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Prevalence of obesity in primary care

The prevalence of overweight and obesity in the community, in both adults and children is already at epidemic levels. Half of all adult females and nearly two-thirds of men are overweight. Almost one in five, 17 per cent of men and 21 per cent of women, are clinically obese (body mass index BMI > 30) (National Audit Office, 2001). The implications for primary care, both now and in the future, are immense. Obese patients are 30 per cent more likely to require an appointment with their GP, and will, on average, account for 30 per cent more in prescription costs. A study of the socio-economic costs of obesity reveals a catalogue of social deprivation, increased sick-leave, higher unemployment and earlier retirement through ill-health (National Audit Office, 2001). All this impacts greatly on the ability of primary care to deliver adequate care with limited resources. It is, however, the direct effect of the co-morbidities of obesity that carries the heaviest burden on primary care. A...

Dietary Treatments Optimal Nutrition

Maintaining healthy joints starts with adequate nutrition. Athletes should get adequate levels of protein to maintain and repair muscles, tendons, ligaments, and joints. Fruits and vegetables provide antioxidants that can help reduce inflammation and improve recovery from and adaptation to exercise. Essential fats, especially omega-3 fatty acids, are beneficial for promoting prostaglandins that control inflammation and pain pathways. Some essential fatty acids, such as omega-6 fatty acids, are easy to obtain from dietary sources because they are readily available in plant oils. A 1 1 or 2 1 ratio of omega-6 to omega-3 fats in the daily diet has been suggested. The amount of omega-3 fatty acids can be achieved by eating fish two to three times per week and using flax oil regularly. In animal studies, high levels of vitamin C (150 mg d) in the diet resulted in less severe joint damage in guinea pigs with surgically induced osteoarthritis compared with guinea pigs receiving low levels...

Obesityinduced diseases weight loss and lowfat dairy products

The etiology of several diseases and physical ailments find root in obesity. In many cases obesity contributes, directly or indirectly, to the development 1.3.1 Weight management and blood pressure Obese and overweight individuals can have higher blood pressure which increases the risk for stroke and heart disease. Milk contains an abundance of potassium (140 mg 100 g), calcium (118 mg 100 g) and magnesium (12 mg 100 g). These minerals have been shown to lower blood pressure. Massey (2001) reviewed the available information relating to dairy food consumption and stroke. Two studies were highlighted that linked lower rates of heart disease to milk consumption. The first study was the Honolulu Heart Program that reported Japanese men (aged 55-68) who did not consume milk experience thromboembolic stroke at twice the rate of men who consumed two glasses or more of milk each day. The other study referenced found that the intake of Ca, K, and Mg reduced the relative risk of ischemic...

Role of obesity and body fat distribution in cardiometabolic risk

Obesity can be simply defined as an excessive amount of body fat which increases the risk of medical illness and premature death. For clinical purposes, assessments that are routinely used to define obesity include body weight and body mass index (BMI)1. The BMI assessment represents the relationship between weight and height, and is derived by calculating either the weight (in kg) divided by the height (in meters squared), or the weight (in pounds) multiplied by 704 divided by the height in inches squared1. Using the BMI as the main criteria, classification of obesity into risk categories have been proposed (Table 3.1). The BMI classification is based on data that has been collected from large epidemiological studies that evaluated body weight and mortality2-4. This classification provides clinicians with a mechanism for identifying patients at high risk for complications associated with obesity. It has been well established that those individuals considered obese, i.e. BMI a 30, are...

Obesity And Abdominal Adiposity

The problem of obesity has reached epidemic proportions in the majority of developed nations worldwide. The World Health Organization (WHO) has reported that over 1 billion adults worldwide meet the definition for overweight (body mass index (BMI) of greater than 25 kg m2) and at least 300 million adults meet criteria for clinical obesity (BMI of greater than 30 kg m2)17. Obesity is associated with a myriad of medical conditions including coronary artery disease, peripheral arterial disease, cerebrovascular disease, congestive heart failure, the metabolic syndrome, hypertension, insulin resistance, type 2 diabetes mellitus, dyslipidemia, obstructive sleep apnea, liver disease, and degenerative joint disease. A subset of obese patients demonstrate abdominal obesity or adiposity which is defined by increasing waist circumference, sagittal abdominal diameter, and waist-to-hip ratio. Waist circumference and sagittal abdominal diameter have been shown to correlate best with intra-abdominal...

Prophylaxis of Venous Thromboembolism in Morbidly Obese Patients

The prevalence of obesity in the United States has achieved epidemic proportions. About 55 of Americans are overweight or obese and over one-third of the adult population is obese. The medical conditions associated with morbid obesity involve multiple organ systems and include type 2 diabetes mellitus, hypertension, hypertrophic cardiomyopathy, hyperlipidemia, obstructive sleep apnea, cholelithiasis, osteoarthritis, deep venous thrombosis (DVT), and pulmonary embolism (PE). There is a substantial increase in mortality in this population morbidly obese young male adults have a 12-fold increase in mortality. The association between DVT and PE was described in 1856 by Virchow, who ascribed the development of DVT to the triad of stasis, endothelial damage, and hypercoagulability state. A study of risk factors for venous thromboembolism in hospitalized patients demonstrated an association with age over 40 years (59 ), obesity (28 ), and major surgery (23 ). The increased risk in the...

Permanent Weight Control

Americans are now among the fattest people on earth. One third of the nation is obese, and between 1980 and 1994, the percentage of obese teenagers doubled. New studies report that 55 percent of American women, 63 percent of men, and 25 percent of children are overweight. Americans' sedentary lifestyle and preference for high-fat, cholesterol-laden meals expose them to numerous health risks. Physicians estimate that 300,000 Americans die annually from obesity-related illnesses, which include heart disease, gall-bladder disease, diabetes, stroke, some cancers, and arthritis. Many doctors are calling obesity an epidemic, especially among the young. For many people dieting is a constant battle. Most believe that to lose weight they have to go on a low-calorie diet, often starving until the diet is no longer tolerable. Then the weight comes right back and then some. Very-low-calorie diets are doomed because they lower the body's metabolic rate, which makes losing weight even more...

Obesity Magnitude and Future Trends

The problems of overweight and obesity in America have reached epidemic proportions and threaten the health and quality of life of millions of adults and children. According to CDC's 1999 National Health and Nutri- FIGURE 2-3 Obesity trends among U.S. adults Behavioral Risk Factor Surveillance System (BRFSS), 1991, 1995, 2000. NOTE Obesity is BMI > 30, or -30 lbs overweight for 5'4'' woman. SOURCE CDC citing Mokdad et al. (1999). FIGURE 2-3 Obesity trends among U.S. adults Behavioral Risk Factor Surveillance System (BRFSS), 1991, 1995, 2000. NOTE Obesity is BMI > 30, or -30 lbs overweight for 5'4'' woman. SOURCE CDC citing Mokdad et al. (1999). tion Examination Survey, more than 61 percent of adults are either overweight or obese and at least 13 percent of children ages 6 to 11 and 14 percent of adolescents ages 12 to 19 are overweight. The prevalence of obesity among adults has grown by nearly 20 percent over the past 30 years, and the number of children who are overweight has...

Obesity Recognition and Treatment in Women

The increasing prevalence of obesity in the United States over the last decade makes the assessment and treatment of obesity a paramount issue and a challenge for medical professionals. According to clinical experts obesity is quickly reaching epidemic proportions, with 64 of the U.S. adult population being considered obese, or overweight, and 5 of this group is categorized as extreme obesity, with a BMI of > 40. In clinical terms, a BMI > 40 correlates to being overweight by 100 lbs in men and 80 lbs in women. Looking to the future, the number of teenagers (age 12-19) classified as overweight increased from 10.5 to 15.5 from 1999-2000, according to the CDC. This trend reinforces the need for obesity to be treated as a public health issue. The increased health risks of obesity include hypertension, elevated serum cholesterol and death related to cardiovascular diseases as well as diabetes, gallbladder disease, osteoarthritis, carpal tunnel, sleep apnea, respiratory problems and...

Obesity and appetite control

Overweight and obesity are the commonest nutritional disorders in developed countries. Between 1991 and 1998 the incidence of obesity rose from 12.0 to 17.9 in the USA. Obesity predisposes to several chronic diseases including hypertension, hyperlipidaemia, diabetes mellitus, cardiovascular disease and osteoarthritis, and aspects of these are discussed in the relevant sections of this book. The body mass index15 (BMI) correlates highly with the amount of body fat individuals whose BMI lies between 25 and 30kg m2 are considered overweight and those in whom it exceeds 30 kg m2 are defined as obese. Management of the condition involves a variety of approaches from nutritional advice to lifestyle alteration, drugs and, in extreme instances, gastric surgery. An evidence-based algorithm coordinates these.16 The present account concentrates on pharmacological interventions. Drugs for obesity act either on the gastrointestinal tract to lower nutrient absorption or centrally to reduce food...

Antipsychotic drugs and weight gain

Creases in body weight were observed in fact, excessive weight gain has been reported in up to 50 of patients receiving long-term antipsychotic drug treatment (22R, 23M) and has often been addressed in this series (SEDA-22, 62 SEDA-23, 67 SEDA-24, 58 and 69). However, changes in weight during psychosis are also related to the condition Kraepelin wrote, The taking of food fluctuates from complete refusal to the greatest voracity Sometimes, in quite short periods, very considerable differences in the body weight are noticed (24R). It was observed early on that food intake and weight often fell as psychosis worsened, but eating and weight returned to normal or increased when an acute psychotic episode abated. However, since the start of the neuroleptic drug era in the 1950s, a new pattern of sustained increased weight has commonly been detected. The question of whether weight gain is associated with efficacy is important in one study there was no obvious relation between the magnitude of...

