s wort (like Prozac) may initially increase the level of anxiety. Homeopathic constitutional therapy can help rebalance the patient’s mental, emotional, and physical well-being, allowing the behaviors of OCD to abate over time.

Other alternative treatments for OCD are intended to lower the patient’s anxiety level; some are thought to diminish the compulsions themselves. Alternative recommendations include the following:

• Bach flower remedies:White chestnut, for obsessive thoughts and repetitive thinking.
• Traditional Chinese medicine: a mixture of bupleurum and dong quai, to strengthen the spleen and regulate the liver. In Chinese medicine, obsessive-compulsive disorder is due to liver stagnation and a weak spleen.
• Aromatherapy: a mixture of lavender, rosemary, and valerian for relaxation.
• Yoga:Yogis in India developed a special technique of yogic breathing specifically for OCD. The specific yogic technique for treating OCD requires blocking the right nostril with the tip of the thumb; slow deep inspiration through the left nostril; holding the breath; and slow complete expiration through the left nostril. This is followed by a long breath-holding out period.
• Schuessler tissue salts: for OCD, 10 tablets of Ferrum phosphorica 30X and 10 tablets of Kali phosphorica 200X, twice daily.
• Massage therapy: with special emphasis on loosening the muscles in the neck, back, and shoulders.

Cognitive-behavioral therapy (CBT) teaches patients how to confront their fears and obsessive thoughts by making the effort to endure or wait out the activities that usually cause anxiety without compulsively performing the calming rituals.

Eventually their anxiety decreases. People who are able to alter their thought patterns in this way can lessen their preoccupation with the compulsive rituals. At the same time, the patient is encouraged to refocus attention elsewhere, such as on a hobby.

Allopathic treatment

Obsessive-compulsive disorder can be effectively treated by a combination of cognitive-behavioral therapy and medication that regulates the brain’s serotonin levels.

Drugs that are approved to treat obsessive-compulsive disorder include fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), and sertraline (Zoloft), all SSRIs that affect the level of serotonin in the brain. Drugs should be taken for at least 12 weeks before deciding whether or not they are effective.

In a few severe cases where patients have not responded to medication or behavioral therapy, brain surgery may be attempted to relieve symptoms. Surgery can help up to a third of patients with the most severe form of OCD.

The most common operation involves removing a section of the brain called the cingulate cortex. The serious side effects of this surgery for some patients include seizures, personality changes, and decreased ability to plan.

Expected results

Obsessive-compulsive disorder is a chronic disease that, if untreated, can last for decades, fluctuating from mild to severe and worsening with age. When treated by a combination of drugs and behavioral therapy, some patients go into complete remission.

Unfortunately, not all patients have such a good response. About 20% of people cannot find relief with either drugs or behavioral therapy. Hospitalization may be required in some cases.

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Omega-3 fatty acids

Omega-3 fatty acids are one of two groups of fatty acids—the omega-3s and the omega-6s—that are vital to human life. They are called essential fatty acids (EFAs), which the body cannot make but absolutely needs for normal growth and development.

These fats must be supplied by diet. People living in industrialized western countries eat up to 30 times more omega-6 than omega-3 fatty acids, resulting in a relative deficiency of omega-3 fats.

Omega-6 metabolic products (inflammatory prostaglandins, thromboxanes, and leukotrienes) are formed in excessive amounts causing allergic and inflammatory disorders and making the body more prone to heart attacks, strokes, and cancer.

Eating diets rich in omega-3 acids or taking fish oil supplements can restore the balance between the two fatty acids and can possibly reverse these disease processes.

General use

Heart disease and stroke

The American Heart Association (AHA) has endorsed omega-3 fatty acids as good for the heart. The omega-3 oils increase the concentrations of good cholesterol (high density lipoproteins, HDL) while decreasing the concentrations of bad cholesterol (triglycerides).

In addition, eating omega-3-rich food will result in a moderate decrease in total cholesterol level. In a clinical study of 38 women, flaxseed flour, which contains high amounts of omega-3 fatty acids, decreased total cholesterol level by 6.9% and LDL cholesterol by 14.7%.

In addition, lipoprotein(a), which is associated with heart attacks in older women, decreased by almost 10%. Thus, omega-3 fatty acids are natural alternatives to estrogen in prevention of heart attacks in postmenopausal women.

Furthermore, omega-3 oils protect the heart by preventing blood clots or keeping other fats from injuring the arterial walls. They not only relax arteries but also help to decrease constriction of arteries and thickening of blood.

