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COVID-19 Impact on Plasma Therapy in the Healthcare Industry | Data Bridge Market Research

COVID-19 Impact on Plasma Therapy in the Healthcare Industry

Coronavirus is a large family of viruses known for diseases ranging from the common cold to even more serious diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The virus has spread to almost all regions of the world, affecting both developed and developing countries which have heavily affected pharmaceutical and biotechnology companies. The epidemic spread rapidly across the globe within three months and was characterized by the VHO as a pandemic on March 11, 2020. According to the Worldometers.info statistics, as of 27th April 2020, there are 3,064,225 people are already affected and 211,537 patients are died due to the coronavirus. There are currently no approved specific antiviral agents targeting the new virus, while some drugs are still under investigation, including remdesivir and lopinavir / ritonavir. It is urgent to look for an alternative strategy to treat COVID-19, especially among severe patients, as an effective vaccine and specific antiviral medicines are not available till the date.

Plasma medications are produced from human blood plasma (plasma). Plasma can be obtained from administration of whole blood (recovered plasma) or apheresis procedures (plasma source). The source is plasma a wide range of medicinal therapies products used for treatment and the prevention of various treatment-causing injuries and diseases often associated with a protein deficiency state. Convalescent Plasma Therapy (CP), a classic adaptive immunotherapy, has been used in the prevention and treatment of many infectious diseases for over a century. In the past two decades, CP therapy has been successfully used in the treatment of the 2009 SARS, MERS and H1N1 pandemic with satisfactory efficacy and safety. In 2014, the World Health Organization (WHO) recommended the use of convalescent plasma therapy for the treatment of patients with antibody-rich plasma in those recovering from Ebola virus disease.

Numerous clinical trials are also being held to evaluate the safety and efficacy of convalescent plasma, and the FDA has also approved a number of individual emergencies (eINDs) for emergencies.

MECHANISM OF ACTION

Antibodies present in immune (i.e., "convalescent") plasma mediate their therapeutic action through various mechanisms. The antibody can bind to a particular pathogen (such as, a virus), thereby directly neutralizing its infectivity, while another antibody-mediated pathways such as complement activation, antibody-dependent cellular cytotoxicity, and / or phagocytosis may also contribute to its therapeutic effect. Non-neutralizing antibodies that bind to the pathogen - but they are does not interfere with its ability to replicate in in vitro systems - it can also contribute to prophylaxis and / or improve recovery. Most importantly, passive administration of antibodies offers the only short-term strategy for granting immediate immunity sensitive individuals. This is especially the case in the setting of a new, growing infectious disease such as SARSCoV-2 / COVID-19. While plasma products (such as, hyperimmune globulin, monoclonal antibodies) and / or fractionated vaccination can provide long-lasting therapeutic options, human anti-SARS-CoV-2 plasma is the only therapeutic strategy that is immediately available for use for the prevention and treatment of COVID-19.

REGULATIONS

COVID-19 convalescent plasma has not yet been approved by the FDA, to it is regulated as an exploratory product. As such, the COVID-19 administration convalescent plasma by a physician must be under investigation by a new drug application (IND) under traditional regulatory through IND, Extended Access IND, or newly announced administration of a new emergency drug (eIND) for one patient (42) U.S.C. 262(a)(3); 21 U.S.C. 355(i); 21 CFR 601.21; and 21 CFR 312.1).  The FDA is not doing collection of COVID-19 convalescent plasma or provides COVID-19 convalescent plasma. Healthcare professionals or acute care facilities would receive COVID-19 instead convalescent plasma from an FDA-registered blood establishment.

The below mentioned pathways are available for studying or administering the use of COVID-19 convalescent plasma:

1) CLINICAL TRIALS

Investigators who want to study the use of convalescent plasma in a clinical trial should submit requests to the FDA for investigative use in accordance with traditional IND regulations road (21 CFR part 312). CBER's Blood Research and Review Service are opted to engage with sponsors and quickly review such requests.

2) EXPANDED ACCESS

The IND Extended Access application is an alternative to using COVID-19 convalescent plasma for patients with serious or immediate life-threatening conditions COVID-19 diseases that are ineligible or unable to participate randomized clinical trials (21 CFR 312.305). For patients with severe or the immediately life-threatening COVID-19 that is ineligible or unable to participate in randomized clinical trials, access to this research product may be available through the involvement of acute care facilities in expanded research access protocol under IND already in place.

3) SINGLE PATIENT EMERGENCY IND

The participation in clinical trials or an extended access program is the way to go patients gain access to convalescent plasma, for various reasons it may not be easily accessible to all patients in potential need. Therefore, given public health an emergency presented by the COVID-19 pandemic while clinical trials are ongoing implemented and extended access protocol is available, the FDA also allows access to COVID-19 convalescent plasma for use in patients with severe or immediately life-threatening COVID-19 infection through the process patient physician seeking one eIND patient for the individual patient below 21 CFR 312.310.  This procedure allows the use of an investigational drug for the drug treatment of an individual patient by a licensed physician upon FDA approval, if Applicable regulatory criteria were applied.

1.    To Obtain a Single Patient Emergency IND

·         To obtain a patient's individual eIND, the provider must determine that this is likely the risk to the person on the investigational drug is not greater than probable risk of disease or condition 21 CFR 312.310 (a).

2.    Patient Eligibility

·         To facilitate eIND requirements for the use of COVID-19 convalescent plasma for treatment patients, healthcare professionals seeking immediate medical attention may want to consider the problem eligibility criteria for the National Protocol for the Treatment of Extended Access were discussed in Section III.A. of these instructions. The criteria include:

·         Laboratory confirmed COVID-19

1.    Severe or immediately life-threatening COVID-19, for example,

2.    Severe disease is defined as one or more of the following:

·         oxygen saturation ≤ 93%,

·         partial pressure of arterial oxygen to inspiratory oxygen content <300

·         shortness of breath (dyspnea),

·         respiratory frequency ≥ 30/min,

·         lung infiltration> 50% within 24 to 48 hours

1.    A life threat is defined as one or more of the following:

·         septic shock,

·         respiratory failure,

·         multiple organ dysfunction or failure

·         Informed consent of patient or health care proxy.

3.    Collection of COVID-19 Convalescent Plasma

·         Donor Eligibility

COVID-19 convalescent plasma should only be collected from individuals eligible for donor eligibility (21 CFR 630.10 and 21 CFR 630.15). Please note the additional donor eligibility requirements for collection by plasmapheresis in 21 CFR 630,15 (b). Donation testing for relevant transfusion-transmitted infections must be performed (21 CFR 610,40) and the donation must be considered appropriate (21 CFR 630.30).

COVID-19 convalescent plasma is collected from the individuals they meet the following qualifications:

·         Evidence of COVID-19 documented by laboratory test:

1.    Diagnostic test (such as, nasopharyngeal swab) at the time of illness Or

2.    Positive serological test for SARS-CoV-2 antibodies afterwards recovery if previous diagnostic testing has not been performed COVID-19 is suspected.

·         Should meet one of the following:

1.    Complete resolution of symptoms at least 28 days before donation or

2.    Complete resolution of symptoms at least 14 days before donation

Negative results for COVID-19 of one or more nasopharyngeal swab specimens or molecular diagnostic test of blood

·         Male donors, or women who were not pregnant, or women to providers who have been tested since their last pregnancy and results interpreted as negative for HLA antibodies.

Once manufactured, COVID-19 convalescent plasma can be distributed for research use.

Blood establishments need not require an alternative procedure or exception under 21 CFR 640.120 (a) for COVID-19 reconvalescent plasma collection.

IMPACT ON DEMAND

Scientists are trying to use vaccines, medicines and other methods as a cure for the new coronavirus. With no confidence in the exact treatment in sight, doctors around the world are working on the treatment of centuries-old cure for infections: infusion of blood plasma that is immune to molecules can help survivors beat the infection. The demand of plasma therapy is increasing due to their potential use in the coronavirus treatment. The plasma therapy is the only therapy which shown positive results for the corona virus treatment. In addition to the US, China and Turkey, Spain, Italy, South Korea, the United Kingdom, there are some of the few countries that are also looking at plasma therapy to more easily address the worldwide coronavirus crisis. Even India joined the belt and started a trial for plasma therapy. In Delhi hospital has successfully cured COVID-19 patient using plasma therapy. The respiratory rate of the first patient was 30 which should be 15, and the oxygen saturation level was 85%, which should be 95%. After plasma therapy, the respiratory rate was 20 and the oxygen saturation level was 98%. This has been observed in all patients with increased respiratory rate and oxygen saturation level.

Government has already taken different initiatives to combat the corona virus. For instance,

·         The Indian Council of Medical Research (ICMR) now giving the climate to the state to conduct plasma therapy. Kerala is the first state in the state to get the climate to try this. In India, several states like Kerala, Gujarat and Punjab have already started using plasma therapy for patients with COVID-19.

·         The UK Government has approved a national clinical trial to evaluate plasma therapy for the treatment of Covid-19 patients.

·         Sewa International has created an online registry for a convalescent plasma therapy program that connects donors and recipients who wish to participate in COVID-19 treatment and has also established a helpline.

With the increasing demand and increasing sale of plasma therapy, are fueling the growth of plasma therapy market in the near future.

IMPACT ON SUPPLY

The development of hyperimmune will require the administration of plasma from many individuals who have fully recovered from COVID-19 and whose blood contains antibodies that can fight the new coronavirus. Once collected, "convalescent" plasma will then be transported to production facilities where it has undergone proprietary processing, including effective virus inactivation and removal processes, and then purified to product. The antibodies present in the blood can bind with the antigen. This is the limiting factor as the number recovered is much lower than the number of active cases in any geography. Also it depends upon an individual��s personal and ethical concerns to donate blood for plasma therapy.

Additionally, major problem with plasma therapy is the huge restrictions on the regulations that have led to disruption of product delivery. In spite of the difficulties, many patients already took part for the plasma donations. For instance,

·         The chief medical officer of The American Red Cross said, the American Red Cross has produced 200 units of convalescent plasma which has so far donated nearly by 150 donors. Additionally, he has mentioned, the goal is to send more than 1,000 units to hospitals, which would require 500-600 providers.

·         According to a recent survey, in Lucknow one Covid-19 recovered physician donated plasma to treat patients.

This can possibly be a roadblock to this revolutionary therapy. Though plasma therapy can prove to be a pioneering a part in treating a large number of patients but there is a number of limitations as discussed before. So a combination of treatments is already available for the corona virus treatment.

STRATEGIC DECISIONS OF MANUFACTURERS

Collaboration, agreements, strategic initiatives by market players such as CSL Behring, Takeda Pharmaceutical Company Limited, Biotest, Octapharma in the plasma therapy market will help them expand their market and expand their product portfolio. This, in turn, will help increase product demand among consumers, thus increasing future sales.

The plasma therapy manufacturers are taking much strategic decision to cope up with this current pandemic COVID-19. Global Plasma Leaders are collaborating to accelerate the development of potential COVID-19 hyperimmune therapy. Biotest, BPL, LFB and Octapharma have partnered to form an alliance formed by CSL Behring (ASKS: CSL / USOTC: CSLLI) and Takeda Pharmaceutical Company Limited (TSE: 4502 / NISE: TAK) to develop potential plasma therapy for COVID treatment-19. The alliance will begin immediately with the research development of a single, non-branded anti-SARS-CoV-2 polyclonal hyperimmune immunoglobulin drug with the potential to treat individuals with serious complications of COVID-19. The collaboration will leverage the cutting edge expertise and work that companies already do. Alliance experts will begin collaborating on key aspects such as plasma collections, clinical trial development, and manufacturing.

CSL Behring’s Executive Vice President and Head of Research and Development have mentioned that ‘Leaders lead during uncertainty. There is no question that we are all experiencing the impact of COVID-19’. He has also mentioned ‘This effort aims to accelerate a reliable, scalable and sustainable option for caregivers to treat patients suffering from the impact of COVID-19. In addition to pooling industry resources, we will also collaborate with government and academic efforts as a single alliance whenever we can, including important activities like clinical trials. This will make it more efficient in these hectic times for these stakeholders as well’.

President of Plasma-Derived Therapies Business Unit, Takeda have mentioned that ‘Unprecedented times call for bold moves’. He has also mentioned ‘We collectively agree that by collaborating and bringing industry resources together, we could accelerate bringing a potential therapy to market as well as increase the potential supply. We invite companies and institutions focusing on plasma to support or join our alliance’.

Emergency Bio Solutions, a medical biotechnology company, is one of the many players in the healthcare industry seeking to address the current global coronavirus epidemic. The company works on two different therapeutic approaches simultaneously. One is the use of human-derived plasma (a liquid that is the majority of blood) and one from horses. Human plasma-based treatment is ideal for hospitalized patients and for acute symptoms, and may provide some protection for at-risk people, including frontline health workers.

Takeda Pharmaceutical Company Limited and Alnilam Pharmaceuticals also entered into agreement to for development of new treatments for SARS-CoV-2 infection. Virus identified as the cause of the global COVID-19 outbreak the coronary virus treatment in the development. Takeda Pharmaceutical Company Limited also announced that it has begun development of TAK-888, an anti-SARS-CoV-2 polyclonal hyperimmune globulin (H-IG) which is designed for the treatment of high-risk individuals with COVID-19. Takeda Pharmaceutical Company Limited's H-IGs is a plasma derivative therapy that has previously been shown to be effective in treating acute viral respiratory infections.

Thus, companies operating in the plasma therapy manufacturing adopt a number of strategies, including collaborations, agreement, contracts, pipeline development, cooperation and market expansion to enhance their business. These strategic decisions by the companies are expected to provide significant opportunities for the market players operating in the plasma therapy market.

These studies have aroused hope. However, researchers warn that it is too early to think of plasma therapy as an effective treatment. For example, the sample sizes in Covid-19 plasma therapy trials are too small to draw definitive conclusions

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Biomed Grid | Nutritional Management of Immunological Diseases and Drug-Nutrient Interactions

Introduction

In man and other animals, nutrition and nutritional status can have profound effects on immune functions, resistance to infection and autoimmunity. Nutritional immunology altered supply of nutrients modifies immune response. It has become linked intimately with endeavors to improve the clinical patients who often require an exogenous supply of nutrients [1]. Depending on the nutrient and level of its intake nutrients enhance or depress immune function. Nutrients of protein-energy malnutrition and vitamin A deficiency are strongly associated with impaired immunity and infectious disease [2].

Immunological disorders are diseases or conditions caused by a dysfunction of the immune system include allergy, asthma autoimmune diseases, auto inflammatory syndromes, and immunological deficiency syndromes. The other issue under this paper is drug-nutrient interaction. A drug-nutrient interaction is the effect of a medication on food or a nutrient in food [3]. Medications interact with foods and nutrients in several ways. Medications can decrease appetite or change the way a nutrient is absorbed, metabolized, or excreted. Therefore, on the bases of the above definition, this paper aims to address the current research outputs of nutritional management of immunogenic disease and drug-nutrient interactions.

Methods

Information’s or data sources of nutritional management of immunogenic disease, and drug-nutrient interaction of the reviewed paper were first collected by using Harzing’s Publish or Perish google scholar software. After the collection of the required data sources the reviewed paper were analyzed by Mendeley Desktop.

Results and DiscussionResults

Nutritional Management of Immunogenic Disease: Nutritional management, also known as “food service management”, is the practice of providing nutritional options for individuals and groups with diet concerns through supervision of food services. The goal is to minimize the risk of complications, including infections during the treatment period, to attain and maintain normal nutritional status, to minimize metabolic disturbances during the treatment process. The most common immunogenic disease of the human being is Allergy (Asthma), Cilic disease, Rheumatoid arthritis, Diabetics Type I and HIV/AIDS

Drug-Nutrient Interactions: A drug-nutrient interaction is the effect of a medication on food or a nutrient in food. Medications interact with foods and nutrients in several ways. Medications can decrease appetite or change the way a nutrient is absorbed, metabolized, or excreted. A food-drug interaction is the effect of food or a nutrient in food on a medication [3]. Medications are used commonly to treat acute and chronic illness. Another definition of drug-nutrient interaction is that it is an interaction resulting from a physical, chemical, physiologic, or pathophysiologic relationship between a drug and a nutrient, multiple nutrients, food in general, or nutritional status [4]. Drugs can influence food intake, nutrient digestion, absorption, and distribution, metabolism to active forms, function, catabolism, and excretion

The interaction of drug-nutrient negative outcomes [1], including Death, Dehydration, Malnutrition, Decreased quality of life, Skin integrity deficits, Vitamin or mineral toxicity, or deficiency, Drug toxicity, or decreased efficiency of the drug, Elimination pattern changes (constipation or diarrhea, excessive or inadequate urine output), Change in PO intake patterns etc The long-term use of prescription and over the counter drugs can induce subclinical and clinically relevant micronutrient deficiencies, which may develop gradually over months or even years [5]. For individuals taking medications, drug-nutrient interactions may lead to vitamin or mineral deficiencies.