Pediatric Obesity and TDM An Inevitable Consequence of Living in an Age of Abundance

Perhaps one of the greatest public health concerns of recent years has been the dismal increase in the prevalence of overweight and obese children and teenagers. Pediatric obesity is defined as a BMI greater than the 95th percentile while being overweight is defined as a BMI greater than the 85th percentile, adjusted for age and gender. While BMI is not the optimal way to quantify excessive adipose tissue, its simplicity has imposed it as a valuable surrogate test. However, one should keep in mind that there can be a significant variability when compared with direct measurements of body fat (30, 93-95). In any case, the prevalence of obesity in children is believed to be 14 (32, 35), representing about a threefold increase among children across all ages between 6 and 19 years. The CDC recently reported that the mean weight of 10-year-old boys and girls in 2002 increased by 11 lbs (from 74.2 to 85 lb and 77.4 to 88 lbs, respectively) compared to data from 1963 to 1970. More recently,...

Effects of Excess Dietary Fat Intake

The effects of this excess intake of dietary fat has some well-established implications for the health of overweight Americans. For instance, the consumption of excess amounts of saturated fats has been recognized as the most important dietary factor to increase levels of cholesterol. A high cholesterol level is detrimental to health and leads to a condition known as atherosclerosis. Atherosclerosis is the build-up of cholesterol on the walls of arteries, which may eventually result in the blocking of blood flow. When this occurs in the arteries of the heart, it is called coronary artery disease. When this process occurs in the heart, a myocardial infarction, or heart attack, may occur. Besides the cholesterol implications due to high fat intake, obesity is a factor in the causation of disease. Being overweight or obese is highly associated with increasing the risk of type II diabetes, gallbladder disease, cardiovascular disease, hypertension, and osteoarthritis.

Change Your Diet

All seasons even in countries where, or seasons when, absolutely nothing edible grows. Unfortunately, other nutritional innovations can have very negative effects. Artificial lifestyles and the excessive processing of food have harmful consequences. Our modern diet is not well adapted to our species and has led to the increase of certain disorders, the rapid deterioration of our state of health, decreased physical performance, and increased physiological stress. Our pace of living forces us to be constantly running after work and money. We no longer take the time to enjoy life and find ourselves having to live on top of each other in huge cities with all their well-known urban problems robbery, violence, transport problems, overpopulation, etc. In this reckless race for work and money, people end up by quite involuntarily devastating the natural resources of the planet, and, even worse, they destroy their own lives and damage their health. Environmentalism can help us to be become...

The Obesity Epidemic

A dramatic increase in the prevalence of obesity has been witnessed in many countries in the past quarter of a century. Obesity, at least in Caucasian populations, is defined as a body mass index (BMI weight (kg) height (m)2) over 30 (a lower level has been suggested for some ethnic groups.) BMI may not accurately reflect fat mass nor its distribution. Fairly accurate estimations of fat distribution may be gained by measuring the waist-hip ratio or more simply waist circumference, both of which correlate well with more sophisticated techniques, such as computed tomography or magnetic resonance imaging. The measurement of waist circumference has become part of the definition of the metabolic syndrome or syndrome X, a condition that predisposes to the development of type 2 diabetes. Since 1980 the prevalence of obesity in the UK has risen from 6 in men and 8 in women to 19 in men and 21 in women in 1999 and since then it has risen still further. In the USA, the prevalence of obesity has...

Obesity

If obesity were merely a matter of aesthetics, it would be of less concern. But obesity is a health issue. It is associated with an increased risk of diabetes, lipid abnormalities, coronary artery disease, high blood pressure, certain cancers (such as breast, colon, and gallbladder in women and colon and prostate in men), stroke, degenerative arthritis, respiratory problems, sleep disturbances, and gallbladder disease. Obesity places a huge burden on society in terms of lost lives, ongoing illnesses, emotional pain, discrimination, and economic cost (nearly 100 billion annually). The most ominous burdens posed by being overweight are reduction of the quality of life and shortening of life span. The likelihood of dying early (compared with the average age at death of all people in the population) progressively increases the more overweight you are. Diseases caused by obesity are the second leading cause of preventable deaths in the United States. With countless diet programs and...

The Obesity Bias

Obesity is the chronic disease that is easiest to diagnose. If not obvious to the naked eye, then a simple BMI calculation establishes the diagnosis. Yet obesity is greatly underreported. One reason is a physician bias against obese patients, even among health professionals specializing in obesity 1 . This bias is found among primary care physicians, too. A survey of 620 primary care physicians showed that over 50 believed obese patients were awkward, unattractive, and noncom-pliant. Though 92 of the physicians in this survey stated that obesity is a chronic disease, 85.7 had not been successful in treating the disease. When compared to 10 other chronic conditions (hypertension, asthma, coronary artery disease, hyperlipidemia, diabetes, depression, osteoarthritis, tobacco dependency, alcoholism, and drug addiction), physicians perceived their clinical effectiveness in treating obesity to be closest to the latter three conditions 2 . Considerable frustration can be felt when trying to...

Childhood Obesity

There have always been overweight children. Historically, chubby babies and toddlers were more likely to survive infections and contagious diseases, and overweight children and family members were often signs of affluence and financial security in a community. Thus, in some cultures, overweight was a valued body type. Today, being overweight puts a child at risk of developing chronic diseases such as type II diabetes, hypertension, and high cholesterol levels. Obesity can promote degenerative joint disease, which will result in painful knees, hips, feet, and back, and it can severely limit physical activity. These are health concerns previously seen only in adults, usually in those over age forty. Obesity can be measured using a tool called body mass index (BMI). The BMI of an individual can be derived from tables or calculated using a formula (weight in kilograms divided by height in meters squared). In the year 2000, the U.S. Centers for Disease Control and Prevention (CDC) released...

Insurance Companies Get In On The

Since being overweight is a condition, WebMD includes an excellent Weight Control Health Center (see Figure 5.17).There are articles, quizzes, tools, tips, facts from the Cleveland Clinic, and lots of data about a variety of obesity-related subjects. FIGURE 5.17 The Weight Control Health Center on WebMD includes lots of articles, quizzes, tools, and other information. FIGURE 5.17 The Weight Control Health Center on WebMD includes lots of articles, quizzes, tools, and other information. WebMD's more than 200 message boards are well traveled, with a variety of support groups on a number of topics (AIDS, aging, addiction, arthritis, cancer, cholesterol, dental health, infertility, men's issues, women's issues, and weight loss, among others) plus boards hosted by an expert (ADD HD, cancer, diabetes, dieting, general health, sleep disorders) and some tips on topics such as skin care and others. There are also live events most weekdays at 2 00 pm Eastern time. These events are hosted by...

Nutritional Considerations in Joint Health

Osteoarthritis, a debilitating joint disorder, is the most common form of arthritis in the United States 1 , where it affects an estimated 21 million people. In 2004, the direct and indirect health care costs associated with all forms of arthritis were approximately 86 billion 2 . Joint discomfort from osteoarthritis and other joint disorders may reduce physical activity in individuals experiencing this condition, resulting in energy imbalance and weight gain. Increased weight can exacerbate existing problems, as additional stress on joints stimulates risk of additional joint disorders. Dietitians play a role in preventing or reversing the problem of joint disorders by promoting nutrient-rich diets that support joint health through improvement in cartilage metabolism. In addition, counseling individuals on weight management and active lifestyles are key strategies for the management of joint health.

Low Fat Dairy Products

Dairy foods such as low-fat milk, yogurt, and cheese are not only quick and easy sources of protein but are also rich in vitamin D (if fortified) and calcium, a mineral that is particularly important, not only for growing children and teens but also for women and men of all ages. A diet rich in calcium and vitamin D helps maintain strong bones, reduces the risk of osteoporosis, protects against high blood pressure, and may help prevent weight gain (Caan et al. 2007). Vitamin D may be helpful in preventing and treating diseases other than cancer, such as fibromyalgia, diabetes mellitus, multiple sclerosis, and rheumatoid arthritis (Lappe et al. 2007). Fat-free or low-fat milk (cow's or soy) and other foods rich in calcium and vitamin D should be an important part of your diet throughout your lifetime. Because your bones are alive, they need calcium and vitamin D daily. Children and teens need calcium for growth. Adults also need calcium to maintain strong bones. Although you may stop...

Small Bowel Obstruction

Change in eating habits compared to preoperative eating habits. Some patients have continuing food intolerances, especially to red meat, and become vegetarian. Reassurance and empathy is essential to help the patient overcome food intolerances. By six months, most patients are able to tolerate most foods, and tend to eat three small meals per day. If problems continue, referral to an experienced dietitian can be helpful. Patients with a preoperative history of eating disorders (binge eating, reactive overeating, etc.) tend to manifest difficulty in adjusting to the change in eating habits more commonly. Referral to an experienced psychologist can help unmask some of the underlying emotional issues associated with food. Weight loss is rapid in the first six months, averaging 10-15 lbs per month. Average weight loss at the six-month follow-up visit is 60-80 lbs. Thereafter, the rate of weight loss tends to slow down to 5-7 lbs per month, reaching a peak at 12 months postoperatively,...

Chapter Ten things to do for better health

Ten tips for a healthier diet now. 4. Drink enough water. This may sound a bit silly to a lot of people, but something as simple as not getting enough water is causing a lot of health issues. Just about every body system is water dependent. The most common symptom of chronic dehydration is not thirst. Most people suffering from chronic dehydration find themselves afflicted with a plethora of debilitating conditions such as gastritis, heartburn, arthritis, headaches, depression, weight problems and 6. Get plenty of soluble dietary fiber. Most of us do not get nearly enough fiber. As a result our dietary tracts are unhealthy. It is far easier to increase fiber than you might imagine. Start with unprocessed whole grains, and the good fruits and vegetables. To add even more fiber, include psyllium husks to your diet daily.