Hundreds of studies have shown that diets rich in omega-3 fatty acids decrease risk of heart attacks, strokes, and abnormal heart rhythms.

Eskimos, who eat a lot of cold-water fish, have low rates of heart attacks and strokes, possibly because they have thinner blood, high HDL to LDL cholesterol ratio, and less buildup of fatty deposits (plaques) in the arteries. Two clinical trials have shown that regular consumption of fish or fish-oil supplements can prevent sudden deaths due to abnormal heart rhythms.

In the Diet and Reinfarction Trial (DART) of 2,033 men who previously suffered a heart attack, men who ate two to three servings of fatty fish a week had their risk of sudden cardiac death lowered by 29% compared to those who had a low fat or high fiber diet.

In the Physician’s Health Study of 20,551 doctors, a 52% reduction in risk of heart attacks was observed in those who ate at least one fish meal per week compared with those who ate fish once a month or less.

Mild hypertension

Several studies have shown that eating 200 g of fatty fish or taking six to 10 capsules of fish oil daily will lower blood pressure (BP). Therefore, omega-3 can benefit patients with borderline high blood pressure. Omega-3 oils also effectively prevent hypertension in cardiac patients after transplantation.


Supplement for newborns and babies

Omega-3 fatty acids are essential for normal development of vision and brain function, especially in newborns and children. Very low birth weight pre-term infants often have poor vision and motor skills, possibly because they receive less than one-third of the amount of omega-3 fatty acids outside the mother’s womb that they would have received as a fetus.

Human breast milk contains the appropriate amount of omega-3 and -6 fats and is believed best for babies. If mother’s milk is unavailable, formulas with soybean oil that provide higher amounts of omega-3 fatty acids are more beneficial than those made from cow milk.

Even full-term babies benefit from the addition of essential fatty acids to cow-milk formulas. Studies have shown that babies given formulas supplemented with EFAs have better vision and score higher in skills and problem-solving tests compared to babies on formulas that do not contain additional EFAs.

Rheumatoid arthritis

Because omega-3 fatty acids inhibit the action of inflammatory prostaglandins and leukotrienes, they can help control arthritis symptoms. Significant reduction in the number of tender joints and morning stiffness, as well as an increase in grip strength, have been observed in patients taking fish oil capsules.

Studies have shown that patients taking fish oil supplements for rheumatoid arthritis require fewer pain medications; some are able to discontinue their nonsteroidal anti-inflammatory treatment.

Despite the beneficial effects of omega-3 fats, regular antirheumatic drugs and nonsteroidal anti-inflammatory medications most likely still are required to control this chronic condition.

Diabetes

Early studies in laboratories indicate that omega-3 fatty acids in fish oils might prolong life in people with autoimmune disorders like diabetes. A new study looked at substituting fish oil for corn oil in diets and found a tendency to suppress immune system dysfunction and prolong life. More studies are required to prove the diet’s benefits in humans.

Inflammatory bowel disease

High-dose fish-oil supplements have shown to decrease abdominal cramping, diarrhea, and pain associated with Crohn’s disease. In one study of 96 patients, patients who received 4.5 g of omega-3 fatty acids (15 fish oil capsules) required significantly less steroids to control symptoms.

In another study of 78 Crohn’s disease patients, 59% of patients who received nine fish oil capsules (2.7g of omega-3 fatty acids) daily did not have any disease flare-ups for at least one year compared to 26% recurrence rate in patients who were not given fish oil. Omega-3 fatty acids also are effective in preventing reappearance of Crohn’s disease after surgery to remove sections of diseased bowel.

In a clinical trial involving 50 patients, patients who received 2.7 grams of omega-3 fats as fish oil cut their rate of disease reappearance in half compared to patients receiving placebo. However, the effectiveness of omega-3 oils varies depending on the type of omega-3 oils being used, length of use, and the patient’s diet.

Asthma

Taking high dose omega-3 fatty acids can reduce inflammation of the airways and reduce asthma attacks. According to Donald Rudin, the author of the book titled Omega-3 Oils, allergic disorders such as asthma may be triggered by too much omega-6 and too little omega-3 fats in our body.

Excessive amounts of omega-6 prostaglandins cause the body to produce antibodies that cause allergic reactions. Flaxseed or fish oil supplements can keep the omega-6 fats in check and decrease the inflammatory reactions associated with asthma.

Berger’s disease (Immunoglobulin A nephropathy)

Omega-3 fats may be effective in treating this autoimmune disease in which kidney function fails over time with few treatment options available.

