Allergy Self Help

What Is Hyperinsulinism?

2011-09-06T22:26:00.001-07:00

Simply put, hyperinsulinism is the condition that results from too much
insulin being produced by your body. It's easy to see how this might happen when
you realize that there's a relationship between the kinds of foods you eat and
the amount of insulin in your bloodstream.

Foods rich in carbohydrates-especially sugar, honey, milk and fruit, which
contain simple sugars, and refined carbohydrates such as flour, white rice and
potato starch-are readily absorbed through the stomach, so they speedily convert
to glucose. When these foods are eaten in excess, they require a lot of insulin
for transport.

Foods made of protein and fat, on the other hand, require little or no
insulin. (Protein in excess converts to glucose in the liver and requires some
insulin to transport it to the cells; fat requires essentially none.) And what
happens when there is too much insulin?

As an overweight person becomes heavier, insulin's effectiveness may decline.
The cells become desensitized to the action of insulin so it can no longer
effectively transport glucose to them. This is known in medical circles as
insulin resistance, which quickly leads to hyperinsulinism.

Numerous studies have shown that insulin resistance is more prevalent among
the obese, although even some individuals who appear slim and healthy may
actually be insulin resistant. What appears to happen is that the insulin
receptors on the surfaces of the body's cells are blocked, which in turn
prevents glucose from reaching the cells for energy use.

That's one reason overweight individuals may be tired much of the time. When
insulin is ineffective in taking glucose into the cells, the liver converts more
and more glucose to stored fat. Your body is, in fact, becoming a fat-producing
machine instead of an efficient energy-producing machine.

Your body's hormonal system is now in desperate straits. At this point,
insulin is being secreted more and more frequently to deal with high blood-sugar
levels, and it is doing its job less and less effectively. Which makes you crave
sweets and carbs, which compounds the problem in a vicious cycle.

In time, even the insulin receptors that convert glucose to fat start getting
worn out, forecasting diabetes.

Here are some further reasons why high insulin levels can lead to big
problems:

Insulin increases salt and water retention, a recipe for high blood
pressure.
Insulin is directly involved in creating atherosclerotic plaques, which,
if not controlled, can lead to heart disease.
High insulin levels have been shown to correlate with high levels of
triglycerides and low levels of "good" HDL cholesterol.
High insulin levels correlate with increased risk of breast cancer and
polycystic ovarian syndrome. (Conversely, the lower the levels of insulin,
the better the survival rates for breast cancer.)

Obesity increases insulin resistance. This means that you can sharply reduce
your risk of blood-sugar disorders-and by extension, heart disease and other
ailments-by simply keeping your weight down and controlling carbohydrate intake.
Even if you have a hereditary predisposition to diabetes, you may be able to
stall or completely avoid its onset.

Understanding the Importance of Insulin

2011-09-06T22:00:00.000-07:00

Almost everyone knows that insulin is given to people with a certain kind of
diabetes, to help control their blood sugar levels when their own supplies
become depleted or insufficient. Insulin is one of the most powerful and
efficient substances that the body uses to control the use, distribution and
storage of energy.

At its most basic, insulin is the control hormone for glucose, a basic form
of sugar. So listen up. Your body is an energy machine, never resting, always
metabolically active-and it powers its operations mainly through the use of
glucose in the blood, which is why glucose is interchangeably called blood
sugar.

The body must maintain a certain level of glucose in the blood at all times.
So when there is no carbohydrate food source to make glucose, the liver will
actually convert protein to glucose.

Remarkably, even on a prolonged, total fast, a healthy body can maintain its
glucose level within a rather narrow normal range. As a general rule, of course,
the body obtains its principal supply of fuel from food.

What Happens to a Meal

You sit down at the table and consume a three-course dinner. Somewhere
between chewing and excreting, your body absorbs certain substances from your
food, mostly across the surface of your small intestine.

From the carbohydrate you eat, your body will absorb sugars, all of which
are, or quickly and easily become, glucose. From fat, it absorbs glycerol and
fatty acids, and from protein, it absorbs amino acids, the building blocks of
all cells.

Obviously, if you eat a lot of carbohydrate, you'll end up with a lot of
glucose in your blood. Sounds good, doesn't it? All that energy coursing through
your system. Eat sugar, starches and fruits and you're going to get those
blood-sugar levels up fast, aren't you?

If you love candy bars, perhaps you're saying, "That's great-the more I eat,
the more energy I'll have." Alas, a bad mistake. You see, the human body evolved
and primitive humans thrived as hunter-gatherers who subsisted primarily on
meat, fish, vegetables, fruit, whole grains and seeds and nuts. Candy bars were
few and far between.

The human body is used to dealing with unrefined foods as they occur in
Nature. Consequently, your body's capacity to deal with an excess of processed
foods is pretty poor, which is why our twenty-first-century way of eating so
often gets us into trouble. If you don't understand this yet, let's look at what
insulin and the other energy-controlling hormones do when you eat.

As Your Blood Sugar Rises

Consuming carbohydrates impacts your blood-sugar levels. The amount of
carbs-and the type-will determine how your blood sugar responds. For example, a
food full of refined sugar and white flour, such as a jelly doughnut, will raise
blood sugar much more dramatically than does a salad.

To be useful to your body, blood sugar has to be transported to your cells.
Think of insulin as the barge that transports glucose from your blood to your
cells. Once it reaches the cells, three things can happen to that glucose: It
can be mobilized for immediate energy; it can be converted into glycogen for
later use as a source of energy; or it can be stored as fat.

Let's delve in a little deeper. Insulin is manufactured in a part of your
pancreas called the Islets of Langerhans. As the sugar level in your blood goes
up, the pancreas releases insulin to move the sugar out of the blood. It then
transports the blood sugar to your body's cells for their energy needs.

But as we previously mentioned, when these needs are met the liver converts
excess glucose into glycogen, which is stored in the liver and muscles, where it
is readily available for energy use.

Once all the glycogen storage areas are filled, the body has to do something
with excess glucose. And here is the big revelation: The liver converts the
remaining glucose to fat, which becomes the "storage tanks" of fat on your
belly, thighs, buttocks and elsewhere. That's why insulin is called "the
fat-producing hormone."

Since fat is much more efficient-and has more capacity to store energy-than
glucose, we can store a lot more fat in our bodies than glucose. That, my
friends, results in obesity. And by the way, the main chemical constituent of
all this fat (the fat you're reading this book to get rid of) is triglyceride,
the very same triglyceride that, in your blood, can be a risk factor for heart
disease and stroke. Insulin is a pretty efficient worker.

If it were not, your cells could not get enough glucose, their basic fuel,
and blood-glucose levels would rise while the cells searched for other
fuels-first for protein in your muscles and organs, and then for fat in your fat
stores.

That's why people with poorly controlled, insulin-deficient diabetes can lose
weight when no insulin is present. And that's why a person on a low-calorie diet
may lose lean body mass. (This shouldn't happen on Atkins, where sufficient
calories and protein are consumed to meet the body's energy needs.)

On the other hand, excessive carbohydrate intake results in high amounts of
blood sugar and may, in turn, overstimulate insulin production. When this
happens, it causes a drop in blood sugar, robbing the body of energy for the
cells.

The result of the process is destabilized blood-sugar levels, quite possibly
causing fatigue, brain fog, shakiness and headaches. The body attempts to adjust
by liberating counter-regulatory hormones-such as adrenaline-to raise the
glucose level, but another stiff dose of insulin can overpower the effect of
those hormones.

Fortunately for most of us, this glucose balancing act takes place
automatically and our blood sugar stays in a fairly narrow, normal range.

But for some, the bodily insult of massive insulin release to deal with
massive blood-glucose levels has been going on for years, causing the
glucose-regulating mechanism in the body to break down, initiating unstable
blood sugar and eventually diabetes.

Dogs May Protect Kids From Allergies

2011-04-01T18:28:00.001-07:00

Infants who live in a house with multiple dogs may be less likely to develop allergies later in life, according to a new study.

Researchers found that infants who live in a home with two or more dogs and a high level of certain types of a bacterial substance were a third less likely to develop wheezing in the first year of life than those who didn't live with dogs.

Wheezing in infants is associated with a higher risk of developing allergies and asthma later in life.

In the study, researchers looked at the effects of pet ownership on wheezing in more than 500 infants at high risk of developing allergies because at least one parent had them.

The results, published in the Journal of Allergy and Clinical Immunology, showed that wheezing was not independently associated with either dog or cat ownership, or a high level of indoor endotoxins.

Endotoxins are natural compounds produced by bacteria. Some believe exposure to these compounds may stimulate the immune system.

However, infants living in a household with two or more dogs and a high level of indoor endotoxins (measured from house dust) were a third less likely to develop wheezing than infants living without dogs.

"Our bodies are programmed to produce allergic responses early in life," says David Bernstein, MD, professor of immunology at the University of Cincinnati, in a news release. "But there are environmental factors like bacterial endotoxins that may modify the immune system and block development of allergies early in life.

"We do not yet understand how and why exposure to high levels of bacterial endotoxins and multiple dogs in the home exert a protective effect in these high-risk infants from wheezing early in life," says Bernstein.

Hot Water Removes Allergens Best

2011-04-01T18:26:00.001-07:00

May 21, 2007 -- Hotter is better when it comes to killing dust mites and other allergens in your laundry.

A new study shows washing laundry in hot water (140 degrees Fahrenheit) kills 100% of dust mites. But turn the dial down just 36 degrees to a warm, 104 degree Fahrenheit wash and only 6.5% of dust mites are killed in the laundry. Hotter water was also better at removing dog dander and pollen.

But if your delicate laundry can’t take the heat, researchers also suggest another way to reduce dust mites and allergens in the laundry: wash at a lower temperature (between 86-104 degrees Fahrenheit) and then rinse the laundry twice with cold water for at least three minutes each.

In the study, presented at the American Thoracic Society’s 103rd International Conference in San Francisco, researchers compared the effectiveness of washing cotton sheets with regular laundry detergent at various temperatures in removing dust mites, dog dander, and pollen allergens.

The results showed that washing laundry at hotter temperatures was significantly more effective than warm water at killing dust mites as well as other allergens. For example:

Washing laundry in warm, 86- to 104-degree Fahrenheit water killed only about 6% of dust mites.
Hot water washing (at 140 degrees Fahrenheit) killed 100% of dust mites.
Washing in hot water also removed nearly 90% of dog dander compared with about 60% removed in warm water washing.
Hot water washing removed nearly 97% of pollen in the laundry compared with 69% at 86 degrees Fahrenheit and 95% at 104 degrees Fahrenheit.
The study also showed that steam cleaning of the sheets was equally effective as hot water (140 degrees Fahrenheit) washing at killing dust mites and removing dog dander and pollen.

In addition, researcher Jung-Won Park, MD, PhD, of Yonsei University in Seoul, South Korea, and colleagues found rinsing laundry twice in cold water was also effective at removing all traces of dog dander in laundry washed at any temperatures.

Herbal Remedy Soothes Seasonal Allergies

2011-04-01T18:23:00.001-07:00

Jan. 18, 2002 -- A European study suggests that an obscure herbal supplement may be as powerful as the most effective antihistamine for treating the symptoms of hay fever, but an expert warns that it is way too soon to head to the health food store for it.

Researchers in Switzerland report that seasonal allergy patients treated with an extract of the botanical butterbur reported symptom relief similar to patients treated with the antihistamine cetirizine, known by the brand name Zyrtec. Butterbur -- also known as butter dock, bog rhubarb, and exwort -- grows in Europe, northern Africa, and southwestern Asia.

The 125 patients participating in the study were treated with either butterbur or cetirizine for two weeks and then were evaluated though questionnaires. Patients reported similar symptom relief with both treatments, and there were equal numbers of adverse reactions in both groups. Those treated with the antihistamine did report more drowsiness, however.

"Butterbur was well tolerated and did not have the sedative effects associated with antihistamines," the authors wrote in the Jan. 19 issue of the British Medical Journal. "We believe butterbur should be considered for treating seasonal allergic rhinitis, particularly in cases where the sedative effects of antihistamines need to be avoided."

But a California rheumatologist who has spent years searching for effective alternative therapies to treat allergies and asthma is not impressed by the study. M. Eric Gershwin, MD, of the University of California at Davis, says it does little to convince him that butterbur extract is either effective or safe for treating hay fever. Gershwin is a founder of The Center for Complementary and Alternative Medicine Research in Asthma, Allergy, and Immunology at UC Davis.

"Butterbur has been around forever, and it has been used for everything from treating migraines to urinary symptoms to asthma," Gershwin tells WebMD. "And a few years ago, there was a study suggesting that it inhibits testosterone. But the fact is, very little is known about its constituents and interactions with other drugs."

Gershwin says the European study was poorly designed and failed to answer basic questions needed to prove the efficacy and safety of butterbur extract. The European researchers acknowledge that more studies need to be done.

"There is a tendency to think that if something is natural, it is safe," Gershwin says. "But hemlock is natural. Socrates drank hemlock and died. Just because something is natural doesn't mean it is good for you."

So far, Gershwin says, studies evaluating alternative approaches to the treatment of allergies and asthma have proven disappointing. He adds that the best strategies for dealing with seasonal allergies are still avoiding environmental triggers and taking antihistamines.

"All kinds of things have been tried for hay fever, but nothing looks very promising," he says.

Relieve Allergies the Natural Way

2011-04-01T18:20:00.001-07:00

If spring and fall send your seasonal allergies into a spin, many experts say look to Mother Nature for relief that can be as comforting and easy as a day at the beach.

Whether it's the long-awaited change of winter into spring, or the quiet fading of summer into fall, for many folks the changing of the seasons means more than just vacation plans and a new wardrobe -- it signals the start of seasonal allergies.

Sneezing, wheezing, runny nose, and itchy, watery, red eyes -- these are just some of the symptoms that more than 35 million Americans face each year as the pollen from trees, grass, flowers, and plants makes it way into the air.

For many, relief is just a drugstore counter away -- with a wide array of traditional medications available to help. However, for an increasing number of allergy sufferers the road to relief is best paved by Mother Nature, with a variety of all-natural treatments that studies show can help -- often without many of the troubling side effects ascribed to traditional care.

"Using nature-based products can be a very useful way to handle mild allergies and a useful adjunct for more significant allergies, and there are many types of treatments you can safely try," says Mary Hardy, MD, director of integrative medicine at Cedars Sinai Medical Center in Los Angeles.

Among those generating the loudest buzz right now is the European herb butterbur (Petasites hybridus), which, says Hardy, "has had some very impressive clinical trial results."

In one study, published recently in the British Medical Journal, a group of Swiss researchers showed how just one tablet of butterbur four times daily was as effective as a popular antihistamine drug in controlling symptoms of hay fever -- without the traditional symptom of drowsiness that sometimes occurs. In a second study, presented at the 60th annual meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI), a group of British researchers put their stamp of approval on butterbur's effectiveness in quelling symptoms of grass allergy.

Other herbal supplements proving helpful, says Hardy, include freeze-dried nettles and a tonic made from the herb goldenseal, which she recommends adding to still one more natural treatment -- a saline (salt water) nasal spray.

"The saline works to wash out pollen and reduce or thin mucous -- the goldenseal has astringent and local antibacterial properties which can aid in this process," Hardy tells WebMD.

In addition to herbs, many naturopathic doctors also believe certain nutrients can be helpful in quieting seasonal symptoms. Among the most popular are grape seed extract and a flavonoid compound known as quercetin. Although both occur naturally in many foods -- and are especially abundant in red wine -- when used in supplement form they can be extremely helpful in reducing allergy symptoms, particularly in conjunction with vitamin C, says James Dillard, MD.

"There is even some evidence that quercetin may control the release of histamine and other chemicals that help initiate the allergic response," says Dillard, clinical advisor to Columbia University's Rosenthal Center for Complementary and Alternative Medicine, and assistant clinical professor at Columbia University College of Physicians and Surgeons.

Turning the focus from the medicine chest to the kitchen cabinet, you might want to try cooking up some allergy relief in the form of hot, spicy foods. The reason: Experts say the spicier the dish, the more likely it is to thin mucous secretions, which in turn can clear nasal passages. Among the most frequently recommended spices for this purpose include cayenne pepper, hot ginger, and fenugreek, as well as the traditional onion and garlic.

Interestingly, what you don't eat may be even more important than what you do eat. The reason, according to Hardy, is that food intolerance may be far more intimately entwined with seasonal allergies than we realize.

"You have to really look at your diet and cut out any foods that seem to provoke even a mild sensitivity, such as occasional hives or even stomach upset, " says Hardy. In doing so, she says, you can literally lighten the burden on your immune system, which in turn may help reduce the impact of seasonal allergic reactions.

According to New York University allergist Clifford Bassett, MD, if you suffer from ragweed or other weed pollen allergies, "you should avoid eating melon, banana, cucumber, sunflower seeds, chamomile, and any herbal supplements containing echinacea, all of which can make symptoms much worse," he says.

Seasonal Allergies From the Inside Out

If your seasonal allergies are causing you to spend more time indoors than out, you may be tempted to try an air filtration system, which many say can remove irritating dust and pollens from your personal space, and in the process improve seasonal allergies. But according to a recent report from the Agency for Health Care Research and Quality, while these sometimes-costly units may clear the air, once an allergy is in progress they don't appear to have much impact on symptoms.

What may work somewhat better, however, is donning a paper dust filter when outdoors in high pollen conditions.

In addition to whatever natural treatments you try on your own, you may also find significant relief visiting a practitioner of the ancient Chinese medical practice known as acupuncture. Based on the idea that stimulating points outside the body can change or initiate reactions inside, in this case treatment is thought to affect the immune system, where allergic reactions begin.

In a small but significant study of 26 hay fever patients published in the American Journal of Chinese Medicine, acupuncture reduced symptoms in all 26 -- without side effects. A second study of some 72 people totally eliminated symptoms in more than half, with just two treatments.

"Acupuncture can be particularly useful if you are suffering from multiple allergies, since it works to quiet the areas of the immune system that are overstimulated by exposure to multiple irritating factors," Dillard tells WebMD.

Though many nontraditional treatments can be extremely helpful, allergist Marianne Frieri, MD, cautions that natural doesn't always mean better -- or safer. She points out that it's possible to overdose on even the most seemingly mild preparations, and it's important to remember that almost anything in nature's pharmacy could cause a toxic reaction if you use too much.

More important, she says, is never to mix alternative treatments with traditional drugs without your doctor's approval.

"If, for example, you are taking the allergy drug Allegra -- an antihistamine -- at the same time you decide to try a natural substance with antihistaminic properties, you can end up with far too much antihistaminic activity -- which can result in some significant problems," says Frieri, chairwoman of the department of allergy and immunology at Nassau University Medical Center in East Meadow, N.Y.

In addition, both Hardy and Frieri caution that if allergies are moderate to severe, you should not self-treat -- even with seemingly benign natural products -- without checking with your allergist first. When you are ready to try some alternative care, Hardy says one key to success is starting treatment before allergy symptoms kick in. The ideal time to begin, she says, is "three weeks before allergy season is scheduled to start."

Is Conventional Testing Important?

2011-02-01T23:05:00.001-08:00

Conventional testing of allergies remains an important part of any workup in a patient. Most of my patients have already been tested before they come to see me. I just review the testing to ensure that they have been tested correctly. Allergy testing can confirm a reaction to clinically suspected allergens.

If you do undergo allergy testing—and I highly recommend that you do—here are the main points to keep in mind:

Percutaneous testing should be done first.
Intradermal testing should be done on anyone over thirty or on anyone who tested negative to the percutaneous test, especially if the allergen is highly suspicious.
Percutaneous and intradermal testing must be performed and interpreted by an experienced practitioner.
In vitro antibody testing (RAST) gives little useful information, so I recommend that you not have it done.
If something tests positive, then do everything you can to avoid it—even if it means drastic changes in your life.

Despite their importance in helping to diagnose your problem, these conventional tests usually show positive for the same things in most patients: molds, dust, grasses, pollens, and cats. I would say that most patients have had these tests and have been found to be positive to at least one of those five things. That information never did them any good.

While it is true that most of us are allergic to these things, there is something missing in the diagnostic process. I have seen too many patients who eliminate these things from their environment, and still suffer.

Diagnosing Your Allergies

2011-02-01T23:02:00.001-08:00

Since allergies play such a significant role in lost productivity, increased healthcare costs, and simply making your life miserable, it is important to determine which allergens are responsible for specific diseases, so the proper medical decisions can be made.

Allergy testing has serious limitations, and the diagnosis of an allergy to a specific allergen cannot be made on the basis of testing alone. Your history is just as critical to the diagnosis. The basic conventional forms of allergy testing include percutaneous testing, intradermal testing, in vitro antibody testing, and delayed hypersensitivity testing.

Percutaneous Testing

This is the skin prick testing most of us are familiar with. The basic mechanism behind skin testing is the interaction of the injected allergen with specific IgE antibodies on the surface of your skin mast cells.

This injection will trigger the release of histamine and the formation of a wheal and flare at the site. A wheal is the swelling you see; a flare is the redness. This reaction usually will occur within fifteen minutes after the allergen is introduced. This test remains the primary diagnostic procedure to determine the cause of allergies in this country.

Most practitioners perform this test on the back of the forearm, the upper arm, or the upper back. The upper back is by far the most sensitive but is not used as often. Certain guidelines should be followed to ensure that the test is done properly. For example, each allergen must be a certain distance apart, never done near the wrist or the elbow, and skin testing should never be performed on sites of active skin flare-ups such as dermatitis or hives.

Your doctor should use both positive and negative controls. A negative control tests the diluent that the allergen is in, to make sure you are not allergic to that rather than to the allergen. A positive control is usually histamine itself, to ensure that your body’s immune system is giving an adequate response.