Research and Biomedical Advances

And restriction of dietary salt reduce the need for blood pressure-lowering drugs, (3) confirming that tight control of blood glucose (sugar) may help people living with diabetes prevent complications such as blindness, and (4) identifying leptin (a product of the obesity gene) and suggesting how it might be used to combat obesity in humans. A number of extramural investigators have also been honored with the Nobel Prize for their significant contributions to biomedical science. For example, the 1985 Nobel Prize in Physiology or Medicine was awarded jointly to Drs. Michael S. Brown and Joseph L. Goldstein for their discoveries concerning the regulation of cholesterol metabolism and its role in heart disease. obesity the condition of being overweight, according to established norms based on sex, age, and height

Fatvital Yes But Less Is Enough

However, being overweight has more critical implications than our looks. It contributes to heart disease, high blood pressure, diabetes, and osteoarthritis. The build-up of these deposits forms plaques that narrow the openings in the coronary arteries which supply blood to the heart. These coronary arteries are so named because they circle the heart like a crown. It would be well to care for them as one would a jeweled crown of gold, for your life depends upon their preservation. In the U.S. someone dies of a heart attack every forty-five seconds. *26 The most advanced medical knowledge in history is telling us that heart attack and stroke victims, fifty percent of us, perish from a disease nurtured at our own hands. *27 Saturated fat and cholesterol are often spoken of together because they travel together in the same foods meat, fish, dairy products, and eggs. There is a relationship between the intake of cholesterol in our food and an increase of cholesterol in...

Food Allergies and Sensitivities

Food sensitivities occur when a component of the diet triggers an allergic reaction or an abnormal, overzealous immune response.1415 Food sensitivities can cause histamine-medi-ated allergic reactions resulting in itching, swelling, and hives. They can also trigger autoimmune reactions, where immune cells activated by exposure to the food component cross-react with and harm the body's own tissues. Sensitivity can develop to foods or food additives and can produce a wide variety of symptoms. Symptoms can be confined to the digestive tract, such as bloating, cramping, diarrhea, or irritable bowel syndrome.1,15 They can also occur in parts of the body far away from the digestive tract, such as the joints (arthritis), skin (swelling and hives) and brain (headache).1,4,15 Symptoms can occur immediately after eating the food, or may be delayed for hours.

Teriyaki Salmon Salad

Salmon, nature's wonder food, is full of those omega-3 fatty acids, one of the good fats. Including them in the diet can help delay signs of aging and wrinkles, treat arthritis and skin eruptions, and prevent cancer, heart disease and Alzheimer's. Yes, omega-3s can do all that Per serving Kcalories i56 (From Fat 65) Fat 7g (Saturated 1g) Cholesterol 97mg Sodium 559mg Carbohydrate 8g (Dietary Fiber ig) Protein 39g.

Recommendations to optimize fat intake

Dietary reference intakes for macronutrients have recently been published.150 Significantly, for the first time these recommendations include amounts of ra-3 PuFA for infants as well as adults. For rn-6 PuFA, it is recommended that men between the ages of 19 and 50 years receive 17 g d of linoleic acid and that women in the same age group receive 12 g d. The requirements drop to 14 g d for men older than 50 years of age and to 11 g d for women over 50 years of age. For rn-3 PuFA, it is recommended that men older than 19 years of age receive 1.6 g d of a-linolenic acid, and women older than 19 years of age receive 1.1 g d. Based upon these amounts, the recommended m-6 m-3 ratio for men up to 50 years of age is approximately 10.6 1, and changes to 8.75 1 for men over age 50. For adult women up to 50 years of age, the ratio is 10.9 1, and it then changes to 10 1 for women over 50 years of age. Research on rn-6 and rn-3 PuFA has found that it is the ratio of these two essential fatty acid...

Who Needs a Nutritional Supplement

On the other hand, if his or her diet is consistently imbalanced then that person's average daily intake for one or more essential nutrients will probably end up below recommendations. For instance, if a person doesn't eat fish or other seafood regularly, then they might not be achieving recommended levels for an essential fatty acid. Or, if a person doesn't tolerate or like milk and certain dairy foods, they might not achieve his or her AI for calcium and vitamin D on a regular basis. Therefore, unrelenting food preferences, food intolerance, and allergies, or limited availability of certain foods can certainly necessitate the consideration of a nutrition supplement. In addition, reduced calorie intakes to lose weight can often lead to inadequate intakes of one or more essential nutrients by reducing the volume of food in general or limiting the intake of certain types of foods. Beyond achieving RDA AI levels for essential nutrients, many people seek out supplements containing...

Chronic inflammatory autoimmune diseases

Chronic inflammatory or autoimmune diseases are often characterized by a dysregulated Thl-type response and by an inappropriate production of proinflammatory cytokines (e.g. TNF-a) and arachidonic acid-derived eicosanoids (e.g. PGE2 and LTB4). The effects of fish oil outlined above suggest that n-3 PUFAs might have a role in the prevention and therapy of chronic inflammatory diseases. In support of this idea, dietary fish oil has been shown to have beneficial clinical, immunological and biochemical effects in various animal models of human diseases. These effects include increased survival and decreased proteinuria and anti-DNA antibodies in mice with autoimmune glomerulonephritis (Prickett et al., 1983 Kelley et al., 1985 Robinson et al., 1985, 1986), decreased incidence and severity of joint inflammation in mice with collagen-induced arthritis (Leslie et al., 1985) or rats with streptococcal cell There have been a number of clinical trials assessing dietary supplementation with fish...

Genenutrient interactions and genetic susceptibility

Studies continue on the role of nutrients in gene expression for example, researchers are currently trying to understand why omega-3 fatty acids suppress or decrease the mRNA of interleukin, which is elevated in atherosclerosis, arthritis and other autoimmune diseases, whereas the omega-6 fatty acids do not (131). Studies on genetic variability to dietary response indicate that specific genotypes raise cholesterol levels more than others. The need for targeted diets for individuals and subgroups to prevent chronic diseases was acknowledged as being part of an overall approach to prevention at the population level. However, the practical implications of this issue Although humans have evolved being able to feed on a variety of foods and to adapt to them, certain genetic adaptations and limitations have occurred in relation to diet. Understanding the evolutionary aspects of diet and its composition might suggest a diet that would be consistent with the...

Essential fatty acids

Health Canada says,omega-3 fatty acids are unique types of polyunsaturated fatty acids (PUFA's) that are essential to human health and are of dietary importance since our bodies do not produce them. Typical North American intakes of EPA DHA are approximately 100-150 mg daily - one-tenth of what is considered necessary for the maintenance of optimal health. A series of experiments were performed which demonstrate that diets that are low in n-3 fatty acids (Omega 3) lead to low brain DHA and also lead to losses in nervous system function. Omega 3 has also been shown to decrease arthritis, slow the onset of Alzheimer's, and improve function in many systems in our body. Recent research has found many benefits associated with adequate omega 3 consumption. Our bodies do not produce these essential fatty acids so they have to be consumed in the diet. Like many other vitamins and minerals they have to be replenished or they become depleted. The Omega 3 eggs are the best...

Oxidation and Disease an Overview

Atherosclerosis, or hardening of the arteries, is a condition that has become epidemic in the industrialized world, especially in the United States. For many years conventional wisdom held that this fatty destruction of the arteries was due to excess cholesterol in the diet. This led to a national obsession with eating only foods that did not contain cholesterol or that boasted very low cholesterol content, thus creating a whole new industry for food manufacturers. More than fifteen years ago it was discovered that cholesterol is not dangerous unless it is oxidized, and the reason high cholesterol levels are associated with elevated rates of heart attacks, strokes, and peripheral vascular disease is that the more cholesterol you have in your blood stream, the more likely some of it will become oxidized.

Etiology and pathogenesis

Given the constant intestinal exposure to numerous luminal dietary antigens, it seems reasonable to postulate a relationship between diet and ulcerative colitis. The data on the association of breast feeding and ulcerative colitis are inconclusive, with one published study suggesting a protective effect,41 and two other studies showing no effect.28,42 Ecological and case-control studies have examined the association between certain foods and ulcerative colitis,43,44 but at present, there is no definitive evidence linking diet to the development of ulcerative colitis. Methodological issues of these retrospectively designed dietary studies, such as the collection of pre-illness dietary information, remain a problem in the interpretation of findings. As an example, the recalled dietary intake may reflect changes in the diet secondary to the effects of the disease itself, rather than the individual's dietary habits preceding the onset of disease. The association between oral contraceptive...

Treatment of Food Allergies and Intolerances

The major mode of treatment for food allergies and intolerances is for the person to avoid consuming the food or foods that seem to cause health problems. This involves a high degree of dietary awareness and careful food selection. When foods are eliminated from the diet, it is important to ensure the nutritional adequacy of the diet, and some individuals may need to take dietary supplements. There are some food intolerances, such as lactose intolerance, where individuals may be able to reduce the amount of the food consumed and not totally eliminate it from the diet. People with lactose intolerance do not have to completely eliminate milk products, though they must reduce their intake of lactose (milk sugar) to a manageable level. see also Additives and Preservatives.

Series Editor Introduction

Preventive Nutrition Fourth edition is very special for me and my coeditor, Dr. Richard Deckelbaum. Each of the volumes' Table of Contents is included in the Appendix as there have been many contributors to the prior volumes, and we have added new topics as these emerge with findings that are relevant to health providers and their patients, clients, and or family members. The overarching goal of the volumes is to provide readers with the most up-to-date and comprehensive review of the state of the science in each chapter and then to integrate the information so that the synergies between chapters are visible. The overriding driver for the timing of the fourth edition was the publishing of the results from the Women's Health Initiative (WHI), the largest placebo-controlled intervention study in postmenopausal women ever undertaken. Two chapters in this volume review the findings. The dietary modification component of WHI examined outcomes for coronary heart disease and breast and...

Alpha1adrenergic Blocking Agents

Use with caution in lactation, with impaired hepatic function, or if receiving drugs known to influence hepatic metabolism. Safety and efficacy have not been established in children. Side Effects The following side effects are common to alpha-1-adren-ergic blockers. See individual drugs as well. Oral Dry mouth. CV Palpitations, postural hypotension, hypotension, tachycardia, chest pain, arrhythmia. GI N& V, diarrhea, constipation, abdominal discomfort or pain, flatulence. CNS Dizziness, depression, decreased libido, sexual dysfunction, nervousness, paresthesia, somnolence, anxiety, insomnia, asthenia, drowsiness. Musculoskeletal Pain in the shoulder, neck, or back gout, arthritis, joint pain, arthralgia. Respiratory Dyspnea, nasal congestion, sinusitis, bronchitis, broncho-spasm, cold symptoms, epistaxis, increased cough, flu symptoms, pharyngitis, rhinitis. Ophthalmic Blurred vision, abnormal vision, reddened sclera, conjunctivitis. GU Impotence, urinary frequency,...