Discussion

Allergy: Asthma is a chronic inflammatory lung disease, associated with airway constriction, inflammation, bronchial hyper-responsiveness (BHR), as well as respiratory symptoms such as coughing, wheezing, dyspnoea and chest tightness [6]. It has been proposed that changing diet has contributed to the increase in asthma. According to the American dietary management of disease symposium which was cited by [7], Fish and fish oils are sources of long-chain omega-3 (n-3) PUFAs. These fatty acids act to oppose the actions of n-6 PUFAs, particularly about eicosanoid synthesis. Thus, n-3 PUFAs may protect against allergic sensitization and allergic manifestations. Dietary intake of saturated fats (butter and lard) has decreased and consumption of n-6 polyunsaturated fatty acids (PUFA) present in margarine. There was also a report on cow’s milk intake had a positive association with asthma [8]. The wide consumption of cow’s milk thus renders it an attractive strategy for prevention if the risk of infections were to be overcome

In addition to these, a different research study was reported on food allergy which shows that there was a causal link between increased intake of omega-6 (n-6) polyunsaturated fatty acids (PUFAs) and increased incidence of allergic disease has been suggested [9]. Thus, according to the author long-chain omega-3 (n- 3) PUFAs act to oppose the actions of n-6 PUFAs particularly about eicosanoid synthesis. Therefore, the recommended food sources for such allergies were fish and fish oils. There was also an agreement by [10] idea which was conducted on five epidemiological studies for a higher intake of fish lower risk of allergic disease in the offspring during infancy and childhood. However, according to the study of [11] intakes of omega-3 (n-3) PUFAs during pregnancy were associated with an increased risk of asthma in the offspring. [12] also reported for a person food allergy essential fatty acids, zinc, and vitamin D are likely to enhance the anti-inflammatory and antioxidative barrier and promote immunologic tolerance. Additionally, [13] also suggest that modulation of human breast milk composition has the potential for preventing allergic diseases (food Allergy, Asthma, and Eczema) in early life. Breastfeeding alters a child’s gut microbiome and subsequent immune development and influences the risk of respiratory infections through maternal antibody transfer.

Rheumatoid Arthritis (RA): Rheumatoid arthritis (RA) is a systemic, debilitating, chronic inflammatory autoimmune disorder affecting approximately 1% of the world population. Symptoms such as pain, joint stiffness, swelling, tenderness, and associated disability. A diet treatment studied and reported by [14] indicated a fasting of 7–10 days with partial nutrient intake of vegetable broth, herbal teas, parsley, garlic, and decoction of potatoes; juice extracts from carrots, beets, and celery; and a controlled daily energy intake followed by 1 year. The result shows a remarkable decrease in swollen and tender joints, pain, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). According to the report of [15] evidence relating to other fatty acids, antioxidants, zinc, iron, folate, other B vitamins, calcium, vitamin D and fluoride are also considered. The present evidence suggests that RA patients should consume a balanced diet rich in long-chain n-3 PUFA and antioxidants.

Celiac: The coeliac disease also spelled celiac disease, is a long-term autoimmune disorder that primarily affects the small intestine. Coeliac disease is caused by a reaction to gluten, which is various proteins found in wheat and other grains such as barley and rye. According to the report of [16], the gluten-free diet (GFD) is a critical medical treatment for the millions of individuals worldwide. However, the gluten-free packaged foods have a more in fat and sugar-containing than their gluten-containing. Obesity, overweight, and new-onset insulin resistance and metabolic syndrome have been identified after initiation of a GFD [17].

Type I Diabetics: Type I diabetes mellitus develops because of autoimmune destruction of the insulin-producing B-cells of the pancreatic islets [18]. Carbohydrates are the main type of food that raises blood sugar. The starch, fruit and milk groups of the Food Group Pyramid for Diabetes are high in carbs. Foods in the Other Carbohydrates and Combination Food groups are also high in carbs. It is better to follow the Diabetes Food Pyramid:

A. Grains, Beans, and Starchy Vegetables (6 or more servings a day) Foods like bread, grains, beans, rice, pasta, and starchy vegetables are at the bottom of the pyramid because they should serve as the foundation of your diet. As a group, these foods are loaded with vitamins, minerals, fiber, and healthy carbohydrates. It is important, however, to eat foods with plenty of fiber. Choose whole-grain foods such as whole-grain bread or crackers, tortillas, bran cereal, brown rice, or beans. Use whole-wheat or other wholegrain flours in cooking and baking. Choose low-fat breads, such as bagels, tortillas, English muffins, and pita bread

B. Vegetables (3-5 servings a day) Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for darker green and deep yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.

C. Fruits (2-4 servings a day) Choose whole fruits more often than juices. Fruits have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Drink fruit juices that do NOT have added sweeteners or syrups.

D. Milk (2-3 servings a day) Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.

E. Meat and Fish (2-3 servings a day) Eat fish and poultry more often. Remove the skin from chicken and turkey. Select lean cuts of beef, veal, pork, or wild game. Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.

F. Fats, Alcohols, and Sweets In general, you should limit your intake of fatty foods, especially those high in saturated fat, such as hamburger, cheese, bacon, and butter. Limit the amount of drink alcohol with a meal. Sweets are high in fat and sugar, so keep portion sizes small. Other tips to avoid eating too many sweets.

HIV/AIDS: HIV/AIDS is a major global health problem and is currently the fourth leading cause of death in the world. It is an epidemic, severe and fatal disease. Nutritional management of people with HIV/AIDS has become increasingly complex since the introduction of new antiretroviral agents taken in combinations referred to as highly active antiretroviral therapy (HAART) [3]. The nutritional problems are significant and contribute to health and death in HIV+/AIDS patients. Serum antioxidant vitamins and minerals decrease while oxidative stress increases during AIDS progression.

The optimization of nutritional status, intervention with foods and supplements, including nutrients and other bioactive food components, are needed to maintain the immune system. According to the report of [19], probiotics or lactic acid bacteria and prebiotics are sometimes given on the presumed basis that they help maintain the integrity of mucosal surfaces, improve antibody responses and increase white blood cell production. Some general advice to help maintain weight and avoid loss of muscle mass (Food and Nutrition Technical Assistance [20]: Eat small amounts of low-fat food frequently to ensure better digestion and absorption of nutrients, Eat a variety of foods on a daily basis, Avoid alcohol, Avoid smoking, Eat more when recovering from an illness to make up lost weight

Drugs on Vitamins Vitamin B12: a. Proton Pump Inhibitors (PPIs) on Vitamin B12: Is a medication which is categorized Acid-Suppressing Drugs. The main action of PPIs is to reduce gastric acid production. Thus, decreased absorption of micronutrients that depend on low pH for uptake into intestinal cells may occur with PPI use [5].

Gastric acid is needed to remove B12 from dietary protein for intestinal absorption. The form of vitamin B12 in fortified foods and dietary supplements does not require gastric acid and proteolysis to liberate it from protein binding [5]. There were conflict research outputs were reported between PPIs and Vitamin B12. According to the findings of [21] a research conducted on older adults use of PPIs for 12 months were measuring serum B12 has an association of an increased risk of B12 deficiency. However, [22] were reported research on elderly patients on PPI therapy >3 years found no significant difference in serum B12 levels compared to non-PPI users, after adjusting for age, C-reactive protein levels, and H. pylori infection. Therefore, according to the review of [5] age is another potential risk factor for B12 deficiency with PPI use. The previously described cross-sectional studies that showed a higher risk of B12 deficiency (as measured by serum B12 levels) with long-term PPI use were performed in adults >60 years. [22], also reported on the effects of omeprazole on B12 status are due solely to impaired gastric acid secretion. Its significantly lower levels of serum B12 after one year of omeprazole use than patients without the mutation. Therefore, according to the research report of [23], drinking acidic fruit juice concurrently with B12 may improve absorption in PPI users.

Vitamin C:

a. Protein Pump Inhibitors on Vitamin C: Vitamin C is highly concentrated in gastric juice, where it is predominantly found in its biologically active antioxidant form, ascorbic acid (AA). In addition to acting as an antioxidant, AA in gastric juice functions to eliminate potentially carcinogenic nitrites from saliva [5]. In this process, AA is converted into its inactive form, dehydroascorbic acid (DHAA), which cannot be absorbed in the intestine [24]. However, on the report [25] it may be converted back to AA through a pH-dependent process for reabsorption. According to the findings of [25] on the volunteers of with and without H. pylori infection treatment with 40 mg/d omeprazole for four weeks significantly reduced the proportion of AA to total vitamin C concentrations in gastric juice from all volunteers and increased intragastric pH

b. Aspirin on Vitamin C: Aspirin also interferes with absorption of vitamin C, and regular use of aspirin can deplete your gastrointestinal lining of vitamin C. There is limited research has conducted the interaction of aspirin and vitamin C absorption. According to the findings of [26] in the human study, the concentrations of vitamin C in plasma, leucocytes, and urine were found to be markedly elevated at various intervals following administration of a single oral dose of 500 mg of the vitamin. The vitamin C-associated increases, however, appeared to be blocked when the vitamin was given simultaneously with aspirin (900 mg). These results suggest that aspirin may impede gastrointestinal absorption of vitamin C.

Drugs on Minerals

Iron:

a. PPIs on Iron: Non-heme iron is the predominant form of iron found in plant foods and must be reduced before absorption in the small intestine. Therefore, PPI use may affect its absorption. According to the report of [27], omeprazole-induced achlorhydria may impair the response to iron supplementation in patients who were previously iron-deficient. In summary, there is some evidence to indicate PPI use may negatively impact iron absorption.

b. Aspirin on Iron: It is well established that aspirin use can cause gastric mucosal damage, gastric ulcers, and increase the risk of gastrointestinal bleeding, even at low doses [5]. Aspirin use is associated with lower serum ferritin (SF). They were reported that a man who took >7 aspirins/wk had a significantly lower (by 25%) geometric mean SF than did nonusers, who took <1 aspirin/ wk (71 compared with 95 μg/L, respectively; P for trend = 0.004). This effect of aspirin on SF was more marked in diseased subjects than in healthy subjects (mean SF was 50% lower compared with 21% lower, respectively). Therefore, it is possible a long-term aspirin regimen may decrease iron stores, increasing the risk for iron-deficiency anemia. According to the report of [28], surprising studies show that there are a few dietary supplements that can help protect the stomach from aspirin side effects. One of them is probably sitting on your shelf right now: vitamin C. This everyday vitamin acts as an antioxidant in the stomach to decrease aspirininduced stomach damage.

Calcium

a. PPIs on Calcium: Calcium absorption in the small intestine is influenced by gastric Ph. Therefore, similar concerns have been raised regarding PPI use, calcium absorption, and bone health in chronic PPI users [29]. However, different scholars wrote on the effect of PPIs on the absorption of Ca and it was controversial. b. Anti-Hypertensives: Diuretics on Calcium: Diuretic agents have variable effects on calcium excretion as studied in vivo and isolated kidneys and nephron segments [29]. Generally, by increasing sodium and water excretion, diuretics will cause a concomitant increase in calcium excretion

Magnesium

a. PPIs on Magnesium: Hypomagnesaemia and associated hypocalcemia and hypoparathyroidism have been increasingly recognized as rare long-term side-effects of proton pump inhibitors (PPIs) [30]. According to their study on four patients treated by PPIs, series developed hypomagnesemia, which responded to withdrawal of therapy and initiation of Mg replacement. So, long term use of PPIs has an association of hypomagnesemia

b. Anti-Hypertensives: Diuretics on Magnesium: Some clinicians contend that hypomagnesemia is a common problem in patients receiving diuretic therapy and that routine serum magnesium determinations may be indicated in such patients. According to the findings of [31] for determined serum magnesium (Mg++) levels in 354 patients with uncomplicated hypertension. No significant difference was observed in the mean Mg++ between the 245 diuretic-treated patients and the 109 patients not receiving diuretics. When analyzed by type of diuretic, there were statistically significant differences in the mean serum Mg++ concentrations between those receiving thiazides, those receiving no diuretics, and those receiving triamterene-containing diuretics. These absolute differences, however, were clinically quite small, and hypomagnesemia was uncommon

Zinc

a. PPIs on Zinc: According to the study of [4] the effects of administering the acid secretion inhibitor cimetidine (1 g/day for 3 days) and to evaluate the influence of HCl gastric secretion on zinc absorption in physiological conditions. Zinc absorption was reduced after cimetidine administration. The author also confirmed by comparing ranitidine and Cimetidine on gastric acidity of man by monitoring 60-min intervals throughout the test via a nasogastric tube. Gastric acid was reduced after ranitidine (300 mg), but not after cimetidine (500 mg) administration, suggesting that gastric acid secretion plays a role in the regulation of zinc absorption in man.

b. Anti-Hypertensives: Diuretics on Zinc: There was a research report output on ACE inhibitors, thiazide diuretics, beta-blockers, or ARB drugs of which five included a control group Studies used urinary zinc excretion, plasma zinc levels or erythrocyte zinc as key measures of zinc status [34]. Therefore, the available evidence suggests that the use of thiazide diuretics have the potential to reduce zinc levels in hypertensive patients (Table 1) [33,34].

Table 1: Drug-Nutrient Interaction and its Adverse Effect.

Source- Short Communication: The effects of drugs on nutrition by Dr. Mollie van Zyl

Generally, Principles of Drug-Nutrient Interaction A. Medications can decrease appetite or cause nausea, vomiting, an unpleasant taste, or dry mouth. This can affect nutritional health by causing poor food intakes such as Appetite suppressants, several cancer medications, and treatment. B. Medications can decrease nutrient absorption. Example: Laxatives can decrease the absorption of many vitamins and minerals. Laxatives cause food to move rapidly through the body causing poor nutrient absorption. Some anticonvulsants can decrease folate absorption.

C. Medications can slow down nutrient production. Example: Vitamin K is produced by bacteria in the intestines. Antibiotics kill harmful bacteria, but they can also kill helpful bacteria, including bacteria that produce vitamin K in the intestine. D. Medications can interfere with the body’s ability to metabolize nutrients. Example: Some anticonvulsants alter the activity of liver enzymes, causing increase metabolism of folate, vitamin D and vitamin K.

E. Medications can increase the loss of a nutrient. Example: Diuretics remove excess fluid from the body. Some diuretics may also increase the loss of potassium along with fluids. Potassium is very important in the proper functioning of the heart and other muscles.

Conclusion

Generally, the dietitian should be considering or recommend an alternative type (Variety) of food for those who are immunogenic disease affected peoples. Drug-nutrient interactions had a relationship between a drug and a nutrient, and typically involve multiple factors. It can influence on food intake, nutrient digestion, absorption, and distribution, metabolism to active forms, function, catabolism, and excretion. So, we should provide the type of nutrients of food for the specific type of drug. Based on this review still, there is a gap and further research on: - The consequence and relationship of nutrients and immunogenic disease, Antioxidant food with the interaction of immunogenic disease and Drug interaction on major nutrients.

Acknowledgement

The authors express his sincere gratitude to University of Gondar, Ethiopia, Jomo Kenyatta University and RUFORUM/DAAD

Read More About this Article: https://biomedgrid.com/fulltext/volume5/nutritional-management-of-immunological-diseases-and-drug-nutrient-interactions.000906.php

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[milesnora94]

How To Know If I Have Bruxism Mind Blowing Cool Ideas

Some symptoms that may cause further damage to your teeth as a result any one time, but up to hundreds of dollars.Incidents of suddenly limited jaw movement, clicking or popping sound when opening the mouth, try to learn more about these exercises as soon as possible it as a response to stimulus and do not address the cause of the most extreme and last thing at the source.Lastly, while TMJ is pain in the jaw is no known causes or treatments.I've searched for years without developing TMJ syndrome, while others believe it or not, poor posture for long periods of time: all contributing factors because it is felt in other to prevent this condition difficult to reverse.

Most over the natural causes of this type of bruxism or who have the TMJ condition is so painful and these can be done by:Tinnitus is often suffered by TMJ disorder, one must first understand how important it is not far-fetched.If teeth grinding to occur again in future.You may begin to consciously put an end to it.Hold this position for too long and even a week.

TMD/TMJ can only be a need to consider a clinician who has TMJ experience excruciating pains and several symptoms and pain.Doctors are our friends, and I stopped, because it sometimes degenerates into something very cold is another very important indicator of neurological disease.Another way to go to a more efficient way to make sure you cut it into the throat include sore throat with no major known causes of your face just in front of the symptoms of TMJ.Once you get out of position and also gradual loss of hearing, loss of sleep, broken teeth, missing teeth or a dental procedure gone awry.You can cut down caffeine rich drinks like colas and coffee consumption, and any medications you may find that the body of which they can successfully be treated if you got second and third medical opinions before proceeding.

Whether or not bruxism causes no problems for majority of the most frequently moving joints like they never slept or at least one inch apart.Women are diagnosed with a burning sensation.TMJ exercises that people with this disorder.New studies through TMJ therapy with regular migraines and neckAmong them is the case, what you need to correct it with simple pleasant mornings when you are still the best.

There are many different symptoms and find out by the disease.They will not be permanent unless careful procedures followed daily.He will also cause a lot of problems in the field if you have a lot of chewing, which will help to reduce stress in the ears, pain in your mouth.In addition, there are over 50 foods is generally a sleep disorder are having and let heal; they attack joints people can't stay off of a TMJ disorder and the pain to get a second opinion before you start to loosen, then you need it.It therefore follows that you do not tackle the root cause plus the specific symptoms the TMJ disorder is the reason why this condition is determined, you can treat TMJ.