The prick test can be performed in patients as young as one month of age, although this is quite rarely done. Allergen skin reactions start to decline in adults after one’s twenties, due to decreased skin reactivity to histamine and lower IgE levels. Therefore, if you are older than this when this test is done, you may get many false negative results.

This test is also limited because it measures only a clinically immediate IgE hypersensitivity. If you do not have an IgE-mediated allergy, the test will be negative, and your doctor will tell you that you are not allergic to a certain substance.

The test is also dependent on the person performing the test. Such factors as the exact amount of allergen used, the depth and force of the needle, the duration of force, the angle of application, and the stability of the allergen extracts are all variables that can cloud interpretation of the test.

Use of antihistamines should be stopped twenty-four to seventytwo hours prior to taking these tests; use of tricyclic antidepressants and benzodiazepines (Valium and similar substances) need to be stopped for seven to fourteen days beforehand; use of systemic corticosteroids and topical steroids should be stopped up to three weeks prior to any testing.

It is believed that nonsteroidal medications such as ibuprofen do not interfere, but I always advise my patients to stop use of these as well. You do not want anything to interfere with the accuracy of your test results. It is better to get a proper test result than one that does not give you the correct information.

Intradermal Testing

This is used when skin prick testing is not deemed sensitive enough to detect the cause of an allergic reaction. This is usually what happens when a patient tests negative on a prick test but has a strong clinical history of symptoms triggered by exposure to a specific allergen. This should also be used in patients for whom skin prick testing is not valid, as in anyone over thirty.

However, skin prick testing usually is done first, to avoid a systemic allergic reaction, which may be quite serious. Intradermal testing is performed through injection of an allergen extract that is diluted a hundred to a thousand times of what would be given in a skin prick test.

It is injected into the back of the forearm or on the upper arm. Swelling occurs immediately; changes in the size of the swelling and the redness are measured after twenty minutes.

This test also has limitations because small positive reactions may actually not be reactions, and positive and negative controls must be used so the test is interpreted properly. Despite their many drawbacks, percutaneous testing and interdermal testing are the most widely used conventional allergy tests.

In Vitro Antibody Testing

The first test of this kind was the RAST (radioallergosorbent test). It is a simple blood test that measures the amount of IgE that binds to a specific allergen versus the amount of IgE that doesn’t. This test can be used in patients for whom skin testing cannot be performed, such as those who cannot stop taking their medications, those with severe skin conditions, and those who have near-fatal reactions to certain offending substances.

The main disadvantage of this type of test is that there is no uniform method for reporting results, making separate tests not comparable to each other and difficult to use in clinical practice with any certainty. I hardly ever recommend this test because of its lack of useful information.

Delayed Hypersensitivity Testing

Whereas skin prick tests measure IgE immediate hypersensitivity responses, delayed hypersensitivity testing uses patches to measure type 4 delayed hypersensitivity. A clinical example of this involves contact dermatitis.

The antigens that cause this type of reaction are found in cosmetics, jewelry, household cleansers, and similar products, as opposed to pollens and foods. This test is performed by applying various materials to an absorbent pad, which is then placed on your skin, usually your back.

The site is then checked at forty-eight and at seventy-two hours after application. A positive response is characterized by redness and swelling. Most of us have taken a test like this such as for tuberculosis—a PPD.

Food Allergy

2011-02-01T22:59:00.000-08:00

There are many foods that can cause true allergies. These can be lifethreatening and are quite common. A food allergy occurs through an IgE-mediated response similar to what I have previously described.

The most common symptoms of a food allergy are vomiting; stomach pain; asthma attack; breathing difficulties; headaches; joint swelling and pain; hives; itchiness; diarrhea; and, in the worst cases, anaphylaxis. Some minor food allergy symptoms can be a tingling sensation in the mouth or a swelling of the tongue.

Some people are so allergic to certain foods that they will get a reaction if the food is simply in the room, or if their skin comes into contact with the food. Sometimes patients may even have reactions to food residue on restaurant tables and chairs.

Ninety percent of all food allergies are to milk, peanuts, soy, eggs, nuts such as cashews, almonds, or walnuts (peanuts are actually legumes), shellfish, fish, or wheat. Peanuts, fish, shellfish, and nuts usually cause the most severe reactions.

Peanut allergies are increasingly common, and this is especially important in school-age children because peanuts are in so many foods. It is not just the peanut itself that can cause the allergy but also peanut oil, peanut sauce, and anything that contains peanuts.

Peanut oil is so commonly used that it may be one of the ingredients in your food, so check labels. Peanut allergies are usually so severe that if a pot had peanut oil in it prior to your use, a reaction may occur. Peanut allergies are very common, and the reactions tend to be the most severe. Peanuts are responsible for 63 percent of all food-allergyrelated deaths.

For this type of severe food allergy, I recommend three things:

1. Prepare for an emergency. Should a situation arise where the allergy occurs, you and/or your child should know immediately what to do. In the case of a young child, let the school or sitter know exactly what to do and send written instructions with the child so there is no confusion.

2. Very careful shopping. Read food labels very carefully. Know what is in everything that you buy or that your child is buying at school or in a store. If you don’t know what is in a particular item and the school or store can’t tell you, do not buy it. Always carry a snack for yourself or your child in case there is nothing else available. This especially holds true for airline travel. Never get caught unprepared.

3. Carry an Epi-pen. This is a disposable cartridge that carries the drug epinephrine. Learn how to use it, and teach anyone, including your child, in its proper use. This is something you get a prescription for from your doctor.

Allergic Rhinitis or Hay Fever

2011-02-01T22:56:00.001-08:00

Although the name may be a misnomer since this rarely produces a fever and hay has nothing to do with it, hay fever affects millions of people. Most people are allergic to pollens, and that is why the symptoms are seasonal.

The most common offenders are trees, grasses, and ragweed. The timing of the symptoms is variable due to where you live. Other common offenders are weeds, dust mites, and mold spores.

The symptoms of allergic rhinitis can make us very uncomfortable. Nasal congestion is usually the most troubling of the symptoms— it can affect our speech and give us a dry mouth. Other symptoms include a runny nose, and swelling and inflammation of the mucus membranes.

This inflammation causes sneezing, itchy eyes, itchy and scratchy throat, and loss of smell and taste, all of which can make life miserable for a hay fever sufferer. Most people also get a clear mucus drainage that leads them to blow their nose all day and to get a red nose from the irritation.

Allergic rhinitis symptoms also include the following characteristics:

intermittent symptoms that are either seasonal, food-related, environmental, or emotionally triggered
symptoms are relieved with antihistamines, food elimination, environmental elimination, or stress reduction techniques
symptoms are persistent or perennial
postnasal drip, sore throat, cough, hoarseness, wheezing or difficulty breathing, and/or skin rash
dark circles under the eyes
symptoms are usually preceded by a personal or family history of allergies, eczema, or asthma

Allergy Types

2011-02-01T22:54:00.000-08:00

There are almost as many types of allergies as there are allergy sufferers. They are usually classified according to what causes them, or the symptoms they cause. Allergens may cause a reaction in several ways: inhalation, injection, ingestion, or through skin contact. Allergic reactions can involve any part of the body but most frequently affect the nose, eyes, lungs, and skin.

Allergies that are defined by what causes them:

Inhalant allergy, such as from pollen or dust
Infectious allergy, with symptoms made worse by a cold or flu
Insect allergy, usually from the bite of a particular insect
Drug allergy, which can be quite serious and may result in anaphylaxis—a life-threatening condition
Physical agent allergy, such as an allergy to cold, heat, or exercise
Contact allergy, such as to latex, household chemicals, or newsprint
Food allergy, including anything that you could ingest that is not a poison; it is different from a food sensitivity. Food allergies are generally severe and will cause a noticeable reaction

Allergies that are defined by their symptoms:

Allergic rhinitis or hay fever, the most common form of allergy
Eczema
Hives, also known as chronic urticaria
Skin rashes, including rashes that are not included in any other grouping
Rosacea
Anaphylactic shock

How Allergy Works?

2011-02-01T22:50:00.000-08:00

An allergy can be broadly defined as an abnormal, adverse, physical reaction of the body to certain substances known as allergens. It is usually referred to as a hypersensitive state because those who suffer from an allergy usually react to quantities of the allergen that leave most people unharmed.

The process of how this allergen can cause a problem in the body involves the immune system. Most allergic individuals will develop an excess of the antibody IgE when exposed to an allergen. The IgE antibodies then attach to mast cells (a component of your immune system), and the mast cells cause histamines and leukotrienes to be released from certain other cells, causing the disturbing allergic reactions. This is your immune system doing its job, but in this case, it overreacts.

Allergy attacks also may occur through a non-IgE-mediated response. This mechanism is less clear from a scientific point of view, but no less irritating. The food sensitivity test measures sensitivities not related to IgE. Candida antibodies do not measure the IgE response. Certain bacteria or foods can create antigen-antibody complexes that lodge themselves in the lungs in this instance, and cause chronic inflammation, without involving IgE at all.

I mention this because most of the commonly available allergy tests search for an IgE response. If the traditional tests are negative, your doctor will tell you that you don’t have any allergies. This is not necessarily true.

Sleep Disorders in Children

2010-12-22T03:00:00.002-08:00

Many children at some point in their young lives will have problems with sleeping. There’s nothing more frustrating for a parent than a child who won’t sleep or sleeps irregularly. Is there anything you can do? You bet! The most common sleep problem with infants, toddlers, and preschoolers is sleep-onset association disorder sometimes accompanied by issues of parent and child sleeping together.

Children who have this type of disorder just don’t sleep. Parents often describe a child who insists on being nursed to sleep or on having a parent lie alongside until he or she falls asleep. Parents are often unaware that their well-meaning habits have created the difficulty.

The problem occurs when the child awakens fully if the parent or other condition he or she has learned to associate with falling asleep is not present. The child has learned to rely on the parent to fall asleep and may lack the self-soothing skills necessary to settle back into sleep independently. Sleep-onset association disorder can lead to frequent nightly arousals for both child and parent.

Management of sleep-onset association disorder involves two critical elements. First, you must gain an understanding of your child’s “brain clock” or typical time of sleep onset and morning awakening. It might be helpful for you to keep a sleep log to accomplish this.

Then, you must undertake a period of training the child to shift from wake to sleep independently. Making this transition requires that parents put the child to bed when he or she is drowsy but still awake-- in other words, at a time that coincides with natural sleep onset rather than at an arbitrary hour they have chosen as bedtime.

Even when timing is optimal, most children protest when their bedtime routine is changed. Parents vary in their ability or willingness to allow their child to cry for brief intervals during this period of training. Simply allowing infants to cry themselves to sleep is unnecessary and potentially harmful, particularly in babies with daytime symptoms of separation anxiety.

Try also using a delayed-intervention method. This only works in children older than ten months. This method gradually increases the time parents remain away from a crying child at bedtime--from several seconds to 2 minutes on the first night depending on the child and parent comfort level and up to 5 minutes on subsequent nights. When they return to the room after each interval away, parents are advised to reassure the child over the crib rail or at their bedside, without picking him or her up, and without turning on the light.

Talking in a slow, quiet voice to a child who is distressed or angry can help calm both the parent and the child. After comforting the baby for a minute or two with endearments (e.g., "I am right here with you, you are okay, sleepy baby, slow down"), the parent may need to again step out of the room while the child is still crying. Many parents find looking at a watch with a second hand during these intervals helpful, because listening to their baby cry for just 1 minute feels like an eternity to many parents.

The goals are to offer nurturance, comfort, and safety; to enhance the baby's self-soothing skills; and to set a clear, consistent limit regarding sleep location, assuming the parents choose not to have the child sleep with them.

For many cultures around the globe and for many families in the United States, parents sharing their bed with their infants and children are the norm and a strongly felt personal preference. This is a sound option when both parents are agreeable to it and commonsense safety precautions are observed. Whatever the sleep location, supine sleep positioning is recommended in babies.

Nighttime snacks and drinks, with the exception of water, should be avoided, because these can exacerbate nocturnal arousals from a physiologic standpoint and negatively affect dental health.

During the middle-childhood years, short sleep requirement, sleep-onset anxiety, and obstructive sleep apnea are commonly encountered problems. In these cases, making a sleep chart is very helpful both for parent and doctors if the problem becomes persistent.

When dealing with sleep-onset insomnia caused by anxiety, physicians will ask about daytime complaints, fears, or worries, which may suggest a more pervasive anxiety problem warranting referral to a children's mental health professional. Exposure to frightening media events and a history of stressful events such as a death in the family or the arrival of a new sibling should be explored.

More severe stressors, such as enduring sexual abuse or witnessing family violence, are considerations in some cases. A simple but common cause of sleep-onset insomnia in children is rumination on issues of the day at bedtime. This problem can often be settled with a small amount of extra attention and conversation with a parent at bedtime.

Anxious children are best treated with a combination of therapies, including a cognitive-behavioral approach that empowers them to generate solutions and gain mastery over their worries. For example, the physician might say to the child, "Adults sometimes feel nervous, too. Let's make a list of the things that could make you feel safe and brave and strong."

In persistent and difficult cases, a 1- to 3-month trial of the short-acting benzodiazepine alprazolam (Xanax) may be indicated, along with referral to a mental health professional. Obstructive sleep apnea is seen in as many as 3% of preschool and school-age children. Parents often complain that the child snores nightly in all positions, perhaps worse when lying on their backs.

Parents may also observe choking spells or what they refer to as breath holding or a halting pattern in the snoring. Children may assume a position of neck hyperextension during sleep. Sleep fragmentation caused by obstructive sleep apnea may lead to daytime sleepiness, manifested as increased napping or falling asleep at school or while watching TV.

Alternatively, children may show changes in daytime behavior, including hyperactivity, distractibility, and mood changes. Common childhood causes of sleep apnea are inflammation of the tonsils or adenoids. These can usually be removed in a simple operation and give your child some relief.

Sleep disorders to watch for in adolescents are delayed sleepphase syndrome - a disorder of circadian rhythm and narcolepsy. Delayed sleep-phase syndrome is common among teenagers, although some delay in sleep phase is considered normal in this agegroup. These teens often describe feeling wide awake in the lateevening hours, with a delay in sleep onset until 3 or 4 AM.

When they manage to drag themselves to school, their performance is impaired, and they may fall asleep in morning classes. Accordingly, the young person often presents with academic failure, truancy, or tardiness. Their sleep debt accumulates until the weekend, when they may sleep until early afternoon, further disturbing their circadian clock.

Changing a delayed sleep cycle is usually a challenge. It consists of setting the morning wake-up time 15 minutes earlier each successive day until the desired target is reached. This procedure is accompanied by exposure to bright natural light or use of a highintensity (2,500-lux) light box in the morning.

Other measures that may be beneficial in resetting the brain clock are minimizing exposure to evening light, a trial of melatonin 4 to 5 hours before desired sleep onset, and a short course of sedative medication in the evening. Strict adherence to the new sleep schedule, even on weekends and holidays, is usually necessary to prevent relapse to previous patterns.

Pre-Sleep and WhenYou Wake

2010-12-22T03:00:00.000-08:00

The following suggestions are in general and can help you have a good night’s sleep.

Keep a regular schedule. Try to go to bed and wake up at the same time everyday, even on the weekends. Keeping a regular schedule will help your body expect sleep at the same time each day. Don’t oversleep to make up for a poor night’s sleep – doing that for even a couple of days can reset your body clock and make it hard for you to get to sleep at night.

Incorporate bedtime rituals. Listening to soft music, sipping a cup of herbal tea, etc., cues your body that it's time to slow down and begin to prepare for sleep.

Relax for a while before going to bed. Spending quiet time can make falling asleep easier. This may include meditation, relaxation and/or breathing exercises, or taking a warm bath. Try listening to recorded relaxation or guided imagery programs.

Don’t eat a large, heavy meal before bed. This can cause indigestion and interfere with your normal sleep cycle. Drinking too much fluid before bed can cause you to get up to urinate. Try to eat your dinner at least two hours before bedtime.

Bedtime snacks can help. An amino acid called tryptophan, found in milk, turkey, and peanuts, helps the brain produce serotonin, a chemical that helps you relax. Try drinking warm milk or eat a slice of toast with peanut butter or a bowl of cereal before bedtime. Plus, the warmth may temporarily increase your body temperature and the subsequent drop may hasten sleep.

Jot down all of your concerns and worries. Anxiety excites the nervous system, so your brain sends messages to the adrenal glands, making you more alert. Write down your worries and possible solutions before you go to bed, so you don't need to ruminate in the middle of the night. A journal or "to do" list may be very helpful in letting you put away these concerns until the next day when you are fresh.

Go to sleep when you are sleepy. When you feel tired, go to bed.

Consider avoiding "over-the-counter" sleep aids, and make sure that your prescribed medications do not cause insomnia. There is little evidence that supplements and other over-thecounter "sleep aids" are effective. In some cases, there are safety concerns. Antihistamine sleep aids, in particular, have a long duration of action and can cause daytime drowsiness. Always talk to your doctor or healthcare practitioner about your concerns!

Get into a calming bedtime routine that you start 30-60 minutes before your desired bedtime. Avoid watching tense or scary movies, or other highly stimulating activities. Find some activities that you find calming, and that take your mind off of things that are bothering you. This could include using a relaxation CD, reading, taking a hot bath, having a warm drink (such as decaf tea or milk), or listening to music. Avoid using alcohol to feel drowsy — it tends to contribute to waking up in the middle of the night.

Earlier in the evening, before you go to bed, make a list of things you will need to do tomorrow or in the near future. Once you have made the list, put it away and focus on relaxing. You can start working on your list again tomorrow, and you will have more energy to tackle your list if you get some sleep.

When you wake in the middle of the night, you CAN get back to sleep.

Do visualization. Focus all your attention on your toes or visualize walking down an endless stairwell. Thinking about repetitive or mindless things will help your brain to shut down and adjust to sleep.

Get out of bed if unable to sleep. Don’t lie in bed awake. Go into another room and do something relaxing until you feel sleepy. Worrying about falling asleep actually keeps many people awake.

Don't do anything stimulating. Don't read anything job related or watch a stimulating TV program (commercials and news shows tend to be alerting). Don't expose yourself to bright light. The light gives cues to your brain that it is time to wake up.

Get up and eat some turkey. Turkey contains tryptophan, a major building block for making serotonin, a neurotransmitter, which sends messages between nerve cells and causes feelings of sleepiness. Note that L-tryptophan doesn't act on the brain unless you eat it on an empty stomach with no protein present, so keep some turkey in the refrigerator for 3am.

Consider changing your bedtime. If you are experiencing sleeplessness or insomnia consistently, think about going to bed later so that the time you spend in bed is spent sleeping. If you are only getting five hours of sleep at night, figure out what time you need to get up and subtract five hours (for example, if you want to get up at 6:00 am, go to bed at 1:00 am). This may seem counterproductive and, at first, you may be depriving yourself of some sleep, but it can help train your body to sleep consistently while in bed. When you are spending all of your time in bed sleeping, you can gradually sleep more, by adding 15 minutes at a time.

Natural Cures For Insomnia

2010-12-22T02:58:00.001-08:00

Herbal remedies such as valerian root, kava kava, chamomile, lemon balm, St. John’s Wort, and passionflower have been used for insomnia for many years. However, the effectiveness and safety of these products has not been documented. Studies done on herbal remedies are often hard to interpret because they are inconsistent with standards of studies for regulated substances like prescription drugs.

According to the National Institute of Health, although the results of some studies suggest that valerian may be useful for insomnia and other sleep disorders, results of other studies do not. Interpretation of these studies is complicated by the fact the studies had small sample sizes, used different amounts and sources of valerian, measured different outcomes, or did not consider potential bias resulting from high participant withdrawal rates. Overall, the evidence from these trials for the sleep-promoting effects of valerian is inconclusive.

Many people with insomnia choose herbal remedies for treating their insomnia. Some such as chamomile tea or lemon balm are harmless for most people. It should be strongly noted that a being labeled "natural" is neither equal to being safe or necessarily to even being natural. Herbal remedies are not regulated. Some even contain conventional medicines.

You may want to give melatonin a try. Melatonin is the best studied natural remedy for insomnia, although in the US it remains unregulated. Evidence on its effects remains unclear. Some studies have found that although many people fall asleep faster with melatonin, it has no effect on total sleep time or daytime feeling of sleepiness or fatigue. Some studies suggest that it may help specific individuals, such as the following:

Elderly people. It may help certain older people with insomnia, such as those with evidence of low melatonin levels and those dependent on prescription sleeping medications. It is not clear, however, how significant the benefits are.

People without sight. A 2000 study reported that melatonin can help people without sight retrain their circadian cycle so that they can sleep at regular hours. The best dosages and timing, however, need to be clarified. High doses (10 mg) may be needed to start with, but can probably be reduced over time.

Travelers and Jet Lag. Some studies have reported that melatonin may help prevent jet lag in some travelers. The optimal dosages or timing for preventing jet lag are still unclear, however.

During withdrawal from prescription sleep medication. Melatonin may help people who are dependent on sleeping medications withdraw from these agents and maintain good quality sleep.

People with delayed sleep syndrome. It might be somewhat helpful for people with who fall asleep very late at night or in early morning hours but then they sleep normally.

One difficulty in assessing study results is that there are no consistent standards on melatonin dosages or usage. Some studies suggest that 0.3 mg may be the most effective dosage in many people with insomnia. In fact, higher doses (3 to 5 mg) may keep some people awake. (A study on blind people, however, suggested that much higher doses may be needed for this group, at least at the beginning of treatment.)

High doses of melatonin have been associated with the following adverse events:

Mental impairment.
Drowsiness.
Severe headaches.
Nightmares.
It may increase the risk for seizures in children with existing neurological disorders.
Interactions with other drugs are not completely known.