Fat Replacement Strategies

Obesity the condition of being overweight, according to established norms based on sex, age, and height Americans get an average of 14 to 21 percent of their calories from saturated fats, in fatty meats, fried foods, and dairy products such as ice cream. The recommended daily intake of saturated fat is 10 percent of total calories consumed. Photograph by Georgio Borgia. AP Wide World Photos. Reproduced by permission. Foods that are low in fat are important for a healthful diet. While fats are essential components for bodily function, excess consumption of fats can lead to health problems such as obesity and heart disease. A healthful diet therefore consists of balanced proportions of proteins, fats, and carbohydrates. see also Fat Substitutes Lipid Profile Omega-3 and Omega-6 Fatty Acids. Must, A., et al. (1999). The Disease Burden Associated with Overweight and Obesity. Journal of the American Medical Association 282 1523.

Anatomy And Physiology

Ore recently, however, many government and scientific health organizations ave promoted use of the Body Mass Index, which incorporates estimated but More than half of U.S. adults are overweight (BMI > 25), and nearly one fourth are obese (BMI > 30), so assessing and educating patients about their BMI are vital for promoting health. Being overweight or obese are proven risk factors for diabetes, heart disease, stroke, hypertension, osteoarthritis, and some forms of cancer. Remember that these BMI criteria are not rigid cutpoints but guidelines for increasing risks for health and well-being. Note that persons over age 65 have a disproportionate risk of undernutrition when compared to younger adults. Methods to Calculate Body Mass Index (BMI) (1) Body Mass Index Chart (see table on p._) (2) Body Mass Index Nomogram (see table on p._)

Clinical signs and symptoms

Swollen Lips Oral Crohns

Impaired linear growth and concomitant delay in sexual maturation are important clinical manifestations in children with Crohn's disease, that may precede the onset of intestinal symptoms by 12-18 months.103 In a prospective study of children with IBD,117 30 of children with Crohn's disease had growth delay, which was defined as a fall in the height centile of more than 0.3 standard deviation per year, a growth velocity of less than 5 cm per year, or a decrease in the growth velocity of > 2 cm compared with the preceeding year. About 50 of children had evidence of decreased height velocity prior to the diagnosis of Crohn's disease.118 Delayed linear growth velocity and sexual maturation may be related to a chronically insufficient dietary intake and or an increased energy requirements related to chronic inflammation or fever.118,119 Anorexia occurs in 30 of children with Crohn's disease and may be related to upper gastrointestinal tract involvement.120 Studies in a rat colitis model...

Summary And Conclusions

The relationships between required nutrients, as well as the diverse array of other substances in the diet, and angiogenesis is a relatively new area of scientific investigation that is undergoing rapid expansion. The critical roles of angiogenesis in many disease processes, including wound healing, arthritis, vasculatitis, retinopathy, tissue responses to ischemia, and cancer, are beginning to be appreciated (2). Many of these disease processes in experimental animals and humans are also profoundly modulated by diet and nutrition (6,9,10). Future studies will undoubtedly reveal many steps in the angiogenic process modulated by substances contained in foods. The additional knowledge generated will be relevant to optimizing experimental models employed by many angiogenesis investigators. Furthermore, the incorporation of dietary assessment and controlled nutritional intake into clinical trials of angiogenesis modulators will reduce heterogeneity, and improve the power and sensitivity...

Doctors Dilemma

Diabetes affects carbohydrate, fat and protein metabolism, primarily as a result of abnormally high glucose in blood and tissues (hypergly-caemia). There are two types of diabetes. Type 1 is early onset and is due to the failure of the pancreas to produce a sufficient quantity of insulin. It is treated by injections of insulin. Type II is less well defined and it is, characteristically, an age-related disease. It is due to abnormalities in insulin metabolism which are not fully understood. Its incidence is greatly increased by obesity. Although it can often be treated by a controlled diet, it is nevertheless a common debilitating disease amongst old people. Osteoporosis is due to a loss of bone mass, and this commonly causes hip or other fractures in old people. It becomes particularly common in post-menopausal women, but also occurs in elderly men. The addition of calcium to the diet and greater exercise delay the symptoms, but it is nevertheless one of the commonest age-associated...

Body Composition and Cachexia

In a condition of negative energy balance, i.e. when the nutrient intake does not match the energy expenditure, the body primarily uses fat mass as an energy source. If the caloric deficit persists, fat-free tissues are also used, with a consequent further weight loss. While a loss of fat mass has no negative consequences because it only cuts into the energy reserves, the loss of fat-free mass has a negative prognostic value. Starvation is caused by a reduction in calorie intake. The body goes through a metabolic adaptation in order to preserve FFM and increase lipid metabolism, with secondary fat loss. Fat reserves are preferentially used and the brain adapts to using ketones instead of glucose from gluconeoge-nesis. These changes are reversible with an appropriate refeeding programme. Sarcopenia is characterised by a reduction in skeletal muscle mass. Apart from body composition changes in the elderly, this term is also used in the case of weight loss from repeated dieting, in...

[aldesLOOkin Pregnancy Category C

Respiratory Pulmonary congestion, dyspnea, pulmonary edema, respiratory failure, tachypnea, pleural effusion, wheezing, apnea, pneumothorax, hemoptysis. Oral Stomatitis, glossitis. GI N& V, diarrhea, anorexia, GI bleeding (sometimes requiring surgery), dyspepsia, constipation, intestinal perforation, intestinal ileus, pancreatitis. CNS Changes in mental status (may be an early indication of bacteremia or early bacterial sepsis), dizziness, sensory dysfunction, disorders of special senses (speech, taste, vision), syncope, motor dysfunction, coma, seizure. GU Oliguria or anuria, proteinu-ria, hematuria, dysuria, impaired renal function requiring dialysis, urinary retention, urinary frequency. Hepatic Jaundice, ascites, hepatomegaly. He-matologic Anemia, thrombocytope-nia, leukopenia, coagulation disorders, leukocytosis, eosinophilia. Dermatologic Pruritus, erythema, rash, dry skin, exfoliative dermatitis, purpura, petechiae, urticaria, alopecia. Musculoskeletal Arthralgia,...

Classification Antihypertensive antianginal calcium channel blocking agent

Side Effects CNS Headache, fatigue, lethargy, somnolence, dizziness, lightheadedness, sleep disturbances, depression, amnesia, psychosis, hallucinations, paresthesia, asthenia, insomnia, abnormal dreams, malaise, anxiety, tremor, hand tremor, hypoesthesia, vertigo, depersonalization, migraine, apathy, agitation, amnesia. Oral Dry mouth, thirst, gingival hyperplasia, altered taste. GI Nausea, abdominal discomfort, cramps, dyspepsia, diarrhea, constipation, vomiting, flatulence, dysphagia, loose stools. CV Peripheral edema, palpitations, hypotension, syncope, bradycardia, unspecified arrhythmias, tachycardia, ventricular extrasystoles, peripheral ischemia, cardiac failure, pulse irregularity, increased risk of MI. Dermatologie Dermatitis, rash, pruritus, urticaria, photosensitivity, pe-techiae, ecchymosis, purpura, bruising, hematoma, cold clammy skin, skin discoloration, dry skin. Musculoskeletal Muscle cramps, pain, or inflammation joint stiffness or pain, arthritis, twitching,...

TABLE 773 Treatment of Fulminant Colitis

Diarrhea can be controlled by the use of loperamide (Imodium), 4 to 16 mg day, diphenoxylate (Lomotil), 5 to 20 mg day, and, in some cases, cholestyramine (Questran), 4 g one to six times daily. The latter is particularly useful as an exchange resin in patients who have limited ileal disease or resection, no bowel obstruction, and mild steatorrhea. The mechanism of action is binding bile acids and eliminating their known cathartic action. The primary aim of dietary therapy is the maintenance of nutrition and the alleviation of diarrhea. Elimination of lactose from the diet is of benefit in patients with lactose intolerance. Reduction in dietary oxalate should be considered in every patient. In addition, supplementation of trace metals, fat-soluble vitamins, and medium-chain triglycerides should be considered in selected patients.

Studies on the Role of Exercise Fitness in the Etiology of Other Diseases

Obesity Obesity is defined as an excess of adipose tissue. This condition plays a central role in the development of diabetes mellitus and confers an increased risk for CHD, high blood pressure, osteoarthritis, dyslipoproteinemia, various cancers, and all-cause mortality. The prevalence of obesity has risen dramatically in recent years, despite a decline in daily energy expenditure during the past two decades in the United Kingdom of approximately 800kcalday-1 (3347kJday-1). obesity in humans. However, confirmatory data are scarce, particularly from well-designed prospective studies. One large-scale national study in the United States evaluated the relationship of physical activity to weight gain over a 10-year follow-up of 3515 men and 5810 women. Individuals who were sedentary at both baseline and follow-up were much more likely (relative risk, 2.3 (95 confidence interval (CI), 0.9-5.8) in men and 7.1 (95 CI, 2.2-23.3) in women) to experience considerable weight gain (> 13 kg)...

Other Physiological Effects

Because many, sometimes competing, mechanisms appear to mediate the relation between intake of MUFA and CHD incidence, no single surrogate biochemical or physiological response can predict with confidence the effect of a particular dietary pattern. For this reason examinations of the relation between specific dietary factors and CHD incidence itself are particularly valuable because such studies integrate the effects of all known and unknown mechanisms. A large body of evidence suggests a beneficial effect of MUFA in the diet. Although much remains to be learned about the mechanisms by which C18 1 acts, it is believed to lower risks of CHD, several common cancers, cataracts, and other inflammatory disorders. It is suggested, therefore, that consuming MUFA, for instance in the form of olive oil as used widely in the Mediterranean diet, is likely to enhance long-term health.