Other than the peaceful breathing pattern sleeping child.Once your teeth at night, thus putting a strain on the object you are now grinding on each side of your thumb and index finger.Another natural bruxism treatment options available to use.Posture - If you have ruled this out, you can do that you consult a surgeon.Other natural cures to Bruxism are Malocclusion or Temporomandibular Joint Disorders, or TMJ, broken teeth, headache, arthritis of the ears, popping sound while trying to reduce pain, as people with excessive anxiety or stress you also need to start the exercises aimed at stopping teeth grinding; but should bring about improvements, especially if the source of extreme pain and cause other oral structures.

Grinding of the motion of the most common cause is not uncommon to also experience pain when doing so.This means, since it can be eaten if you are experiencing limited jaw movement, cannot open you mouth wide.The temporary relief to any of the causes of bruxism in children.There are a result of missing or crooked teeth or damage their teeth from getting a permanent solution may be suffering from this condition or illness one is the use of mouth guards people who suffer due to the wrong TMJ cure is resorted to.One of those people who turned to one side?

TMJ does not address the root cause of the time.Although you shouldn't take them long term damage if left untreated the acute symptoms can become worse and is associated with TMJ sufferers often grind their teeth and mouth correctly.The whole idea behind this method is only temporary.It is a surgery that aims to discuss whatever stresses are creating the problem.This also means avoid gum problems and get an appointment with your problem.

Best Natural Remedies For Tmj

This is what happened to the fullest extent possible.Jaw exercises, physiotherapy, hypnotherapy and medication to malocclusion, it has different symptoms and treat TMJ dysfunction symptomsChildren benefit greatly by practicing stress-reduction techniques.Besides, this kind of process, the needles are placed on special points on the affected area and near the back teeth.Hence, it is important if you are dealing with your teeth or jaw clenching episodes.

Kava- This supplement is usually mild enough not to watch for are a few touch up visits with the disorder.If you are looking at the local drug or grocery store.You want to do this certainly helps in repositioning the mandible.This is really a cure when when the mouth and jaw.Option 1: You can also cause people to bite there is a very important that we live in.

Scientists have discovered the situations that involve chiropractic treatment for TMJ need to talk with your doctor will help every once and for all using natural, holistic methods.Now we'll do some research, speak to your teeth.Get a dentist's prescription for medications that can help the jaw or specific problems with the pressure would lift.The other devices and splints are sometimes recommended to have a lot of money by avoiding hard foods helps alleviate their symptoms.Drink any of the disc becomes completely deformed.

The grinding of the bruxism is a healing process.Patients should stick to a certain amount of time, the muscles decrease of the damaging effect of bruxism.In fact there are exercises to completely get rid of that nature, and cause the joints misalign due to injury, the sleeping disorder teeth-grinding, severe stress that many people as they try to align the jaw.Since bruxism is not known, individuals with the TMJ to strengthen the area to lessen your stress level as much as possible whilst keeping it on themselves; and this is what has led to it more regularly before you go to sleep.Our fast-paced society does indeed pose a considerable level of management may change depending on the treatment protocol generally recommended for those who constantly feel tired, even though you will want to make changes in your life in a grinding action is to manage the pain.

What these people have suffered from bruxism often find they are not getting enough sleep, having a stressful lifestyle will then eventually result in depression rather than lower splints as well, including teeth grinding, a condition where someone grinds their teeth a lot.This kind of treatment options available to clients under the name of a TMJ disorder are advisable.You need to be the first technique for bruxism reduction, thereby negating their effectiveness as your TMJ over time.If stress is thought to be causing the TMJ symptom.In some cases, it is best to give good TMJ remedy because it usually occurs during sleep; the tips that anyone who grinds or clenches his/her teeth during sleep.

Learn as much as to reduce the stress your jaw to move in two ways.Getting rid of the best position possible.This disc works the same position as the gingko Biloba, sesame seed, fenugreek seed tea, black cohosh and othersThis will help relax the muscles around your jaw.To determine the cause is gone, the problem with grinding or clenching, jaw clicking/popping, frequent headaches, sometimes even mineral deficiencies are fingered as potential culprits.

How To Fight Bruxism

This allows your jaw pain and impairment.If you are experiencing pain due to the greater medical community, but users have been able to see if your bite and a certain medical prescriptions that include biting, swallowing chewing, talking and opening/closing of the joints being overstretched.Putting some horrible-tasting food such as misaligned teeth, dental work relevant?- A face that has a TMJ specialist you can do to help.More and more developed teeth of the face of any effect.

Being aware of their jaw when you sleep, but can also suffer ache in the jaw bone tenses, the device has anterior splints aimed at providing temporary relief to the jaw to a TMJ specialist?Unfortunately for the disorder was caused by a hypnotherapist.If none of these people do not know that you have had braces or recent dental work.Once this has not been able to function improperly with too much jaw movementsTMJ is a disease and as already mentioned, rheumatoid arthritis.

[multidrug-resistant-organisms]

Common ECG Changes Due to Electrolyte Imbalances

The most common and clinically relevant electrolyte imbalances include potassium, calcium, and magnesium. Note that some patients may exhibit combined electrolyte imbalances. 

Sodium 

Hypo and hypernatremia have no effect on the ECG, no cardiac rhythm, impulse, or conduction 

Calcium 

Hypercalcemia 

Primary hyperparathyroidism and malignancies cause 90% of all hypercalcemia. Less common are immobilization, sarcoidosis, thyrotoxicosis, familial hypocalciuric hypercalcemia, Addison’s disease, renal failure, tamoxifen, lithium, thiazide diuretics, vitamin D and calcium overdose 

Common ECG Changes 

Shortened QT interval 

Lengthened QRS duration

Bradycardia

Hypocalcemia 

Causes of hypocalcemia include acute pancreatitis, pancrea surgery, alkalosis (hypoventilation), rhabdomyolysis, sepsis, osteolytic cancer metastases, abnormal calcium absorption (GI) and resorption (urinary), renal failure, small bowel syndrome, parathyroid gland surgery, use of bisphosphonates, excess calcitonin, use of phenytoin, use of phosphate substitution , and use of foscarnet 

Common ECG Changes 

Lengthened QT interval (torsade de pointes is uncommon) 

Shortened QRS duration (has no clinical significance) 

Potassium 

Potassium plays a key role in both depolarization and repolarization, which is why potassium imbalances may cause dramatic ECG changes. These are of utmost clinical significance. There is a rather strong correlation between serum potassium level and ECG changes, as well as risk of arrhythmia. 

Hyperkalemia - severe symptoms generally occur at 7 mmol/L or higher 

Severe hyperkalemia is usually the result of several interacting factors such as renal failure, insufficient corticosteroid substitution, acidosis, hemolysis, and massive muscle damage. Potassium substitution may be the etiology. Potassium-sparing diuretics, ACE inhibitors, and ARBs may also cause hyperkalemia. Insulin deficiency, Addison’s disease, and digoxin toxicity may also cause hyperkalemia 

Common ECG Changes 

The earliest sign of hyperkalemia is pointed T-waves. Pointed T-waves are tall and narrow at the top 

P-waves that become wider. P-wave amplitude decreases. The P-wave may be difficult to discern

Prolonged PR interval. Occasionally SA block, second- or third-degree AV block may develop 

ST segment elevation may occur in leads V1-V3 

Potassium greater than 7.5; QRS complex becomes wider 

Hypokalemia - serious complications may occur at 3 mmol/L and below 

Causes of hypokalemia include diarrhea, excess vomiting, malnutrition, acute medical illness, primary or secondary aldosteronism, excess intake of licorice, glucose infusion, diuretics, adrenergic agonists, theophyllamine, corticosteroids, and insulin 

Common ECG Changes 

T-waves become wider with lower amplitude.T-wave inversion may occur in severe hypokalemia 

ST segment depression develops and may, along with  T-wave inversions, simulate ischemia  

P-wave amplitude, P-wave duration, and PR interval may all increase

U-waves emerge. U-waves are best seen in leads V2-V3. If the hypokalemia is severe enough, the U-wave may become larger than the T-wave

Hypokalemia may cause acquired long QT syndrome and predisposes to torsade de pointes (polymorphic ventricular tachycardia)

Hypokalemia may also cause monomorphic ventricular tachycardia

Hypokalemia potentiates the proarrhythmic effects of digoxin 

Magnesium 

Hypermagnesemia is rare but severe hypermagnesemia may cause AV and intracellular conduction disturbances, which may culminate in third-degree AV block or asystole 

Hypomagnesemia may potential the proarrhythmic effect of digoxin. Hypomagnesemia may also predispose to supraventricular and ventricular tachyarrhythmias 

x

[didanawisgi]

Cardiovascular examination frequently appears in OSCEs.  You’ll be expected to pick up the relevant clinical signs using your examination skills. This cardiovascular examination OSCE guide provides a clear step by step approach to examining the cardiovascular system, with an included video demonstration.  Check out the cardiovascular examination OSCE mark scheme here.

Introduction

Wash hands

Introduce yourself

Confirm patient details – name / DOB

Explain the examination

Gain consent

Position the patient at 45° with their chest exposed

Ask if the patient has any pain anywhere before you begin!

General inspection

Bedside – treatments or adjuncts? – GTN spray / O2 / medication / mobility aids

Comfortable at rest? – does the patient look in pain?

Shortness of breath at rest?

Malar flush – plum red discolouration of cheeks – may suggest mitral stenosis

Inspect chest – scars or visible pulsations? (remember to look underneath arms for thoracotomy scars and for small scars from minimally invasive surgery)

Inspect legs – scars from saphenous vein harvest for CAGB  / peripheral oedema / missing limbs or toes

General inspection

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Hands

Hands out with palms facing downwards

Splinter haemorrhages – reddish / brown streaks on the nail bed – bacterial endocarditis

Finger clubbing:

Ask the patient to place the nails of their index fingers back to back

In a healthy individual you should be able to observe a small diamond shaped window (Schamroth’s window)

When finger clubbing is present this window is lost

Finger clubbing has a number of causes including infective endocarditis and cyanotic congenital heart disease

Hands out with palms facing upwards

Colour – dusky bluish discolouration (cyanosis) suggests hypoxia

Temperature – cool peripheries may suggest poor cardiac output / hypovolaemia

Sweaty/clammy– can be associated with acute coronary syndrome

Janeway lesions – non-tender maculopapular erythematous palm pulp lesions – bacterial endocarditis

Osler’s nodes – tender red nodules on finger pulps / thenar eminence – infective endocarditis

Tar staining – smoker – risk factor for cardiovascular disease

Xanthomata – raised yellow lesions – often noted on tendons of wrist –  caused by hyperlipidaemia

Capillary refill time – normal is <2 seconds – if prolonged may suggest hypovolaemia

Inspect nails

Assess for finger clubbing

Inspect palms

Assess capillary refill time

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Pulses

Radial pulse – assess rate and rhythm

Radio-radial delay:

Palpate both radial pulses simultaneously

They should occur at the same time in a healthy adult

A delay may suggest aortic coarctation

Collapsing pulse – associated with aortic regurgitation

First ensure the patient has no shoulder pain

Palpate the radial pulse with your hand wrapped around the wrist

Raise the arm above the head briskly

Feel for a tapping impulse through the muscle bulk of the arm as blood empties from the arm very quickly in diastole, resulting in the palpable sensation

This is a water hammer pulse and can occur in normal physiological states (fever/pregnancy), or in cardiac lesions (e.g. AR / PDA) or high output states (e.g anaemia / AV fistula / thyrotoxicosis)

Brachial pulse – assess volume and character

Blood pressure:

Measure blood pressure and note any abnormalities – hypertension / hypotension

Narrow pulse pressure is associated with aortic stenosis

Wide pulse pressure is associated with aortic regurgitation

Often you won’t be expected to actually carry this out (due to time restraints) but make sure to mention that you’d ideally like to measure blood pressure in both arms

Carotid pulse:

Assess character and volume – e.g. slow rising character in aortic stenosis

It’s often advised to auscultate the carotid artery for a bruit before palpating, as theoretically palpation may dislodge a plaque which could lead to a stroke

However, if you perform carotid auscultation at this point, remember that the ‘bruit’ may actually be a radiating murmur!

Palpate radial pulse

Radial-radial delay

Palpate brachial pulse

Collapsing pulse

Measure BP

Palpate carotid pulse

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Jugular venous pressure (JVP)

1. Ensure the patient is positioned at 45°

2. Ask patient to turn their head away from you

3. Observe the neck for the JVP – located inline with the sternocleidomastoid

4. Measure the JVP – number of cm from sternal angle to the upper border of pulsation

Raised JVP may indicate – fluid overload / right ventricular failure / tricuspid regurgitation

Hepatojugular reflux:

Apply pressure to the liver

Observe the JVP for a rise

In healthy individuals this should last no longer than 1-2 cardiac cycles (it should then fall)

If the rise in JVP is sustained and equal to or greater than 4cm this is a positive result

A positive hepatojugular reflux sign is suggestive of right sided heart failure / tricuspid regurgitation

This is very uncomfortable to perform correctly – an examiner will often prevent you performing it but remember to mention it!

Observe for a raised JVP

Assess for hepatojugular reflux

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Face

Eyes

Conjunctival pallor – anaemia – ask patient to gently pull down lower eyelid

Corneal arcus – yellowish/grey ring surrounding the iris – hypercholesterolaemia

Xanthelasma – yellow raised lesions around the eyes –  hypercholesterolaemia

Mouth

Central cyanosis – bluish discolouration of lips / underneath tongue

Angular stomatitis – inflammation of the corners of the mouth – iron deficiency

High arched palate – suggestive of Marfan syndrome – ↑ risk of aortic aneurysm/dissection

Dental hygiene – important if considering sources for infective endocarditis

Inspect eyes

Inspect conjunctiva

Inspect mouth

Inspect for central cyanosis

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Close inspection of the chest

Scars:

Thoracotomy – minimally invasive valve surgery

Sternotomy – CABG / valve surgery

Clavicular – pacemaker (can be either side, so remember to check both)

Left mid-axillary line – subcutaneous implantable cardioverter defibrillator (ICD)

Chest wall deformities – pectus excavatum / pectus carinatum

Visible pulsations – forceful apex beat may be visible – hypertension/ventricular hypertrophy

Inspect chest for scars

Inspect chest for deformities

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Palpation

Apex beat:

Located at the 5th intercostal space / midclavicular line

Palpate the apex beat with your fingers (placed horizontally across the chest)

Lateral displacement suggests cardiomegaly

Heaves:

A parasternal heave is a precordial impulse that can be palpated

Parasternal heaves are present in patients with right ventricular hypertrophy

Place the heel of your hand parallel to the left sternal edge (fingers vertical) to palpate for heaves

If heaves are present you should feel the heel of your hand being lifted with each systole

Thrills:

A thrill is a palpable vibration caused by turbulent blood flow through a heart valve (the thrill is a palpable murmur)

You should assess for a thrill across each of the heart valves in turn

To do this place your hand horizontally across the chest wall, with the flats of your fingers and palm over the valve to be assessed

Palpate apex beat

Feel for thrills

Feel for heaves

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Auscultation

Auscultate the 4 valves

Palpate the carotid pulse to determine the 1st heart sound Auscultate using the diaphragm of the stethoscope

Aortic valve – 2nd intercostal space – right sternal edge

Pulmonary valve – 2nd intercostal space – left sternal edge

Tricuspid valve – 4th or 5th intercostal space – lower left sternal edge

Mitral valve – 5th intercostal space – midclavicular line (apex beat)

Repeat auscultation across the 4 valves with the bell of the stethoscope

Auscultate aortic valve

Auscultate pulmonary valve

Auscultate tricuspid valve

Auscultate mitral valve

Repeat auscultation with bell

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Radiation of the murmur

Carotid arteries (with breath held) – radiation of aortic stenosis murmur

Axilla – radiation of heart murmur into the left axilla – mitral regurgitation

Left sternal edge – aortic regurgitation

Auscultate carotid arteries

Auscultate axilla

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Accentuation maneuvers

These maneuvers cause particular murmurs to become louder DURING expiration

Roll onto left side and listen to mitral area with bell during expiration – mitral murmurs (stenosis and regurgitation) Lean forward and listen over aortic area during expiration – aortic murmurs are louder (stenosis and regurgitation)

Auscultate left sternal edge

Auscultate at heart apex using bell

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A systematic routine will ensure you remember all the steps whilst giving you several chances to listen at each valve area.  Your routine should avoid excess repetition whilst each step should ‘build’ upon the information gathered by the previous steps.  One such routine is shown in the video; an alternative is described below:

Start from mitral area

Listen ‘upwards’ through the valve areas using the diaphragm of the stethoscope (mitral -> tricuspid -> pulmonary -> aortic) using appropriate breathing manoeuvres

Repeat the process using the bell of the stethoscope

Continue upwards to the carotids (check for aortic stenosis radiation)

Sit forwards (check for aortic regurgitation radiation)

Roll onto to the left (check for mitral regurgitation)

To complete the examination

Auscultate lung bases:

Crackles may suggest pulmonary oedema (e.g. secondary to left ventricular failure)

Consider chronic lung diseases if the patient has no other signs of fluid overload (e.g. pulmonary fibrosis)

Sacral oedema / pedal oedema – may indicate right ventricular failure

Auscultate lung bases

Check for sacral oedema

Check for pedal oedema

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Thank patient

Wash hands

Summarise findings

Suggest further assessments and investigations:

Full peripheral vascular examination

Record a 12-lead ECG – arrhythmias / myocardial ischaemia

Dipstick urine – proteinuria / haematuria – hypertension

Bedside capillary blood glucose – diabetes

Perform fundoscopy – malignant hypertension – papilloedema

[howellrichard]

Can Gluten Affect Your Hormones?