It should be stressed that melatonin is currently classified as a dietary supplement and not as a drug, so its quality and effectiveness is uncontrolled in the US. (The United State is the only developed nation that does not regulate this agent.) Melatonin is a powerful hormone that can have major effects, many still unknown, on all parts of the body. The bottom line is that at this time, people who take melatonin are experimenting on themselves.

Keep in mind that alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the body's chemistry can, like any drug, produce side effects that may be harmful.

Even if studies report positive benefits from herbal remedies, the compounds used in such studies are, in most cases, not what are being marketed to the public. There have been a number of reported cases of serious and even lethal side effects from herbal products. In addition, some so-called natural remedies were found to contain standard prescription medication.

The following warnings are of particular importance for people with insomnia:

Chinese Herbal Remedies. Studies suggest that up to 30% of herbal patent remedies imported from China having been laced with potent pharmaceuticals such as phenacetin and steroids. And one study reported a significant percentage of such remedies containing toxic metals. For example, the herbal remedy Sleeping Buddha was recalled in 1998 because it actually contains a benzodiazepine, the major ingredient in many prescription sleeping pills, and also appeared to increase the risk for birth defects in pregnant women. Reports of a few cases of acute hepatitis have occurred from Jin Bu Huan, a Chinese herbal remedy sold as treatment for pain and insomnia.

Valerian root. A number of studies suggest that valerian may be helpful for insomnia. Side effects include vivid dreams. It should be noted that high doses of valerian can cause blurred vision, excitability, and changes in heart rhythm.

Kava kava. Kava kava has sedative actions and studies have reported that it helps improve stress-induced insomnia. The most common side effect reported is dizziness. It should be noted, however, that kava kava has been associated with liver failure in some cases. It also interacts dangerously with certain medications; including alprazolam, an anti-anxiety drug. And it increases the potency of certain other drugs, including other sleep medications, alcohol, and antidepressants.

Tryptophan and 5-L-5-hydroxytryptophan (HTP). Tryptophan is an amino acid used in the formation of the neurotransmitter serotonin, which is known to promote wellbeing and has been associated with healthy sleep. L-tryptophan was marked for insomnia and other disorders but was withdrawn from the market after a contaminated batch caused a rare and even fatal disorder called eosinophilia myalgia syndrome. 5-htp, a byproduct of tryptophan, is still available as a supplement. There have been reports that some brands contain a substance called Peak X, which some evidence suggests may be harmful. To date, no serious adverse effects have been reported and reliable brands are available. Evidence that 5-HTP alleviates insomnia is scant.

You don’t have to use drugs – whether natural or chemical to help you beat insomnia. There are some great behavior therapies that can be implemented to help you get to sleep.

Light For Healing

2010-12-22T02:53:00.003-08:00

The circadian rhythm is more a function of darkness and light rather than actual time of day. Bright light can discourage drowsiness, and darkness can cause sleepiness, day or night. Light therapy is a treatment used for people who suffer from circadian rhythm sleep disorders. Your body has an internal clock that tells it when it is time to be asleep and when it is time to be awake.

This clock is located in the brain just above an area where the nerves travel to the eyes. This area is called the SCN. Your clock controls the “circadian rhythms” in your body. These rhythms include body temperature, alertness and the daily cycle of many hormones.

The word “circadian” means to occur in a cycle of about 24 hours. Circadian rhythms make you feel sleepy or alert at regular times every day. Some people have a circadian rhythm sleep disorder. This causes their natural sleep time to overlap with regular awake activities such as work or school.

Among other factors, your clock is “set” by your exposure to bright light such as sunlight. Exposure to bright light or “light therapy” is one method used to treat people with a circadian rhythm sleep disorder. The goal for treating patients who have circadian rhythm problems is to combine a healthy sleep pattern with an internal clock that is set at the right time. This will allow them to enjoy the benefits of good sleep.

Light therapy can help someone “re-set” a clock that is off. Regular sleep patterns help to keep the clock set at the new time. Light therapy is only part of a treatment plan that should be guided by a doctor who is familiar with sleep disorders. The use of a special light box may be helpful.

The procedure is noninvasive and simple. The patient sits a few feet away from a box-like device that emits very bright fluorescent light (over 4,000 lux) for about 30 minutes every day. The following people might benefit from light therapy in specific ways.

Shift workers. Light therapy should be maximized during hours they are at work and minimized when they need to sleep.
Frequent travelers. Light therapy may be useful for adjusting to new time zones and reducing jet lag.
Nursing home patients.
People with delayed sleep-phase syndrome. (These people have a natural tendency to fall asleep very late at night or in early morning hours, but then sleep normally.)

Everyone should check with their physician before using light therapy. The following people should avoid it or use it only under a physician's direction:

Anyone with eyes or skin that is highly sensitive to light.
Anyone taking medications that increase the risk for photosensitivity.
People with bipolar disorder.

Timing of the therapy depends on the type of insomnia or sleep schedule of the individual. For example, in people who cannot get to sleep at night, light therapy in the morning and restricting bright light at night may be helpful. People who wake up early in the morning may benefit from light therapy performed in the evening, although a 2002 study reported that it had no effect in this group. Some light boxes have dawn/dusk simulators that help determine the correct brightness.

Patients typically receive bright light therapy at home, with the use of a light box. The light box emits a standard dosage of 5,000 to 10,000 lux (a measure of illumination) of white light while you sit in front of the light, at a specified distance, for approximately 30-60 minutes after waking in the morning. Light therapy should always be used within the proper limits for light intensity and duration of exposure.

Bright light therapy has not been known to show any major side effects. Some patients have reported minor side effects including: eye irritation and dryness, headache, nausea, and dryness of skin. To reduce the chance of experiencing these minor side effects, it is recommended that you begin light therapy very slowly and consult your doctor before use.

Progressive Muscle Relaxation

2010-12-22T02:53:00.001-08:00

One of the most simple and easily learned techniques for relaxation is Progressive Muscle Relaxation (PMR), a widely-used procedure today that was originally developed in 1939.

The PMR procedure teaches you to relax your muscles through a two-step process. First you deliberately apply tension to certain muscle groups, and then you stop the tension and turn your attention to noticing how the muscles relax as the tension flows away.

Through repetitive practice you quickly learn to recognize—and distinguish—the associated feelings of a tensed muscle and a completely relaxed muscle. With this simple knowledge, you can then induce physical muscular relaxation at the first signs of the tension that accompanies anxiety. And with physical relaxation comes mental calmness—in any situation.

Before practicing PMR, you should consult with your physician if you have a history of serious injuries, muscle spasms, or back problems, because the deliberate muscle tensing of the PMR procedure could exacerbate any of these pre-existing conditions. If you continue with this procedure against a doctor’s advice, you do so at your own risk.

There are two steps in the self-administered Progressive Muscle Relaxation procedure: (a) deliberately tensing muscle groups, and (b) releasing the induced tension. This two-step process will be described after you are introduced to the muscle groups.

After learning the full PMR procedure as follows, you will spend about 10 minutes a day maintaining your proficiency by practicing a shortened form of the procedure. As you practice the short procedure, you will be simultaneously learning cue-controlled relaxation.

Ultimately, you will acquire something that will probably become an indispensable part of your daily life, and the initial drudgery of practice will be long-forgotten. It is recommended that you practice full PMR twice a day for about a week before moving on to the shortened form (below). Of course, the time needed to master the full PMR procedure varies from person to person. Here are some suggestions for practice:

Always practice full PMR in a quiet place, along, with no distractions like television or phones. We don’t suggest even using background music.
Remove your shoes and wear loose clothing
Don’t eat, smoke or drink right before practicing PMR. It’s best to practice before meals rather than after to avoid problems with digestion.
Never practice this while under the influence of any intoxicants.
Sit in a comfortable chair or lying down in bed. · Plan on falling asleep before the cycle is complete if you do this in bed
If you are doing PMR just to relax instead of falling asleep, after you are done, relax with your eyes closed for a few seconds and then get up slowly. If you stand up too quickly, you could experience a sudden drop in blood pressure which could cause you to feel faint. Some people like to count backwards from 5 to 1 timed to slow, deep breathing and then say “Eyes open, supremely calm, fully alert.”

You will be working with most all the major muscle groups in your body, but for convenience you will make a systematic progression from your feet upwards. Here is the most popular recommended sequence:

Right foot
Right lower leg and foot
Entire right leg
Left foot
Left lower leg and foot
Entire left leg
Right hand
Right forearm and hand
Entire right arm
Left hand
Left forearm and hand
Entire left arm
Abdomen
Chest
Neck and shoulders
Face

If you’re left handed, begin with your left side. Here is how to perform the tension-relaxation procedure.

Step One: Tension. The process of applying tension to a muscle is essentially the same regardless of which muscle group you re using. First, focus your mind on the muscle group; for example, your right hand. Then inhale and simply squeeze the muscles as hard as you can for about 8 seconds; in the example, this would involve making a tight fist with your hand.

Beginners usually make the mistake of allowing muscles other than the intended group to tense as well; in the example, this would be tensing muscles in your right arm and shoulder, not just in your right hand. With practice you will learn to make very fine discriminations among muscles; for the moment just do the best you can. It can be very frustrating for a beginner to try to experience a fine degree of muscle separation.

Because neglect of the body is an almost universal cultural attitude, it is usually very difficult to begin learning how to take responsibility for your body’s mechanics. Take heart and realize that learning fine muscle distinction is in and of itself a major part of the overall PMR learning process. PMR isn’t just about tension and relaxation – it’s also about muscle discernment.

Relax and realize that no part of the body is an isolated unit. The muscles of the hand, for example, do have connections in the forearm, so when you tense your hand, there will still be some small tension occurring in the forearm. When PMR asks that the hand be tensed without tensing the arm, it is really speaking to the beginner who, out of unfamiliarity with the body’s muscles will unthinkingly tense everything in the whole arm.

If you accept the fact that you are in the beginner phase and not inept at practicing the procedure, then you will begin to patiently discover the fine muscles with practice. It’s important to really feel the tension. Done properly, the tension procedure will cause the muscles to start to shake, and you will feel some pain.

Be careful not to hurt yourself, as compared to feeling mild pain. Contracting the muscles in your feet and your back, especially, can cause serious problems if not done carefully; i.e., gently but deliberately.

Step Two: Releasing the Tension. This is the best part because it is actually pleasurable. After the 8 seconds, just quickly and suddenly let go. Let all the tightness and pain flow out of the muscles as you simultaneously exhale. This would be imagining tightness and pain flowing out of your hand through your fingertips as you exhale.

Feel the muscles relax and become loose and limp, tension flowing away like water out of a faucet. Focus on and notice the difference between tension and relaxation. The point here is to really focus on the change that occurs as the tension is let go. Do this very deliberately, because you are trying to learn to make some very subtle distinctions between muscular tension and muscular relaxation.

Stay relaxed for about 15 seconds and then repeat the tensionrelaxation cycle. You’ll probably notice more sensations the second time. Once you understand the muscle groups and the tensionrelaxation procedure, then you are ready to begin the full PMR training.

Simply follow the list of muscle groups in the sequence given and work through your entire body. Practice twice a day for a week. Spend extra time, if necessary, until you can achieve a deep sense of physical relaxation; then you can move on to the Shortened PMR schedule.

In the shortened form of PMR, you will work with summary groups of muscles rather than individual muscle groups, and begin to use cue-controlled relaxation. The four summary muscle groups are:

Lower limbs
Abdomen and chest
Arms, shoulders, and neck
Face

Instead of working with just one specific part of your body at a time, simply focus on the complete group. In Group 1, for example, focus on both legs and feet all at once.

Cue-controlled relaxation: Use the same tension-relaxation procedure as full PMR, but work with the summary groups of muscles. In addition, focus on your breathing during both tension and relaxation. Inhale slowly as you apply and hold the tension.

Then, when you let the tension go and exhale, say a cue word to yourself (below). This will help you to associate the cue word with a state of relaxation, so that eventually the cue word alone will produce a relaxed state. Many people find that cue-controlled relaxation does not have to depend on only one word; it may actually be more helpful in some situations to use a particular phrase. Some suggestions for cue words/phrases include:

Relax
Let it go
It’s OK
Stay calm
All things are passing
Trust in God

Initially, you should practice the shortened form of PMR under the same conditions as you practiced full PMR. After about a week of twice-daily practice you will then have enough proficiency to practice it under other conditions and with distractions. Or you might want to move on to the final process of Deep Muscle Relaxation.

Once you have learned PMR and are familiar with the feeling of muscle relaxation, you can then induce relaxation without even bothering with the tension-relaxation process. All you need to do is use your imagination to think of and then relax the various muscle groups using your cue word(s). Usually this is done by starting at the top of your head and then working down through your body, as if relaxation were being poured over your head and flowing down over all of your body. This process is called Deep Muscle Relaxation.

And, anywhere, anytime, you can simply perform a quick “body scan” to recognize where in your body you might be holding muscle tension and then, using imagery and your cue word/phrase, let it go. There are other approaches toward combating insomnia that can work well too.

Other techniques that can help you improve your sleep habits are stimulus control, paradoxical intention and sleep restriction. All three techniques have to do with changing your habits and reframing your current way of thinking about sleep. As you sleep better, you will create positive associations with sleep based on your new practices.

Stimulus control - Stimulus control therapy derives from the idea that a person with chronic insomnia associates bedtime and the bedroom with not being able to sleep. The technique limits the amount of time spent in the bedroom for non-sleep activities to retrain the brain to associate bedtime and the bed/bedroom with successful sleep attempts rather than sleeplessness. The general guidelines of stimulus control are:

Go to bed only when you are sleepy.
Don’t read, watch television, eat or do other non-sleep things in bed.
If you are not asleep within 15 minutes, leave the bedroom and don't return until you are sleepy.
If you are awake at night for more than 15 minutes, get out of bed.
Have a consistent wake time every day, regardless of how much sleep you got.
Avoid naps.

Paradoxical intention - Paradoxical intention is a psychological approach that is based on doing the opposite of what you want or fear and taking it to extreme. Some people who experience insomnia may continue to experience insomnia because they fear another sleepless night or they fear the thoughts and worries that accompany going to bed, and their fear keeps them awake.

Paradoxical intention focuses on confronting, and hopefully, eliminating the fear so that it stops getting in the way of sleep. This approach is used for other fears as well. Rather than trying, unsuccessfully, to go to sleep night after night, try to stay awake and do something instead. Turning your attention to something else removes the fear of not being able to sleep and may allow you to relax and eventually go to bed.

Sleep restriction - Sleep restriction is based on the idea that people require different amounts of sleep, and that often, a person with insomnia stays in bed thinking that they will get more sleep, when staying in bed really just increases frustration and sleep difficulty.

Sleep restriction therapy reduces the amount of nonsleeping time a person with insomnia spends in bed. To practice sleep restriction, you determine your average total sleep time by keeping a log of your sleep habits for two weeks. If you usually sleep 6 hours per night, but spend 8 hours a night in bed (tossing and turning, watching TV, reading, staring at the ceiling for the other 2 hours), sleep restriction therapy will only allow to spend 6 or 6 1/2 hours in bed at first.

In the beginning, you might not sleep all of the time, but gradually, the time spent sleeping should increase. If you continue to have trouble sleeping, the time allowed in bed is further restricted to encourage sleep when you are in bed. The overall time spent in bed is adjusted as it becomes clear how much sleep you need.

Stress Management and Relaxtion

2010-12-22T02:52:00.002-08:00

Learning to be physically and mentally relaxed before going to bed will help you fall asleep more quickly. Additionally, many relaxation techniques can be put to use when you wake up in the middle of the night and need to get back to sleep. Quieting your mind and body is not something that can be done immediately, so you should try to start winding down at least an hour before bed.

Some people find that reading a book, taking a bath, playing solitaire or working a crossword puzzle are good ways to slow down from activity of the day. You may want to try one or more of the following activities:

Progressive Muscle Relaxation (PMR) – PMR is a set of exercises you can use to reduce anxiety and stress at bedtime. PMR is a two-step process where you first tense certain muscle groups and then relax them. As you go through the process, you should be focused on actively tensing and then relaxing, helping to relax your mind as well as your body. The procedure takes some time to learn, but after learning it, you can practice a shorter version of the exercises. When practicing PMR to help with sleep, you should plan to fall asleep before finishing all of the exercises. See the next chapter for a quick course on PMR!

Diaphragmatic breathing – Learning to breathe slowly and deeply from your belly or diaphragm is a good way to slow down. To practice belly breathing, put a hand on your stomach and take slow breaths, letting your stomach expand as you breathe in. As you breathe out, relax your chest and shoulders. Concentrate on your breathing as you do it to encourage your mind away from stressful or anxious thoughts.

Visual imagery relaxation – Practicing visual imagery means choosing peaceful, soothing thoughts to focus on which calm you and allow you to stop thinking of your to do list. Everyone’s peaceful situation is different, and you can choose to think about things that personally soothe you – a walk in the mountains, canoeing on a lake, swimming, petting your dog, etc. As long as the image doesn’t excite your mind, it should work.

You might also choose to focus on something that is very repetitious as a way of relaxing. For example, if you are a skier, you might imagine going to the slopes, zipping up your jacket, putting on your gloves and hat, tightening your boots, riding the chairlift and then the smooth and rhythmic motion of sinking your poles in and turning side to side as you ski down the mountain. Slowly going over every detail of a repetitious activity can be soothing and relaxing.

Stress management – If you learn to deal with stress more effectively through meditation or self-guided imagery, you should be able to fall asleep more easily. Try the following suggestions to help reduce your stress:

Change or resolve the things causing you stress when possible.
Accept situations you can't change.
Keep your mind and body as relaxed as much as possible throughout the day.
Give yourself enough time to do the things you need to do -including eating.
Don't take on too much and avoid unrealistic demands.
Live in the present, rather than worrying about the past or fearing the future.
Talk to your partner if there are problems in your relationship.
Have some relaxing, non-competitive activities - something you do just for pleasure, for fun.
Give yourself some 'quiet time' each day.
Practice a relaxation technique or breathing exercises regularly.

Anger management – Anger, anxiety and frustration can stand directly in the way of getting a good night’s sleep. You may feel angry or anxious when you go to bed or you may become angry and frustrated when you can’t go to sleep. Regardless of the source of the anger, recognize that it keeps your mind occupied and your body tense, two conditions which don’t encourage sleep. A few things that might help you deal with your anger or anxiety:

Exercise daily – it will help you release excess anger and frustration.
Think about the cause of your anger. If there isn’t anything you can do to resolve it, move on. If you can resolve it, make steps to do so.
Develop a method of releasing the anger by the end of the day, before you try to relax or go to sleep. For example, you might choose to write it down in your journal or talk to a spouse or friend about it. After you have processed the anger and let it out, try to move on

Word and imagination games – For some, playing mental games at bedtime may not be helpful at all. But others find that engaging their mind in something unimportant can be a good way to unwind and shift attention away from actively trying to fall asleep. Try playing some mental games:

Spell long words and sentences backwards.
Think of a poem or song and then count how many a’s or b’s there are in it.
Work your way through the alphabet thinking of a four-letter word beginning with each letter.
Repeat long pieces of poetry or prose.
Recall in great detail a favorite painting, a piece of music or place.

Self-help strategies are usually effective and aren’t addictive. Using these alternatives to over-the-counter or prescription medication are less expensive than pharmacological treatment, have fewer side effects, and can provide longer lasting relief particularly when behavioral treatments are used as well.

Consider, too, altering your sleep environment. Put a board under your mattress if it sags or try putting your bed in a different position. Make sure your bedding is clean and that you are warm enough but not too hot. If light troubles you, use thicker curtains or put a scarf or sleep mask over your eyes. If you feel more comfortable with a little light, leave the curtains open a little or use a night light.

A common cause of sleeplessness is noise. Use earplugs if it’s noise you can’t do anything about. Change your attitude toward the noise, too. People can sleep through high levels of noise. It’s not so much the level of the noise as it is how you feel about it that keeps you awake.

Use relaxation exercises to calm yourself and take your mind off of it. Take some diplomatic action to combat the noise that’s disrupting your sleep. If your family is being noisy while you’re trying to sleep, talk to them calmly about your need to sleep and ask them to please curtail the noise during bedtime hours.

Keep a radio or tape player by your bed and use it to mask other noise. Try playing a relaxation tape or CD such as nature noises that can put you in a calmer mood and make you better able to cope with distractions. You may want to look into hypnosis for your sleeping problems.

Self-hypnosis is especially helpful. This can be done online at many different sites that will allow you to download hypnotic sessions tailored to your specific problem. They are extremely relaxing and definitely worth the small investment! Research suggests that people who suffer from insomnia tend to be less confident and have lower self esteem than others. Therefore anything that you can do to increase your confidence or improve your self esteem is likely to help you sleep better.

Cognitive-Behavioral Therapy - Cognitive-behavioral therapy (CBT) tries to reduce a person's misconceptions about sleep, as well as teach more positive sleep behaviors. The therapy consists of talking with a therapist (alone or with a group) to address your beliefs, assumptions and behaviors regarding sleep, and is often used in conjunction with stimulus control, sleep restriction and good sleep hygiene. Several studies have shown that CBT is an effective way of treating insomnia and that the therapy can reduce the number of long term medical issues associated with insomnia.

Cognitive behavioral therapy addresses a person’s beliefs about sleep and helps replace negative or unhelpful behaviors with positive ones. The significance of one’s thinking about sleep is often underestimated. Sleep problems which start as isolated incidents can become chronic because of mental hang-ups.

How we think about sleep can play an important role in how we deal with sleep difficulties. For this reason, an essential part of your sleep treatment involves identifying your thoughts about sleep that tend to make sleeping more difficult and replacing these thoughts with more helpful thinking.

One technique for examining your thinking is to treat your thoughts as scientific hypotheses or ideas. You may have had certain beliefs about your sleep for a long time. At this time you are being asked to consider alternative beliefs and determine which of these beliefs is best supported by the information available to you.