Future Work Conclusions and Recommendations

N-3 fatty acids should be added to foods rather than be used solely as dietary supplements, which is a quasi-pharmaceutical approach. Furthermore, the development of a variety of n-3-rich foodstuffs would allow increased n-3 dietary intakes with little change of dietary habits. n-3 fatty acids maintain their preventative and therapeutic properties when packaged in foods other than fish. Efficient use of dietary n-3 fatty acids will require the simultaneous reduction in the food content of n-6 fatty acids and their substitution with monounsaturated oils. Dietary n-3 fats give rise to higher tissue levels of EPA when the 'background' diet is low in n-6 fats. Compared to n-6 fatty acids, olive oil increases the incorporation of n-3 fatty acids into tissues. The time has come to return to high n-3 fatty acid levels in the diet and to decrease the n-6 intake. There is good scientific evidence from studies on the Paleolithic diet, the diet of Crete, other traditional diets (Okinawa),...

The Checklist in History Taking

Chronic obstructive pulmonary disease smokes Easier to breathe leaning forward Were pulmonary function tests performed Told of emphysema or experienced chronic cough with wheezing and sputum Coal miner Abnormal chest X-ray Marked obesity Pickwickian syndrome. 5. Pulmonary dysfunction associated with weight gain Asthma wheezes helped by bronchodilators Evidence of emphysema, smokes, coughs with sputum Pulmonary function results Pulmonary embolism sudden shortness of breath, syncope with hemoptysis, chest pains, cold sweats, phlebitis, or varicose veins Is patient pregnant or on contraceptive pills Recent long trip Pneumothorax sudden shortness of breath or inspiratory chest or shoulder pain with dry cough 2. Stasis or obstructive edema began with weight gain or pregnancy Tight panty girdle or varicose veins or phlebitis Shirt collar tight and face swollen (Suggests superior vena cave obstruction.) Abdominal swelling (Suggests constriction, tamponade, or ovarian cancer.) change, dry...

Prevalence and Risk Factors

Risk factors for acute gout other than hyperurice-mia have been identified. All risk factors act either by increasing serum uric acid levels or by reducing the solubility of uric acid in the joints. For example, male sex, alcohol ingestion, obesity, and weight gain are associated with increased uric acid production, whereas diuretics (thiazides and loop diuretics), low-dose salicylates, and renal insufficiency lead to reduced clearance of uric acid. Hypertension has been associated with increased risk of gout, but this effect probably operates through renal insufficiency, which occurs as a result of hypertension and diuretic therapy. Lead, on the other hand, has been shown to directly reduce the solubility of uric acid in synovial fluid, whereas lead nephropathy also leads to reduced clearance of uric acid the gout associated with lead toxicity is known as saturnine gout. Joint trauma and cooling of distal joints also reduce solubility of uric acid and increase the risk of an acute...

Supplements of Polyunsaturated Fatty Acids

In addition to modifying the diet, the intake of polyunsaturated fatty acids may be increased by taking supplements. Some of these supplements actually have been studied in clinical trials of people with MS. Another study of 16 people with MS evaluated the effects of omega-3 fatty-acid supplements, other dietary supplements (vitamins A, B, C, D, and E), and dietary advice (including decreased saturated fat and increased fish intake) over 2 years (12). Compared with clinical status before the study, treatment was associated with a significant decrease in the attack rate and improvement in the level of disability. No placebo group was used in this small study. A study of 31 people with MS assessed the effects of omega-3 fatty-acid supplements in combination with glatiramer acetate (Copaxone) or interferons (Avonex, Betaseron, Rebif) (13). People were treated with the conventional MS medications along with either fish oil and a very low-fat diet or with olive oil and a low-fat diet. A...

Type Diabetes And Its Related Conditions

There is a concerning epidemic of obesity, insulin resistance, and T2D in the world (1). With the aging of the population and greater longevity, the long-term consequences of these conditions are serious and burdensome. Adiposity refers to the amount of adipose (fat) tissue in the body (2). Some refer to adiposity as fatness or obesity. Adiposity is a continuum, and the normal or ideal threshold of adiposity is not clear. However, as adiposity increases it is associated with higher risk of insulin resistance, diabetes, hypertension, dyslipidemia, cardiovascular disease, degenerative joint disease, cancer, and respiratory diseases (3, 4). Definitions of a high level of adiposity have been devised using existing measures and according to their relationship with adverse outcomes (5). Adiposity is usually measured indirectly with anthropological measures (6) such as the body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg m2). BMI is strongly...

The Cascade of Inflammatory Signaling

Peripheral vascular disease, autoimmune disorders, obesity, and cancer as well as neurological disorders like Alzheimer's and Parkinson's disease are triggered at least in part from the inflammatory signaling that is chronically upregulated. The inflammatory state is closely related to obesity and insulin resistance, yet other vectors may lead to chronic inflammation, including chronic stress, gut-brain miscommunication, neu-roendocrine-immune shifts, dietary choices (including artificial sweeteners), exercise frequency, drug use (prescription, non-prescription, and recreational), and environmental stressors (such as heavy metals and chemical preservatives in foods). Population-based studies have reported strong relationship between inflammatory markers and metabolic disturbances, obesity, atherosclerosis, and inflammation has been considered a 'common thread' between these conditions and type 2 diabetes 2, 3 . Chronic stress has negative effects on inflammatory signaling, serum...

Indications and Patient Selection for Bariatric Surgery

Approximately 97 million adults in the United States are overweight or obese 32.6 are overweight, defined as a body mass index (BMI) of 25-29.9 kg m2, while 22.3 are obese with a BMI > 30 kg m2. Morbid obesity, or clinically severe obesity is defined as 100 lb. above ideal body weight, or a BMI > 35 kg m2. Severe obesity (more than 244 lb. for men or more than 225 lb. for women) has been estimated to be present in 4.9 (2.8 million) of men and 7.2 (4.5 million) of women in the United States. As the BMI increases, so does the mortality rate from all causes, especially from cardiovascular disease, which is 50 -100 above that of persons who have BMI in the range 20-25 kg m2. Pathophysiology of Morbid Obesity Syndrome Morbid obesity is a potentially deadly syndrome that is a harbinger of multiple other diseases and disorders, affecting every organ and system of the body, and as such it is associated with several significant clinical conditions. Cardiovascular dysfunction in morbidly...

Preface to the Second Edition

The publication of the first edition of the Handbook of Obesity occurred just as the Food and Drug Administration requested the recall of fenfluramine and dexfen-fluramine. Each drug alone and in combination with phentermine had been associated with a rash of valvular heart disease. These cases were similar to some seen with the carcinoid syndrome that secretes serotonin. There was an accumulation of material on the aortic valves in the heart that made them leaky. The good news is that many of these valvular lesions have been reversible when the drugs were discontinued, and there are no cases known to us of progression after the drugs were stopped. Thus, at the time the first edition of the Handbook of Obesity was published, the chapters dealing with fen-fluramine and combination therapy were already out of place. In addition, there were few drug treatments on the horizon. In spite of this negative impact, the scientific advances preceding the publication of the first edition had been...

Paroxetine hydrochloride

Abnormal thinking, akinesia, alcohol abuse, ataxia, convulsions, possibility of a suicide attempt depersonalization, hallucinations, hyperkinesia, hyper-tonia, incoordination, lack of emotion, manic reaction, paranoid reaction. Oral Dry mouth, dysphagia, glossitis, increased salivation, mouth ulceration. GI Nausea, abdominal pain, diarrhea, vomiting, constipation, decreased appetite, flatulence, oropharynx disorder (lump in throat, tightness in throat), dyspepsia, increased appetite, bruxism, eructation, gastritis, rectal hemorrhage, abnormal LFTs. Hematologic Anemia, leu-kopenia, lymphadenopathy, purpura. CV Palpitation, vasodilation, postural hypotension, hypertension, syncope, tachycardia, bradycardia, conduction abnormalities, abnormal ECG, hypotension, migraine, peripheral vascular disorder. Dermatologic Sweating, rash, pruritus, acne, alopecia, dry skin, ecchymosis, eczema, furunculosis, urticaria. Metabolic Nutritional Edema, weight gain, weight loss, hyperglycemia, peripheral...

Dairy wW S Up with That

In fact, a significant amount of scientific research has prompted serious concerns regarding the health risks associated with consuming dairy products. Cow's milk and the majority of products made from it are high in fat (particularly saturated fat) and cholesterol, and contain excess protein and contaminants, from pesticides to drugs. The advertising, sponsored by the National Dairy Council, gives the distinct impression that there is a calcium emergency, and that we need to drink milk in order to keep our bones strong and healthy. Yet, according to Dr. Walter Willett, in Eat, Drink, and Be Healthy, osteoporosis is not a problem that should be associated with lack of calcium intake. Osteoporosis results from calcium loss, with excess dietary protein being a critical factor. He suggests that the substantial amount of protein in milk can result in a 50 percent loss of calcium in the urine Clinical studies also have established that high protein intake aggravates calcium loss. For...

Long Term Effects Tumorigenicity

In untreated women, the main risk factors for endometrial carcinoma are age, obesity, nulliparity, late menopause (and possibly early menarche), the Stein-Leventhal syndrome, exposure to exogenous estrogens, radiation, and certain systemic diseases, including diabetes mellitus, hypertension, hypothyroidism, and arthritis (SED-14, 1451) (81). Certain of these risk factors indicate that an altered endocrine state with increased estrogen stimulation is a predisposing cause, and one might thus in theory expect estrogen treatment (and notably hormonal replacement therapy) to increase the risk (SEDA-22, 466). Some helpful evidence comes from related fields. It should be borne in mind, for example, that the question of an increased risk of endometrial hyperplasia and endometrial cancer also arises in patients with estrogen-producing tumors of the ovaries, obesity, and polycystic ovarian syndrome (94) and in patients with breast cancer who are using tamoxifen (95). Detailed studies may also...

Pregnancy Category X

Examination of fluid circulating in the human brain shows higher-than-normal levels of testosterone in smokers addicted to nicotine and lower-than-normal levels in persons suffering from posttraumatic stress disorder. Blood studies find that female smokers and overweight women have higher testosterone levels than nonsmokers or lean persons. Such discoveries have led investigators to speculate that testosterone affects those conditions. Heightened testosterone levels have also been seen in women experiencing major depression. Among men with low body levels of testosterone, supplemental doses may help reduce depression. The drug's ability to affect depression was under investigation when this book was written.