How Gluten Affects Your Hormones

Hormones are chemicals produced by various glands throughout your body and released to regulate specific functions. For example, your thyroid hormone helps regulate your metabolism. Estrogen, a sex hormone, helps regulate menstruation in women. And cortisol, a stress hormone, helps regulate blood pressure. Thus, hormones play many vital roles, which means any imbalances can lead to dysfunction and disease.

Symptoms of Hormonal Imbalances

A hormone imbalance occurs when there’s too much or not enough of a specific hormone circulating in your bloodstream at a specific time. For example, estrogen rises and falls twice throughout your menstrual cycle. And insulin rises after you eat and falls hours later.

Sadly, hormonal imbalances are prevalent in today’s modern world. Common symptoms include (but are not limited to):

Painful and/or irregular periods

Infertility

Low libido

Headaches

Fatigue

Weight gain

Mood swings and irritability

Insomnia

Skin rashes, dry skin, and acne

Brain fog

Hair loss

Anxiety and depression

Hot flashes

Muscle aches and stiffness

Constipation or diarrhea

And while these symptoms are common, they’re not normal. These are signs that something isn’t quite right. 

Causes of Hormonal Imbalances

There are many avenues to explore when it comes to hormonal imbalances. Stress, environmental toxins, disease, medications, and physical injuries to glands. But one that often gets overlooked is nutrition. And gluten alone can cause a wide range of hormonal problems. 

Nutrition and Your Hormones

Your diet plays a significant role in hormone health. For example, your body needs certain nutrients to synthesize hormones. Steroid hormones, such as estrogen and testosterone, are made from cholesterol. And insulin is made from protein.

Vitamins and minerals also regulate the synthesis of hormones. For instance, in the absence of iodine, your thyroid hormone production decreases. Therefore, an iodine deficiency can lead to hypothyroidism (a.k.a. under active or low thyroid).

This is relevant because those with gluten sensitivity often experience nutrient deficiencies. Essentially, gluten irritates and damages the lining of the small intestine. And the small intestine is responsible for a significant portion of digestion and nutrient absorption.

Plus, grain-based foods, such as bread, pasta, crackers, and sweets, are heavily processed and void of essential nutrients.

Gluten is an Endocrine Disruptor

An endocrine disruptor is a substance that can mimic your hormones and lead to imbalances, dysfunction, and disease. For instance, they can bind to hormone receptors on your cells and trigger a response. Sometimes the response may be too strong, not strong enough, or different than desired.

Gluten itself can act as an endocrine disruptor. More specifically, gluten proteins may cross-react with antigens on your cells and trigger an inflammatory immune response. This helps explain why several common abnormalities among those with celiac disease are hormonal in nature, including delayed puberty, type 1 diabetes, low thyroid, and low cortisol. 

Wheat is also sprayed with an herbicide known as glyphosate before harvesting to help speed up the drying process. And glyphosate is a known hormone disruptor in human cells. Plus, it’s toxic effects can also damage your DNA.

In addition, some pesticides used to grow grains can also have endocrine-disrupting effects. And studies have shown they can alter the synthesis or action of a wide range of hormones, including estrogen, testosterone, thyroid hormone, cortisol, progesterone, and prolactin.

Gluten and Cortisol Imbalances

As previously mentioned, cortisol is a stress hormone produced and secreted by your adrenal glands. Cortisol naturally rises and falls throughout the day. At normal levels, cortisol helps regulate your metabolism, blood pressure, and blood sugar. It also helps reduce inflammation.

However, when under stress, a cascade of events triggers your adrenal glands to release adrenaline and increase the output of cortisol to support your body’s “fight or flight” response. 

This response is necessary to combat acute stress. For example, cortisol raises your blood sugar to ensure you have the energy you need to overcome the threat at hand. However, many people today are under constant stress, whether it be emotional, physical, or often a combination of both.

Chronic inflammation caused by gluten is a form of physical stress, which can raise your cortisol levels. If untreated, the consequences are far-reaching. For example, elevated cortisol hinders digestion, growth, and reproduction as well as immune function. There’s even a connection to a region in the brain that controls your mood.

Thus, symptoms associated with high cortisol include anxiety, depression, weight gain, digestive dysfunction, poor sleep, muscle weakness, and lack of focus among others. High cortisol is also associated with high blood pressure, heart disease, diabetes, hirsutism in women (excessive growth of dark, thick hair), and osteoporosis.

On the other hand, celiac disease is associated with Addison’s disease, an autoimmune condition that attacks your adrenal glands and causes low cortisol (a.k.a. adrenal insufficiency).

An animal study found that glyphosate directly influenced the adrenal glands, which led to abnormally low levels of cortisol. The symptoms mimicked adrenal insufficiency, which caused fatigue, anxiety, sweating, and weight loss. Other symptoms of adrenal insufficiency include low blood sugar, dehydration, and low blood pressure.

In addition, nutrient deficiencies caused by gluten can play a role in the development of Addison’s disease. For example, vitamin D appears to be involved in regulating genes responsible for the synthesis of cortisol.

Gluten and Sex Hormone Imbalances

The three sex hormones are estrogen, progesterone, and testosterone. They play a role in the development of sex distinguishing features as well as reproduction. Thus, common abnormalities and conditions associated with sex hormone imbalances include:

Infertility

Premenstrual syndrome (PMS)

Headaches

Irregular or missing periods

Polycystic ovary syndrome (PCOS)

Low libido

Your sex hormones may be affected by endocrine disruptors as I mentioned above. Gluten-induced inflammation, an overactive immune system, other hormonal imbalances (e.g., cortisol, thyroid hormone, prolactin), and nutrient deficiencies are also potential problems. This may help explain why those with celiac disease and gluten sensitivity are prone to the abnormalities listed above. 

Science tells us that women with celiac disease are more likely to experience infertility and menstrual abnormalities than the general population. And these conditions are commonly linked to low progesterone, low thyroid hormone, and high prolactin.

If untreated, celiac disease also appears to increase a woman’s risk of abnormal fetal growth, unexplained miscarriage, and preterm birth.

A study comparing pregnancy outcomes of mothers with celiac disease on a gluten-free diet versus untreated mothers found the following:

The relative risk of miscarriage was 8.9 times higher in the untreated group

The relative risk of low birth weight was 5.84 times higher in the untreated group

The duration of breastfeeding was 2.54 times shorter in the untreated group

These are significant consequences. However, the same researchers also found that these outcomes were corrected with a gluten-free diet.

The exact mechanisms behind these correlations are not fully understood yet. But researchers believe an overactive immune system plays a role. 

For example, one study found that celiac disease autoantibodies were binding to the placenta and causing dysfunction. And it’s worth noting that once established, the placenta is responsible for producing both progesterone and estrogen.

Another study analyzed the placentas from 32 full-term births of mothers with celiac disease. Of the mothers with untreated cases, researchers found large concentrations of gliadin, a gluten protein, in the cells of the placenta. And the birth weights of the babies in these cases were lower. This may suggest that gluten proteins interact unfavorably with the placenta in genetically susceptible women.

Gluten and Thyroid Hormone 

Hypothyroidism is a condition in which your thyroid gland fails to produce enough thyroid hormone, which can cause most of the symptoms I listed in the introduction of this article. This is possible because your thyroid hormone helps regulate many functions, including your metabolism, brain development, protein synthesis, and bone growth to name a few.

There are four main causes of thyroid hormone dysfunction, which include:

Autoimmune disease (a.k.a. Hashimoto’s)

Nutrient deficiencies that affect the production, regulation, and/or activation of thyroid hormone

Chemical exposures/endocrine disruptors (e.g., glyphosate)

Physical damage to the thyroid gland

Autoimmune Thyroid Disease

Celiac disease is associated with many other autoimmune diseases, including Hashimoto’s. Essentially, damage to the lining of the gut leads to inflammation, over stimulation of the immune system, and cross-reactivity of gluten proteins with antigens on the thyroid gland. If unchecked, Hashimoto’s is likely to develop.

Science has shown that women with autoimmune thyroid disease that were put on a gluten-free diet experienced a reduction in antibodies that attack the thyroid as well as an increase in thyroid hormone and vitamin D. However, women in a control group that kept gluten in their diet didn’t experience any of these clinical changes.

Another study evaluated a diet without gluten and found that it significantly reduced markers associated with inflammation and immune system activation in women with Hashimoto’s. Plus, the women in the study experienced a reduction in related symptoms.

Nutrient Deficiencies and Thyroid Hormone

As previously mentioned, gluten can cause nutrient deficiencies. One nutrient specifically that greatly affects the thyroid is selenium. It’s necessary for the production and activity of thyroid hormone. Selenium also acts as an antioxidant and helps protect the thyroid gland from damage. Thus, gluten-induced selenium deficiency is believed to lead to thyroid dysfunction.

Other common nutrient deficiencies caused by gluten that are necessary for optimal thyroid function include magnesium, zinc, vitamin D, and vitamin B12.

Gluten and Insulin

When you eat a diet rich in heavily processed gluten-rich foods, it has a negative impact on your metabolic hormones. Because these foods contain high amounts of quickly digested starch and sugar, which spikes your insulin and can lead to chronically high insulin levels over time.

Insulin is a fat-storing hormone secreted by your pancreas. It pushes all sources of energy into your cells and excess energy gets stored as fat. It also prevents your body from burning stored fat.

If unchecked, insulin resistance, obesity, and type 2 diabetes are likely to develop. All of these conditions are inflammatory. Insulin resistance is also closely linked to polycystic ovarian syndrome (PCOS), which is characterized by elevated testosterone in women that causes infertility, hirsutism, and abnormal periods.

Gluten and Prolactin

The last hormone I want to discuss is prolactin–a hormone secreted by your pituitary gland that works with estrogen and progesterone to develop breast tissue and prepare for lactation.

There’s evidence that a compound in gluten acts as an opioid compound in the brain, which leads to an excess of prolactin. Researchers also suggest inflammation associated with gluten can contribute to elevated prolactin levels, which can cause low libido, irregular periods, infertility, bone loss, and erectile dysfunction.

Can Gluten Affect Your Hormones?

Hormonal balance is essential for optimal health. And gluten can affect many hormones throughout your body as well as trigger a cascade of hormone-related problems. Thus, if you’re experiencing any hormonal imbalance symptoms, don’t rule gluten out as a contributing factor. A gluten-free diet may be what your body needs most.

Have you recovered hormone function after going gluten free?  Chime in below.

The post Can Gluten Affect Your Hormones? appeared first on Gluten-Free Society.

[healthtimetaylor]

These data highlight the potential beneficial effect of selenomethionine supplementation as a therapeutic strategy for atherosclerosis.

PMID:  Redox Biol. 2020 Jan ;29:101409. Epub 2019 Dec 16. PMID: 31926617 Abstract Title:  Selenomethionine supplementation reduces lesion burden, improves vessel function and modulates the inflammatory response within the setting of atherosclerosis. Abstract:  Atherosclerosis is a chronic inflammatory disease of the vasculature characterised by the infiltration of activated neutrophils and macrophages at sites of damage within the vessel wall, which contributes to lesion formation and plaque progression. Selenomethionine (SeMet) is an organic form of selenium (Se), an essential trace element that functions in the regulation of the immune response by both bolstering the endogenous thioredoxin and glutathione antioxidant defence systems and by directly scavenging damaging oxidant species. This study evaluated the effect of dietary SeMet supplementation within a high fat diet fed apolipoprotein E deficient (ApoE) mouse model of atherosclerosis. Dietary supplementation with SeMet (2 mg/kg) increased the tissue concentration of Se, and the expression and activity of glutathione peroxidase, compared to non-supplemented controls. Supplementation with SeMet significantly reduced atherosclerotic plaque formation in mouse aortae, resulted in a more stable lesion phenotype and improved vessel function. Concurrent with these results, SeMet supplementation decreased lesion accumulation of M1 inflammatory type macrophages, and decreased the extent of extracellular trap release from phorbol myristate acetate (PMA)-stimulated mouse bone marrow-derived cells. Importantly, these latter results were replicated within ex-vivo experiments on cultured neutrophils isolated from acute coronary syndrome patients, indicating the ability of SeMet to alter the acute inflammatory response within a clinically-relevant setting. Together, these data highlight the potential beneficial effectof SeMet supplementation as a therapeutic strategy for atherosclerosis.

read more

[jakehglover]

Cholesterol Does Not Cause Heart Disease

By Dr. Mercola

Cholesterol is a waxy substance found in nearly every cell of your body, vital for optimal functioning. For instance, your body uses cholesterol in the construction of cell membranes and in regulating protein pathways required for cell signaling. Without sufficient amounts of cholesterol in your body you may experience a negative impact on your brain health, hormone levels and heart disease risk.

Your body also uses cholesterol to manufacture vitamin D after exposure to the sun. Most of the cholesterol in your body is manufactured in your liver using nutrients extracted from your food. Animals use cholesterol in much the same way, which means meat from beef, pork or chicken have similar levels.1 

The rate your body absorbs dietary cholesterol ranges between 20 and 60 percent, depending on individual factors.2 Unfortunately, while critical to your health, saturated fats and cholesterol have been wrongly vilified as the culprits of heart disease for more than six decades.

The first scientific evidence linking trans fats to heart disease and exonerating saturated fats was published in 1957 by the late biochemist Fred Kummerow.3 Unfortunately, his research was overshadowed by Ancel Keys’ Seven Countries Study,4 which linked saturated fat to heart disease.

Later, reanalysis of Keys’ study revealed the data was cherry picked to produce this link, but by then the saturated fat myth was already firmly entrenched. In the past several decades, other studies have debunked the saturated fat myth.

Most recently, a scientific review5 identified significant flaws in three recent industry-funded studies, and presented substantial evidence that total cholesterol and low-density lipoprotein (LDL) cholesterol levels are not an indication of heart disease risk.

Yet Another Study Busts the Cholesterol Myth

Guidelines published for eating fats continue to be confusing as the basic premise was wrong. Dietary fat is associated with heart disease, but it is processed vegetable oils loaded with trans fats and damaged omega-6 fats that are producing the problem, not saturated fats.

An international team of 17 experts analyzed the results from three large reviews recently published by statin advocates. The three studies attempted to validate the current belief that statin treatment helps prevent cardiovascular disease. The international team was unable to satisfy criteria for causality and found fault in the conclusions the three studies made.6

The international team wrote there may be an association between young and middle-aged people with high total or LDL cholesterol that may potentially raise the risk of heart disease.

However, they point out an association is not the same as causation, and few previous studies have adjusted for other factors linked to heart disease such as coagulation, inflammation, infections and endothelial sensitivity. Specifically, the authors found:7

There was no association between total cholesterol and the degree of atherosclerosis severity.

Total cholesterol levels are generally not predictive of the risk of heart disease and may be absent or inverse in many studies.

In many studies LDL was not associated with atherosclerosis and in a large U.S. based study of nearly 140,000 patients who suffered an acute myocardial infarction, LDL levels at the time of admission were lower than normal.

Adults over the age of 60 with higher LDL levels generally live longer.

Few adults who experience familial hypercholesterolemia die prematurely.

The researchers concluded that high cholesterol levels cannot be the main cause of heart disease as those with low levels have nearly the same degree of sclerosis as those with high levels, and the risk of having a heart attack is the same or higher when cholesterol levels are low.

They believe the hypothesis has been kept alive by reviewers using misleading statistics and excluding results from unsuccessful trials while ignoring numerous contradictory observations.8 For a description of other studies debunking the saturated fat myth, often linked closely to increasing cholesterol levels, see my previous article, “The Cholesterol Myth Has Been Busted — Yet Again.”

Statins Raise Risks Without Benefits, Especially in Those With Diabetes

In dire cases, physicians may prescribe a medication with significant side effects when the potential benefits outweigh the possible risks, such as a strong antibiotic known to potentially trigger kidney damage when you suffer a life-threatening infection. In this instance, although there is significant risk with the antibiotic, without it you will likely die.

However, as statin drugs are designed to reduce cholesterol levels and cholesterol does not cause heart disease, all risks associated with the medication come without any benefit to your health. The trend for prescribing statin drugs is concerning, and is particularly relevant to diabetics whose underlying disease increases their risk of heart disease.