As you pay attention to your thinking about sleep and consider alternatives, you will probably notice two issues to address:

The more important it is to get a good night's sleep, the less you sleep. Believing that a poor night's sleep is a disaster only generates more anxiety and worry about your sleep. Challenge this thinking and consider alternative thoughts that reduce the importance of sleeping on the rest of your life (i.e. "It's no big deal", "I'll be a little tired and cranky tomorrow but nothing I can't handle.").

The more you try to control your sleep, the less you sleep. Sleep is a natural body response. Telling yourself that you must sleep and trying to force yourself to sleep only puts pressure on you and makes your sleep worse. Focusing on what you can control (sleep habits, schedule, when you are in or out of bed) and letting go of what you can not control will allow falling asleep and staying asleep to happen naturally.

Now that you've become aware of the thoughts that make your sleep worse and have considered alternative ways of thinking, the next step is to practice these new thoughts. This challenging of new thoughts replacing old thoughts will take some effort because our thoughts are typically automatic and we are not accustomed to deliberately noticing them.

Scheduling a time each day to examine the ways you think about your sleeping will be helpful in getting you to notice and challenge any maladaptive thought patterns. It is important to do this on a regular basis, as it can be easy to fall into old thought habits if you are not actively monitoring your thoughts.

Like any new skill, it is important to practice it. Keep a diary of your sleep-related thoughts and your ideas on how to think differently. Once you have become accustomed to examining your thoughts, you will find that this is an excellent skill that will prove useful for helping you to approach your sleeping difficulties differently as well as for learning a healthier approach to other life problems as well.

We strongly advocate progressive muscle relaxation (PMR) not only to combat insomnia, but to combat stress as well. Here’s how to do it.

Sleep Hygiene

2010-12-22T02:52:00.000-08:00

Sleep hygiene refers to sleep habits and conditions which promote sleep as opposed to habits such as drinking alcohol or caffeine in the evening, which make it hard for you to unwind and get to sleep.

Sleep hygiene should be your first line of attack against insomnia, and it is often used in conjunction with stimulus control and cognitive behavior restructuring (see below). Review your habits and make some changes in your routine to see if behavioral and environmental changes improve your sleep. Here are some tips for effective sleep hygiene habits:

Establish a regular time for going to bed and getting up in the morning and stick to it even on weekends and during vacations.
Use the bed for sleep and sexual relations only, not for reading, watching television, or working; excessive time in bed seems to fragment sleep.
Avoid naps, especially in the evening.
Exercise before dinner. A low point in energy occurs a few hours after exercise; sleep will then come more easily. Exercising close to bedtime, however, may increase alertness.
Take a hot bath about an hour and a half to two hours before bedtime. This alters the body's core temperature rhythm and helps people fall asleep more easily and more continuously. (Taking a bath shortly before bed increases alertness.)
Do something relaxing in the half-hour before bedtime. Reading, meditation, and a leisurely walk are all appropriate activities.
Keep the bedroom relatively cool and well ventilated.
Do not look at the clock. Obsessing over time will just make it more difficult to sleep.
Eat light meals and schedule dinner four to five hours before bedtime. A light snack before bedtime can help sleep, but a large meal may have the opposite effect.
Spend a half hour in the sun each day. The best time is early in the day. (Take precautions against overexposure to sunlight by wearing protective clothing and sunscreen.)
Avoid fluids just before bedtime so that sleep is not disturbed by the need to urinate.
Avoid caffeine or other stimulants in the hours before sleep. A general recommendation is not to consume anything that might hinder your sleep 4-6 hours before your anticipated bedtime.
Don’t drink alcohol before going to bed.
If one is still awake after 15 or 20 minutes go into another room, read or do a quiet activity using dim lighting until feeling very sleepy. (Don't watch television or use bright lights.)
Give yourself a quiet time right before bed. One or two hours before you retire, take a few moments to spend quietly relaxing and meditating.
Your bedroom should be exclusively for sleeping. Well, maybe one other activity, but avoid eating, reading, smoking, drinking or watching television in bed. The bedroom should be a peaceful place and when it is,
If distracted by a sleeping bed partner, moving to the couch or a spare bed for a couple of nights might be helpful.
If you can't sleep -- don't stay in bed. Get out of bed, move to another room, and return to your bed when you are tired. Sleep hygiene is just one of the behavioral techniques you can use to help with your insomnia.

Medications That Can Help Insomnia

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According to a 1999 survey, about 30% of American women and 20% of men reported taking a medication to help them sleep at some time during the course of a year. Over half of these drugs were over the counter medications.

It should be stressed that only behavioral or psychological techniques can actually cure insomnia, whereas prolonged use of sleeping pills can only result in dependency. In addition, a 2002 study reported lower survival rates in people who took sleeping pills, although more research is needed to clarify this association.

Why do so many people want to take sleeping pills for their insomnia? Many people experiencing sleep problems want a quick fix for their problems. Several of the treatments that are often successful are time intensive and require a lot of work on the part of the person experiencing insomnia.

The thought of a pill or medication that can solve the problem quickly and easily is very appealing. Unfortunately, the reality behind the use of sleep medications is that they don’t solve the problem, and can often exacerbate insomnia over the long term.

If you want to take medications to help you sleep because you are in a great deal of pain, are traveling or just need to get some sleep, pay attention to the type of medication you choose and try to use the medication only when you really need it. Additionally, if you can commit to making your sleep habits and sleep environment better and more conducive to sleep, you have a greater chance of limiting the effects of insomnia on your life.

Drugs used specifically for improving sleeping are called hypnotics. Benzodiazepines are the ones most commonly prescribed, but others are available that may be better tolerated and have less risk of dependency. They should generally be used only to prevent the vicious cycle of psychophysiological insomnia in people with transient or short-term insomnia when non-medical treatments have failed.

Originally developed to treat anxiety, these drugs reinforce a chemical in the brain that inhibits neuron excitability. Commonly prescribed benzodiazepines include the following:

Long acting benzodiazepines include flurazepam (Dalmane) and clonazepam (Klonopin), quazepam (Doral).
Medium- to short-acting benzodiazepines include triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), temazepam (Restoril), oxazepam (Serax), prazepam (Centrax), estazolam (ProSom), and flunitrazepam (Rohypnol). Short-acting benzodiazepines are particularly useful for air travelers who want to reduce the effects of jet lag.

Of course, as with any medication, side effects are to be expected. When taking benzodiazepines, be mindful of what could happen when you take them. Common side effects of these drugs include:

The drugs may increase depression, a common co-condition in any case in many people with insomnia.
Respiratory depression may occur with overuse or with people with pre-existing respiratory illness.
Long-acting agents have a very high rate of residual daytime drowsiness compared to others. They have been associated with a significantly increased risk for automobile accidents and falls in the elderly particularly in the first week after taking them. Shorter-acting benzodiazepines do not appear to pose as high a risk.
Memory loss (so-called traveler's amnesia), sleepwalking, and odd mood states have been reported after taking Halcyon and other short-acting benzodiazepines. These effects are rare and probably enhanced by alcohol.
Because these drugs cross the placenta and enter breast milk, pregnant women or nursing mothers should not use them. An association was reported between the use of benzodiazepines in the first trimester of pregnancy and the development of cleft lip in newborns.
In rare cases, overdoses have been fatal.

Elderly people are more susceptible to side effects and should usually start at half the dose prescribed for younger people and should not take long-acting forms. Side effects may differ depending on whether the benzodiazepine is long- or shorting acting. Benzodiazepines are potentially dangerous when used in combination with alcohol, and some medications, like the ulcer medication cimetidine, can slow the metabolism of the benzodiazepine. This type of medication can be highly addictive.

When you stop taking this medication, you will probably have some withdrawl symptoms. Withdrawal symptoms usually occur after prolonged use and indicate dependence. They can last one to three weeks after stopping the drug and may include the following:

Gastrointestinal distress.
Sweating.
Disturbed heart rhythm.

In severe cases, patients might hallucinate or experience seizures, even a week or more after the drug has been stopped. Rebound insomnia, which often occurs after withdrawal, typically includes one to two nights of sleep disturbance, daytime sleepiness, and anxiety.

In some cases patients may experience the return of original severe insomnia. The chances for rebound are higher with the short-acting benzodiazepines than with the longer-acting ones. In addition, the following precautions are important in taking sleeping pills:

Start with non-prescription medication.
If prescription hypnotics are required, start with as low a dose as possible.
In general, do not take either prescription nor non-prescription sleeping pills on consecutive days or for more than two to four days a week.
If insomnia is still a problem after stopping the drug and continuing with good sleep hygiene, this pattern can be repeated again, but for no longer than four weeks.
Medication should be withdrawn gradually and the patient should be aware of the possibility of rebound insomnia when stopping medication.
Alcohol intensifies the side effects of all sleeping medication and should be avoided.

If chronic insomnia is a companion to depression or anxiety, treating these problems first may be the best approach. Some newer antidepressants may be effective at treating both depression and insomnia at once. Over-the-counter and prescription sleeping medications are very commonly used medications.

Antihistamines cause drowsiness and many over-the-counter preparations are available that might help transient insomnia. Most over the counter sleep aids use antihistamines ingredients, most commonly diphenhydramine. They may simply contain diphenhydramine alone (Nytol, Sleep-Eez, Sominex) or contain combinations of diphenhydramine with pain relievers (Anacin P.M., Exedrin P.M., Tylenol P.M.). Doxylamine (Unison) is another antihistamine used in sleep medications.

Unfortunately, most of these drugs can leave patients drowsy the next day and may not be very effective in providing restful sleep. Side effects include daytime sleepiness, dizziness, drunken movement, blurred vision, and dry mouth and throat.

In general, these types of medications should be avoided by people with angina, heart arrhythmias, glaucoma, problems urinating, or while taking medications to prevent nausea or motion sickness. Some, such as those containing doxylamine should also be avoided by patients with chronic lung disease.

Actually, for most people, over-the-counter (OTC) sleep medications are not a good choice. These medications are not intended for long-term use and rely on the sedating side effects of antihistamine to facilitate sleep. While taking an OTC sleep medication, avoid driving and other tasks where mental alertness is required. The sedative effects of antihistamines may increase your risk of falling as well.

Sleep experienced while taking OTC sleep medications is not of the same quality as normal sleep. Some people who take OTC sleep medications spend as little as 5% of their total sleep time in deep sleep (compared to approximately 10-25% for healthy sleepers). Only use OTC sleep medications for transient or short-term insomnia and in conjunction with changes to your sleeping habits. Be sure to pay attention to your body’s physical response to them.

Immediately discontinue use if you experience any severe adverse effects such as forgetfulness, constipation, urinary retention, and dizziness. There are some medications on the market that do not contain benzodiazepine. These pills are shorter acting and can induce sleep with fewer side effects than the benzodiazepines. These hypnotics include zolpidem (Ambien), zaleplon (Sonata), and zopiclone (Imovane).

The brands have some differences, such as the following:

Zaleplon (Sonata) is the shortest-acting hypnotic available. It can be taken even in the middle of the night and if a patient needs to awaken in only four hours. In such cases, the medication is effective and still does not leave the person overly sedated in the morning. It appears to have a better safety record than other hypnotics and may be particularly useful for patients in the younger and older age groups.

Zolpidem (Ambien) may be useful for people who take it as soon as they go to bed, since it is longer acting than Sonata. A 2002 study suggested that the drug might be used on an as-needed basis, with up to five tablets taken a week. After three weeks, two-thirds of the patients taking zolpidem in this way were able to reduce their tablet intake by more than 25% without losing improvements in sleep.

These agents can be particularly helpful for preventing jet lag. They also may be beneficial for people who also have accompanying mood disorders, such as depression or post-traumatic stress disorder. They also appear to be safe and effective for elderly patients, even possibly those with chronic lung problems, but research is needed to confirm this. They are expensive, however.

Of course, there will be some possible side effects that can come about even with these types of pills. They have fewer morning side effects than the benzodiazepines, including morning sedation and memory loss (although they can occur to some degree). Ambien's record of adverse effects is similar to that of triazolam (Halcyon), the short-acting benzodiazepine. Sonata appears to have less severe side effects. In general, for both drugs, the side effects are mild but can include the following:

Nausea.
Dizziness.
Nightmares.
Agitation or antagonistic mood in the morning.
Amnesia (in high doses).
Headache.
Rare fatal overdoses have been reported.

As with any hypnotics, alcohol poses a danger with these drugs. The risk for rebound, dependence, and tolerance is lower with these agents than with benzodiazapine, particularly with Sonata. In one study, people who took this hypnotic every night for one year had no evidence of dependency or withdrawal symptoms, but more large studies are needed to confirm long-term safety. These agents are still subject to abuse.

In any case, no hypnotic should be taken for more than a few days or at higher than the recommended dose. A combination of newer antidepressants and structured psychotherapy is proving to be very effective for improving both depression and insomnia in patients with both conditions.

Chloral hydrate is relatively reliable and has been in use since 1832. Many physicians prescribe it for short-term use if other hypnotics cannot be used. It has significant adverse effects, however, and some experts believe it no longer has a role in the treatment of insomnia.

In any case it does not appear to be effective in the elderly. Chloral hydrate poses a risk for addiction and it can be fatal in overdose. It also has carcinogenic properties and can harm genetic material. Potential side effects also include irritation of the skin, mucous membranes, and stomach.

People with stomach, heart, kidney, or liver disorders should not take this drug at all. If a child is given it (usually for minor surgery), then that child should never be given chloral hydrate again in his or her lifetime. Since most of these drugs are available by prescription only, a thorough consultation with your physician is necessary.

When under the care of a doctor, he or she can make sure that the medication is working for you and they can even assist you with any withdrawal symptoms should you stop taking the medicine. The most significant concern about the use of medications for treating insomnia is that medication does not address the root cause of the problem, and instead becomes a crutch to lean on rather than a cure.

Just as you would not leave a cast on a broken bone indefinitely because it would cause the muscle to atrophy, sleep medication should be seen as a temporary aid for sleep problems and not a long term one. Other concerns about the use of over-the-counter and prescription sleep medications include:

development of drug tolerance and/or dependence
reduced effectiveness of drug
physical side effects
interactions with other drugs or chemicals in the body
withdrawal symptoms
rebound insomnia

There are obviously some natural ways to help you sleep. Let’s take a look at those non-prescription methods of sleep inducement.

Sleep Disorder Clinics

2010-12-22T02:51:00.001-08:00

There are numerous sleep disorder centers designed to specifically diagnose and provide ways for you to overcome your insomnia. While the thought of going to a clinic and having people watch you sleep is just a little much for you, fear not.

Actually, sleep disorder centers are there for that specific reason and you will most likely get some answers to your sleeping problems. Among the signs that may indicate a need for a sleep disorders center are the following:

Insomnia due to psychological disorders.
Sleeping problems due to substance abuse.
Snoring and sudden awakening with gasping for breath (possible sleep apnea).
Severe restless legs syndrome.
Persistent daytime sleepiness.
Sudden episodes of falling asleep during the day (possible narcolepsy).

What can you expect when you go to a clinic like this? You will be participating in a sleep study or polysomnogram which is a test that will record your physical state during various stages of sleep and wakefulness. It provides data that are essential in evaluating sleep and sleep-related complaints, such as identifying sleep stages, body position, blood oxygen levels, respiratory events, muscle tone, heart rate, amount of snoring and general sleep behavior.

Usually you will make an appointment for your visit, which will take place at night. The sleep center may send you forms requesting your medical and sleep history prior to your appointment with the doctor. The form may ask for your bed partner's responses to some of these questions, since you may not be aware that you snore, stop breathing (sleep apnea) or kick your legs when you sleep. It also may provide tips and some special instructions for your sleep test.

Before your sleep test, you may meet with a physician or sleep specialist, who will go over your medical and sleep history. You may participate in a "split-night" test, in which half the night will be used to diagnose your sleep problem, and the other half will be used to treat the problem. This is sometimes done with patients who are being tested for sleep apnea.

After your arrival at the sleep center, you may be asked to complete a questionnaire on your sleep the night before. Many sleep centers offer a video or other information about the sleep study or specific disorders such as sleep apnea, since a significant percentage of those who have sleep tests are suspected to have sleep apnea. The video may also address what you should expect during the sleep test to ease any fears that you may have. Then you will be asked to change into nightclothes.

After changing, a polysomographic technician will connect you to the electrodes that will record your brain waves and muscle movements throughout the night. The electrodes are placed in specific areas and applied with water-soluble glue and tape. The electrodes record brain waves, muscle movement, rapid eye movement (REM), air intake, and periodic limb movement.

A microphone attached to your neck records snoring, and two belt-like straps around the chest and lower abdomen monitor muscle movement during breathing. Despite all of the equipment, most people say it doesn't disrupt their sleep.

After settling into bed, your technician may go to a monitoring room and ask you over an intercom to perform certain tasks that will show the electrodes are recording properly. You will be observed on a television monitor during the night, but that is to allow the technician to note your body movements during sleep.

When everything is working properly, the lights will be turned off and you can go to sleep. Many patients are so chronically tired that they have no problem falling asleep.

While you are sleeping, your brain waves will be recorded to determine when you are awake or in Stage 1, 2, 3, 4 or REM sleep. You will be awakened in the morning and the electrodes will be removed. Since they are applied with water-soluble glue or tape, removal isn't painful.

You will need to make an appointment with a sleep specialist to review the results of your study. You might be asked to complete a questionnaire concerning your sleep the previous night, and then you can go home.

Based on the results of your sleep study, you may be given treatment for a specific sleep disorder. For example, patients with sleep apnea may be prescribed Continuous Positive Airway Pressure or CPAP, which is a device that gently blows air into your nasal passages to keep the airway open while you are asleep.

Here are some things you need to bring along with you for your sleep test:

Nightgown, pajamas or any comfortable sleep wear, preferably with a button-down front.
Your favorite pillow or blanket. Sleep centers provide bedding including sheets, blankets and pillows, but yours may help you sleep better.
Toiletries such as a toothbrush, toothpaste, hairbrush or comb.
Clothes for the following day. · Any needed medications.
A book or other reading material.

On the day of your test, wash and dry your hair. Try not to use any hair products, such as gels, hairsprays or heavy conditioners, because it may prevent the electrodes from sticking to your scalp. Remove nail polish and/or artificial nails from at least two fingers. The oximeter that is placed on your finger to monitor blood oxygen levels reads this information through the nail, so any polish or acrylic will not provide an accurate reading.

Do not wear make-up. Some electrodes are on the face, so this area must be clean in order to get a good connection. Generally, you are asked to obtain a normal night's sleep before the test, unless instructed otherwise by your doctor. Continue to take your regular medications and limit caffeine intake the day of your test. Once you have the diagnosis of insomnia, you might be wondering what you can do to overcome it.

With the help of your doctor or sleep specialist, you can work together to overcome your sleeplessness. You should also be aware of the information you can do yourself or ask your doctor about in treatment of this disorder. Drug therapy is a popular method of overcoming insomnia.

Diagnosing Insomnia

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Diagnosing sleep disturbance and its cause is the most important step in restoring healthy sleep. There is little agreement, even among experts, however, on the best methods for effectively assessing a patient's insomnia.

A major difficulty in diagnosing this problem is its subjective nature. One study showed that there was no difference in sleep behaviors between people who said they were insomniacs and people who said they weren't.

People who believe they have insomnia may have actually had frequent brief awakenings during sleep that they perceive as being continuously awake. Some experts recommend, however that any individual should be treated aggressively if he or she believes they have insomnia and also is suffering daytime fatigue and impaired concentration and memory.

A number of questionnaires are available for determining whether a patient has insomnia or other sleep disorders. For example, the physician may ask the following questions:

How would the sleep problem be described?
How long has the sleep problem been experienced?
How long does it take to fall asleep?
How many times a week does it occur?
How restful is sleep?
Does the difficulty lie in getting to sleep or in waking up early?
What is the sleep environment like (Noisy? Not dark enough?)?
How does insomnia affect daytime functioning?
What medications are being taken (including the use of selfmedications for insomnia, such as herbs, alcohol, and over-thecounter or prescription drugs)?
Is the patient taking or withdrawing from stimulants, such as coffee or tobacco?
How much alcohol is consumed per day?
What stresses or emotional factors may be present?
Has the patient experienced any significant life changes?
Does the patient snore or gasp during sleep (an indication of sleep apnea)?
Does the patient have leg problems (cramps, twitching, crawling feelings)?
If there is a bed partner, is his or her behavior distressing or disturbing?
Is the patient a shift worker?

It may be suggested that you keep a sleep diary to keep track of your sleeping habits. Every day for two weeks, the patient should record all sleep-related information, including responses to questions listed above described on a daily basis. A bed partner can help by adding his or her observations of the patient's sleep behavior. Here’s what you should include in your sleep diary:

Time you went to bed and woke up
Total sleep hours
Quality of sleep
Times that you were awake during the night and what you did (e.g. stayed in bed with eyes closed or got up, had a glass of milk and meditated)
Amount of caffeine or alcohol you consumed and times of consumption
Types of food and drink and times of consumption
Feelings - happiness, sadness, stress, anxiety
Drugs or medications taken, amounts taken and times of consumption.

Believe it or not, there is a way to actually measure sleepiness. It’s called the Epworth Sleepiness Scale and it uses a simple questionnaire to measure excessive sleepiness during eight situations.

You might also be given a Multiple Sleep Latency Test. The multiple sleep latency test (MSLT) employs a machine that measures the time it takes to fall asleep lying in a quiet room during the day: The patient takes four or five scheduled naps two hours apart. People with healthy sleep habits fall asleep in about 10 to 20 minutes. The test can detect changes in sleepiness associated with sleep deprivation in patients with insomnia.