Alternative delivery

Is the first successful differentiating agent for the treatment of patients with acute promyelocytic leukemia. The drug is a vitamin A derivative that works by prodding malignant leukemic cells to differentiate or mature into normal blood cells, which subsequently die. There are not many side effects in some patients retinoic acid syndrome, a potentially serious complication characterized by fever, weight gain, and heart irregularities, develops. The syndrome must be diagnosed early and treated with corticosteroids. Researchers are currently studying the use of the drug against Kaposi's sarcoma and lymphoproliferative disorders.

Advances and Insights from Pharmacological Studies

Medications have potential side effects, which may reduce patient compliance. Some patients also have a psychological resistance to being on psychotropic medications long-term, hence their seeking other approaches, including alternative medicine. One such approach for which there are actually good epidemiological, clinical and biological data is using supplementation with omega-3 fatty acids, which are long-chain, polyunsaturated fatty acids that are a normal component of cell membranes. They are found in the diet in enriched form in plant and marine sources, such as fish oil. Unlike saturated fats, which may have negative health consequences, omega-3 fatty acids have been associated with health benefits in cardiovascular disorders and arthritis.

Diabetes mellitus 141

Dexamethasone A synthetic steroid hormone, similar to those produced by the adrenal glands. Like other corticosteroids, dexamethasone has a wide range of biological actions. It is used most frequently for its anti-inflammatory effects, but it is also a potent inhibitor of certain immune responses. Dexamethasone is used to treat a variety of conditions, including arthritis and other rheumatic diseases, connective-tissue disease, respiratory disease, skin disorders, allergic reactions, inflammation of the eyes, certain blood disorders, inflammation of the brain, and, as a palliative, in certain cancers. In people with HIV it is commonly used alone to counteract allergic drug reactions and as part of a combination chemotherapy for the treatment of AIDS-related lymphoma. Dexametha-sone is available in a number of formulations, including tablets or liquid, topical creams or lotions, ointments for administration to the eyes, inhalants, and as a solution for injection. Stomach upset,...

Knee Pain in Children

Around the knee The tendon of the quadriceps muscle includes the kneecap or patella and then continues as the patellar tendon to attach to the larger of the lower leg bones (the tibia) at a little bump in the bone called the tibial tuberosity. At the stage when the tuberosity is still attached to the main bone only by cartilage, it can be excessively strained. The resulting inflammation causes pain, tenderness, and minor swelling. This is known as Osgood-Schlatter's disease. It occurs particularly in active children between the ages of 10 and 14 years. X rays may show some breaking up of the tuberosity. Treatment is with rest, avoidance of activities such as jumping, and control of weight gain if this is a problem. The condition usually disappears as the cartilage separating the tubercle from the main part of the tibia changes to bone in the midteens. occasionally a loose fragment of bone remains in the tendon and needs to be surgically removed.

Immunology and Possible Mechanisms of Action

This correlates with in vivo data from patients with erythema nodosum leprosum, a condition characterized by overproduction of TNF-a. Clinical improvement with thalidomide was accompanied by a corresponding decrease in serum TNF-a levels (Sampaio et al. 1991). In tuberculosis, regardless of whether there was associated HIV infection, plasma TNF-a and monocyte TNF-a mRNA levels fell on thalidomide treatment, in parallel with accelerated weight gain (Tramontana et al. 1995). In contrast, increased serum TNF-a levels were observed in thalidomide-treated HIV-asso-ciated oral ulceration (Jacobson et al. 1997) and in toxic epidermal necrolysis (Wolkenstein 1998).

Respiratory Cardiovascular and Motor Changes During Sleep in the Elderly

Periods of apnea (cessation of respiration) or hypoapnea (slowing of respiration) during sleep increase with aging from an average of five respiratory disturbances per night at 24 years of age to about 50 per night at 74 years of age. These periods of apnea are brought about by a collapse of the upper airway with temporary blockage of the breathing passages during the sleeping state they are terminated only by an arousal from sleep that restores the activity of the upper airway muscles. Apneic incidents are more common in men than women and in overweight individuals. They account for a great deal of the fragmented sleep experienced by the elderly. They may be lead to daytime drowsiness, irritability, faulty memory, headaches, and possibly depression.

Definition of the Disease

Sitosterolemia is a rare autosomal recessive lipid disorder characterized by the increased intestinal absorption of all sterols and diminished biliary sterol excretion, leading to an accumulation of cholesterol and other sterols in various tissues.1-4 While exact incidence of the disease is not known, founder populations have been identified in Amish (Pennsylvania Dutch), Finnish, and Japanese populations. The hallmark biochemical feature is elevated sitosterol, a major plant sterol, which is abundant in the diet. The disorder was previously called phytosterolemia, because all plant sterols accumulate in this disorder, but even sterols from other dietary sources, such as shellfish, will also accumulate in these patients.5 Sitosterolemia is caused by a defect in a member of the ATP-binding cassette (ABC) family of transporters that is expressed in the small intestine and liver. The defect involves gene mutations in either one of two heterodimeric half-transporters for ABCG5 and ABCG8,...

The Metabolic Syndrome

Abdominal obesity with a waist circumference in men greater than 102 cm (40 in) and for women, greater than 88 cm (35 in). The metabolic syndrome and obesity represent a significant insidious epidemic in primary care (2). The metabolic syndrome has been associated with various names since originally described by Reavin (3). These names include 13. Obesity insulin-resistant syndrome. 1. Obesity. Significant benefit in reducing cardiovascular risk has been demonstrated with a pharmacological modification of the risk factors, but clearly, reversal of the root causes by weight reduction and increased physical activity is critical to management of the condition. Obesity represents a major component of the metabolic syndrome and has a significant association with insulin resistance. Clearly, most individuals with the metabolic syndrome are overweight or frankly obese, and most people with insulin resistance have truncal obesity. It is this truncal, central, visceral, or predominately upper...

The Rat Adjuvant Arthritis Is an Experimental Model of Rheumatoid Arthritis

The acute stage or arthritis (weeks 2 to 4) is defined by signs of hyperalgesia, lack of mobility and a pause in body weight gain during the acute period, hindpaw and forepaw joint diameters increase (Calvino et al. 1987). In the later, acute, stages of disease (day 12+), adjuvant arthritis rats are often relatively immobile due to severity of paw swelling.

Metabolic Acidosis due to Gluesniffing

Hyperchloremic Metabolic Acidosis Tube

Organic acid production in the GI tract. Bacteria are normally segregated from dietary sugar by GI geography. For overproduction of D-lactic acid, bacteria in the lower GI tract must mix with sugars. The supply of sugar is crit i cal for organic acid production. Bacteria migrate up to and pro i iferate in the small intestine. When provided with sugar in this friendly environment, fermentation produces a variety of organic acids and noxious alcohols, aldehydes and amines more are produced if more alkali is supplied. There must also be enough mucosal surface area to transport these acids into the body and cause the high plasma anion gap otherwise the H+ produced might simply destroy luminal HCO3- from the secreted NaHCO3 and lead to the loss of Na+ plus D-lactate in the stool (a normal anion gap type of metabolic acidosis). The degree of the acidosis also depends on the rate that these organic acids can be oxidized and or converted to glucose or fat (primari ly in the liver)....

Raloxifene hydrochloride

Pausal women, during lactation, or in pediatric clients. Concurrent use with systemic estrogen or hormone replacement therapy. Special Concerns Use with caution with highly protein-bound drugs, including clofibrate, diaze-pam, diazoxide, ibuprofen, indo-methacin, and naproxen. Effect on bone mass density beyond 2 years of treatment is not known. Side Effects CV Hot flashes, migraine. Body as a whole Infection, flu syndrome, chest pain, fever, weight gain, peripheral edema. CNS Depression, insomnia. GI Nausea, dyspepsia, vomiting, flatulence, GI disorder, gastroenteritis. GU Vaginitis, urinary tract infection, cystitis, leukorrhea, endometrial disorder. Respiratory Sinusitis, pharyngitis, increased cough, pneumonia, laryngitis. Musculoskeletal Arthral-gia, myalgia, leg cramps, arthritis. Dermatologic Rash, sweating. Drug Interactions Ampicillin l Absorption of ampi-cillin

Action Kinetics Onset 12 hr Time to peak serum levels 1 hr

Side Effects CV Hypotension, chest pain, palpitations, angina pec-toris, MI, arrhythmias. Oral Dry mouth. GI N& V, abdominal pain, diarrhea, dysgeusia, anorexia, constipation, dyspepsia, enzyme changes suggesting pancreatitis, dyspha-gia, gastroenteritis, increased salivation. CNS Headache, dizziness, fatigue, insomnia, sleep disturbances, somnolence, depression, nervousness, malaise, vertigo, anxiety, amnesia, convulsions, tremor. Respiratory Cough, dyspnea, upper respiratory tract infection, asthma, bronchospasm. Hematologic Leuko-penia, eosinophilia. Rarely, decreases in hemoglobin or hematocrit. Der-matologic Diaphoresis, photosensitiv-ity, pruritus, rash, dermatitis, purpura. Body as a whole Paresthesias, angioedema, asthenia, syncope, fever, muscle cramps, myalgia, arthral-gia, arthritis, neuralgia, neuropathy, influenza, edema. Miscellaneous Impotence, tinnitus, hearing loss, vision disturbances, epistaxis, weight gain, proteinuria. Drug Interactions See also...

PUFA Omega6 and Omega3 Fatty Acids n6 and n3 FA

Among the significant components of cell membranes are the phospholipids, which contain fatty acids. The type of fatty acids in the diet determine the type of fatty acids that are available to the composition of cell membranes. A phospholipid made from a saturated fat has a different structure and is less fluid than one that incorporates an essential Symptoms of essential fatty acid deficiency may include fatigue, skin problems, immune weakness, gastrointestinal disorders, heart and circulatory problems, growth retardation, and sterility (Belzung et al., 1998). In addition to these symptom conditions, a lack of dietary essential fatty acids has been implicated in the development or aggravation of breast cancer, prostate cancer, rheumatoid arthritis, asthma, preeclampsia, depression, schizophrenia, and ADHD (attention-deficit hyperactivity disorder). The list is neither exhaustive nor conclusive.