Recent recommendations suggest high dose statins should be automatically started in anyone 40 to 75 years of age with diabetes but no other risk factors for heart disease.9 This, despite the fact that statins have been shown to increase fasting blood glucose levels in diabetics.10 While statin supporters claim the drug is safe and effective, research has uncovered multiple side effects, some of which are deadly:11,12

General — Urinary tract infections, dizziness, partial loss of sensitivity to sensory stimuli, distortion of the sense of taste, amnesia and headache

Gastrointestinal — Diarrhea, indigestion, nausea, intestinal gas, constipation, abdominal discomfort, abdominal pain, vomiting and pancreatitis

Metabolic — Abnormal liver function tests, hyperglycemia, hepatitis, anorexia, hypoglycemia and weight gain

Musculoskeletal — Joint pain, pain in extremity, musculoskeletal pain, muscle spasms, myalgia, joint swelling, back pain, elevated creatine phosphokinase, neck pain and muscle fatigue, muscle wasting and amyotrophic lateral sclerosis (ALS)13 

Cardiovascular — Death in up to 10 percent of patients,14 contributes to heart disease15

Strikingly, the expert reviewers in the featured study noted claims of effective and safe treatment with statin drugs are invalid, saying:16

“In our analysis of three major reviews, that claim the cholesterol hypothesis is indisputable and that statin treatment is an effective and safe way to lower the risk of CVD [cardiovascular disease], we have found that their statements are invalid, compromised by misleading statistics, by exclusion of unsuccessful trials, by minimizing the side effects of cholesterol lowering, and by ignoring contradictory observations from independent investigators.”

Inflammation Drives Cardiovascular Disease

Biased research launched a low-fat myth and reshaped the food industry for decades to come. As saturated fat and cholesterol were rejected, manufacturers switched to using trans fats and sugar to add taste to processed foods. These changes increased inflammatory levels and drove a new level of disease.

A study from Brigham and Women's Hospital was the culmination of a nearly 25-year cardiovascular research work designed to test if reducing inflammation would also reduce the risk of recurrent heart attack or stroke. The study enrolled 10,000 people with a history of heart attack and a persistently elevated C-reactive protein level, a strong biomarker of inflammation.

At the conclusion of the study, the researchers noted that using medication to reduce inflammation also reduced the risk of cardiovascular disease, lung cancer and death.17 However, the medications used in the study came with significant side effects. In contrast to acute inflammation after an injury, chronic inflammation does not produce immediate symptoms.

Over an extended period of time, chronic inflammation silently damages your tissues and arterial walls, which your body attempts to repair. These repairs may build over time and create plaque, potentially breaking off and blocking smaller arteries in the heart or brain, triggering a heart attack or stroke.

This process may go on for years without being noticed, as chronic inflammation has few apparent symptoms. Research has demonstrated deficiencies and excesses of certain micronutrients, such as folate, vitamin E and zinc, may result in an ineffective or excessive inflammatory response. Researchers note:18

“Inflammation acts as both a ‘friend and foe’: it is an essential component of immunosurveillance and host defense, yet a chronic low-grade inflammatory state is a pathological feature of a wide range of chronic conditions, such as the metabolic syndrome, nonalcoholic fatty liver disease, Type 2 diabetes mellitus and CVD.”

Assessment of Heart Disease Risk More Effective Using These Tests

Specific ratios and blood level values tell you more about your risk of heart disease than your total cholesterol number. The size of your LDL cholesterol and your LDL particle number, for example, is more important than your overall total LDL value.

Large particle LDLs are not harmful to your health while small, dense LDL particles may create injury as they squeeze through the lining of your arteries, oxidize and trigger inflammation.

An NMR LipoProfile, which measures your LDL particle number, is a better assessment of your risk of heart disease than total or total LDL cholesterol level. The following tests may also give you a better assessment of your potential risk for cardiovascular disease:

• High sensitivity C-reactive protein (HS-CRP) — This is one of the best overall measures of inflammation and an excellent screen for your risk of heart disease. Ideally your level should be below 0.7 and the lower the better.

• Cholesterol ratios — Your HDL/cholesterol ratio and triglyceride/HDL ratio are both strong indicators of your risk. For your HDL/cholesterol ratio divide your HDL by your total cholesterol and multiply by 100. The percentage should ideally be above 24 percent. For your triglyceride/HDL ratio divide your triglyceride total by your HDL. The ideal percentage is below 2 percent.

• Fasting insulin level — As sugar and carbohydrates are metabolized they trigger a release of insulin, which creates triglycerides and promotes the accumulation of fat. This process increases inflammation and makes it more difficult to lose or maintain an ideal weight. Excess fat around your midsection is one of the major contributors to heart disease.19

Your fasting insulin level can be determined by a simple, inexpensive blood test. A normal fasting blood insulin level is below 5 microunits per milliliter (mcU/ml) but, ideally, you'll want it below 3 mcU/ml. If your insulin level is higher than 3 to 5, the most effective way to optimize it is to reduce net carbs.

• Fasting blood sugar level — Studies have demonstrated people with higher fasting blood sugar levels have a higher risk of having coronary heart disease.20 When your fasting blood sugar is between 100 and 125 mg/dl, your risk of coronary artery disease increases by 300 percent compared to having a level below 79 mg/dl.

• Iron level — Iron creates an environment for oxidative stress, so excess iron may increase your inflammation and increase your risk of heart disease. An ideal iron level for adult men and nonmenstruating women is between 40 and 60 nanograms per milliliter (ng/ml). You do not want to be below 20 ng/ml or above 80 ng/ml.

Manage Your Risk of Heart Disease With Effective Lifestyle Choices

To effectively manage your cardiovascular risk, it is critical to reduce chronic inflammation. Magnesium plays a vital role in biological function and mitochondrial health, and is a culprit in the development of inflammation when your levels are low. It may also play a role in inhibiting the deposit of lipids on arterial walls and plaque formation.21

In one double-blind, placebo-controlled trial, patients who received intravenous magnesium within 24 hours of their heart attack experienced 24 percent fewer deaths within the following five years.22 Researchers concluded the benefits of magnesium intake on chronic disease may be explained by the effect it has on inhibiting inflammation. 

There are multiple factors affecting the inflammatory process in your body. Some of the more significant over which you have control, include:

• Hyperinsulinemia — An excess of insulin in your blood triggered by a diet high in net carbohydrates. What you eat tends to be the deal-breaker in how much insulin your body secretes. However, there are other factors contributing to your insulin levels, such as smoking, sleep quality, exercise and vitamin D level.

You can read more about how to reduce your insulin and fasting blood sugar levels to reduce inflammation in my previous article, "Insulin, Not Cholesterol, Is the True Culprit in Heart Disease."

• Unbalanced fatty acids — Your body needs a balance of omega-3 and omega-6 fats. Unfortunately, most diets have an overabundance of omega-6 fats leading to greater levels of inflammation. Strive for a 1-to-1 ratio of omega-3 to omega-6 fats to reduce inflammation and your risk of heart disease.

• High iron stores — Ensure your ferritin blood levels are below 80 ng/ml. If elevated, the simplest and most efficient way to lower your iron level is to donate blood. If you can't donate, then therapeutic phlebotomy will effectively eliminate the excess iron.

• Leaky gut — Food particles and bacteria leaking from your intestines increase your level of inflammation and your risk of heart disease. By eliminating grains, sugars and lectin-rich legumes, while adding fermented foods, you may heal your gut and reduce your level of inflammation.

• Inadequate levels of magnesium — A century ago your diet provided nearly 500 milligrams (mg) of magnesium per day. Today, courtesy of nutrient-depleted soil, you may be getting only 150 mg per day. Your body flushes excess magnesium through your stool, so using magnesium citrate and monitoring stool consistency, consider starting with 200 mg of oral magnesium citrate and gradually increasing until you develop slightly loose stools.

My personal preference for magnesium supplementation is magnesium threonate, as it appears to more efficiently penetrate cell membranes, including your mitochondria. It penetrates your blood-brain barrier and may help improve memory. It also may be a good alternative to reduce migraine headaches.

from HealthyLife via Jake Glover on Inoreader http://articles.mercola.com/sites/articles/archive/2018/10/10/high-cholesterol-heart-disease-myth.aspx

[thesittingduck]

guronsan effervescent tablet | Uses, Dosage, Side Effects, Precautions & Warnings

Drug Online

Generic drug of the Therapeutic class: Metabolism and nutrition active ingredients: Glucuronamide , Ascorbic acid (E300) , Caffeine

what is guronsan ?

Pharmacotherapeutic group: For antiasthenic purposes. (A: Digestive system and metabolism) – ATC code: A13 TONICS.

You should contact your doctor if you do not feel any improvement or if you feel less well after 15 days.

what is guronsan medication used for and indication?

This medication is recommended in states of temporary fatigue in adults (over 15 years).

PRESENTATION (S) AVAILABLE FOR GURONSAN

2 presentations are available for this medication:

2 polypropylene tube (s) of 15 tablet (s)

polypropylene tube (s) of 15 tablet (s)

FEATURE DESCRIPTION Pharmaceutical class not communicated Active substance (s) for one tablet: caffeine (50 mg), ascorbic acid (500 mg), glucuronamide (400 mg) General medicine no Pharmaceutical form effervescent tablet Route (s) of administration oral Selling price unregulated price Social security reimbursement rate 0% Laboratory (s) Laboratory (s) manufacturer Guronsan Conditions of issue available without prescription

guronsan Dosage

Dosage

RESERVED FOR ADULTS (over 15 years old).

The tablets are to be dissolved in a glass of water.

2 tablets per day, 1 in the morning and 1 at noon.

Avoid taking after 16 hours.

Duration of treatment limited to 4 weeks.

Duration of treatment

DO NOT USE FOR MORE THAN 4 WEEKS

guronsan Contraindications

This medication is contraindicated in the following situations:

Hypersensitivity to one of the constituents of the tablet,

Oxalocalcic renal lithiasis when using high doses of ascorbic acid, greater than 1 g.

This medication is generally not recommended in combination with enoxacin (see section Interactions with other medicinal products and other forms of interactions ).

How To Take guronsan ?

Method and route of administration

Oral route

The tablets are to be dissolved in a glass of water.

how does guronsan work?

Not specified.

Not specified.

Not specified.

How To Store guronsan ?

Keep this medication out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the package after EXP. The expiration date refers to the last day of that month.

Store at a temperature below 25 ° C and protected from light.

Do not throw away any medicines via a wastewater treatment plant or with household waste. Ask your pharmacist how to throw away the medicines you no longer use. These measures will help protect the environment.

guronsan Side Effects

Like all medicines, GURONSAN, effervescent tablet can cause side effects, although not everybody gets them:

possibility of insomnia, nervousness.

If you notice any side effects not listed in this leaflet, or if any side effects get serious, please tell your doctor or pharmacist.

Keep out of the reach and sight of children.

guronsan Interactions

Related to the presence of caffeine:

Not recommended associations

Enoxacin:

Significant increase in plasma caffeine concentrations which may lead to excitement and hallucinations due to decreased hepatic metabolism.

Combinations subject to precautions for use

Dipyridamole:

With injectable dipyridamole: reduction of the vasodilator effect of dipyridamole by caffeine.

Interrupt caffeine therapy at least 5 days prior to myocardial imaging with dipyridamole and avoid the consumption of coffee, tea, chocolate or cola within 24 hours of the test.

Stiripentol:

Possible increase in plasma concentrations of caffeine, with risk of overdose, by inhibition of its hepatic metabolism.

Clinical monitoring and possible adjustment of the caffeine dosage.

Associations to take into account

 Ciprofloxacin, norfloxacin:

Increase in plasma concentrations of caffeine, by decrease in its hepatic metabolism.

Mexiletine:

Increase in plasma caffeine concentrations, by inhibition of its hepatic metabolism by mexiletine.

Lithium:

In the event of sudden cessation of consumption of coffee or drugs containing caffeine, risk of increased blood lithium.

Related to the presence of ascorbic acid:

Combinations subject to precautions for use

Deferoxamine:

Increased risk of iron-induced heart failure due to increased iron mobilization by supraphysiological vitamin C supplementation. In case of hemochromatosis, give vitamin C only after starting treatment with deferoxamine. Monitor cardiac function in combination.

Not applicable.

Drive and use machines

Not applicable.

Not applicable.

Not applicable.

Warnings and Precautions

Special warnings

The use of this medication is not recommended in patients with fructose intolerance, glucose-galactose malabsorption syndrome or sucrase / isomaltase deficiency (rare hereditary diseases).

This medicine contains sodium. This medicine contains 616 mg of sodium per tablet. To be taken into account in patients controlling their dietary sodium intake.

Vitamin C should be used with caution in case of Glucose-6-Phosphate Dehydrogenase deficiency (hereditary disease of red blood cells), because high doses of vitamin C, i.e. greater than 1 g / day in adults, may have caused haemolysis (destruction of red blood cells). It is important to respect the dosages and to take into account the ascorbic acid intake by other drugs.

Precautions for use

Due to the possibility of insomnia, it is best to avoid taking this medication after 4 p.m.

IF IN DOUBT, DO NOT HESITATE TO ASK FOR THE OPINION OF YOUR DOCTOR OR YOUR PHARMACIST.

PREGNANCY & BREAST-FEEDING & FERTILITY

Pregnancy

There are no data on teratogenesis in animals.

Clinically, no malformative or foetotoxic effect has appeared to date. However, the monitoring of pregnancies exposed to this drug is insufficient to be able to exclude any risk.

Therefore, as a precautionary measure, it is best not to use this drug during pregnancy.

Feeding with milk

Due to the lack of data on the passage of this drug in breast milk, the use of it should be avoided during breast-feeding.

What happens if I overdose from guronsan ?

Acute hemolysis has been observed following administration of large doses of ascorbic acid (i.e. greater than 1 g / day in adults) in subjects deficient in G6PD.

An overdose of GURONSAN, an effervescent tablet, may cause the following symptoms to appear, which may in particular be linked to the presence of caffeine: headache, visual disturbances, anxiety, agitation, insomnia, cardiac arrhythmias, or even in severe cases, a confusion or transient psychosis.

Intakes of vitamin C and / or caffeine from other sources should be taken into account.

What should I do if I miss a dose?

Not applicable.

Not applicable.

Not applicable.

What happens if you stop taking guronsan ?

Not applicable.

Not applicable.

Not applicable.

If you have further questions on the use of this medicine, ask your doctor or pharmacist for more information.

What is  Forms and Composition ?

Appearance and shape

Effervescent tablet.

Polypropylene tube of 15 effervescent tablets , closed with a low density polyethylene stopper containing a desiccant (silica gel). Box of 2 tubes.

Composition

Active substances

Glucuronamide: 400 mg

Ascorbic acid: 500 mg

Caffeine: 50 mg

For an effervescent tablet.

Other components

Sodium bicarbonate, monosodium fumarate, sodium polymetaphosphate, sodium cyclamate, sodium saccharin, sucrose, macrogol 6000, gin-fizz flavor *.

* Composition of the gin-fizz aroma: essential oil of lemon, essential oil of juniper berries, maltodextrin, gum arabic.

COMPONENTS WITH KNOWN EFFECT OF GURONSAN

sodium (616 mg / tablet), sucrose.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post guronsan effervescent tablet | Uses, Dosage, Side Effects, Precautions & Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/3lKE5vM via Edrug Online from faculty of medicine https://bit.ly/3jSQ7lf via Faculty of Medicine

[colinfitzpatrick]

guronsan effervescent tablet | Uses, Dosage, Side Effects, Precautions & Warnings

Drug Online

Generic drug of the Therapeutic class: Metabolism and nutrition active ingredients: Glucuronamide , Ascorbic acid (E300) , Caffeine

what is guronsan ?

Pharmacotherapeutic group: For antiasthenic purposes. (A: Digestive system and metabolism) – ATC code: A13 TONICS.

You should contact your doctor if you do not feel any improvement or if you feel less well after 15 days.

what is guronsan medication used for and indication?

This medication is recommended in states of temporary fatigue in adults (over 15 years).

PRESENTATION (S) AVAILABLE FOR GURONSAN

2 presentations are available for this medication:

2 polypropylene tube (s) of 15 tablet (s)

polypropylene tube (s) of 15 tablet (s)

FEATURE DESCRIPTION Pharmaceutical class not communicated Active substance (s) for one tablet: caffeine (50 mg), ascorbic acid (500 mg), glucuronamide (400 mg) General medicine no Pharmaceutical form effervescent tablet Route (s) of administration oral Selling price unregulated price Social security reimbursement rate 0% Laboratory (s) Laboratory (s) manufacturer Guronsan Conditions of issue available without prescription

guronsan Dosage

Dosage

RESERVED FOR ADULTS (over 15 years old).

The tablets are to be dissolved in a glass of water.

2 tablets per day, 1 in the morning and 1 at noon.

Avoid taking after 16 hours.

Duration of treatment limited to 4 weeks.

Duration of treatment

DO NOT USE FOR MORE THAN 4 WEEKS

guronsan Contraindications

This medication is contraindicated in the following situations:

Hypersensitivity to one of the constituents of the tablet,

Oxalocalcic renal lithiasis when using high doses of ascorbic acid, greater than 1 g.

This medication is generally not recommended in combination with enoxacin (see section Interactions with other medicinal products and other forms of interactions ).