It has limitations, however, and does not take into consideration any situations that may affect the patients' mental state and therefore their ability to fall asleep. It is used mainly after other sleep disorders have been ruled out and the doctor is uncertain whether or not insomnia is a correct diagnosis. In cases where a physician is unable to help with your insomnia, you may be referred to a sleep disorder clinic for diagnosis and treatment.

How Serious Insomnia?

2010-12-22T02:50:00.000-08:00

A 2002 study of sleeping habits in over one million people reported that people who slept seven hours a night enjoyed the longest lifespan. Those who slept 8 hours or more or 6 hours or less had higher mortality rates. People with insomnia did not have elevated mortality rates, which supported earlier evidence. People who took sleeping pills, however, did have lower survival rates.

Insomnia is virtually never lethal except in rare cases, such the genetic disorder called fatal familial insomnia. This rare degenerative brain disease develops in late adulthood. It is progressive and the individual develops intractable insomnia, which eventually becomes fatal.

As many as 200,000 automobile accidents in the US and 1,500 deaths from such accidents are caused by sleepiness. Studies continue to report that drowsy driving is as risky as drunk driving. Estimates on fatigue as a cause of automobile crashes range from 1% to 56%, depending on the study.

In a major 1995 poll, for example, 33% of those surveyed said they had fallen asleep while driving and 10% of these people had had accidents because of this. One study strongly suggested that it was habitual sleepiness, however, and not just being sleepy at the time of an accident that places people at higher risk.

Surveys in 2001 and 2002 reported that people with severe insomnia had a quality of life that was almost as poor as in people with chronic conditions such as heart failure. In these studies, people with known depression or anxiety were not included.

In addition to more daytime sleepiness, people with insomnia complained of more attention and memory problems compared to good sleepers. Insomniacs also experience more irritability, mistakes at work, and poorer relationships with their family than people who sleep well.

Insomnia can have an effect on your waking behaviors such as job performance and thinking. In fact, sleep disorders will probably worsen some behaviors in the following way:

Reduced concentration. Some experts report that deep sleep deprivation impairs the brain's ability to process information.
Impaired task performance. One study reported that missing only two to three hours of sleep every night for a week significantly impaired performance and mood. An Australian study reported that 17 hours of sleep deprivation causes impaired performance levels comparable to those found in people who have blood alcohol levels of 0.10%, a level that defines intoxication in many US states.
Effect on learning. Whether insomnia significantly impairs learning is unclear. Some studies have reported problems in memorization, although others have found no differences in test scores between people with temporary sleep loss and those with full sleep.

We have already told you that stress and depression are major causes of insomnia; however, lack of sleep may also increase the activity of the hormones and pathways in the brain that can produce emotional problems.

Even modest alterations in waking and sleeping patterns can have significant effects on a person's mood. Persistent insomnia may even predict the future development of emotional disorders in some cases. Some investigators, in fact, are exploring the possibility of preventing psychiatric disorders by early recognition and treatment of insomnia.

In fact, the inability to sleep can be a major cause of depression. Signs to look out for that link insomnia with depression include:

waking in the middle of the night or early morning and being unable to get back to sleep
loss of interest, energy, and appetite
aggression and anti-social behavior
aches and pains that have no physical explanation

Although alcohol and substance abuse can cause insomnia, the conditions may be reversed. For example, a 1999 survey reported that 14% of American adults use alcohol within a month to help them sleep, with 2.5% reporting frequent use of alcohol to reduce sleep.

Although there has been some concern that insomnia may increase the risk for heart problems, little evidence has supported any significant dangers. One study reported signs of heart and nervous system activity in people with chronic insomnia that might place such individuals at risk for coronary heart disease.

If it exists, however, this increased danger is very modest compared with other risk factors for heart disease. Yet another report suggested that sleep complaints in elderly people without coronary artery disease predicted a first heart attack. Sleep disorders in such cases may have been a marker for depression, however, which is a risk factor for heart attacks in elderly people.

There’s no doubt that insomnia can take its toll on the human body. Lack of sleep does more than make us tired. If the disorder exists for a period of time, it can have serious health consequences.

We can give you all sorts of signs to look out for to see if you have insomnia, but many times, going to a professional can help you find out if you have insomnia.

Who Has Insomnia?

2010-12-22T02:49:00.001-08:00

Studies estimate that between a quarter and one-third of American and European adults experience some insomnia each year, with between 10% and 20% of them suffering severe sleeplessness. In spite of this widespread problem, however, studies suggest that only about 30% of American adults who visit their doctor ever discuss sleep problems. Conversely, physicians seem rarely to ask patients about their sleep habits or problems.

Studies report that the strongest risk factors for insomnia are psychiatric problems, particularly depression, and physical complaints, such as headaches and chronic pain that have no identifiable cause (called somatic symptoms). About 90% of people with depression have insomnia.

In addition, insomnia and depression often coincide with somatic symptoms, particularly chronic pain. In fact, insomnia worsens chronic pain even in people who are not depressed. Headaches that occur during the night or early in the morning may actually be caused by sleep disorders. In one study, patients who had these complaints were treated for the sleep disorder only, and over 65% reported that their headaches were cured.

Overall, insomnia is more common in women than men, although men are not immune from insomnia. Sleep efficiency deteriorates equally in men and women as they get older.

One major study suggested that as men go from age 16 to 50, they lose about 80% of their deep sleep. During that period, light sleep increases and REM sleep remains unchanged. (The study did not use women as subjects, and there is some evidence to suggest they are not as affected.) After age 44 REM and total sleep diminish and awakenings increase.

Younger adult women suffer from insomnia because of both cultural and biologic factors. As we’ve already examined, a number of hormonal events can disturb sleep, including premenstrual syndrome, menstruation, pregnancy, and menopause. All these conditions are natural, and in most cases the wakefulness associated with them is temporary and can be ameliorated with sleep hygiene and time.

After childbirth, most women develop a high sensitivity to the sounds of their children, which causes them to wake easily. Women who have had children sleep less efficiently than women who have not had children. It is possible that many women never unlearn this sensitivity and continue to wake easily long after the children have grown.

After menopause women are susceptible to the same environmental and biologic causes of insomnia as men are. Older women who are not bothered by sleeplessness tend to have longer and better sleep than non-insomniac men their own age.

Other groups of individuals who are likely to suffer from insomnia include those who travel frequently – especially when crossing time lines, those with post-traumatic stress syndrome, and individuals with brain injuries.

Most people sleep around 7 hours a night. Doctors suggest that we get a full 8 hours of rest. The reason is because we are much more mentally alert when we do get a good night’s sleep. Without that sleep, the risks can be huge.

What Causes Insomnia?

2010-12-22T02:48:00.003-08:00

While there is no one cut and dried reason why some people can’t sleep, most experts agree that insomnia is brought on by stress, anxiety, medications, and/or caffeine – among other things. Transient and short-term insomnia has many causes.

A reaction to change or stress is one of the most common causes of short-term and transient insomnia. This condition is sometimes referred to as adjustment sleep disorder. The precipitating factor could be a major or traumatic event such as the following:

An acute illness.
Injury or surgery.
The loss of a loved one.
Job loss.

Temporary insomnia could also develop after a relatively minor event, including the following:

Extremes in weather.
An exam at school.
Traveling.
Trouble at work.

In such cases, normal sleep almost always returns when the condition resolves, the individual recovers from the event, or the person becomes acclimated to the new situation. Treatment is needed if sleepiness interferes with functioning or if it continues for more than a few weeks.

Fluctuations in female hormones play a major role in insomnia in women over their lifetimes. Such insomnia is most often temporary. The hormone progesterone promotes sleep. Levels of this hormone plunge during menstruation, causing insomnia. When they rise during ovulation, women may become sleepier than usual. During Pregnancy, the effects of changes in progesterone levels in the first and last trimester can disrupt normal sleep patterns.

Insomnia can be a major problem in the first phases of menopause, when hormones are fluctuating intensely. Insomnia during this period may be due to different factors that occur. In some women, hot flashes, sweating, and a sense of anxiety can awaken women suddenly and frequently at night during the first months of menopause. In such women, hormone replacement therapy may be beneficial.

Insomnia may also be perpetuated by psychological distress provoked by this life passage. In most cases, insomnia is temporary. Cases of chronic insomnia in women after 50 are more likely to be due to other causes.

In one study, 20% of adults reported that light, noise, and uncomfortable temperatures caused their sleeplessness. Depending on the time of day too much or too little light can disrupt sleep. It is well known that a person's biologic circadian clock is triggered by sunlight and very bright artificial light to maintain wakefulness. One study indicated that even dim artificial light may disrupt sleep.

Insufficient exposure to light during the day, as occurs in some disabled elderly patients who rarely venture outside, may also be linked with sleep disturbances. One study suggests that when a person is exposed to bright daylight, melatonin levels increases in response to darkness at night, which aids sleep.

Caffeine most commonly disrupts sleep. Nicotine can cause wakefulness. Quitting smoking can also cause transient insomnia. In fact, it has been suggested that if sleeping could be improved during withdrawal from smoking, then perhaps it would be easier to quit smoking.

Your partner’s sleep habits can also cause you to have insomnia. In one 1999 survey, 17% of women and 5% of men reported that their partner's sleep habits impaired their own sleep. Snoring can certainly be a factor in a partner's insomnia. In fact, in the same survey 44% of men and 36% of women reported snoring a few nights a week and of those who snored, 19% could be heard through a closed door.

Insomnia is a side effect of many common medications, including over-the-counter preparations that contain caffeine. People who suspect their medications are causing them to lose sleep should check with a physician or pharmacist.

Chronic insomnia can also have deep seated roots. In many cases, it is unclear if chronic insomnia is a symptom of some physical or psychological condition or if it is a primary disorder of its own. In most instances, a collaboration of psychological and physical conditions causes the failure to sleep.

Psychophysiologic insomnia is the revolving door of sleeplessness:

An episode of transient insomnia disrupts the person's circadian rhythm.
The patient begins to associate the bed not with rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges.
Overtime, this event repeats, and bedtime becomes a source of anxiety. Once in bed, the patient broods over the inability to sleep and the loss of mental control. All attempts to sleep fail.
After such a cycle is established, insomnia becomes a selffulfilling prophecy that can persist indefinitely.

Sometimes anxiety and the inability to sleep dates back to childhood when parents used various threats to force their children into sleep for which they may not have been ready.

Pain and discomfort from an injury, illness, or disability can also impair sleep. Among the many medical problems that can cause insomnia are: allergies, arthritis, cancer, heart disease, gastro reflux disease, hypertension, asthma, and ADHD.

When people are in pain or sick, they general have medication to help them through the uncomfortable symptoms. Unfortunately, many of these medicines can also cause insomnia to onset or worsen. They include: nicotine, some anti-depressants, beta-blockers, etc.

A large percentage of chronic insomnia cases prove to have a psychological or even psychiatric basis. The disorders that most often cause insomnia are the following: anxiety, depression, and bipolar disorder.

It should be noted, however, that insomnia may cause emotional problems, and it is often unclear which condition has triggered the other, or if the two conditions, in fact, have a common source.

Anxiety accounts for almost 50 percent of the cases of chronic insomnia. Feeling uptight and anxious can keep you from relaxing enough to go to sleep.

A national survey by the US Department of Health and Human Services found that 47 percent of those reporting severe insomnia also reported feeling a high level of emotional distress. It could be that you become so tense and restless during a hard day at work that you don't even expect to sleep well at night.

An estimated 10% to 15% of chronic insomnia cases result from substance abuse, especially alcohol, cocaine, and sedatives. One or two alcoholic drinks at dinner, for most people, poses little danger of alcoholism and may help reduce stress and initiate sleep.

Excess alcohol or alcohol used to promote sleep, however, tends to fragment sleep and cause wakefulness a few hours later. It also increases the risk for other sleep disorders, including sleep apnea and restless legs. Alcoholics often suffer insomnia during withdrawal and, in some cases, for several years during recovery.

A number of studies have reported that shift work throws off the body's circadian rhythm and have suggested that such changes could lead to chronic insomnia. One study found that 53% of night-shift workers fall asleep on the job at least once a week, implying that their internal clocks do not adjust to unusual work times.

They are also at much higher risk than other workers for automobile accidents due to their drowsiness and may also have a higher risk for health problems in general. A Japanese study reporting on different aspects of insomnia found that excessive computer work was associated with all forms of insomnia. People who were overinvolved with their work tended to have trouble falling asleep and they tended to awaken earlier than average.

Persistently high levels of stress hormones, particularly cortisol, may be key factors in many cases of chronic insomnia, particularly insomnia related to aging and psychiatric disorders. High levels of cortisol reduce REM sleep. Abnormal levels of other biologic factors may also a play a role in specific situations.

An imbalance in specific hormones important in sleep has been associated with aging and may be partly responsible for the higher incidence of insomnia in older people. Older people experience higher levels of major stress hormones (cortisol and adrenocorticotropin) during the night. Why?

Normal aging is associated with a blunting of regular, cyclical surges of growth hormone. This hormone, which is normally secreted in the late night, is associated not only with growth but with deep, slow-wave sleep. Older people generally have less slow-wave sleep.

Melatonin levels, the hormone secreted by the pineal gland are lower, in older people. Some research suggests that elderly people may have lower levels in general simply because many stay mostly indoors and out of normal sunlight.

In spite of such observations a number of studies report no higher risk for insomnia in older adults who have no accompanying mental or physical problems.

There may also be a genetic link to insomnia. Sleep problems seem to run in families; approximately 35% of people with insomnia have a positive family history, with the mother being the most commonly affected family member. Still, because so many factors are involved in insomnia, a genetic component is difficult to define.

So we’ve seen that there can be many reasons why some people simply cannot sleep. Does this disorder affect certain people more than others?

The Sleep Cycle

2010-12-22T02:48:00.001-08:00

Sufficient and restful sleep is a human need as basic as food, vital to emotional and physical well being. In recent years, scientists have made great strides in identifying patterns and functions of brain activity in sleep.

The daily cycle of life, which includes sleeping and waking, is called a circadian (meaning "about a day") rhythm, commonly referred to as the biologic clock. Hundreds of bodily functions follow biologic clocks, but sleeping and waking are the most prominent circadian rhythms.

Light signals coming through the eyes reset the circadian cycles each day. The response to light signals in the brain is an important key factor in sleep and in maintaining a normal circadian rhythm.

Light signals travel to a tiny cluster of nerves in the hypothalamus in the center of the brain, the body's master clock, which is called the supra chiasmatic nucleus or SCN. This nerve cluster takes its name from its location, which is just above (supra) the optic chiasm. The optic chiasm is a major junction for nerves transmitting information about light from the eyes.

The approach of dusk each day prompts the SCN to signal the nearby pineal gland (named so because it resembles a pine-cone) to produce the hormone melatonin. Melatonin is an important hormone released in the brain that some experts believe is critical for the body's time-setting. The longer a person is in darkness the longer melatonin is secreted. Levels drop after staying in bright light. Research is ongoing to determine if high levels of melatonin cause sleep regardless of whether it is dark.

The sleep-wake cycles in humans are designed to produce activity during the day and sleep at night. There is also is a natural peak in sleepiness at mid-day, the traditional siesta time. The sleeping and waking cycle is approximately 24 hours. If confined to windowless apartments, with no clocks or other time cues, sleeping and waking as their bodies dictate, humans typically live on slightly longer than 24- hour cycles.

In sleep studies, subjects spend about one-third of their time asleep, suggesting that most people need about eight hours of sleep each day. Infants may sleep as many as 16 hours a day. Individual adults differ in the amount of sleep they need to feel well rested, however.

Daily rhythms intermesh with a number of biologic and physical factors that may interfere or change individual patterns. For example, the firing of nerve cells in the brain may be faster or slower in different individuals. Such differences are fractions of a second but they can cause variations in the type, timing, and duration of a person's sleep.

In women, their monthly menstrual cycle can shift the sleep/wake pattern. Changes in season or various exposures to light and dark often unsettle the sleeping pattern.

The importance of sunlight as a cue for circadian rhythms is dramatized by the problems experienced by people who are totally blind: they commonly suffer trouble sleeping and other rhythm disruptions.

Sleep consists of two distinct states that alternate in cycles and reflects differing levels of brain nerve cell activity. During a normal night's sleep, one progresses through these stages about five or six times:

Non-Rapid Eye Movement Sleep (Non-REM) sleep is also termed quiet sleep. Non-REM is further subdivided into three stages of progression:

Stage 1 (light sleep).
Stage 2 (so-called true sleep).
Stage 3 to 4 (deep "slow-wave" or delta sleep).

With each descending stage, awakening becomes more difficult. It is not known what governs Non-REM sleep in the brain. A balance between certain hormones, particularly growth and stress hormones may be important for deep sleep.

Rapid Eye-Movement Sleep (REM) sleep is termed active sleep and most vivid dreams occur during this stage. REM-sleep brain activity is comparable to that in waking, but the muscles are virtually paralyzed, possibly preventing people from acting out their dreams.

In fact, except for vital organs like lungs and heart, the only muscles not paralyzed during REM are the eye muscles. REM sleep may be critical for learning and for day-to-day mood regulation. When people are sleep-deprived, their brains must work harder than when they are well rested.

The cycle between quiet (NREM) and active (REM) sleep generally follows the same pattern. After about 90 minutes of Non-REM sleep, eyes move rapidly behind closed lids, giving rise to REM sleep. As sleep progresses the Non-REM/REM cycle repeats. With each cycle, Non-REM sleep becomes progressively lighter, and REM sleep becomes progressively longer, lasting from a few minutes early in sleep to perhaps an hour at the end of the sleep episode.

Seems pretty simple and basic, doesn’t it? After all, we don’t have to learn how to sleep – it’s something we automatically know how to do, but some people still have problems. Why?

What is Insomnia?

2010-12-22T02:46:00.001-08:00

Insomnia is the sensation of daytime fatigue and impaired performance caused by insufficient sleep. In general, people with insomnia experience an inability to sleep despite being tired, a light, fitful sleep that leaves them fatigued upon awakening, or waking up too early.

Under debate is the question of whether insomnia is always a symptom of some other physical or psychological condition or whether in some cases it is a primary disorder of its own.

Common symptoms of insomnia include:

feeling tired during the day
having frequent headaches
irritability
lack of concentration
you wake up feeling tired and not refreshed
sleeping better away from home
taking longer than 30 or 40 minutes to fall asleep
waking repeatedly during the night
waking far too early and being unable to fall back asleep
being able to sleep only with the aid of sleeping pills or alcohol

Insomniacs often complain of being unable to close their eyes or rest their minds for any period of time. This author certainly knows what it’s like to have your mind racing at bedtime. In our stress-filled world, we are often plagued with unfinished to-do lists in ur heads. When it’s quiet and time for sleep, many people have problems pushing those to-do lists aside in favor of dreamland.

Artistic types claim that they get their best ideas at night while lying in bed trying to sleep. One scholar even said that if a man had as many ideas during the day as he does when he has insomnia, he'd make a fortune. That may be true, but eventually, the lack of sleep will take its toll.

The worst part of insomnia is wanting to sleep but being unable to. The mind races and is unable to rest and that makes you overly tired and barely able to function the next day. Sometimes insomnia lasts longer than just a few nights.

Insomnia, usually temporary, is often categorized by how long it lasts:

Transient insomnia lasts for a few days.
Short-term insomnia lasts for no more than three weeks.
Chronic insomnia occurs when the following characteristics are present:

When a person has difficulty falling asleep, maintaining sleep, or has non-restorative sleep for at least three nights a week for one month or longer.

In addition, the patient is distressed and believes that normal daily functioning is impaired because of sleep loss.

Chronic insomnia may also be primary or secondary, depending on the cause:

P rimary chronic insomnia occurs when it is the sole complaint of a patient.
Secondary chronic insomnia is caused by medical or psychiatric conditions, drugs, or emotional or psychiatric disorders.

Some common types of secondary insomnia include:

Sleep apnea is a sleep disorder caused by difficulty breathing during sleep. Persistent, loud snoring and frequent long pauses in breathing during sleep, followed by choking or gasping for breath are the main sighs of sleep apnea. For more information, visit www.sleepapnea.org.
Restless Legs Syndrome is a sleep disorder characterized by unpleasant sensations (creeping, burning, itching, pulling or tugging) in the legs or feet, occurring mostly in the evening and at night. Moving the legs around tends to relieve the unpleasant sensation temporarily. For more information, visit www.rls.org .
Sleep-wake schedule o r c ircadian rhythm disorders are sleep disorders caused by having sleep-wake schedules that do not match up with your natural sleep schedule. People who work the night shift may suffer from this problem.
Insomnia due to medical conditions: Many common medical problems and the drugs that treat them can cause insomnia, including allergies, arthritis, heart disease, hypertension, asthma, Parkinson's disease, attention deficit hyperactivity disorder, or hyperthyroidism. Physical discomfort (e.g. chronic pain) may also cause problems sleeping.
I nsomnia due to substance use or withdrawal: Many drugs and medications can cause sleep disturbances, either while taking them or while withdrawing from them. Alcohol, stimulants, sedatives, and even long-term use of sleep medications can cause insomnia.
I nsomnia due to an emotional problem: Insomnia can be a symptom of a number of emotional difficulties. If you find that you worry excessively about numerous minor matters or if you have experienced sadness or a loss of interest in activities for a number of weeks consult your physician.

Insomnia may also be defined in terms of inability to sleep at conventional times. The following are examples and are referred to as circadian rhythm disorders.

D elayed Sleep-Phase Syndrome:. Delayed sleep-phase syndrome is the term for a circadian clock that runs late but reliably. People who have this condition (usually adolescents) fall asleep very late at night or in early morning hours, but then they sleep normally.
Advanced Sleep Syndrome. This syndrome tends to develop in older people; it produces excessive sleepiness in the morning and undesired awakening early in the morning.

It might be helpful for you if we look at the basic sleep patterns and how doctors are able to identify specific problems based on what they already know about sleep.