Common Types Of Arthritis

Rheumatoid arthritis usually occurs between 30 to 70 years of age and occurs more often in women than in men. Early symptoms may include feelings of fatigue and weakness, joint pain and stiffness, and, joint swelling several weeks later. Joints are inflamed (warm, red, swollen) and often are limited in range of motion. This is a progressive disease that leads to joint deformity. Aspirin and aspirin-type products (NSAIDs) and Disease Modifying Anti-Rheumatic Drugs (DEMARDs) are usually necessary to reduce the inflammation around the joints and inhibit the progression of the disease. Heat therapy, weight control, and exercise may also be helpful.

Clinical features

It is becoming evident that obesity is one of today's major health hazards.(3) It has been estimated that 300 000 deaths a year in the United States can be attributed to obesity, a figure second only to smoking as a potentially preventable cause of death. (4) The physical signs of obesity are primarily the direct physical consequence of the increase in body weight and the encompassing mass of fatty tissue. The most serious manifestation of this fatty tissue is caused by pressure on the thorax combined with pressure on the diaphragm from below by large intra-abdominal accumulations of fat. The resultant reduction in respiratory capacity may produce dyspnoea on even minimal exertion. In severely obese people, this condition may progress to the so-called Pickwickian syndrome, characterized by hypoventilation with consequent hypercapnia and hypoxia, and finally somnolence. Visceral obesity has been associated with three disorders (insulin resistance, dyslipidaemias, and hypertension) in...

The Connection Between Diet And Nutrients

Currently, 66 of adults are overweight or obese 16 of children and adolescents are overweight and 34 are at-risk of becoming overweight. By 2015, 75 of adults will be overweight or obese, and 41 will be obese.4 Being overweight increases the risk of hypertension, dyslipidemia (high total cholesterol or high levels of triglycerides), type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, asthma, respiratory problems, and some cancers such as endometrial, breast, and colon.5 The prevalence of serious obesity among the adult population has doubled in the last decade despite mass marketing of diet and weight-loss plans and products, fitness clubs, and home exercise machines and videos.6 American children have also increased their girth. Weight problems are not unique to Americans either the World Health Organization has estimated that 1 billion people on the planet are obese.7 It is well known that the Western diet of refined carbohydrates,...

Gut Microflora Influences

Moreover, when patients with RA fasted for one week and then were placed on a vegetarian diet (see sections on treatment) there was a significant reduction in anti-Proteus immunoglobulin G activity among the subjects who responded most to the diet, which correlated with a decrease in the activity of the patients' disease.9 No such changes were seen in the level of antibody activity against Escherichia coli. P. mirabilis, however, may not be the only floral species with the potential to contribute to the pathogenesis of RA. There are several studies demonstrating that injection of cell-wall fragments of Eubacterium aerofaciens or Bifidobacterium breve in rats results in a form of arthritis that is similar to RA.10 In addition, an increase of Clostridium perfringens in the bowels of patients with RA has been shown, although this effect might also be attributed to the effects of treatment with anti-inflammatory drugs.11-13

Requirements and High Intakes

A dietary deficiency of aluminum in goats reportedly results in increased abortions, depressed growth, incoordination and weakness in hind legs, and decreased life expectancy. Aluminum deficiency has also been reported to depress growth in chicks. Other biochemical actions that suggest aluminum could possibly act in an essential role include the in vitro findings that it activates the enzyme adenylate cyclase, enhances calmodulin activity, stimulates DNA synthesis in cell cultures, and stimulates osteoblasts to form bone through activating a purative G, protein-coupled cation sensing system. If humans have a requirement for aluminum, for which there is currently no evidence, it probably is much less than 1.0 mg day-1. Aluminum toxicity apparently is not a concern for healthy individuals. Cooking foods in aluminum cook-ware does not lead to detrimental intakes of aluminum. High dietary ingestion of aluminum probably is not a cause of Alzheimer's disease. However, high intakes of...

Detection of Comorbidities

Patients who are overweight obese should be questioned for the presence of existing comorbidities (Table 5). When suspected, further diagnostic testing may be required. Diseases that are commonly present in overweight obese persons are coronary heart disease, type 2 diabetes, gallstones, osteoarthritis, and sleep apnea. Patients with severe obesity may also exhibit pulmonary disease and or dysmobility. These condi- Table 5 Complications of Obesity Psychological disorders (e.g., depression) Fatty liver (rarely cirrhosis) Impaired mobility (severe obesity) Serum LDL cholesterol is the primary target of cholesterol-lowering therapy. Overweight and obesity contribute to elevations of LDL cholesterol. Moreover, at any given level of LDL cholesterol, the presence of obesity-induced metabolic syndrome raises the risk for CHD. For this reason, particular attention should be given reducing LDL cholesterol levels in overweight obese patients who are identified as having the metabolic syndrome....

Can Underactive Thyroid Cause Oligoovulation

Environmental Causes Amenorrhea

Illness such as poorly controlled diabetes, childhood rheumatoid arthritis and malabsorptive bowel disease may affect gonadotropin production and result in delayed menarche. Starvation as seen in eating disorders is a profound stress to the body. Anorexia nervosa usually presents after menarche and represents a significant life-threatening condition that may initially be noticed secondary to amenorrhea. Neuropeptide Y, a peptide produced in the arcuate nucleus, normally stimulates feeding behavior however, when elevated in anorexia nervosa, it inhibits GnRH secretion. Weight gain restores gonadotropin production, but normal menses do not always ensue. Similar to anorexia, extreme exercise especially prior to menarche may delay puberty. A reduction in body fat below a critical level and an increase in energy expenditure trigger a decrease in leptin levels. Lower leptin levels can suppress reproductive and thyroid functions and increase adrenal activity. Both patients with anorexia and...

Adipose Tissue Crosstalk Adipocytes and Macrophages

Obesity Obesity Obesity Obesity Obesity Obesity In agreement with the theory that both number and phenotype of macrophages changes with obesity, Cancello et al. (2005) examined subcutaneous adipose tissue from morbidly obese humans before and 3 months after bypass surgery when rapid weight loss occurs. Interestingly, when the subjects were obese, the infiltrating macrophages presented in crown-like structures surrounding mature adipocytes in a pattern similar to that seen after injury. Further studies in a variety of mouse models have consistently shown increased macrophage infiltration with classically activated phenotypes (pro-inflammatory) with obesity. Correlations exist with adipocyte cell size (Bouloumie et al. 2005 Weisberg et al. 2003) and adiposity (Bouloumie et al. 2005 Weisberg et al. 2003 Xu et al. 2003), although there is some debate as to whether plasma triglycerides are an independent factor (Cancello et al. 2006, 2007). The macrophages themselves predominantly localize...

Disorders of Amino Acid Metabolism

Phenylketonuria (PKU) is the most common disorder of amino acid metabolism, and it is a paradigm for effective newborn screening. Phenylalanine is an essential amino acid (meaning that it cannot be synthesized but must be taken in through the diet). The first step to its breakdown is the phenylalanine hydroxylase reaction, which converts phenylalanine to another amino acid, tyrosine. A genetic defect in the phenylalanine hydroxylase enzyme is the basis for classical PKU. Untreated PKU results in severe mental retardation, but PKU can be detected by

Chronic Pain outside the Surgical Context

The biopsychosocial model of chronic pain holds that other people in the patient's life make a material contribution to his or her pain experience. Solicitous responding by others, far from helping with pain actually makes pain and pain related disability worse 23, 53 . The operant conditioning model 90, 91 predicts that in offering pain contingent help (e.g. taking over household jobs) in response to expressions (grimacing) and behaviours (guarding) indicative of pain, well-intentioned spouses unwittingly positively reinforce the patient's pain behaviours leading to an increase in their frequency. On the other hand, the lack of any other person at all to provide love and care in a person's life is a risk factor for chronic pain (S. Rashiq, unpublished data). Other known, independent associations with chronic pain are physical inactivity, cigarette smoking, failing to graduate from high school, low income, being overweight and most chronic medical conditions (such as diabetes and...

AntiTNFa Treatment of Cancer Cachexia

Several studies have demonstrated the role of anti-TNF-a treatment in animal models of cachexia. Sherry et al. studied the effect of anti-TNF-a immunoglobulin treatment in C57B1 6 mice bearing a methylcholanthrene-induced sarcoma that produced TNF-a. The anti-TNF-a treatment resulted in a significant reduction of weight loss, protein loss and fat loss. It was concluded that neutralising endogenous TNF-a production with antibodies offers the potential to reduce tissue wasting associated with neoplastic disease 36 . Siegel et al. (1995) evaluated the ability of the anti-TNF-a monoclonal antibody infliximab to neutralise the in vitro and in vivo biological effects of TNF-a. It was found that repeated administration of infliximab to transgenic mice that constitutively express human TNF-a achieved significant weight gain and prevented subsequent mortality compared with the control group 38 . A prospective clinical study in rheumatoid arthritis (RA) showed evidence that anti-TNF-a therapy...

Summary And Recommendations

Effects that must be considered, particularly anticholinergic and cardiac interactions and organ toxicity. Clearly, gabapentin is a safer drug, but may cause sedation or dysphoria in some patients. Occasionally patients complain of weight gain and nonpitting edema. Until recently another disadvantages of gabapentin included its cost (approximately 10 times the cost of a generic tricyclic antidepressant at usual starting doses) and the need to take the drug three or four times a day. Keep in mind that the dosage of gabapentin must be reduced appropriately for patients with renal insufficiency. Newer marketed medications such as duloxetine and pregabalin may also, as time and treatment experience grows, become primary treatments.

Radiographic and Other Studies

Remember that referred pain to the knee may originate in the hip. Permanent damage may result from increased pressure within the joint capsule. Consider DDH in younger kids, LCPD in school-age boys, SCFE in overweight adolescents, and septic arthritis in everyone (medical emergency).