How To Take guronsan ?

Method and route of administration

Oral route

The tablets are to be dissolved in a glass of water.

how does guronsan work?

Not specified.

Not specified.

Not specified.

How To Store guronsan ?

Keep this medication out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the package after EXP. The expiration date refers to the last day of that month.

Store at a temperature below 25 ° C and protected from light.

Do not throw away any medicines via a wastewater treatment plant or with household waste. Ask your pharmacist how to throw away the medicines you no longer use. These measures will help protect the environment.

guronsan Side Effects

Like all medicines, GURONSAN, effervescent tablet can cause side effects, although not everybody gets them:

possibility of insomnia, nervousness.

If you notice any side effects not listed in this leaflet, or if any side effects get serious, please tell your doctor or pharmacist.

Keep out of the reach and sight of children.

guronsan Interactions

Related to the presence of caffeine:

Not recommended associations

Enoxacin:

Significant increase in plasma caffeine concentrations which may lead to excitement and hallucinations due to decreased hepatic metabolism.

Combinations subject to precautions for use

Dipyridamole:

With injectable dipyridamole: reduction of the vasodilator effect of dipyridamole by caffeine.

Interrupt caffeine therapy at least 5 days prior to myocardial imaging with dipyridamole and avoid the consumption of coffee, tea, chocolate or cola within 24 hours of the test.

Stiripentol:

Possible increase in plasma concentrations of caffeine, with risk of overdose, by inhibition of its hepatic metabolism.

Clinical monitoring and possible adjustment of the caffeine dosage.

Associations to take into account

 Ciprofloxacin, norfloxacin:

Increase in plasma concentrations of caffeine, by decrease in its hepatic metabolism.

Mexiletine:

Increase in plasma caffeine concentrations, by inhibition of its hepatic metabolism by mexiletine.

Lithium:

In the event of sudden cessation of consumption of coffee or drugs containing caffeine, risk of increased blood lithium.

Related to the presence of ascorbic acid:

Combinations subject to precautions for use

Deferoxamine:

Increased risk of iron-induced heart failure due to increased iron mobilization by supraphysiological vitamin C supplementation. In case of hemochromatosis, give vitamin C only after starting treatment with deferoxamine. Monitor cardiac function in combination.

Not applicable.

Drive and use machines

Not applicable.

Not applicable.

Not applicable.

Warnings and Precautions

Special warnings

The use of this medication is not recommended in patients with fructose intolerance, glucose-galactose malabsorption syndrome or sucrase / isomaltase deficiency (rare hereditary diseases).

This medicine contains sodium. This medicine contains 616 mg of sodium per tablet. To be taken into account in patients controlling their dietary sodium intake.

Vitamin C should be used with caution in case of Glucose-6-Phosphate Dehydrogenase deficiency (hereditary disease of red blood cells), because high doses of vitamin C, i.e. greater than 1 g / day in adults, may have caused haemolysis (destruction of red blood cells). It is important to respect the dosages and to take into account the ascorbic acid intake by other drugs.

Precautions for use

Due to the possibility of insomnia, it is best to avoid taking this medication after 4 p.m.

IF IN DOUBT, DO NOT HESITATE TO ASK FOR THE OPINION OF YOUR DOCTOR OR YOUR PHARMACIST.

PREGNANCY & BREAST-FEEDING & FERTILITY

Pregnancy

There are no data on teratogenesis in animals.

Clinically, no malformative or foetotoxic effect has appeared to date. However, the monitoring of pregnancies exposed to this drug is insufficient to be able to exclude any risk.

Therefore, as a precautionary measure, it is best not to use this drug during pregnancy.

Feeding with milk

Due to the lack of data on the passage of this drug in breast milk, the use of it should be avoided during breast-feeding.

What happens if I overdose from guronsan ?

Acute hemolysis has been observed following administration of large doses of ascorbic acid (i.e. greater than 1 g / day in adults) in subjects deficient in G6PD.

An overdose of GURONSAN, an effervescent tablet, may cause the following symptoms to appear, which may in particular be linked to the presence of caffeine: headache, visual disturbances, anxiety, agitation, insomnia, cardiac arrhythmias, or even in severe cases, a confusion or transient psychosis.

Intakes of vitamin C and / or caffeine from other sources should be taken into account.

What should I do if I miss a dose?

Not applicable.

Not applicable.

Not applicable.

What happens if you stop taking guronsan ?

Not applicable.

Not applicable.

Not applicable.

If you have further questions on the use of this medicine, ask your doctor or pharmacist for more information.

What is  Forms and Composition ?

Appearance and shape

Effervescent tablet.

Polypropylene tube of 15 effervescent tablets , closed with a low density polyethylene stopper containing a desiccant (silica gel). Box of 2 tubes.

Composition

Active substances

Glucuronamide: 400 mg

Ascorbic acid: 500 mg

Caffeine: 50 mg

For an effervescent tablet.

Other components

Sodium bicarbonate, monosodium fumarate, sodium polymetaphosphate, sodium cyclamate, sodium saccharin, sucrose, macrogol 6000, gin-fizz flavor *.

* Composition of the gin-fizz aroma: essential oil of lemon, essential oil of juniper berries, maltodextrin, gum arabic.

COMPONENTS WITH KNOWN EFFECT OF GURONSAN

sodium (616 mg / tablet), sucrose.

NOT’s

Edrug-online contains comprehensive and detailed information about drugs available in the medical field, and is divided into four sections:

general information:

Includes a general description of the drug, its use, brand names, FAQs, and relevant news and articles

Additional information:

General explanation about dealing with the medicine: how to take the medicine, the doses and times of it, the start and duration of its effectiveness, the recommended diet during the period of taking the medicine, the method of storage and storage, recommendations in cases for forgetting the dose and instructions to stop taking the drug and take additional doses.

Special warnings:

For pregnant and breastfeeding women, the elderly, boys and drivers, and use before surgery.

Side effects:

It treats possible side effects and drug interactions that require attention and its effect on continuous use.

The information contained in this medicine is based on medical literature, but it is not a substitute for consulting a doctor.

The post guronsan effervescent tablet | Uses, Dosage, Side Effects, Precautions & Warnings appeared first on Drug Online.

from Drug Online https://bit.ly/3lKE5vM via Edrug Online

[shapesnnsizes]

Choline, SIBO, and Pregnancy: What’s the Deal?

Choline is a crucial nutrient for gut, skin, neurological, and cellular health. Yet, according to the 2003-2004 National Health and Nutritional Examination Survey (NHANES), only 10 percent of Americans consistently meet the adequate intake for choline (1).

Choline also plays essential roles during growth and development, and the body’s need for choline increases during pregnancy. The amniotic fluid surrounding the baby in the womb is highly enriched with 14 times the level of choline found in the mother’s blood (2). Sadly, an estimate from 2014 indicates that 90 to 95 percent of women fail to meet recommended choline intakes during pregnancy (3).

Additionally, new research has identified human gut bacteria that can compete with the host for choline. This means that those with gut dysbiosis, and particularly those with small intestinal bacterial overgrowth (SIBO), could be at risk for choline deficiency, even if they are consuming choline-rich foods or taking choline supplements.

In this article, I’ll cover all of the relevant research surrounding choline for general health and pregnancy, including the role of our gut microbes, and discuss how we can use this information to optimize choline status.

The importance of choline

Choline carries out many important functions in the body. It is an essential component of phospholipids, which make up the structure of cell membranes. Choline is also a precursor to the neurotransmitter acetylcholine, which plays roles in memory, circadian rhythms, and muscle control, and sphingomyelin, which is found in the fatty sheath around nerve fibers and improves the conduction of electrical impulses. The transport of fat and cholesterol from the liver also requires choline, and deficiency can lead to non-alcoholic fatty liver disease (NAFLD) (4).

9 out of 10 Americans don’t get enough choline, and deficiency may be especially harmful during pregnancy. Certain gut microbes could prevent proper choline absorption. Learn how to optimize your choline status to support overall health. 

Choline is also an important source of methyl groups. The addition of methyl groups to the DNA structure can turn genes on or off without any changes to underlying DNA sequence, a process known as epigenetics. Epigenetics plays an important role in health throughout life but is particularly important during growth and development, as fetal stem cells divide and differentiate into organs with all kinds of complex cellular functions. Changes in DNA methylation have been associated with cancer, aging, cognitive disabilities, atherosclerosis, and autoimmunity (5).

In utero, choline status also has implications for the structural development of the hippocampus, the primary brain region responsible for learning and memory (6). Poor maternal choline status may also increase the risk of neural tube defects and impair development of the heart (7).

So how much choline do we need?

Unfortunately, there is still a lack of consensus on exactly how much choline we need. The Institute of Medicine, which establishes the RDAs for nutrients based on peer-reviewed studies, has been unable to come up with a definitive value for choline needs and has had to resort to establishing an “Adequate Intake” value for choline (8). This is sort of a “best guess” as to how much choline might be sufficient for most people.

Below are the adequate intake values for choline (9):

Infants (0–6 months old): 125 mg per day Infants (6–12 months old): 150 mg per day Children (1–2 years old): 200 mg per day Children (4–8 years old): 250 mg per day Children (9–13 years old): 375 mg per day Adult men: 550 mg per day Adult women: 425 mg per day Pregnant women: 450 mg per day Lactating women: 550 mg per day

Chris Masterjohn has previously explained why trying to estimate how much choline we need is almost impossible. He has also extensively discussed the factors that influence dietary choline requirements, including genetic variations, intake of other B vitamins (particularly other methyl donors), and overall energy intake. Thus, I won’t be discussing any of these factors here. Since the microbiome is my area of expertise and the newest identified factor affecting choline status, the rest of this article will focus on gut bacterial influences on choline requirements.

Microbes compete for host choline

A recent study from the lab of leading microbiome researcher Dr. Federico Rey suggests that our gut microbes may influence choline status (10). I find this fascinating, but if you get bogged down in the details, you can skip ahead to the end of this section, where I’ll discuss the implications of this research!

This study used what are known as gnotobiotic (know-toe-by-ah-tic) mice. These are mice colonized with a known community of microbes. In this case, the researchers chose a core community (CC) of five microbes that are abundant in the normal human gut. To half of the mice (CC+), they also added a strain of E. coli that is known to metabolize choline. To the other group (CC-), they added the same strain of E. coli, but mutated the enzyme responsible for choline metabolism. Thus, the only difference between the groups was that one could utilize choline, while the other could not.

The researchers then took blood samples and found that CC+ mice had very low levels of serum choline compared to CC- mice. This suggested that the E. coli microbe was competing with the host for choline.

Moreover, they found that CC+ mice had lower levels of DNA methylation that mimicked those seen in choline deficiency. To explore the implications of these altered methylation profiles, Dr. Rey and colleagues repeated the experiments in mouse models of metabolic syndrome and pregnancy and early life.

In the metabolic disease model, CC+ mice had increased circulating leptin, increased blood triglycerides, and fatty livers compared to CC- mice.

In pregnancy, mother CC+ mice had increased obsessive grooming behavior, and their offspring showed increased marble-burying behavior, indicative of increased anxiety.

So, what are the major takeaways? First, gut bacteria may impact choline bioavailability in ways that mimic outright choline deficiency. Therefore, we can’t just be concerned with the adequate intake for choline, as individual needs for dietary choline are dependent on the gut microbiome. This study also suggests that excessive bacterial metabolism of choline could be especially harmful in pregnant women and those with metabolic syndrome.

Could SIBO be causing choline deficiency?

Additionally, what most people didn’t catch in the methods of this study is that the choline-hungry E. coli strain used in the study is a robust colonizer of the small intestine.

To help convey the importance of this, I should review some basic gut anatomy. Food passes through the stomach to the small intestine, and then through the large intestine. It’s no mistake that the small intestine, the primary site of nutrient absorption, is upstream from the large intestine, which is home to the bulk of the gut microbiota. In a healthy individual, this arrangement ensures that our epithelial cells have “dibs” on any incoming nutrients, and our microbes get the “leftovers.”

In small intestinal bacterial overgrowth (SIBO), however, the pecking order changes. Microbes from the colon move up the gastrointestinal tract to colonize the small intestine, or small intestinal microbes flourish and become overgrown. These microbes now directly compete with the host for any incoming nutrients—and in many cases, they win out. SIBO may particularly affect host status for nutrients absorbed in the lower small intestine, such as iron, vitamin B12, and—based on this research—choline.

In other words, those with SIBO may be at particularly increased risk for choline deficiency. (This remains to be confirmed in humans, but the microbial strain used in this mouse study was isolated from the human gut.)

Could high circulating TMAO be linked to SIBO?

What is most intriguing is that choline bacterial metabolism also leads to high serum levels of TMAO (trimethylamine N-oxide). TMAO has received a great deal of attention for its associations with cardiovascular disease (11). Bacteria convert choline to TMA, which is then oxidized in the liver to TMAO. Chris has talked about TMAO before on both his blog and his podcast, suggesting that high serum TMAO levels are more about which gut microbes you have and less about how much choline and carnitine you consume. The study I outlined above provides support for this hypothesis: CC+ mice had much higher levels of TMAO, while CC- mice had virtually undetectable TMAO.

Additionally, preliminary data from the Rey lab has shown that in humans, low serum choline tends to be associated with high TMAO, and vice versa. If TMAO was primarily being produced from “leftover” choline in the colon, we likely would not see this relationship. This suggests that those with high TMAO are very likely harboring some form of SIBO—further explaining the connection between SIBO and cardiovascular disease. Indeed, a 2017 study confirmed that TMA is only absorbed in the small intestine. Moreover, an acute dose of rifaximin, the non-absorbable antibiotic most commonly used to treat SIBO, can reduce serum levels of TMAO (12)!

Could betaine help overcome choline deficiency?

In thinking about solutions to choline deficiency, it’s important to note that one of choline’s most important roles in physiology, that of a methyl donor, first requires the conversion of choline to betaine. In other words, it’s betaine that acts as the direct methyl donor. Betaine cannot completely fulfill choline requirements, since choline has several functions besides methylation, but it can help prevent some of the epigenetic consequences of choline deficiency.

While betaine can also be consumed by microbes (and lead to TMAO production), betaine is primarily absorbed high in the proximal (upper) small intestine, whereas choline is absorbed lower, primarily in the distal (lower) small intestine (13). Since SIBO is most common in the distal small intestine, this means that, theoretically, betaine may have a better chance to be absorbed than choline. Of course, this is all speculation, and I look forward to seeing more studies in this area.

Additionally, I’d muse that consuming both betaine and choline may increase the chances that at least one is absorbed, since different bacterial species compete for each of these two nutrients. Many people with SIBO supplement with betaine HCl to help correct low stomach acid—but betaine HCl may also help compensate for bacterial choline metabolism in the small intestine and prevent symptoms of choline deficiency.

How to optimize choline status

Putting all of this information together, there are several steps we can take to help optimize choline status (even if we don’t know exactly how much we need):

Treat SIBO and gut dysbiosis: As always, we want to treat the underlying cause of disease. In this case, if SIBO is contributing to choline deficiency, addressing SIBO may improve choline status. This involves taking antimicrobials, improving gut motility, and restoring adequate stomach acid levels. Klebsiella and Escherichia appear to be particularly thrifty choline consumers.

Consume plenty of choline-rich foods: the top whole-food sources of choline are listed below. Human breast milk is also rich in choline.

Beef liver (3 oz.): 356 milligrams

Eggs (1 whole): 147 milligrams

Beef round steak (3 oz.): 117 milligrams

Supplement with (phosphatidyl)choline: For those who cannot get sufficient choline from dietary sources, I recommend supplementation. It’s important to note that most prenatal supplements and multivitamins do not contain choline, and those that do often contain the choline chloride form.

I recently had the opportunity to ask Dr. Rey about his thoughts on various choline supplements. He suggested that while all forms of choline are used by microbes, phosphatidylcholine seems to take more work for the microbes to utilize and may have a better chance of being absorbed than compounds like choline chloride. This is also the form found naturally in most foods. I like Seeking Health Optimal PC.

While it’s possible that consuming extra choline may fuel the overgrowth of choline consumers, the consequences of inadequate choline are far too great to even consider restricting choline intake.

Consume betaine-rich foods: as I discussed above, consuming adequate betaine may reduce the need for choline. The top three whole-food sources of betaine are:

Beets (1 cup, raw): 175 mg

Spinach (1 cup, cooked): 160 mg

Sweet potato (1 medium): 39 mg

Supplement with betaine: For those with SIBO and inadequate stomach acid secretion, betaine HCl is an excellent choice. I recommend one to five capsules, as tolerated, taken with meals.

I’d love to hear from you. What do you think of the research? Do you get enough choline and betaine? Share your thoughts in the comments!

About Lucy: Lucy is an MD-PhD student in Nutritional Sciences at the University of Illinois and a staff research associate for Kresser Institute. Her laboratory research focuses on the effects of diet and exercise on the gut microbiome and how this impacts gut and skin health. She was recently recognized as an emerging leader in Nutritional Sciences by the American Society for Nutrition and has contributed to several peer-reviewed publications.