Why There's 'No Health Without Mental Health

2010-12-21T00:31:00.000-08:00

Old or young, neglecting your mental health is bad for your physical health and vice versa. If you have a chronic physical illness such as diabetes or heart disease and you suffer from depression or an anxiety disorder, you are at considerably higher risk for disability and premature death. Depression and anxiety disorders often express themselves through physical symptoms: stomach problems, headaches, backaches, sleeplessness, fatigue, weight loss, or obesity.

People in the early or mid stages of a dementia, such as Alzheimer's Disease, are likely to also be depressed and/or anxious, and these co-occurring mental conditions reduce already compromised cognitive functions. If you suffer from a long term, severe mental illness, your life expectancy is at least 10 and perhaps 30 years less than the general population's, largely due to poor health.

Mind and body are inextricably linked. A decade ago the Surgeon General of the United States tried to capture this relationship by saying, "There is no health without mental health." He might have added, "There is no mental health without health." Millennia ago the Romans said much the same thing, "Sound mind, sound body."

Each year about 25 percent of us have a diagnosable mental or substance use disorder or both. Yet only 40 percent of those of us who have such a disorder get treatment. Why? Many people get help from family, friends or clergy. But many of us don't know when we have a mental disorder or are too embarrassed to talk about it openly. In addition, many primary care physicians don't ask questions to identify mental and/or substance use problems; and if they do, they may make referrals, which many people do not follow up on. Besides, in most places there is a shortage of qualified mental health professionals.

It is entirely understandable that many of us don't realize when we have a mental disorder because sometimes the symptoms of a disorder are very much like the ordinary ups and downs of human life. Sometimes we get sad, sometimes we are frightened, sometimes we ruminate at night and can't sleep, sometimes we are lethargic, and sometimes we are really charged up. That's just being human. But sometimes we are not just sad; we are despondent and nothing gives us pleasure. Sometimes we are not just anxious; we are immobilized by our fear. Sometimes we are not just having a little too much to drink from time to time; being drunk or hung over is getting in the way of our work or our relationships.

It is also entirely understandable that many of us are too embarrassed to talk openly about having a mental disorder. It is very hard to say out loud or even to oneself, "I am mentally ill," in a society in which being mentally ill is a curse.

And it is understandable that most primary care physicians are not very good at identifying mental and substance use disorders. They haven't been adequately trained; and, if they do identify a mental illness, they often don't know how to treat it effectively or have time for the part of treatment that depends on talk and human interaction.

What can you do to take care of your mental health?

Preserve it by staying active and involved with other people, particularly those you enjoy.

Try -- hard as it is -- to maintain enough balance in your life so you are not stressed out all the time.

Ask your doctor to screen for mental health problems. There are screening tests that you can fill out in the waiting room that are remarkably accurate. Of course, your doctor may not know what to do if you screen positive; but she/he is more likely to learn once there are test results just as they have learned to manage lipids because there are now tests for cholesterol and triglycerides.

Go to a mental health or substance abuse professional in a local clinic or in private practice. Medical and mental health professionals cannot successfully treat all our suffering. Human life is filled with reasons to be unhappy, frightened and confused. But some of our suffering can be avoided, cured, or ameliorated if we make adjustments in how we live, recognize that our minds are integral to our health, acknowledge that we may have a mental or substance use disorder, and seek help when we need it. Treatment can be, and often is, effective.

Simple Breathing Exercise for Higher VO2max

2010-12-17T01:36:00.001-08:00

Oxygen transport from outer air to muscle cells and final tissue oxygenation are controlled by breathing. Physiological and medical studies proved that the more we breathe at rest, the less oxygenation of tissues. Hyperventilation reduces tissue oxygenation. Why?

While overbreathing cannot improve blood oxygenation (it is up to 98% saturated with O2 during light normal breathing), it reduces CO2 content in the body leading to two negative effects down the oxygen delivery cascade:

Blood vessels become constricted (CO2 is a potent vasodilator);
Oxygen release in capillaries is suppressed since CO2 is a chemical catalyser of this process. This effect is known in physiology for a century and described in many textbooks as the Bohr law.

Hence, the less we breathe (down to 2 l per minute for minute ventilation), the better oxygenation of the human body.

Since CO2 is the main factor in breathing control and it also participates in regulation of dozens of chemical reactions, including synthesis of proteins, lipids, hormones, and immune cells, humans cannot change their unconscious breathing pattern at once. The changes are gradual and usually take, even for healthy people, at least weeks or months.

Obviously, VO2max values are sensitive to the unconscious breathing pattern and body oxygenation at rest. By breathing slightly less (with air hunger) and improving body O2 reserves at rest, we can enhance endurance and VO2max within 10-15 minutes just before exercising.

The breathing exercise is done only on empty stomach, with straight spine (or no slouching) for diaphragmatic breathing, in cool conditions with good air quality. The first step is to listen to own usual breathing for about 20-30 s. Then instead of taking large inhalations, take a slightly smaller breath, using your stomach only, and immediately relax all breathing muscles and the rest of the body.

Continue to breathe in this light mode, so that you gradually accumulate air hunger (or desire to breathe more air), while being totally relaxed (this is the most challenging part of this breathing exercise). In 1-2 minutes, if you do it right, you will notice that your arms and feet will be warmer (due to improved circulation), while your nose will be moister and cooler. If you continue to practice this shallow or reduced breathing for about 10-15 minutes, your heart rate also significantly drops, as you can easily check using devices, and this will also indicate your improved physiological state.

If an athlete learns how to change their unconscious breathing pattern or achieve very light unconscious breathing 24/7, then body oxygenation and VO2max will be greatly improved too. Currently there is only one medically proven therapy that produces these results: the Buteyko breathing technique practiced in Russia by about 200 MDs. In order to learn it, one requires to regularly practice shallow breathing exercise, daily measure own body oxygen content using a special breath holding time test, breathe through the nose during almost all or all training sessions, prevent sleeping on the back at night, and do many other things that are part of the Buteyko method.

Tough to Eat Healthy in Some Neighborhoods

2010-11-30T00:21:00.000-08:00

STATEN ISLAND, NY – STAPLETON/CLIFTON — Something as simple as an apple is a luxury for many on Staten Island’s North and East shores.

In focus groups with City Harvest, youngsters aged 6 to 17 listed the foods they typically purchase in Stapleton and Park Hill: Pizza, chicken, mozzarella sticks, burgers, fries, honey buns, donuts, beef patties, Chinese food, Mexican food, chips, candy, and 50-cent generic-brand “bummy sodas.”

ecent studies reveal the result: Residents of these areas are prone to obesity and nutrition-related health problems, in part because they consume inadequate portions of fresh fruits and vegetables.

The consumers tend to know which foods are healthy, according to a recent community food assessment, but they often fail to maintain a balanced diet because of tight budgets and poor access to supermarkets.

City Harvest, the Manhattan-based non-profit agency that feeds New York’s hungry, conducted the study that focused on Stapleton and the Park Hill section of Clifton.

“We recognize there is a spectrum of needs in addition to emergency food,” said Jennifer McLean, vice president of program operations for City Harvest, discussing the study at a workshop held last week at St. John’s University’s Grymes Hill campus. “With this assessment we addressed why access is limited and asked the community to offer solutions.”

Chief among the barriers to healthy food consumption, the researchers concluded, is poor access to healthy, affordable foods.

The only two supermarkets serving the neighborhoods, Waldbaum’s and Western Beef, are nearly a mile away from both the Park Hill Apartments and the subsidized Stapleton Houses. Limited transportation compounds the problem, according to the study, as buses are infrequent and residents of Park Hill require transfers to reach their closest supermarket. More than 10 percent of the food shoppers surveyed by City Harvest paid for car services to taxi them home with their grocery bags, adding to the cost of shopping.

Various recent studies have pointed to the need for supermarkets on the North Shore. City Planning identified Stapleton and St. George among the neighborhoods most in need of supermarkets citywide. A City Limits study in 2004 reported that 138,283 Staten Islanders have more McDonald’s than grocery stores in their ZIP codes. North Shore residents have unsuccessfully petitioned grocery providers, including FreshDirect and Trader Joe’s, to serve the area.

Limited access to supermarkets makes residents reliant on abundant convenience stores and fast food outlets. These are stocked with limited varieties of poor-quality staples at higher prices, City Harvest reported. Food prices also turn healthy eating into an economic calculus.

Poverty constrains Americans’ ability to eat healthy foods nationwide, and 60 percent of those surveyed by City Harvest reported having trouble stretching their food dollars until the end of the month. Junk foods tend to be much cheaper, calorie for calorie, than fresh produce. And they are readily available.

Anecdotal evidence in the community food assessment suggests that young people in the area may have particularly deficient diets. “I would say, if I had to make up a statistic, that 75 percent of the teens walk into the teen room after school with food in their hands,” a local librarian told City Harvest. “That’s one of our biggest problems in the teen room. They all complain about having no money, but every day they have enough to buy a 20-ounce bottle of soda and chips. Every day.”

Liberian residents in Park Hill discussed generational patterns of food consumption, reporting that elders consume traditional African fresh foods, while youth prefer commercial fast food. Some suggested that cooking classes would help both youngsters and adults know what to do with vegetables that languish in their refrigerators. Community members, speaking with City Harvest, expressed a clear demand for healthier food access, according to the study.

More affordable produce, establishing community gardens, improving the quality of produce at corner stores, organizing cooking and childcare clubs, and arranging shuttle buses to supermarkets were among their suggestions. At a recent workshop, Staten Island stakeholders and service providers discussed various strategies to improve the local food environment, including establishing youth-run produce markets, courting large-scale supermarkets, and lobbying leaders to make food initiatives in the area a priority.

Tevah Platt covers the North and East shores of Staten Island for the Advance. She can be reached at platt@siadvance.com.

By the numbers

City Harvest’s community food assessments indicates Stapleton and Clifton are high-risk areas for community health.

11.2 percent of residents have diabetes, vs. 9.7 percent citywide.
33.8 percent of residents are obese or overweight, vs. 20 percent citywide.
83 percent do not meet the recommended level of physical activity.
60 percent of survey respondents say they have trouble stretching food dollars to the end of the month.
82 percent of survey respondents eat less than three servings of produce per day.

How Much do You Know About Hypertension?

2010-11-30T00:13:00.000-08:00

STATEN ISLAND, N.Y. -- Some of EMT students were recently learning how to measure blood pressure and were practicing on each other. This lesson may have saved the life of one of them.

As a female student was measuring the blood pressure of a 23-year-old classmate, we noticed that she took his pressure over and over. Then, with a puzzled look on her face, she said to us, “Could one of you check this? I don’t think I’m getting his pressure right.”

We did check it and confirmed that this young man had a very high blood pressure — 180/114. He was sent to the doctor immediately.

To see this student you would not think to yourself, ‘Hmmm, high blood pressure.’ He is young, appears healthy and slender, and doesn’t smoke. Did he know about his blood pressure?

“No,” he replied. He then went on to say that he wasn’t really surprised about it, since most of his older family members had high blood pressure (aka hypertension). He came back a few days later with a new prescription and, hopefully, a plan to keep his blood pressure under control.

Could you be someone with undiagnosed high blood pressure? According to recent statistics from the American Heart Association (AHA), one in three adults has high blood pressure. More than half of the known cases of high blood pressure are not controlled. Why is that so important?

Take this true-or-false quiz to test your knowledge about hypertension.

QUESTIONS

There are fewer deaths directly related to high blood pressure today than 10 years ago.
High blood pressure is equally prevalent in all races.
Hot tubs can be risky for people with high blood pressure.
You can usually tell if you have high blood pressure by experiencing headaches or fatigue.
Fatty fish such as salmon should be avoided.
While keeping your weight within healthy limits can help control your blood pressure, if you’re slender that doesn’t mean you’re in the clear.

ANSWERS

False. Surprisingly, between 1996 and 2006 cases of hypertension rose 19.5 percent and deaths due to hypertension rose 48 percent.
False. African Americans have the highest rate of high blood pressure and, as a result, also have a higher rate of complications and death due to heart disease and other long-term effects of uncontrolled hypertension.
True. This may surprise some of you, but if you have uncontrolled high blood pressure, going in and out of a hot tub can cause your blood pressure to increase significantly, especially if you are going from hot to cold to hot. If your pressure is well controlled, a moderate trip to the hot tub should be safe, but clear it with your doctor.
False. Unless your pressure is enough to be at immediate risk for stroke or death, you probably will not notice any changes. For this reason, it’s important to monitor your blood pressure often and get it treated if it is high. Long-term treatment is pretty typical. Keeping it under control is the key. If the medicine has unpleasant side effects, talk with your doctor who can replace it with something else.
False. The fats in salmon, herring, and trout, for example, are rich in omega 3 fatty acids — a benefit for blood pressure control. Eat at least two servings a week.
True. The previously mentioned student is slender, young and appears healthy, but he had a dangerously high blood pressure. Untreated, this can lead to blood vessel damage, heart disease, stroke, kidney failure, and other complications.

So how high is too high? The AHA says that if your systolic (top number) is less than 120, you’re OK. Between 120 and 130 and you’re “pre-hypertension.” If your systolic number is over 140, you have high blood pressure.

For the lower number, 79 is the cutoff for acceptable. Between 80 and 89 and your doctor may issue a warning to change your lifestyle. Numbers higher than 90 mean you need immediate treatment to avoid damaging organs and blood vessels.

High blood pressure is common and manageable. See your doctor. Get it checked. If you need medication, use it until or unless your doctor tells you that you no longer need it. For more information on management and prevention of high blood pressure, visit the AHA’s website at www.heart.org.

How Safe are Your Anti-Acne Products?

2010-10-19T22:52:00.001-07:00

Bothered by constant acne breakouts? Nobody likes to have acne, of course. Aside from being bothersome, it can also affect your self-confidence, and it can create unsightly acne scars if you’re not careful. That is why you, along with millions of people out there, are looking for ways that will help you get rid of this. However, safety can be a serious concern with many of the anti-acne products out there.

So, how safe are your anti-acne products? Not sure? Then, we’ll talk about some of the more popular anti-acne products out there and we’ll show some of the things you need to be aware of in terms of safety. Read on.

Benzoyl Peroxide

Benzoyl peroxide is without a doubt one of the most popular anti-acne products out there, mainly because it can be acquired over-the-counter. However, you should be careful when applying benzoyl peroxide on your skin because some people experience adverse reactions to this, including burning sensations, swelling and itching. Its application may also cause dryness of the skin; however, this reaction usually goes away after a week of usage.

Salicylic Acid

Another popular anti-acne product, salicylic acid has less severe side effects than benzoyl peroxide. However, you should also be careful when applying this on your acne because it can cause dryness and irritation. Should you experience these side effects, you should lessen your use of salicylic acid. If these continue to persist, we recommend that you stop using this altogether.

Tetracycline

Tetracycline is an anti-acne drug that’s prescribed by doctors to patients who do not react positively to less powerful medications such as the ones we mentioned above. Its usage is regulated because it can have serious adverse effects if administered incorrectly and this is why you need a doctor’s prescription to acquire such product. Some of the side effects of tetracycline include staining of the oral cavity and teeth. This drug should not also be used by pregnant women and children who are under 9 years old.

Erythromycin

Erythromycin works by killing bacteria that causes acne. Aside from that, it also helps reduce redness in lesions. It also has an advantage over tetracycline because erythromycin can be used even by pregnant women. However, it is not without side effects. Some people who use this drug experience upset stomach and nausea.

How to Avoid These Side Effects and Safety Issues

The easiest and most obvious way to avoid the side effects of the anti-acne products we discussed is to seek your dermatologist’s advice before trying these products, particularly those drugs that can be obtained over-the-counter.

It also pays to read the safety precautions found on the product’s packaging because these precautions will provide you with the necessary safety information you need regarding the product.

Primary Tinnitus Causes

2010-10-19T22:41:00.000-07:00

The majority of people today who are suffering from tinnitus might be additionally suffering from one more disorder that has in fact caused the symptoms of tinnitus. While there is no known cure for tinnitus, some of its signs and symptoms can be relieved by dealing with the main of a different problem that will have ringing ears as side-effect.

There are diverse factors that can trigger or contribute to ringing in ears. The aging process leads to the human body for you to breakdown in many ways and the ear isn't exempt.

Deterioration of auditory cells due to getting older can cause tinnitus. For those ageing adults who are suffering through hearing loss along with tinnitus as an undesirable side effect as a result of getting older, any hearing aid can help.

By increasing the appears around you, the noises you hear from tinnitus may be perished out. Talk to your medical doctor about ways to experience tinnitus caused by aging.

If you have been around loud noises just like machinery or even deafening music, especially if you are exposed for a long or perhaps repeated time, you could begin to undergo the symptoms of tinnitus. Noises like fireworks as well as gunshots can cause any temporary onset of ears ringing while overexposure could cause permanent tinnitus. In the event you work in a place where loud noises tend to be unavoidable, make sure to put on earplugs or various other ear protection.

Various kinds of medical conditions can cause tinnitus. One of the leading leads to is high blood pressure. A great inner infection that creates the build associated with fluids in the inside the ear will cause ringing in the ears. You may also experience the symptoms oftinnitus because of build-from wax in your ear. Visit your health provider if you are listening to noises in your head which no one else can easily. Getting to underneath of an fundamental medical condition can save you from more than just the aggravation of tinnitus. In very rare situations, an aneurysm or perhaps tumor could be that underlying cause of ears ringing.

One disease that will cause tinnitus is Meniere's Disease which causes any disruption in the flow of the body fluids. Most of the time, merely one ear is impacted but it is possible to own it in both ear. Tinnitus is a complication of this disease that normally strikes both males and females between the age groups of 20 to be able to 50. He buzzing or buzzing inside ears usually starts in Meniere's Illness at the start of vertigo, a faintness also associated with the ailment.

The medicines you are taking could be the explanation you are experiencing tinnitus. Over 2 hundred different medications are acknowledged to have tinnitus as a side effect. Talk to your doctor if you begin to experience any overseas noises in your hearing that can't become heard by other folks around you.

Caring for your health may minimize the triggers of ringing in ears in quite a few situations. Consume a routine and nourishing diet, get sufficient relaxation, and steer clear of putting yourself under too much tension.

Every one of these issues can create about other difficulties that cause tinnitus since an unwanted effect. Coping with tinnitus can be tense enough to cause another health issue to become worse. The best way to stay away from all these kinds of issues with your health can be to take care of your self.

The results regarding being inattentive for a body and its actual state could find yourself putting you in danger of having to deal with ringing in ears on a daily basis. Comprehending the causes of ringing in the ears can help you for the journey to a remedy and finally residing tinnitus-totally free.

Artefill Effective In Treating Atrophic Acne Scars

2010-10-19T02:07:00.000-07:00

Suneva Medical, a privately-held aesthetic medical device company, announced the publication of an open-label, single center, pilot study on Artefill® for the treatment of atrophic acne scars conducted by James M. Spencer, M.D. M.S. and sponsored by Suneva Medical. The article, which appears in the September 2010 issue of Journal of Drugs in Dermatology, shows Artefill to have a significant and lasting effect on patient atrophic acne scars after an eight month period.

The study consisted of fourteen (n=14) healthy male and female patients between the ages of 18 and 60 who met all inclusion and exclusion criteria and had atrophic acne scars amenable to correction with Artefill. Patients were evaluated at six weeks and eight months after the initial injection. The investigators concluded that 96 percent of the treated acne scars noticeably improved and 70 percent improved by two grades. Patients reported being highly satisfied with Artefill with the vast majority or 93 percent willing to have a repeat procedure. No adverse events or side effects were evident over the course of the study.

Dr. Spencer, lead study investigator commented, "Our patients saw an outstanding correction with Artefill and we believe it will provide them long lasting and possibly permanent results. We will continue to follow these patients over a three-year period but the data indicates Artefill is safe and effective for these challenging scars."

Acne is a disorder that effects up to 80 percent of individuals between 11 and 30 years of age and up to 5 percent of older adults. Atrophic acne scars result when there is a loss of tissue and will create a pitted or pockmarked look of the skin. While not all patients will develop acne scars, when they do occur ninety-five percent are on the face, potentially affecting a patient's self-confidence.

About Artefill

Artefill is the first and only FDA-approved microsphere-enhanced dermal filler for the correction of nasolabial folds, better known as smile lines. Since Artefill was approved in 2006, over 25,000 patients have been treated.

The simple, in-office procedure takes approximately fifteen minutes to complete. A patient is injected with microsphere-enhanced collagen similar to other dermal fillers. Artefill comes mixed with local anesthetic, so there is virtually no discomfort during the injection process. The unique microspheres in Artefill are not absorbed by the body and therefore provide the support the skin needs for long lasting natural feeling results. This is different from temporary dermal fillers that are made of different kinds of natural or synthetic materials that are completely absorbed by the body over time and require repeat injections to maintain wrinkle correction. A skin test is required approximately four (4) weeks prior to treatment, to ensure a patient is not allergic to the collagen in Artefill.

Source: Suneva Medical

Tinnitus Hurts Elderly Quality Of Life

2010-10-19T02:06:00.000-07:00

Tinnitus -- annoying, continuous sounds in one or both ears -- often impacts the quality of life of the elderly, a Nigerian researcher says. Study author Akeem Olawale Lasisi says tinnitus is common among elderly Nigerians and he estimates the ear condition affects between 10 percent to more than 30 percent of Nigeria's population, though fewer than 4 percent consult a doctor about it.

Lasisi and colleagues conducted face-to-face interviews of 1,302 elderly people age 65 and older. The researchers found a significant difference in prevalence of tinnitus depending on age. Among young elderly -- those between ages 65-69 -- 6.5 percent reported experiencing the condition, while 41.9 percent of the older group -- those 80 and older -- experienced it.

lso in this study, a non-significant trend was observed for the prevalence of tinnitus to increase with decreasing socioeconomic and educational level. "Our results are of potential value in the overall consideration of the health consequence of aging in this setting, especially given the projections of a rapid increase in the proportion of the elderly in developing countries," Lasisi said in a statement.