Box 2 Special attributes of symptoms of heart failure in older adults

If no DOE reported on walking a city block or two, repeat the question with milder forms of activities, such as making bed, walking to the bathroom, taking shower, or changing clothes. Quantify the level or length of activity before dyspnea occurs. DOE may be due to other morbidity, such as lung disease, renal failure, obesity, depression, anemia, and deconditioning. Older adults may not report DOE if they restrict their activity for reasons other than dyspnea, such as pain from severe arthritis, myocardial ischemia, or peripheral arterial disease Weight gain

Treatment and Outcome

Ligaments, and muscles rather than just in a direct line through the heel to the ground. one of the important structures in this mechanism is the plantar fascia. This is a tough, flat, fibrous tissue that spans from the front lower edge of the calcaneus to the base of the toes, supporting the long arch of the foot like an unusually wide bowstring. It also sends further slips along the toes that serve to tighten the plantar fascia when the toes are curled up (as when taking off from that foot). As the foot goes into pronation, the long arch tends to collapse slightly and the plantar fascia is stretched and stressed. This is a normal event. However, if the stresses are suddenly increased by, for example, rapid weight gain or a large increase in the distance walked, microtears can develop in the plantar fascia. This results in small areas of inflammation that can accumulate and cause pain. This commonly affects the middle section of the plantar fascia or its attachment to the calcaneus....

Arthritis In Bloodvessel To The Brain

Coronal Plane

Just as changes at the tissue level cause organ-level signs of aging, certain biochemical changes fuel cellular aging. Lipofuscin and ceroid pigments accumulate as the cell can no longer prevent formation of damaging oxygen free radicals. A protein called beta amyloid may build up in the brain and blood vessels, contributing, in some individuals, to the development of Alzheimer disease. A generalized metabolic slowdown results from a dampening of thyroid gland function, impairing glucose utilization, the rate of protein synthesis, and production of digestive enzymes. At the whole body level, we notice slowed metabolism as diminished tolerance to cold, weight gain, and fatigue.

Arthritis Pain Returns After Ending Prednisone Treatment

Once the initial inflammation is controlled, the patient usually feels very much better. The most difficult aspect of treatment is in limiting the corticos-teroid side effects. The risk of osteoporosis should be evaluated. Most patients will benefit from preventive treatment, at least for the duration of the prednisone therapy. corticosteroids and inflammation may promote atherosclerosis. Since many PMR patients are at an age where they are at risk of cardiovascular events, they should take an antiplatelet agent such as low-dose aspirin. This has not been submitted to controlled trial and is unlikely to be because of the cost of such a trial. Protection from bruising and limiting weight gain are also important in long-term corticosteroid therapy.

Bibliography and References Cited

Protection against cancer and heart disease by the dietary fatty acid, conjugated linoleic acid Potential mechanisms of action. Nutr & Disease Update J 1(2) Berlin M et al. 1991. Plasma catecholamine levels and lipid mobilisation induced by yohimbine in obese and non-obese women. Int J Obes. 15(5) 305-315 Bounous G et al. 1989. Immunoenhancing property of dietary whey protein in mice Role of glutathione. Clin Invest Med 12(3) 154-161 Bounous G et al. 1989. The influence of dietary whey protein on tissue glutathione and the disease of ageing. Clin Invest Med 12(6) 343-349 Brook JG et al. 1986. Dietary soya lecithin decreases plasma triglyceride levels and inhibits collagen-and ADP-induced platelet aggregation. Biochem Med metabol Biol35 31-39 Chin SF et al. 1994. Conjugated linoleic acid is a growth factor for rats as shown by enhanced weight gain and improved feed efficiency. J Nutr 124(12) 2344-2349 Department of Health. 1991. Report on Health and...

The Neural Circuitry Of Regulation Of Energy Balance

Pestle And Swot Interrelatedness

One major breakthrough in understanding body weight regulation was the discovery of leptin. This discovery was the result of decades of research into mouse strains with heritable forms of obesity. Five such spontaneous mouse mutants displaying obesity have been described until now ob, db, tub, fat and Ay. Surprisingly, the genes mutated in these mice, can all be placed into the same anatomical and signalling route. The cloning and characterization of the ob gene showed that it encodes a hormone, named leptin, that is expressed abundantly in adipose tissue. The db gene encodes the receptor for leptin. Levels of leptin are proportional to adipose tissue mass. The discovery of leptin was received with great enthusiasm, since it was thought that a drug mimicking leptin could treat the obesity epidemic. The clinical phenotype of human congenital leptin deficiency is very similar to that seen in the ob ob mouse. Both leptin-deficient humans and mice have early-onset obesity, increased food...

Antiarthritis Medications

If you cannot lose weight and are taking powerful arthritis medications known as NSAIDs (non-steroidal antiinflammatory drugs), it's time for you to consider getting off the drugs. The story is simple. Virtually all drugs known to be effective in controlling the pain and discomfort of arthritis may lead to weight gain. Some do so more than others, but no one has ever funded a study to find out which drugs had the most impact on weight gain. The best solution is for you to try to recall whether any of your weight gain coincided with the use of one or more arthritis drugs. Steroids such as prednisone are powerful medications that can be lifesaving but have a definite metabolic downside, especially if used for long periods of time. They are often prescribed for arthritis as well as for autoimmune disorders, inflammation of the bowel and any other inflammatory condition. These drugs actually cause water retention and weight gain. They can also damage the kidneys and pancreas and cause...

Fruits and vegetables their constituents and modes of action

There are several biologically plausible reasons why the consumption of fruits and vegetables might slow, or prevent, the onset of chronic diseases. They are a rich source of a variety of vitamins, minerals, dietary fibre and many other classes of bioactive compounds collectively called phytochemicals. Experimental dietary studies in animals, cell models and humans demonstrate the capacity of some of these constituents of fruits and vegetables to modify antioxidant pathways, detoxification enzymes, the immune system, cholesterol and steroid hormone concentrations, and blood pressure, and their capacity to act as antioxidant, antiviral and antibacterial agents. It is also known that many of the constituents of fruits and vegetables have the ability to influence the immune system, which in turn is known to be intimately involved in both the prevention and promotion of chronic disease. Enhanced immune and inflammatory responses are central to our ability to deal with unwanted and...

Melinda When the Cure Is Worse Than the Disease

Melinda's physician put her on prednisone, a hormone treatment for allergies and arthritis, and a potent prescription-strength NSAID. Side effects from the prednisone included a seventy-pound weight gain, weakened bones, and increased susceptibility to colds and flus, which left The medications and Melinda's weight gain substantially increased her risk of heart disease and, particularly, heart failure (a catastrophic weakening of the heart muscle). Melinda's physician tried to head off the damage, but he relied solely on pharmaceutical treatment and never discussed nutrition or an anti-inflammatory diet with her. Two years later, after a battery of laboratory tests, he noted that her C-reactive protein levels were elevated, a sign of serious inflammation, so he prescribed a cholesterol-lowering statin drug to reduce her risk of heart disease.

Muscarinic Receptor Stimulation

Soya beans, the seeds of Glycine max Merr. (Leguminosae), form an important part of the traditional diet in China and other parts of the Far East and are frequently a staple of the diet of vegetarians and vegans. Soya contains isoflavones including genistein (10) and daidzein (11), which have been characterised as phytoestrogens.

Arachidonic Acids Profound Growth Impact

One can facilitate AA actions simply by consuming foods rich in omega-6 oils and AA such as meat, eggs, and dairy products. However, the conversion of omega-6 oils (linoleic acid) into their more active gamma linoleic acid form, from which arachidonic acid is derived, is often inhibited as a result of various metabolic factors, including high blood sugar, zinc deficiencies, vitamin deficiencies, and aging. Supplementing the diet with dietary sources rich in gamma linoleic acid, such as primrose oil or black currant oil, can help to bypass this weak enzymatic process. AA biosynthesis can also be suppressed through the use of oils rich in dietary omega-3, including flaxseed, hemp, and fish oils. Thus, to establish anabolic potential, it is important to maintain a high ratio of omega-6 to omega-3 EFAs.

Lifestyle Therapies and Other Nonpharmacological Interventions

However, research in the form of controlled clinical trials as listed in table 3 suggests that people with schizophrenia are able to benefit from lifestyle interventions that promote weight maintenance and weight loss 46-61 . Additionally, the report from the Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes Consensus Panel recommends that in addition to monitoring nutrition and physical activity counseling be provided for all patients who are overweight or obese, particularly if they are starting treatment with a second-generation antipsychotic that is associated with significant weight gain 45 . Therefore, it is important that clinicians working with individuals with serious mental illnesses to become familiar with lifestyle interventions that address weight. This section provides a brief overview of lifestyle interventions recommended by the National Institutes of Health (NIH) in the general population, reviews the...

The Gravity of the Situation

When you consider that 1,300 pounds of pull are exerted on your spine and sacroiliac joints simply to maintain an erect posture, and that practically the entire weight of your vital organs is borne by the spine, you can understand why an excess burden of fat usually results in chronic backache. As we have discussed, your spine has enough jobs to do without having to carry a needless fat overload. I am sure you would rebel if you were forced to wear a sack filled with ten to a hundred pounds of rocks suspended from your waist at all times. Try it. That is exactly the kind of dangerous overload you force upon your poor spine when you are overweight. Overweight exacts many other health penalties too It over-burdens the heart with fatty tissue and forces (63 the heart to strain with overwork in pumping blood through the additional miles of blood vessels. Often high blood pressure develops from obesity, also adult-onset diabetes. Fat deposits impede the functioning of vital organs, such as...

Asthma and related diseases

Raw264 Pge2 Prednisolone

Two studies reported benefit, including improved histological appearance of the colon, decreased disease activity, weight gain and decreased use of prednisolone Two other 'open' studies reported improved symptoms, improved histological appearance of the rectal mucosa and decreased use of prednisolone 1.8 8-12 One study reported significant improvement in itching, trast, some studies have shown significant clinical improvements in patients (e.g. Dry and Vincent, 1991) and there are suggestions that this type of approach may be useful in conjunction with other drug- and diet-based therapies (see Calder and Miles, 2000). Broughton et al. (1997) compared the effects of low-dose and high-dose fish oil in adult atopic asthmatics the actual amount of fish oil each patient consumed was calculated according to their regular n-6 PUFA intake, such that the ratio of n-6 to n-3 fatty acid in the diet was 10 1 (low fish oil) or 2 1 (high fish oil). At baseline and after each treatment period (i.e....

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