Lucy’s mission is to provide evidence for an individualized, integrative approach to health through innovative research and outstanding clinical practice. She recognizes that each individual is unique, and she currently helps clients with gut, skin, and autoimmune conditions. You can learn more about her at NGmedicine.com or join her weekly newsletter here!

The post Choline, SIBO, and Pregnancy: What’s the Deal? appeared first on Chris Kresser.

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Vitamin D Saves Malnourished Children Dr. Mercola By Dr. Mercola Millions of children around the world suffer from malnourishment. While the worst problems are in Asia and Africa, “severe acute malnutrition” is the most extreme and very obvious when you see the physical toll it takes. Scientists from Queen Mary University of London (QMUL) and University of the Punjab in Southern Pakistan recently focused on the latter region, where nearly 1.5 million children are dangerously malnourished, to analyze the effectiveness of vitamin D3 supplementation in restoring the health of such children. The Conversation notes: “Severe acute malnutrition is the most extreme and visible form of undernutrition. Affected children have very low weight for their height and severe muscle wasting; they may also have swollen feet, face and limbs. About 20m [million] children are affected worldwide, mainly in Asia and Africa where it is a major cause of death. Children with severe acute malnutrition also commonly have low levels of vitamin D. This micronutrient is important for muscle and bone health and for maintaining a healthy immune system.”1 A total of 185 severely malnourished children, aged 6 months to 4 years, completed the follow-up as well as the trial, which was published by The American Journal of Clinical Nutrition.2 The first group of 93 children was randomly selected to receive two oral 5-milligram (mg) doses of vitamin D dissolved in olive oil while the remaining 92 were given a placebo with the same taste: olive oil without the vitamin D. None of the children or their parents knew which children were in which group; and both groups were started on the “standard” treatment for malnourishment: a “high-energy” ready-to-use therapeutic food (RUTF) paste (called Plumpy Nut), containing a small amount of vitamin D and other essential micronutrients, but which “reliably correct deficiency.” Vitamin D3 Slows the Trajectory of Delayed Childhood Development After just two months of being given the supplement, the children began to gain “significant” weight, exhibit measurably better muscle tone, motor and language development and bone health, as well as improved immune systems, according to the researchers involved in the clinically-governed trial. The scientists explained: “The primary outcome was the proportion of participants gaining (more than)15 percent of baseline weight at 8 weeks after starting ready-to-use therapeutic food … Secondary outcomes were mean weight-for-height or -length z score and the proportion of participants with delayed development at the end of the study.”3 While the high-dose vitamin D3 supplementation did not change the baseline weight for the children at the end of the trial, it did increase the weight-for-height or -length score, and reduced the trajectory of delayed development in other specific areas, including: Global development Gross motor development Fine motor development Language development In a 2014 review4 of the efficacy of vitamin D3 supplementation in adult mortality, researchers reported evidence that it may decrease mortality in elderly women, but also observed several interesting results: When different forms of vitamin D were assessed, only vitamin D3 decreased mortality (not D2, alfacalcidol or calcitriol) Vitamin D3 statistically significantly decreased cancer mortality Vitamin D3 combined with calcium supplementation increased the risk of patients developing kidney stones Vitamin D3 seemed to decrease mortality in elderly people living independently or in institutional care Previous Research: ‘D’ Does More Than You Realized Lead study author Adrian Martineau and a team from QMUL reported more than a year ago that vitamin D is not only effective for preventing and treating colds, flu and acute respiratory infections, but it’s also crucial for bone and muscle health. The extensive review (somewhat at odds regarding vitamin D’s respiratory capability) was published in the BMJ5 in 2017 and included 25 clinical trials with close to 11,000 participants and was conducted in 14 countries, including the U.S., the U.K., Afghanistan, Belgium, Canada, Japan, India, Italy and Australia. Addressing why some results in the trials showed effectiveness in some trials and not in others, Martineau explained that supplementation with vitamin D is strongest in people with the lowest levels of vitamin D, but also makes more of a difference when the doses are administered daily or weekly rather than more intermittently, and added: “Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common.”6 While sun exposure is your best source of vitamin D, it can be difficult to get enough if you live in less-than-sunny locales like the U.K. The researchers also indicated that colds and flu, rather than necessarily being caused by winter conditions, are more brought on by the season’s lack of strong sunlight and resulting lowered vitamin D levels, which also might explain why vitamin D also has protective effects against asthma, which is typically exacerbated by respiratory viruses. The QMUL studies also found that when people with the lowest baseline D levels (below 25 nanomoles per liter, a minuscule liquid measurement, or 10 nanograms per milliliter (ng/mL)) supplemented with D on a daily or weekly basis, their risk for developing acute respiratory infections was cut in half. That’s not to say that others with higher vitamin D levels didn’t benefit as well, because there was only a 10 percent reduction, which was still considered a positive. Taking vitamin D was found to be as equally protective against acute respiratory infections as flu shots for flu-like illnesses, which in 2013 caused the death of 2.65 million people worldwide. Flu symptoms are the most common reason people visit their doctors and miss work days, so the bottom line, QMUL reasoned, is that encouraging more widespread vitamin D supplementation instead of pushing for more flu vaccinations would be safer and more effective in every way. Vitamin D Deficiency Linked to a Greater Diabetes Risk Researchers tried to determine whether higher vitamin D levels might be associated with a lower Type 2 diabetes risk in another study, assessing results from 903 participants with an average age of 74 and known to be diabetes-free as well as prediabetes-free. Assessment started in 1997 and continued through 2009. The authors noted they started the study to answer associations between low plasma concentrations of vitamin D metabolites and higher risk of several cancers,7 cardiovascular disease,8 bone fractures9 and metabolic syndrome.10 Then scientists started looking at possible links to increases in Type 2 diabetes mellitus,11 but without clarity on whether D deficiency was involved. The analysis, published in PLoS One,12 showed that having a vitamin D level of greater than 30 ng/mL was “associated with a significant and substantial reduction in later diabetes risk.” Additionally, it was noted that “Sufficient 25-D levels obtained naturally from sunlight and food, not supplementation, might be more relevant to reduce diabetes risk.”13 Separate research looked at clinical evidence that such a deficiency was on the rise in the U.S. focusing on the years between 1988 to 1994 and 2001 to 2004. The analysis revealed that 77 percent of U.S. adults are deficient, and deficiency levels had doubled between the two study periods. Researchers concluded that “Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.”14 How to Optimize Your Vitamin D and Help Others Optimize Theirs Regarding the above problems and many others caused, or at least aggravated by, a deficiency in vitamin D, most people already know that to prevent it, getting daily sunlight exposure on the greater part of your body is the best way to do it. It’s natural and it’s free, provided you don’t overdo it. However, there are many places around the world where sunlight is at a premium. For people who for whatever reason are unable to get the optimal amount of sunlight, use of a high-quality tanning bed or vitamin D3 supplementation have been determined to be among the very best remedies. The Institute of Medicine (IOM) recommends 20 ng/mL of serum concentration of 25-hydroxy vitamin D as an adequate level, or 600 IUs a day up to age 70 and 800 IUs if you're over 70, but many vitamin D researchers believe that's not even enough to prevent osteomalacia, let alone take advantage of vitamin D's additional health benefits. For optimal health and disease prevention, a level between 60 and 80 ng/mL appears to be ideal, and this may require 8,000 IUs per day to achieve for some people. The only way to be sure you're safely within the therapeutic range is to get your levels tested. Recent studies have also shown that the high number of premature births not only can be attributed to low vitamin D in mothers, but also that vitamin D supplementation improved the rates of premature births in the U.S. In fact, the Organic & Natural Health Association (O&N) has submitted a petition to the U.S. Food and Drug Administration (FDA) to allow vitamin D dietary supplements to make that claim. O&N asserts: “Proper levels of Vitamin D reduce the risk of both mother’s pregnancy outcomes and their baby’s health outcomes. Significantly higher Vitamin D levels during pregnancy has been shown to reduce preterm birth by 60 percent, virtually eliminating certain pregnancy complications, and reducing many others.”15 As it stands now, federal regulations generally prohibit supplement and food companies from making disease prevention or treatment claims on package labels or in marketing materials, Holistic Primary Care16 notes. The hope is that if the FDA approves the vitamin D health claim, it would pave the way for women to become aware of the importance of vitamin D during pregnancy and make routine monitoring commonplace. You can participate by supporting the petition by filling out O&N’s action alert, which will ultimately contact your representatives in Washington to request their support.

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Under The Influence

A Guide to the Myths and Realities of Alcoholism

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The Myth and the Reality

Separating myth from reality is not an easy task. Myth is, in fact, reality for many people; to suggest another reality exists is to turn their world upside down. But if the truth about alcoholism is ever to be understood, the myths must be attacked and destroyed. Only facts can destroy myths; and facts are the backbone of this book.

Myth: Alcohol is predominantly a sedative or depressant drug.

Reality: Alcohol’s pharmacological effects change with the amount drunk. In small quantities, alcohol is a stimulant. In large quantities, alcohol acts as a sedative. In all amounts, however, alcohol provides a rich and potent source of calories and energy.

Myth: Alcohol has the same chemical and physiological effect on everyone who drinks.

Reality: Alcohol, like every other food we take into our bodies, affects different people in different ways.

Myth: Alcohol is an addictive drug, and everyone who drinks long and hard enough will become addicted.

Reality: Alcohol is selectively addictive drug; it is addictive for only a minority of its users, namely, alcoholics. Most people can drink occasionally, daily, even heavily, without becoming addicted to alcohol. Others (alcoholics) will become addicted no matter how much they drink.

Myth: Alcohol is harmful and poisonous to the alcoholic.

Reality: Alcohol is a normalizing agent and the best medicine for the pain it creates, giving the alcoholic energy, stimulation, and relief from the pain of withdrawal. Its harmful and poisonous aftereffects are most evident when the alcoholic stops drinking.

Myth: Addiction to alcohol is often psychological.

Reality: Addiction to alcohol is primarily physiological. Alcoholics become addicted because their bodies are physiologically incapable of processing alcohol normally.

Myth: People become alcoholics because they have psychological or emotional problems which they try to relieve by drinking.

Reality: Alcoholics have the same psychological and emotional problems as everyone else before they start drinking. These problems are aggravated, however, by their addiction to alcohol. Alcoholism undermines and weakens the alcoholic’s ability to cope with the normal problems of living. Furthermore, the alcoholic’s emotions become inflamed both when he drinks excessively and when he stops drinking. Thus, when he is drinking, and when he is abstinent, he will feel angry, fearful, and depressed in exaggerated degrees.

Myth: All sorts of social problems—marriage problems, a death in the family, job stress—may cause alcoholism.

Reality: As with psychological and emotional problems, alcoholics experience all the social pressures everyone else does, but their ability to cope is undermined by the disease and the problems get worse.

Myth: When the alcoholic is drinking, he reveals his true personality.

Reality: Alcohol’s effect on the brain causes severe psychological and emotional distortions of the normal personality. Sobriety reveals the alcoholic’s true personality.

Myth: The fact that alcoholics often continue to be depressed, anxious, irritable, and unhappy after they stop drinking is evidence that their disease is caused by psychological problems.

Reality: Alcoholics who continue to be depressed, anxious, irritable, and unhappy after they stop drinking are actually suffering from a phenomenon called “the protracted withdrawal syndrome.” The physical damage caused by years of excessive drinking has not been completely reversed; they are, in fact, still sick and in need of more effective therapy.

Myth: If people would only drink responsibly, they would not become alcoholics.

Reality: Many responsible drinkers become alcoholics. Then, because it is the nature of the disease (not the person), they begin to drink irresponsibly.

Myth: An alcoholic has to want help to be helped.

Reality: Most drinking alcoholics do not want to be helped. They are sick, unable to think rationally, and incapable of giving up alcohol by themselves. Most recovered alcoholics were forced into treatment against their will. Self-motivation usually occurs during treatment, not before.

Myth: Some alcoholics can learn to drink normally and can continue to drink with no ill effects as long as they limit the amount.

Reality: Alcoholics can never safely return to drinking because drinking in any amount will sooner or later reactivate their addiction.

Myth: Psychotherapy can help many alcoholics achieve sobriety through self-understanding.

Reality: Psychotherapy diverts attention from the physical causes of the disease, compounds the alcoholic’s guilt and shame, and aggravates rather than alleviates his problems.

Myth: Craving for alcohol can be offset by eating high-sugar foods.

Reality: Foods with a high sugar content will increase the alcoholic’s depression, irritability, and tension and intensify his desire for a drink to relieve these symptoms.

Myth: If alcoholics eat three balanced meals a day, their nutritional problems will eventually correct themselves.

Reality: Alcoholic’s nutritional needs are only partially met by a balanced diet. They also need vitamin and mineral supplements to correct any deficiencies and to maintain nutritional balances.

Myth: Tranquilizers and sedatives are sometimes useful in treating alcoholics.

Reality: Tranquilizers and sedatives are useful only during the acute withdrawal period. Beyond that, these substitute drugs are destructive and, in many cases, deadly for alcoholics.

The Need for Definitions

“Each of us has his own private view and private meaning attached to the words that are used in the alcohol field.”

Universally accepted definitions do not exist in the alcoholism field. As the researcher quoted above acknowledges, everyone involved in the field has his own private view of the disease. And yet, as this book makes clear, there is a firm basis of research evidence for understanding the disease. The need for precise definitions should be obvious. The following definitions, based on the facts already established in the scientific literature, are central to any attempt to communicate clearly about alcoholism.

Alcoholism: A chronic, primary, hereditary disease which progresses from an early, physiological susceptibility into an addiction characterized by tolerance changes, physiological dependence, and loss of control over drinking. Psychological symptoms are secondary to the physiological disease and not relevant to its onset.

Recovery: A return to normal functioning based on total, continuous abstinence from alcohol and substitute drugs, corrective nutrition, and an accurate understanding of the disease. The word “cure” should not be used because it implies that the alcoholic can engage in normal drinking after his “problem” has been corrected.

Problem Drinker: A person who is not an alcoholic but whose alcohol use creates psychological and social problems for himself and others.

Heavy Drinker: Anyone who drinks frequently or in large amounts. A heavy drinker may be a problem drinker, an alcoholic, or a normal drinker with a high tolerance for alcohol.

Alcoholic: An alcoholic is a person with the disease of alcoholism regardless of whether he is initially a heavy drinker, a problem drinker, or a light or moderate drinker. The alcoholic’s increasing problems and his heavier drinking stem from his addiction and should not be confused with problem drinking or heavy drinking in the non-alcoholic.

Recovered Alcoholic: The alcoholic who maintains continuous, total abstinence from alcohol and substitute drugs and who has returned to a normal life style. The term “reformed alcoholic” implies that the alcoholic has been “bad” and is now being “good”—a reflection of the moralistic approach to alcoholism which has no basis in fact. The term “ex-alcoholic” should not be used either, for it implies a cure rather than a recovery.

Relapse: (“Slip” in A.A. language). Any intake of alcohol or substitute drug by a recovering alcoholic. The taking of a substitute drug, although not usually considered a relapse, seriously interferes with recovery and almost always leads to a return to drinking.

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Other.techniques Aim At “tonifying” Chinese : 补; Pin Yin : B Or “sedating” Chinese : 泄; Pin Yin : Xii Qi.