The findings are published in Otoloaryngology: Head and Neck Surgery. (c) UPI

Pet allergies worsen hay fever symptoms, Queen's study finds

2010-10-18T02:39:00.000-07:00

Being allergic to dogs or cats may worsen your ragweed allergies, according to a study from Queen's University.

Researchers found that people with pet allergies often develop ragweed allergy symptoms more quickly than others. But the study also suggests that once allergy season is in full swing, those symptom differences subside.

The team, led by Anne Ellis, an assistant professor in the departments of medicine and microbiology and immunology, exposed 123 participants to ragweed, and noted that pet allergy sufferers reported symptoms differently than their non-animal allergic counterparts. Dust mite allergic patients also developed symptoms more quickly after ragweed exposure.

'The study results helped us develop a theory of 'pre-priming,'' says Dr Ellis. 'If you have ongoing symptoms from perennial allergies, as soon as you add another allergen into the mix your symptoms develop much faster, and you may have a harder time dealing with it than others.'

Dr Ellis says that ideally patients with animal allergies should find alternative homes for their pets, or at least minimise their exposure by not allowing animals access to the bedroom of the allergic individual. This becomes even more important in the case of children suffering from asthma, and could prevent the development of irreversible lung damage due to ongoing allergic inflammation.

Source: Queen's University

Does Stress Make You Ugly?

2010-10-18T02:35:00.000-07:00

Can stress really affect your physical appearance? Unequivocally, stress not only affects your mental well-being but also has a direct impact on beauty. Aside from the unattractive scowl that stress brings to the face, it creates direct physiological changes.

Stress is defined as the reaction of the body to a stressor or stimulus that causes stress. Stress can be acute, which affects the body in the short term, or chronic, affecting the body in the long term. Synonyms for stress include anxiety, nervousness, apprehensiveness, impatience, fear and restlessness.

There are three basic stages of stress. Alarm, the initial phase, is a reaction to a stimulus that one would perceive as a danger, initiating the "fight or flight" defense mechanism built into our systems. The brain's adrenal gland produces the hormone adrenaline, which stimulates an increase in heart rate and blood pressure, causing a greater amount of blood flow to the large muscle groups of the body, creating a burst of energy and strength. This primeval mechanism permits the body to flee from danger or fight for survival.

The second stage is resistance, in which the body's resources start to deplete in an effort to cope with the drastic changes occurring. The final stage is exhaustion, as the body simply stops functioning normally as resources become completely depleted. This is a simplistic description of the stress mechanism, and obviously there are different degrees of stress that can affect us.

Stress that is well managed or occurring in small increments is not harmful, and when the stressful stimulus is removed, the body reverts back to normal. An example of reasonable and manageable stress may be a deadline for work or school that can provide the initiative to get that particular job done on time.

Stress that is not controlled most certainly affects the body's physical characteristics or beauty. It affects skin, hair, fingernails, digestion and sleep patterns. Stress-induced conditions include hair loss, heart disease, obesity, obsessive-compulsive disorder, sexual dysfunction, tooth and gum disease and ulcers or indigestion.

Stress-induced production of adrenaline and another hormone, cortisol, has a significant deleterious effect on the skin, the body's largest organ. The cell renewal process of the skin occurs every 28 days but slows as we age, causing wrinkles and dry skin. Stress slows that process even further, hastening the aging process. The excessive hormone production also stimulates the skin to create thicker hair follicles and increase the oil production, creating acne breakout. Rashes can occur from stress, too. The immune system is affected by stress, increasing the skin's susceptibility to irritation from outside pollutants and free radicals, also inducing early aging.

The stress hormones also affect digestion, preventing the absorption of needed vitamins from food. Vitamin B deficiency causes hair loss. It forces hair follicles to remain in the "telogen" phase of growth, which is essentially the fall out stage. This can occur up to three months after a stressful event. Vitamin deficiency also causes gum disease and allows fingernails to become brittle or causes nail biting, further affecting growth.

So how can we prevent stress from affecting our appearance? Countless books and articles have been written on the subject of dealing with stress. The first step is recognition. To help deal with your stress, write down a list of what you are most worried about before any event, or what chronically causes worry in your life. Identifying your stressors is the first step in managing them. If you are chronically late or find that it hard to get organized, figure out what you do that makes you late or disorganized. Write it down, and acknowledge it. Then you can come up with a plan to preemptively tackle what may drive you and your loved ones into a stressed-out situation.

Over time, you will find that a small amount of preparation can prevent larger problems from forming in the first place. Another trick in dealing with stress is plain old reasoning and the realization that you cannot control everything. Sometimes we trap ourselves into worrying about things that we have no control over, and recognition of that fact can reduce stress immeasurably.

Develop your own personal stress-busting techniques to allow you to deal with acute stressful situations.

Learn to meditate or do deep breathing exercises.
Express yourself: Sing a song. This will regulate your breathing and stop any stress-related hyperventilation.
Exercise. Take a long walk or run or find whatever physical activity that allows you to circumvent the effects of stress.
Identify those activities that you truly love and permit you to become immersed in their endeavor. This encourages you to think about something other than what is bothering you. These include hobbies, movies or music.
Get a pet. Studies have shown that petting a dog or cat is a proven way to lower your blood pressure.
Volunteer and take the focus off yourself; do community service, help out your kids' PTA, or tutor students in need.

These are just a few recommendations. Each of us must develop our own personal techniques to deal with stress and allow us to go on with our lives in a normal fashion.

Vitamin D Could Help Seasonal Allergy Sufferers

2010-10-16T01:34:00.001-07:00

The pollen is upon us causing sneezing, wheezing, itchy, watery eyes - seasonal allergies. A preliminary study of inner city children ages six to 12-years-old indicates that those who suffer from allergies and asthma were also found to have a vitamin D deficiency. The research was done at Allegheny General Hospital.

"Vitamin D has been shown to be an anti-inflammatory or anti-swelling chemical. So it's been shown to decrease many diseases, or improve many diseases that are involved in inflammation including allergy and asthma," says Dr. Deborah Gentile, one of the researchers. Vitamin D has already been getting attention for boosting the immune system to fight osteoporosis and Seasonal Affective Disorder and now it may help to ease symptoms of allergies and asthma.

"Basically, in children as well as adults who have allergy and asthma, their immune systems tend to make certain chemicals that drive those reactions. These are chemicals that are called cytokines," Dr. Gentile explained. "Basically what vitamin D does is control the regulation of these cytokines so that less of the allergy and asthma-like cytokines are being made."

The best source of vitamin D is 15 minutes of reasonable sun exposure two to three times a week - not always possible in Pittsburgh. Vitamin D is also found naturally in oily fish, cod liver oil and egg yolks. Other products like cereal, milk and other dairy items can be fortified with vitamin D. If using supplements, researchers are still trying to find the ideal therapeutic dosage of vitamin D.

"It depends on your age," Gentile said. "Typically, if you get a supplement, look at the label and see. I probably wouldn't go more than a 1,000 to 1,500 units per day." But, like most everything else, don't overdo it. "Even though vitamin D is something good for our immune systems and good for our health in general, you can still get too much of it and cause problems," Gentile said. Multi-city clinical trials are scheduled. Pittsburgh is one of the sites. Inner city kids will be given supplemental vitamin D to see how it affects their allergy and asthma outcomes.

Alzheimer's Linked to Form of Acne

2010-10-16T01:33:00.000-07:00

A new genetic study has revealed an interesting correlation between the early onset of Alzheimer's Disease and acne inversa, a condition that affects the skin in the armpit and inner thigh. The team that made the finding was investigating the genetic mechanisms underlying the peculiar form of acne when they stumbled upon the connection.

According to the research, mutations in the gene called PSEN1 are responsible for causing acne inversa, and also for underlying symptoms related to the early onset of Alzheimer's. One of the most interesting aspects of the new research is that the mutations taking place in this gene are diverse, and that each of the possible variants underlies one of two conditions.

This led experts to conclude that acne inversa and Alzheimer's may be mutually-exclusive, as in unable to develop in the same patient at the same time. Scientists say that this idea is strengthen by the fact that no reports of two two conditions coexisting in the same patient have ever been reported.

My Health News Daily reports. “We were surprised that PSEN1 mutations caused acne inversa, but got even more excited after realizing” the source of the mutations, explains Xue Zhang. The expert, who is based at the Peking Union Medical College in Beijing, was a researcher on the new study.

Details of the work were published online today, October 7, in the top journal Science. The Chinese group that conducted the research looked at the cases of 50 individuals aged 15 to 81, who were part of families that had been affected by acne inversa for generations. When comparing the results of genetic analyses conducted in this group with readings obtained from 200 people who did not suffer from the condition, the team determined that PSEN1 mutations were clearly responsible for it.

Previous investigations have already linked the early development of Alzheimer's to mutations in the gene. Some 160 possible mutations have thus far been classified. The new study results appear to indicate that people with acne inversa may in fact be protected from the form of dementia, so this may constitute a new avenue for development in Alzheimer's research. Zhang and his group have already announced plans to check the human genome for other genes that may underly the development of acne inversa.

Suicidal Thoughts May Be Due To Acne Rather Than Medication

2010-10-14T23:54:00.001-07:00

Depressive side effects which were thought to be caused by acne medications, such as Accutane and Claravis, may in fact be caused by the acne itself, say researchers in a new study published in the Journal of Investigative Dermatology. The writers suggest that fears that acne drugs may cause suicidal thoughts may have been overstated.

Young people with severe acne have considerably higher levels of depression and suicidal ideation compared to individuals with no acne or mild symptoms, the Norwegian investigators report.

Jon Anders Halvorsen, Oslo University Hospital, Norway, said:

There is a pretty strong and consistent association between acne and symptoms of depression or mental health problems.

A Canadian study in 2008 published in the Journal of Clinical Psychiatry suggested Accutane could increase the risk of depression.

Accutane, an acne medication made by Roche, is also available in generic form isotretinoin - Teva Pharmaceutical Industries, Mylan and Ranbaxy make and sell the generic version. Roche announced last year that it could cease selling Accutane because of generic competition.

The authors write that controversies regarding acne medications have discouraged many dermatologists (skin specialist doctors) from prescribing isotretinoin.

Halvorsen said:

Our study is important because it provides an argument for not being so cautious.

In their study, involving 3,775 males and females aged 18 and 19 years, from Oslo, Norway, the investigators report:

Twice as many females with severe acne reported having suicidal ideation compared to females with no acne or mild symptoms
Three times as many males with severe acne reported having suicidal ideation compared to males with no acne or mild symptoms
14% of the respondents rated their acne as substantial
18 to 19 year olds with severe acne were 51% more likely to be virgin
18 to 19 year olds were more than twice as likely to have no close friends

The researchers concluded:

Acne is frequently found in late adolescence and is associated with social and psychological problems. Adverse events including suicidal ideation and depression that have been associated with therapies for acne may reflect the burden of substantial acne rather than the effects of medication.

Common Allergy Medicines Can Have Pitfalls

2010-10-14T23:46:00.000-07:00

When your allergies flare up, it's easy to reach for something over the counter; but beware, some of these common products can have pitfalls.

"As a general rule we try to avoid topical decongestants, whether it's for the eyes or for the nose," says Dr. David Stukus, an allergist at Children's Hospital.

That's how medicines like Neo-synephrine, Afrin and redness relievers work. The problem is rebound. They work, but for shorter intervals, and when the symptoms return, they are worse than ever before. "I've had several patients in that situation," Dr. Stukus said. "People become physically addicted to these medications."

Decongestants that you take by mouth can also cause rebound and they can affect your whole body - an increase in blood pressure, jitteriness, insomnia. "I see this frequently in young children, who take these medications actually, and this is why they are no longer recommended for treatment in young children," says Dr. Stukus.

With combo medications, you're probably taking stuff you don't need. "There's only one medicine in there that is an actual allergy medicine and that would be the antihistamine," says Dr. Stukus. But antihistamines, especially older ones, can cause drowsiness.

The acetaminophen doesn't help allergies, and the decongestant can cause rebound. Newer, over-the-counter drugs, specifically for allergies - brand names Zyrtec and Claritin - are what Dr. Stukus recommends. "I generally recommend start with cetirizine or loratadine.

I think these are very effective options to use, and you can take them on a daily basis or as needed," says Dr. Stukus. Other options he recommends are by prescription only - these include prescription strength antihistamines and steroid nasal sprays.

Acne Is The #1 Skin Concern Cited Amongst Caucasian, African-American, Hispanic and Asian Ethnicities

2010-10-13T22:22:00.000-07:00

NEW YORK, Oct. 5 /PRNewswire/ -- In a study of 300 women, the L'Oreal Institute for Ethnic Hair and Skin Research revealed that ACNE is the MOST COMMON PROBLEM, as well as the biggest skin concern cited amongst all four major ethnicities. Vichy NORMADERM Anti-Imperfection Hydrating Care is clinically proven to effectively address acne-related skin conditions.

Over-the-counter products and home remedies are the top two most-used approaches to treat ACNE. But still, many women have a very low level of satisfaction from these treatments. Vichy Laboratoires' breakthrough NORMADERM Anti-Imperfection Hydrating Care is the one-stop solution for acne concerns. In fact,69 percent of women across all four major ethnicities reported clearer skin with less acne imperfections after just four weeks of use.(1)

In addition to visibly clearer skin, Caucasian, African-American, Hispanic and Asian women who used Vichy NORMADERM Anti-Imperfection Hydrating Care showed substantial reduction on all acne-related parameters including: tightened pores, an immediate matte effect, a more even complexion and a reduction in skin redness. After eight weeks of using Vichy NORMADERM Hydrating Care twice daily(2), 90 percent of African-American women experienced tightened pores, 96 percent of Caucasian women noticed an immediate matte effect, 86 percent of Asian women had a more even complexion and 81 percent of Hispanic women noticed a reduction in skin redness.(1)

Oil-free, lightweight and easily-absorbed, NORMADERM Anti-Imperfection Hydrating Care replenishes skin with balanced moisture with Zincadone+, an oil-regulating and antibacterial ingredient consisting of renown Salicylic Acid, which encourages the stimulation of dead surface cells and clears acne blemishes and blackheads, and Eperulin, a new organic ingredient that soothes and regulates inflammations. Additionally, Vichy's patent-pending Intra-Pore Technology with micro-exfoliating LHA (Lipo-Hydroxy-Acid) allows each ingredient to penetrate into the heart of the pore, to protect and purify the sebaceous glands, reducing imperfections and preventing future breakouts. Skin is healthier, softer and smoother.

NORMADERM Anti-Imperfection Hydrating Care, $21.00, 1.7 oz., is available on vichyusa.com and at CVS/pharmacy, Longs Drugs, Duane Reade and Rite Aid.

About Vichy:

Vichy's Normaderm is the #1 acne brand in Europe. Vichy Laboratoires is dedicated to advancing skin health through a deep understanding of how skin functions, supported by medical research. Vichy Laboratoires' patented ingredients?combined with Vichy's mineral-enriched Thermal Spa Water?deliver an exceptionally high level of efficacy, clinically proven by independent dermatologists. Vichy products are available in Dermatological Skincare Centers, with trained beauty advisors, in top CVS, Longs Drugs, Rite Aid and Duane Reade drugstores and sold online at www.vichyusa.com.

(1) Based on self-evaluation of 51 Caucasian, 48 Hispanic, 51 African-American and 46 Asian women using Normaderm Hydrating Care twice daily for four weeks. Percent reflects the lowest score of all four ethnicities.

(2) Results after 8 weeks of daily use.

SOURCE Vichy Laboratoires

Peanut menace? Allergy bullies use food to torment

2010-10-13T22:12:00.000-07:00

When a Wenatchee, Wash., high school student smeared peanut butter on the forehead of a fellow student with a serious peanut allergy two years ago, it was so shocking that the offender faced an assault charge and four days in jail.

“What were you thinking when you did this?” district court Judge Nancy Harmon asked Joshua Hickson, then 19, before the sentencing, according to news reports.

But a new study of parents and kids living with allergies suggests that bullying of youngsters allergic to foods of all types is actually a widespread — and potentially life-threatening — worry.

About 1 in 4 kids, teens and young adults with allergies reported being teased, harassed or bullied because they were allergic, according to a new survey published in the Annals of Allergy, Asthma & Immunology. Of 353 families of kids ages birth to 25 surveyed at allergy conferences across the nation, 85 reported that their kids had been plagued because of the problem.

When children under 5 were excluded from the results, that rose to 35 percent, and among kids in grades six through 10, it was as high as 50 percent, noted Dr. Scott H. Sicherer, a professor of pediatrics at the Jaffe Food Allergy Institute of the Mount Sinai School of Medicine in New York.

Verbal taunts, teasing most common “It was a surprise from several aspects,” said Sicherer, noting that the study was the first known effort to quantify allergy bullying. “Overall, the rate was quite high.”

Nearly 4 percent of children younger than 18 in the United States have food allergies, a figure that jumped 18 percent from 1997 to 2007. Peanut allergies rose from .4 percent of kids in 1997 to 1.4 percent in 2008, according to a previous study by Sicherer.

For kids with allergies, bullying can take several forms. In the new study, most of the teasing and harassment — about 65 percent — came in the form of verbal taunts and threats.

“It’s, ‘Oh, I’ve smeared peanut on the water fountain,’ or ‘Ha-ha, you can’t eat this,’” Sicherer explained.

But for 35 percent of those who responded to the survey, the bullying took a physical form. That included everything from waving a peanut butter sandwich in front of an allergic child to intentionally contaminating food with an allergen.

Twelve of the kids said that they had been touched with foods to which they were allergic, contact that could cause minor skin irritation — or a life-threatening anaphylactic reaction. The chance of child being so allergic that the smell or brief touch of a food could trigger a dangerous response is remote, but the fear of such an incident is very real, Sicherer noted.

“The emotional impact is a significant factor here,” he said. “A child being bullied about anything has a significant emotional impact.”

Of 67 kids who reported consequences, about 65 percent reported being sad, depressed or embarrassed, the study showed.

Nearly 86 percent of those bullied said it had happened more than once. About 82 percent of the bullying incidents were carried out by other students, most often at schools. But, Sicherer noted, 18 of those who were bullied, or about 20 percent, were teased or harassed by a teacher or other school staff.

“When an adult does something, it’s even a heavier impact,” he observed.

Just bullying in another form Tormenting someone because of an allergy is no different than any other form of bullying, said Judy Kuczynski, president of Bully Police USA, an advocacy group based in Minneapolis.

“It’s just another variation on theme,” she said. “Bullying is based on an imbalance of power based on contempt.”

But parents of allergic kids who fear bullying might have more forceful allies in school counselors and school nurses, staff who recognize that allergy bullying code pose a serious safety issue, Kuczynski said.

Kids who are bullied must tell their parents — and parents must tell school personnel, Sicherer said.

In the 2008 Wenatchee case, Hickson, the 19-year-old who smeared his fingers with peanut butter from someone's sandwich and then wiped it on the allergic student, was suspended from school before being convicted of simple assault. He told officers — and the judge — that he didn’t know about the seriousness of peanut allergies, news reports said.

Younger children might be excused from knowing that certain foods could cause dangerous reactions, Kuczynski said. But older teens and young adults should certainly know better.

“It’s not surprising,” she said. “It’s horrifying.”

Why Natural Is The Only Way To Get Rid Of Acne In The Long-Term

2010-10-12T20:22:00.001-07:00

There are a lot of different products out there that promise to get rid of acne. Some work. Many more don't.

However, for even those that do, any benefits are often fleeting. In fact, some so-called “Solutions” may do more harm than good in the longterm.

Harsh chemicals agitate the skin and antibiotics often prescribed by dermatologists may work in the short-term, but they kill the good bacteria in your gut necessary to maintain good health.

Not to mention, any antibiotics you take for acne put you on a treadmill. You have to continually increase doses as the bacteria becomes resistant to what you're taking.

Of course, antibiotics are given for a reason. Any downside may seem pale in comparison to the problem of acne. Short-term relief may sound worth it at the moment.

After all, it's not just the appearance of it. But, it's what it does to your selfconfidence and esteem. It changes the way you act and interact with others. Your quality of life suffers.

So, what are you supposed to do?

The good news is that you don't have to just live with it.

It's true that there is not a magic solution to instantly cure it. But, what you can do is take multiple easy steps to eliminate the environment in which acne can thrive.

There are natural solutions that work by getting at the root of the problem. What's more, they begin to work immediately and increase in effectiveness over time.

In fact, you can begin to have normal skin in all of about two months. A step-bystep guide that shows you exactly how to achieve this goal called “Acne No More” is available over at: Acne No More.

Let's move on to talk about how these kind of results are possible.

Giving Your Body What It Needs To Get Rid of Acne.

If you want your body to eliminate acne, you need to bring your body back into balance. All this means is that you want to avoid creating an environment for acne to thrive. You want to make sure your body is in full working order so it can easily regulate itself.

The single biggest way to do this is to drink plenty of water. Water is essential to get your lymphatic system going, which helps to remove toxins. Your body runs more efficiently.

The right amount of water is around 2-4 liters of clean water a day. To ensure you drink it, grab a large water bottle and fill-it up each day. This way you know exactly whether you're getting enough water. You may also buy gallons of spring water to monitor how much you're drinking (be sure you don't buy soft plastic normally used for milk as it leaches into the water over time).

You will find that when you're properly hydrated, you begin to feel better and have more energy.

In addition to drinking, you should also be sweating. This might be using a sauna and exercising. Sweating is another way to release toxins. Exercising also gets your lymphatic system going as well.