In a large, randomized study of 150 patients, those who received 3 g of omega-3 fatty acids daily for two years had significantly less reduction in renal function than those treated with placebo. Therefore, omega-3 fatty acids appear to have protective effects and may stabilize renal function in these patients.

Raynaud’s disease

There have been few studies evaluating the effects of omega-3 fatty acids in treating Raynaud’s disease; however, it appears that fish oil supplements may alleviate some blood clotting disorders.

Mental disorders

According to some studies, many common mental disorders, such as depression, bipolar disorder (manic-depression), attention-deficit hyperactive disorder (ADHD), anxiety, or schizophrenia, may be triggered by deficiencies of omega-3 fatty acids and/or B vitamins.

The rates of depression are low in countries that eat a lot of fish, while the rate of depression steadily rises in the United States as Americans eat increasingly more processed food and less fresh fish and vegetables containing omega-3 fats.

In one study, 53% of bipolar patients on placebo (olive oil) became ill again within four months, while none of the patients who were given 9.6 g daily of omega-3 fatty acids (as fish oil) did.

Supplements containing omega-3 fats also reportedly have been effective in children with ADHD precipitated by essential fatty acid deficiencies. Furthermore, a 25% decrease in schizophrenic symptoms was observed in patients receiving eicosapentanoic acid (EPA), one of the omega-3 fatty acids contained in fish oil.

A report in 2001 revealed that omega-3 fatty acids may have effects on stabilizing mood and relieving depression. As studies continue, researchers are finding it more and more evident that omega-3 fatty acids can be effective for treating depression, though they still are uncertain exactly how they work. A 2003 report linked depression to increased risk of sudden cardiac death.

Acquired Immunodeficiency syndrome (AIDS)

In a small study of 20 AIDS patients, those who received fish oil supplement at dosage of 10 g of omega-3 fatty acids per day for 30 days gained more weight (2.4 kg) and significantly lowered their concentrations of tumor necrosis factor, which is believed to cause wasting in AIDS patients, compared to those who did not.

Cancer prevention

Omega-3 fatty acids inhibit tumor growth when injected into animals. Flaxseed oil, which is a plant source of omega-3 fatty acids, has been shown to prevent cancer of the breast, colon and prostate.

The Mediterranean diet, which is heart healthy, also can decrease risk of getting cancer. Omega-3 fats, it seems, strengthen the immune systems and inhibit the inflammation and blood circulation of the tumors.

Preparations

Omega-3 fatty acids can be found naturally in the oil of cold-water fish, such as mackerel, salmon, sardines, anchovies, and tuna, or as extracted oils from plants, such as flaxseed, canola (rapeseed), or soybean.

As of 2001, the U.S. Food and Nutrition Board had not issued the recommended daily allowance (RDA) for omega-3 fatty acids. However, researchers suggest that 100-200 mg daily of docosahexaenoic acid (DHA) and 200-400 mg daily of eicosapentanoic acid (EPA) were adequate for the majority of adults.

The best way to achieve this dietary requirement is by eating fatty fish two or three times a week and/or eating vegetables and oils containing omega-3 fatty acids. If fish oil supplement is preferred, then one to two capsules a day is sufficient.

Each 1 g fish oil capsule normally contains 180 mg of EPA and 120 mg of DHA. Vitamin E is often contained in fish oil supplements to prevent spoilage and vitamin-E deficiency, which may occur with high dose fish-oil consumption.

Patients should take supplements containing omega-3 fatty acids only under professional supervision to prevent overdosage, adverse reactions, or interactions with other medications. For treatment of diseases, flaxseed oil should be the first choice because it is the richest source of omega-3 fatty acids, relatively safe, and inexpensive.

Precautions

The safest and most effective way to get omega-3 fatty acids is through diets of at least three fish meals a week. Fish-oil or flaxseed supplements should be taken only under a physician’s supervision.

Although fish oils can be helpful in relieving arthritic symptoms, patients still may need anti-inflammatory medications to adequately control the disease.

Taking any medication during pregnancy is not recommended. Women who are pregnant or breastfeeding should talk to doctors before taking fish-oil supplements or any other medications.

Because of its blood thinning activity, those who are on aspirins, nonsteroidal anti-inflammatory drugs (NSAIDS), warfarin, or other anti-clotting medications must consult a physician before using the supplements.

Side effects

Consuming excessive amounts of fish-oil capsules can result in excessive bleeding, gastrointestinal distress, anemia, or strokes.

Interactions

Because of its blood-thinning activity, fish oil supplements may interact with aspirins, nonsteroidal anti-inflammatory drugs (NSAIDS), warfarin, or other anticlotting medications to cause excessive bleeding.

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