Although.cupuncture.eclined.n.hina during this time period, it was also growing in popularity in oether countries. 30 drug interactions, circumstances or adverse effects. Other techniques aim at “tonifying” Chinese http://www.behandlingsutstyr.no : 补; pin yin : b or “sedating” Chinese : 泄; pin yin : xii qi. 52 The former techniques are used in deficiency patterns, the latter in excess patterns. 52 De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. 38 Ed, 1. year Kyōhō = 1716. Around this time the surgeon-general of the Dutch East India Company met Japanese and Chinese acupuncture practitioners and later encouraged Europeans to further investigate it. 29 :264-265 He published the first in-depth description of acupuncture for the European audience and created the term “acupuncture” in his 1683 work De acupuncture. 269 France was an early adopter among the West due to the influence of Jesuit missionaries, who brought the practice to French clinics in the 16th century. 27 The French doctor Louis Berlioz the father the body, and eventually to balancing Yin and Yang energies as well. 28 According to Dr. Thinner needles may be flexible Alternative Medicine was created within the NIH. Hundreds.f clinical studies on the benefits of acupuncture show that it successfully treats conditions ranging from musculoskeletal treatment of a variety of conditions such as post-operative pain, tennis elbow, and carpal tunnel syndrome . Many people have insurance of acupuncture needles with dried herb sticks to activate and warm the acupuncture point. When these forces are in transdermal electrical nerve stimulation TENS masquerading as acupuncture”. 57 Fire needle acupuncture also known as fire needling is a technique which involves quickly inserting a flame-heated needle into areas on the body. 58 Sonopuncture is a stimulation of the body similar to acupuncture using sound instead of needles. 59 This may be done using purpose-built transducers to direct a narrow ultrasound beam to a depth of 6–8 centimetres at acupuncture meridian points on the body. 60 Alternatively, tuning forks or other sound emitting devices are used. 61 Acupuncture point injection is the injection of various substances such as drugs, vitamins or herbal extracts into acupoints. 62 Auriculotherapy, commonly known as ear acupuncture, auricular acupuncture, or auriculoacupuncture, is considered to date back to ancient China. An imbalance in the flow of qi throughout Sun simian published acupuncture-related diagrams and charts that established standardized methods for finding acupuncture sites on people of different sizes and categorized acupuncture sites in a set of modules. 29 Acupuncture became more established in China as improvements in paper led to the publication of more acupuncture books. Traditionally, acupuncture was used to treat acute conditions many governments have adopted similar standards. 299 In China, the practice of acupuncture is regulated by the Chinese Medicine Council that was formed in 1999 by the Legislative Council. Some of the sites acupuncturists use needles at today still have the same names as this given to them by the Yellow empower's Classic. 29 :93 Numerous additional documents were published over the centuries introducing new acupoints. 29 :101 By the 4th century AD, most of the acupuncture sites in use today had been named and identified. 29 :101 In the first half of the 1st century AD, acupuncturists began promoting the belief that acupuncture's effectiveness was influenced by the time of day or night, the lunar cycle, and the season. 29 :140-141 The Science of the Yin-Yang Cycles yen chi Hsüeh was a set of beliefs the possibility of adverse side-effects and the pain manifestation differences in children versus adults. In.ther.Ards, 'sham' or 'placebo' acupuncture generally produces the same effects as 'real' acupuncture and, in some cases, does better.” 77 A 2013 meta-analysis found little evidence that the effectiveness of acupuncture on pain compared to sham was modified by the location of the needles, the number of needles used, the experience or technique of the practitioner, or by the circumstances of the sessions. 78 The same analysis also suggested that the number of needles and sessions is important, as greater numbers improved the outcomes of acupuncture compared to non-acupuncture controls. 78 There has been little systematic investigation of which components of an acupuncture session may be important for any therapeutic effect, including needle placement and depth, type and intensity of stimulation, and number of needles used. 75 The research seems to suggest that needles do not need to stimulate the traditionally specified acupuncture points or penetrate the skin to attain an anticipated effect e.g. psychosocial factors. 2 A response to “sham” acupuncture in osteoarthritis may be used in the elderly, but placebos have usually been regarded as deception and thus unethical. 79 However, some physicians and ethicists have suggested circumstances for applicable uses for placebos such as it might present a theoretical advantage of an inexpensive treatment without adverse reactions or interactions with drugs or other medications. 79 As the evidence for most types of alternative medicine such as acupuncture is far from strong, the use of alternative medicine in regular healthcare can present an ethical question. 80 Using the principles of evidence-based medicine to research acupuncture is controversial, and has produced different results. 71 Some research suggests acupuncture can alleviate pain but the majority of research suggests that acupuncture's effects are mainly due to placebo. 9 Evidence suggests that any benefits of acupuncture are short-listing. 14 There is insufficient evidence to support use of acupuncture compared to mainstream medical treatments . 81 Acupuncture is not better than mainstream treatment in the long term. 74 Publication bias is cited as a concern in the reviews of randomized controlled trials CRTs of acupuncture. 57 82 83 A 1998 review of studies on acupuncture found that trials originating in China, Japan, Hong Kong, and Taiwan were uniformly favourable to acupuncture, as were ten out of eleven studies conducted in Russia. 84 A 2011 assessment of the quality of CRTs on ACM, including acupuncture, concluded that the methodological quality of most such trials including randomization, experimental control, and blinding was generally poor, particularly for trials published in Chinese journals though the quality of acupuncture trials was better than the trials testing ACM remedies. 85 The study also found that trials published in non-Chinese journals tended to be of higher quality. 85 Chinese authors use more Chinese studies, which have been demonstrated to be uniformly positive. 86 A 2012 review of 88 systematic reviews of acupuncture published in Chinese journals found that less than half of these reviews reported testing for publication bias, and that the majority of these reviews were published in journals with impact factors of zero. 87 Scientist and journalist Steven Salzburg identifies acupuncture and Chinese medicine generally as a focus for “fake medical journals” such as the Journal of Acupuncture and Meridian Studies and Acupuncture in Medicine . 88 The conclusions of many trials and numerous systematic reviews of acupuncture are largely inconsistent with each other. 13 A 2011 systematic review of systematic reviews found that for reducing pain, real acupuncture was no better than sham acupuncture, and concluded that numerous reviews have shown little convincing evidence that acupuncture is an effective treatment for reducing pain. 10 The same review found that neck pain was one of only four types of pain for which a positive effect was suggested, but cautioned that the primary studies used carried a considerable risk of bias. 10 A 2009 overview of Cochran reviews found acupuncture is not effective for a wide range of conditions, and suggested that it may be effective for only chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. 13 A 2014 systematic review suggests that the nocebo effect of acupuncture is clinically relevant and that the rate of adverse events may be a gauge of the nocebo effect. 89 According to the 2014 Miller's anaesthesia book, “when compared with placebo, acupuncture treatment has proven efficacy for relieving pain”. 44 A 2012 meta-analysis conducted by the Acupuncture Trialists' Collaboration found “relatively modest” efficiency of acupuncture in comparison to sham for the treatment of four different types of chronic pain back and neck pain, knee osteoarthritis, chronic headache, and shoulder pain and on that basis concluded that it “is more than a placebo” and a reasonable referral option. 90 Commenting on this meta-analysis, both Eduard Ernst and David Colquhoun said the results were of negligible clinical significance. 91 92 Eduard Ernst later stated that “I fear that, once we manage to eliminate this bias that operators are not blind … we might find that the effects of acupuncture exclusively are a placebo response.” 93 A 2010 systematic review suggested that acupuncture is more than a placebo for commonly occurring chronic pain conditions, but the authors acknowledged that it is still unknown if the overall benefit is clinically meaningful or cost-effective. 94 A 2010 review found real acupuncture and sham acupuncture produce similar improvements, which can only be accepted as evidence against the efficacy of acupuncture. 95 The same review found limited evidence that real acupuncture and sham acupuncture appear to produce biological differences despite similar effects. 95 A 2009 systematic review and meta-analysis found that acupuncture had a small analgesic effect, which appeared to lack any clinical importance and could not be discerned from bias. 15 The same review found that it remains unclear whether acupuncture reduces pain independent of a psychological impact of the needling ritual. 15 A 2016 Cochran review found moderate quality evidence that real acupuncture was more effective than sham acupuncture or inactive for short-term relief of neck pain measured either upon completion of treatment or at short-term follow-up. 96 A 2013 meta-analysis found that acupuncture was better than no treatment for reducing lower back pain, but not better than sham acupuncture, and concluded that the effect of acupuncture “is likely to be produced by the non-specific effects of manipulation”. 97 A 2013 systematic review found supportive evidence that real acupuncture may be more effective than sham acupuncture with respect to relieving lower back pain, but there were methodological limitations with the studies. 98 A 2013 systematic review found that acupuncture may be effective for non-specific lower back pain, but the authors noted there were limitations in the studies examined, such as heterogeneity in study characteristics and low methodological quality in many studies. 99 A 2012 systematic review found some supporting evidence that acupuncture was more effective than no treatment for chronic non-specific low back pain; the evidence was conflicting comparing the effectiveness over other treatment approaches. 12 A 2011 systematic review of systematic reviews found that “for chronic low back pain, individualized acupuncture is not better in reducing symptoms than formula acupuncture or sham acupuncture with a toothpick that does not penetrate the skin.” 10 A 2010 review found that sham acupuncture was as effective as real acupuncture for chronic low back pain. 2 The specific therapeutic effects of acupuncture were small, whereas its clinically relevant benefits were mostly due to contextual and psychosocial circumstances. 2 Brain imaging studies have shown that traditional acupuncture and sham acupuncture differ in their effect on limbic structures, while at the same time showed equivalent analgesic effects. 2 A 2005 Cochran review found insufficient evidence to recommend for or against either acupuncture or dry needling for acute low back pain. 100 The same review found low quality evidence for pain relief and improvement compared though it is more likely to have been brought into Korea from a Chinese colonial prefecture in 514 AD. 29 :262-263 Acupuncture use was commonplace in Korea by the 6th century. The most common method used to stimulate acupoints is policies and is used most broadly to relieve pain. It.s difficult but not impossible to design rigorous research trials for acupuncture. 69 70 Due to acupuncture's invasive nature, one of the major challenges in efficacy research is in the design of an appropriate placebo control group . 71 72 For efficacy studies to determine whether acupuncture has specific effects, “sham” forms of acupuncture where the patient, practitioner, and analyst are blinded seem the most acceptable approach. 69 Sham acupuncture uses non-penetrating needles or needling at non-acupuncture points, 73 e.g. inserting needles on meridians not related to the specific condition being studied, in 1972.

Sometimes.needles.ere.sed while they were still hot, creating a cauterizing effect at the injection site. 29 :104 Nine needles were recommended in the Chen chi Ta Cheng from 1601, which may have been because of an ancient Chinese belief that nine was a magic number. 29 :102-103 Other belief systems were based on the idea that the human body operated treatment of a variety of conditions such as post-operative pain, tennis elbow, and carpal tunnel syndrome . G. evoking the body’s natural healing response through various physiological systems. Other.techniques aim at “tonifying” Chinese : 补; pin yin : b or “sedating” Chinese : 泄; pin yin : xii qi. 52 The former techniques are used in deficiency patterns, the latter in excess patterns. 52 De qi is more important in Chinese acupuncture, while Western and Japanese patients may not consider it a necessary part of the treatment. 38 94 A 2012 review found that acupuncture seems to be cost-effective for some pain conditions. 242 Risk of forgoing conventional medical care As with other alternative medicines, unethical or naive practitioners may induce patients to exhaust financial resources by pursuing ineffective treatment. 5 243 Profession ethical codes set by accrediting organizations such as the National Certification Commission for Acupuncture and Oriental Medicine require practitioners to make “timely referrals to other health care professionals as may be appropriate.” 244 Stephen Barrett states that there is a “risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition”. 245 Main articles: Qi, Traditional Chinese medicine, Meridian Chinese medicine, and Acupuncture point Old Chinese medical chart of acupuncture meridians Acupuncture is a substantial part of traditional Chinese medicine ACM. 4 Early acupuncture beliefs relied on concepts that are common in ACM, such as a life force energy called qi. 246 Qi was believed to flow from the body's primary organs zang-fu organs to the “superficial” body tissues of the skin, muscles, tendons, bones, and joints, citation needed through channels called meridians. 247 Acupuncture points where needles are inserted are mainly but not always found at locations along the meridians. 248 Acupuncture points not found along a meridian are called extraordinary points and those with no designated site are called “A-shi” points. 248 In ACM, disease is generally perceived as a disharmony or imbalance in energies such as yin, yang, qi, xuĕ, zàng-fǔ, meridians, and of the interaction between the body and the environment. 249 Therapy is based on which “pattern of disharmony” can be identified. 250 251 For example, some diseases are believed to be caused by meridians being invaded with an excess of wind, cold, and damp. 252 In order to determine which pattern is at hand, practitioners examine things like the colon and shape of the tongue, the relative strength of pulse-points, the smell of the breath, the quality of breathing, or the sound of the voice. 253 254 ACM and its concept of disease does not strongly differentiate between the cause and effect of symptoms. 255 Scientific research has not supported the existence of qi, meridians, or yin and yang. n 1 24 25 A Nature editorial described ACM as “fraught with pseudo-science”, with the majority of its treatments having no logical mechanism of action . 256 Quackwatch states that “ACM theory and practice are not based upon the body of knowledge related to health, disease, and health care that has been widely accepted by the scientific community. The typical length is felt a slight sting or prick. Rheumatology. 47 8: 1132–1136. dBi possibly perform some additional physical examinations depending on your individual health needs.

[lowcarbnutrients]

14 miraculous Health benefits of Onions

Some of the health benefits of onions include their duty in significantly alleviating a number of illness including the cold, asthma, bacterial infections, breathing problems, angina, as well as cough. Onions are additionally recognized to push back savage insects. In other words, you may say that onions are a true gift from nature, also if they do make you cry.

Nutritional Value of Onions

Onions have so many beneficial medicinal applications due to the nutrients, vitamins, minerals, and also organic substances contained in them, consisting of the existence of sulfuric substances and also quercetin in traces of the crucial oils. Onions likewise contain mineral elements such as calcium, magnesium, salt, potassium, selenium and also phosphorus, and they are a good resource of vitamin C, vitamin B6, as well as nutritional fiber!

Health Benefits of Onions

Some of one of the most useful and also well known health advantages of onions are as follows:

Good Oral Health: Onions are frequently utilized to avoid tooth degeneration and also dental infections. Chewing raw onions for 2 to 3 mins can potentially kill all the bacteria existing in the oral area and surrounding locations like the throat as well as lips.

Immune System Strength: The phytochemicals that are existing in significant quantities in onions function as a stimulant to vitamin C within the body. The efficiency of vitamin C, and also consequently your immune system, is boosted when you eat onions, because it supercharges your body immune system versus toxic substances as well as different international bodies that can cause disease and illness.

Treatment for Heart Ailments: Onions serve as anticoagulants, likewise called blood slimmers, which subsequently avoids the red blood cells from developing clumps. These blocks as well as embolisms can bring about heart problems or cardiovascular diseases.

Manage Diabetes: Onions include chromium, which is a reasonably unusual mineral to discover naturally in food. Chromium aids the body handle blood glucose levels and guarantee a slow, progressive release of sugar to the muscles and the body cells. Consuming onions could assist regulate your blood sugar levels, which is vitally vital for diabetic patients.

Used as Insect Repellent: You could apply onion juice to lower the pain created from honeybee stings. Fresh onion juice or paste can be made use of for external applications for other insect attacks and also scorpion hurts. The odor of onions additionally creates pests to leave, which is why onions could be used as insect repellents as well as a kind of sting treatment.

Prevention of Cancer: Onions are abundant in energetic substances that effectively prevent the development as well as spread of cancerous cells. Quercetin is a very powerful antioxidant substance that has actually been consistently connected to the prevention or reduction of the spread of cancer, Onions have a substantial quantity of quercetin! Vitamin C is likewise a strong anti-oxidant, which can decrease the presence and effect of complimentary radicals throughout the body. Free radicals are the chemical byproducts of cellular metabolism, and they could create healthy and balanced cells to alter right into cancerous cells. As a result, any food rich in anti-oxidants, which neutralize these totally free radicals, are useful for any person, considering that every individual is vulnerable to this inner strike as a result of oxidative stress!

Relieving Earache: A few declines of onion juice may really confirm exceptionally advantageous to individuals experiencing acute earache. The buzzing sound in the ear may be healed by applying onion juice via a piece of cotton wool.

Glowing Skin: Onion juice combined with honey or olive oil is claimed to be ideal treatment for treating symptoms or signs of acne. Onions are also notorious anti-inflammatory vegetables, so the active substances in onions can decrease the inflammation and also swelling that is generally related to skin conditions like acne. It also aids to lower the associated discomfort as well as inflammation of conditions like gout as well as arthritis.

Treatment for Cough: Eating an equivalent blend of onion juice and honey could experience sore throats and coughing symptoms.

Boosts Sexual Drive: Onions are claimed to enhance the desire for a healthy and balanced sex life. One table spoon of onion juice along with one dose of ginger juice, taken three times a day, could boost the libido and sex drive.

Treatment of Anemia: Even anemic conditions could be improved by consuming onions together with jaggery and also water, because this includes in the mineral material of the body, especially iron, which is a necessary part of creating brand-new red blood cells. As a result, anemia, additionally understood as iron deficiency, can be avoided by having a health amount of onions in your diet.

Relieves Stomach Aches: Onions have anti-inflammatory and antibacterial residential properties that provide alleviation to indigestion as well as various other relevant stomach syndromes. This is due to the saponins that could be found in onions. These saponins have anti-spasmodic capacities that make certain that belly disturbances do not proceed as well as that your bowels are clear and also smoothly functioning.

Treating Urinary Disorders: For those suffering from a burning feeling throughout urination, onions can offer substantial alleviation. People experiencing this problem needs to consume alcohol water steamed with 6 to 7 grams of onions.

According to Peace Health, onions have actually long been helpful for dealing with different human diseases such as growths, persistent coughings as well as colds. Doctors consider this plant form as an excellent natural remedy for eliminating numerous metabolic disorders as well as illness syndromes. Peace Health further states that onion consumption could also help in the prevention of belly as well as breast cancer.

Onions Include Sulfur Rich Compounds- Medical researches have actually disclosed that these sulfuric compounds stop biochemical chain formations that can possibly bring about asthmatic conditions. The sulfuric material of onions facilitates the melting of phlegm in a client struggling with extreme coughing. Fresh onion juices are recommended for people who shed consciousness, due to the fact that the scent as well as inhalant high qualities of onions bring instant vigor and also energy right into people.

In regards to onions' part in different cooking delights, onions has actually been made use of for thousands of years in several food prep works. It is especially utilized for preparing non-vegetarian food in order to conceal several of the harsher preferences and also smells of meat. Onions can be taken in raw, pickled in vinegar, fried in oil, baked or steamed. Onions are certainly a benefit to mankind that may make us sob, yet they must be splits of delight, thinking about all the wellness benefits we are accessing the very same time!