On top of all this, both of these help to reduce stress. Whenever your body undergoes a lot of stress, it puts added pressure your body. This can then lead to breakouts.

You should actively look for ways to reduce stress.

One key influence on how your body performs is your diet.

Diet influences you in two ways:

Getting the right nutrients helps your body and immune system function at full speed.
If you eat a lot of processed and junk food, you take in a lot of toxins that

So what exactly should you be eating?

The main goal should be avoiding processed foods and eating whole, nutrient rich foods. A processed food is one in which there are a lot of man-made added ingredients, such as preservatives and flavor enhancers. A whole food is one that is completely natural.

This means you should increase the amount of fruit and, especially, the amount of nutrient-rich vegetables.

Although it's not always the case, organic produce is more likely to have far more nutrients your body needs than non-organic. It's also not sprayed with pesticides that your body would otherwise deal with.

Similarly, you should avoid fast-food, sugar, refined grains, too much cheese, and fried foods. You should be having far more whole foods than any meat you consume. With this said, none of these foods in particular is a cause of acne (it's a myth that just one or two foods cause it), but it is your overall health that they influence together.

To ensure you're eating healthier, consider having a salad full of dark greens (not iceberg lettuce) each day. Dark foods are an indication of the amount of nutrients in it.

By following these simple guidelines, your body regains its normal health. Your ability to deal with acne improves.

You should also seek to improve your good bacteria with probiotics. You can eat all of the good nutrient-rich foods you want, but without good bacteria, your body struggles to get much from them. You can find probiotics in the health food store, in yogurt, and drinks such as Kombucha Tea found at the health food store. This may be necessary if you've used antibiotics in the past to treat your acne.

Finally, a common nutrient you may be lacking in is Vitamin D. Luckily, you don't have to get it directly from food. But, by spending 10-15 minutes a day outside, your body is able to make it for you.

On top of all this, it's important you're getting plenty of sleep. This is vital to keep your body in working order. Eight to nine hours is the ideal amount.

All in all, acne can not be cured with just one approach, but it requires a holistic approach where you focus on reducing stress so your body can function at full speed.

When your body is in full working order, it runs more efficiently. An environment where acne can thrive disappears.

At the same time, this does not mean you need to become a “Health nut.” Even small changes can make a big impact.

How to Treat Your Face or Other Problem Areas.

The traditional approach to deal with acne is to ignore the rest of your body and only treat visible problem areas. Treating your face or other areas is necessary.

However, many products to do so cause long-term damage. Your goal should not be to treat acne at the expense of preventing it in the future. To do this, the basic advice of washing your face in the morning and before you go to bed is good. You want to clean your face whenever it is dirty. If you exercise, you should clean it afterwards.

At the same time, you should not wash your face too much. This can cause your skin to dry. Similarly, avoid soaps and treatments that cause dry skin. The soap you choose is important. Make sure you pick a mild face soap that's not going to dry-out your skin or clog your pours. Ideally, you want to keep your pours clear.

Soaps that contain natural oils (instead of synthetic ingredients), such as green tea or lavender are helpful. As you treat your face, you want to avoid destroying the skin. You can be gentle and still remove dirt and debris.

When you are done washing your face, pat your face dry. Don't rub it aggressively with a towel. In addition to washing, exfoliating to remove the top layer of skin and facials can be helpful. However, you don't need to do it more than every one or two weeks. Again, you want to be careful not to damage your skin or dry-it out.

Overall, you don't need to do anything elaborate or use expensive creams. Your goal is to keep your face clean and avoid blocking the pours. Finally, one last word of advice is that you should avoid popping pimples or blackheads. It helps encourage acne. If you absolutely have to pop a pimple, don't use your hands. You can use a Kleenex and avoid an inward and down.

For more detailed secrets to give quick acne relief starting in 3 days, a guide entitled “Acne Free In 3 Days” has been released.

By now, you should see that there are alternatives to only treating your acne with harsh short-term solutions. You can focus on prevention. Taking care of your body and keeping your face clean are vital not just to stopping acne from thriving, but it helps your overall health as well – where you gain confidence and feel better about yourself.

Risk Of Asthma Attacks Raised By Food Allergies

2010-10-12T19:39:00.001-07:00

Food allergies are more common among people with asthma and may contribute to asthma attacks, according to one of the most comprehensive surveys of food allergies ever undertaken. National Jewish Health Associate Professor of Pediatrics Andrew H. Liu and his colleagues also report in the November 2010 Journal of Allergy and Clinical Immunology that food allergies are more prevalent among children, males and non-Hispanic blacks.

"Our study suggests that food allergies may be an important factor, and even an under-recognized trigger for severe asthma exacerbations," said Dr. Liu. "People with a food allergy and asthma should closely monitor both conditions and be aware that they might be related."

The researchers, funded by the National Institute of Environmental Health Sciences (NIEHS), analyzed data from 8,203 people, aged 1 to greater than 60, who completed the National Health and Nutrition Examination Survey in 2005-2006, and had their blood tested for antibodies to four specific foods: peanuts, milk, eggs and shrimp.

"This study is very comprehensive in its scope," said Darryl Zeldin, MD, acting clinical director at the NIEHS and senior author on the paper. "It is the first study to use specific blood serum levels and look at food allergies across the whole life spectrum, from young children aged 1 to 5, to adults 60 and older."

Depending on the IgE antibody levels found in participants blood, they were categorized as sensitized to one or more of the foods or not sensitized. The sensitized participants were subdivided into those with an unlikely (10-20 percent), possible (50 percent) and likely (greater than 95 percent) chance of having food allergies.

Likely food allergies were twice as common among participants who had ever received an asthma diagnosis as among those with no asthma diagnosis.

The odds of having food allergies grew with increasing severity of asthma. Those who currently have asthma were 3.8 times as likely to have food allergies as those who had previously been diagnosed with the disease but no longer had it. Those who had visited an emergency department for asthma in the past year were almost seven times as likely to have food allergies as those who had ever been diagnosed with asthma but not visited an emergency department. Overall, 15.8 percent of participants who had visited the emergency department for asthma had IgE levels indicating possible or likely food allergies.

Researchers could not determine if food allergies actually cause asthma attacks or if asthma and food allergies are both manifestations of a severe allergic profile. They speculated that food-allergic reactions might be triggered in some people with asthma only when combined with strenuous exercise.

Overall, the researchers estimate that 2.5 percent or 7.5 million Americans have food allergies. This estimate is lower than some estimates, but in line with many others. This study's analysis of actual IgE antibody levels to foods in a large nationally representative sample lent authority to the results. However, since the tests measure potential allergies to only four of the most commonly allergenic foods, the results may slightly underestimate overall prevalence of food allergies, wrote the authors.

Children ages 1 to 19 were twice as likely to have food allergies as the general population. Non-Hispanic blacks were three times as likely to have food allergies, and males were twice as likely to have food allergies. Black male children were 4.4 times as likely to have food allergies.

Peanut allergy was the most common food allergy, affecting 1.3 percent of the surveyed population. Contrary to milk and egg allergies, which peaked in children under 5, peanut allergies were highest among children ages 6 to 19 (2.7 percent).

National Jewish Health is known worldwide for treatment of patients with respiratory, cardiac, immune and related disorders, and for groundbreaking medical research. Founded in 1899 as a nonprofit hospital, National Jewish remains the only facility in the world dedicated exclusively to these disorders. Since 1998, U.S. News & World Report has ranked National Jewish the #1 respiratory hospital in the nation.

Source:
William Allstetter
National Jewish Health

Food Allergies Are a Reason for Bullying

2010-10-10T18:21:00.000-07:00

The first study of its kind finds that children with food allergies are often victims of bullying, teasing or even harassment because of their condition.

This is the first time that scientists have studied the social impact of food allergies in children, over the age of five, and researchers from Mount Sinai have concluded that 35% of children with food allergies are victims of bullying, teasing or harassment coming from other children and even from teachers and other school staff.

86% of teased or harassed kids undergo these episodes repeatedly, and besides classmates, who are the most frequent 'attackers', over 20% of children reported harassment or teasing from teachers and school staff.

The team of researchers was led by Scott H. Sicherer, MD, Professor of Pediatrics, Jaffe Food Allergy Institute at Mount Sinai School of Medicine, and they analyzed survey responses from 353 parents or caregivers of children with food allergies and food-allergic individuals.

Dr. Sicherer said that “food allergy in children affects quality of life and causes issues like anxiety, depression, and stress for them and their parents, however, our study is the first to explore teasing, harassment and bullying behaviors aimed at these children.

“The results are disturbing, as they show that children not only have to struggle with managing their food allergies, but also commonly bear harassment from their peers.”

Over 43 percent of children said that the allergen was waved in their face and 64 percent reported being verbally teased.

Fortunately, no allergic reaction was triggered by the bullying, but nearly 65% of children reported feeling depressed and embarrassed because of this kind of behavior.

Recent studies estimated that a child in four has food allergies, according to Dr. Sicherer.

“What is so concerning about these results” he says, “is the high rate of teasing, harassment and bullying, its impact on these vulnerable children, and the fact that perpetrators include not only other children, but adults as well.

“Considering the seriousness of food allergy, these unwanted behaviors risk not only adverse emotional outcomes, but physical risks as well.

“It is clear that efforts to rectify this issue must address a better understanding of food allergies as well as strict no-bullying programs in schools,” he added.

Another recent study carried out by the National Institute of Child Health and Human Development found that 17% of children in grades 6 through 10 reported being bullied.

The authors of the study stress that information about the vulnerability of children with food allergies should be a part of school programs meant to reduce bullying.

Besides this kind of program, all schools should have a no bullying policy and zero tolerance for bullies, as traumatized children are affected by this throughout their lives.

This study was based on a survey conducted at meetings of the Food Allergy and Anaphylaxis Network in Tarrytown, New York, Rosemont, Illinois, and Baltimore, Maryland in 2009.

The data are reported in the October issue of Annals of Allergy, Asthma & Immunology.

Dogs May Act as Allergy Shots

2010-10-08T00:39:00.000-07:00

Children who tested positive for dog allergies were less likely to develop eczema by age 4 if they had lived with a dog before their first birthday, according to a study released Thursday by the University of Cincinnati and Cincinnati Children's Hospital Medical Center.

On the other hand, kids with dog allergies who didn't have dogs while they were infants were four times more likely to develop eczema, a chronic skin condition marked by extreme dryness and irritation.

It's possible dogs might act as four-legged allergy shots to protect allergic children, said Tolly Epstein, a UC allergist and corresponding author of the study, published in the "Journal of Pediatrics."

"Dog ownership seemed to have a protective effect," she said. "It's one hypothesis that it's a kind of natural immunotherapy for these children."

She hopes parents can use the information to help choose a family pet.

Cat ownership didn't offer any protection against eczema, the researchers found.

In fact, children with cat allergies who lived with cats before their first birthday were 13 times more likely to develop eczema by age 4 than allergic children who didn't have cats.

Cats in general are considered to cause more allergy symptoms than dogs.

The current study only looked at eczema, she said, but previously published research has shown children who lived with dogs were less likely to develop wheezing later in life. But that research didn't distinguish between children with and without dog allergies, she said.

Epstein and her colleagues reviewed data from the Cincinnati Childhood Allergy and Air Pollution Study, a long-term study looking at the effects of environmental particulates on childhood respiratory health and allergy development.

The study is following 636 children considered to be at high risk for developing allergies because their parents had allergies.

Epstein said 14 percent of the children in the study had eczema symptoms.

The results are based on skin tests, as well as questionnaires completed by parents.

Doctors are seeing an increase in the number of children with allergic eczema, but they don't know why, she said.

"It's becoming very common," she said, adding 10 percent to 30 percent of children experience it. Estimates of adults with allergic eczema range from 2 percent to 10 percent.

For the ongoing allergy and air pollution study, children were tested annually for 17 different allergies - including foods, airborne allergens like pollen and mold and environmental exposures like diesel particulates.

True allergy or other symptom?

2010-10-07T02:45:00.000-07:00

By guest blogger Michael Cohen:

When patients know they are allergic to a medication, most often they’ll tell their doctors and pharmacists about it so that drug won’t be prescribed. All too often though, the patient doesn’t include the type of reaction they experienced and their health professionals don’t always ask. This could lead to unnecessarily withholding an important medication. Very often the patient has actually experienced a non-life-threatening drug reaction such as stomach upset or rash, which could actually even be a side effect of another drug the patient is taking or a disease symptom, but not a true allergy.

Recently, a doctor wrote to us to point out such a problem, often seen when “codeine” is listed as an “allergy” on patient records. When patients are asked about their “allergy” symptoms, many will state that the drug makes them drowsy or nauseated, which clearly is not an allergy. Sometimes the “allergy” can then mislead practitioners and cause modification of treatment decisions unnecessarily. On occasion that not only prevents the primary treatment, it has also led to other complications.

In one reported case, an elderly debilitated patient was admitted to the hospital for an elective hernia repair. The patient was very thin with recent loss of weight and muscle mass caused by his disease. He had been taking a drug called Tegretol every day for many years for a seizure disorder. In the patient’s chart was a notation that he was “allergic” to codeine, when it really just made him sleepy. Because of this, the surgeon deviated from prescribing codeine, which he normally did after a hernia operation. Instead he ordered Darvocet to be continued after discharge.

The next day, the patient took one dose of Darvocet-N for pain but did not feel well. The following day, he was found dead in his home, which a coroner attributed to carbamazepine poisoning. The patient’s carbamazepine level, which had always been maintained at normal levels, was nearly 4 times higher than normal. This was caused by a drug-drug interaction between Darvocet and Tegretol. Darvocet can decrease the breakdown and excretion of Tegretol, thereby increasing blood levels of the drug, causing toxicity.

No one knows for sure what the surgeon would have prescribed had the patient’s chart reflected that codeine made him sleepy. However, the mischaracterization of the “allergy” clearly led the physician to prescribe a different medication than his usual codeine, which then led to the adverse drug event.

Patients and health professionals need to communicate the symptoms any patient experiences with a problem drug. Details on a reaction to penicillin, for example, can help distinguish classic allergy symptoms such as anaphylactic shock or swelling of tongue or throat, from a non-allergic reaction such as GI symptoms. One of the penicillin antibiotics is often the drug of choice for certain infections, so avoiding its use for easy-to-treat side effects would be inappropriate. Yet about85-90% of patients who say they’re “allergic” to it do not react when penicillin allergy testing is done.

Although not every hospital keeps track of symptoms that led the patient to report an “allergy,” we have seen computer systems in hospitals that require the name of the drug (or category) to be chosen from a pull-down list that is correlated with another pull-down list to document the related symptom.

Make sure to keep your health professionals aware of allergies and side effects. It’s certainly to your benefit.

For information on the Institute for Safe Medication Practices' consumer website gowww.consumermedsafety.org

To check out more Check Up items go towww.philly.com/checkup.

Overdiagnosed of Food Allergies

2010-06-18T20:37:00.000-07:00

Many Americans who think they have food allergies are misdiagnosed, according to a research review published in the Journal of the American Medical Association.
Researchers from Stanford University examined 72 studies of food allergies, but noted that although there is much interest in food allergies, there is no clear consensus on the most effective diagnostic approaches. They also said there is no conclusive evidence to show that the prevalence of food allergies is increasing, but that they likely affect more than 1 to 2 percent of the population, but less than 10 percent.
One major problem, they found, is that it is difficult to diagnose food allergies, as there is no clear dividing line between ‘true’ allergy and food intolerance. “The evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis,” they wrote, adding that overdiagnosis or misdiagnosis of food allergies also “serves to perpetuate some public misperceptions that food allergy is a trivial medical condition.”
They said that this lack of uniform criteria, as well as limited sensitivity of the most common allergy tests, such as the skin test and blood serum test, which looks for antibodies in the blood for certain foods, means that food allergies are overdiagnosed.
In fact, less than 50 percent of those with unclear symptoms who test positive for food allergies actually suffer from a food allergy, they wrote. And while avoiding certain foods may be less dangerous than risking a severe allergic reaction, the authors warn that inappropriate diagnosis could lead to unnecessary nutritional and social difficulties.
They wrote: “Patients with nonspecific symptoms (rash, abdominal complaints) who have positive SPT or serum food-specific IgE studies to foods have less than a 50% likelihood of actually having a food allergy (given the sensitivity, specificity, and prevalence).
“Inappropriately diagnosing such individuals with food allergy may unnecessarily subject them to broad dietary restrictions, the risk of nutritional problems from elimination diets (eg, milk or egg elimination in children), significant anxiety and worry, and the social challenges food allergies cause.”
The researchers concluded that more research in the form of randomized controlled trials is necessary to determine the effectiveness of food elimination diets for the treatment of non-anaphylactic allergies.

Risk of Allergy May Raise in Obesity Children and Teens

2010-06-18T20:33:00.000-07:00

Obese children and teens are at increased risk for allergies, especially food allergies, say U.S. researchers. The study authors analyzed data from 4,111 participants, aged 2 to 19, who took part in the National Health and Nutrition Examination Survey, and found that obese children and teens were 26 percent more likely to have any kind of allergy, and 59 percent more likely to have a food allergy, than their normal-weight peers.
“We found a positive association between obesity and allergies,” senior author Dr. Darryl Zeldin, acting clinical director at the U.S. National Institute of Environmental Health Sciences (NIEHS), said in an institute news release. “While the results from this study are interesting, they do not prove that obesity causes allergies. More research is needed to further investigate this potential link.”
The study is in the May issue of The Journal of Allergy and Clinical Immunology. “Given that the prevalence of both obesity and allergic disease has increased among children over the last several decades, it is important to understand and, if possible, prevent these epidemics,” lead author Cynthia M. Visness, a scientist at Rho Federal Systems Division Inc., in Chapel Hill, N.C., said in the news release.
“Seeing a possible link between obesity and allergies provides additional motivation for undertaking the challenge of reducing childhood obesity,” added Linda Birnbaum, NIEHS director.

Curing Allergy Cough Naturally

2010-05-18T03:38:00.003-07:00

An allergy cough may be relatively harmless. But it can be disruptive, causing interrupted sleep, a sore throat, and in some cases trouble breathing. You can cause the symptoms of your allergy cough to ease up by using natural remedies.
1. Clear out your allergy cough by drinking lots of fluids. Water and fruit juices can help clear mucous out of your throat. It loosens up the mucous and makes it easier for your body to get rid of if through coughing. Take small sips of fluid every time you feel a cough attack coming on.
2. Make your own natural cough syrup. Take a little bit of lemon juice and mix it with twice as much honey. Drink this mixture every time your allergy cough feels like it is getting out of control.
3. Moisturize the air you breathe. Take a hot shower and breathe in the air from the steam. Keep the air moist in your bedroom by using a vaporizer or humidifier. This will help loosen the mucous and ease your allergy cough.
4. Soothe and relax your throat. You can keep your throat from getting that dry uncomfortable feeling by drinking hot tea sweetened with honey. Prevent constant coughing by sucking on hard candy.
5. Sleep with your head elevated. Put one or two extra pillows under your head. This will help reduce night time coughing.
6. Stay away from allergens. This includes dust, pollen, animal dander, and mold. Cigarette smoke can also aggravate your allergy cough.

Seasonal Allergy Mistakes

2010-05-13T19:55:00.000-07:00

Allergies (also called "allergic rhinitis" or "hay fever") are nothing to sneeze at -- just ask the approximately 60 million people in the U.S. who suffer from them. If you have seasonal allergies, watch out for common mistakes that could aggravate them, says Dr. James L. Sublett, section chief of the pediatric allergy department at the University of Louisville School of Medicine in Kentucky. Steer clear of these four most common slipups, according to the American College of Allergy, Asthma and Immunology.

1. Common Mistake: You treat symptoms without knowing what you're allergic to.
Many allergy sufferers are so desperate for relief that they start taking their allergy medications before they have a chance to identify their triggers. This may be why patients report that over-the-counter medications are ineffective more than half the time, says Sublett.
Simple Solution: Get tested.
Before you assume that your allergy medicine isn't working, make an appointment with a board-certified allergist. (Find one near you at www.acaai.org/LocateAllergist.) "The allergist can perform skin testing, which is the most accurate way to identify allergy triggers," says Sublett. Then he or she can help you find the best treatment.

2. Common Mistake: You don't steer clear of your allergy triggers.
Medications aren't the only way to deal with allergy symptoms. It may not always be easy, but avoiding the culprit behind your sneezing and sniffling is just as important as taking meds.
Simple Solution: Play hard to get.
Once you know what your trigger is, minimize your exposure to it.
If you're allergic to pollen:

Keep your windows shut whenever possible.
Shower and change your clothes when you come inside.
Stay indoors when pollen counts are highest (in the middle of the day).

If you're allergic to dust mites:

If possible, remove wall-to-wall carpets from the bedroom.
Use a vacuum with a High-Efficiency Particulate Air (HEPA) filter regularly.
Enclose mattresses and pillows in mite-proof covers.
Wash bedding regularly in hot water.

If you're allergic to mold:

Don't use vaporizers or humidifiers.
Minimize moisture buildup by using vent fans when you shower and cook.
If possible, vent appliances that produce moisture (like clothes dryers and stoves) to outside of your home rather than in.

3. Common Mistake: You wait too long to take allergy medicines.
Don't wait until you start sneezing and sniffling to take medication. "The drugs work best at blocking the occurrence of symptoms, not treating symptoms once you have them," says Sublett.
Simple Solution: Plan ahead.
If you know you have seasonal allergies, start taking medications that usually work for you as soon as the season starts. Watch the weather: As the temperature warms up, pollen is sure to follow.

4. Common Mistake: You eat produce and other foods that might aggravate sniffles and sneezes.
One out of 20 people who are allergic to pollen has oral allergy syndrome, which means his immune system mistakes the compounds in certain foods for pollen proteins, says Sublett. Some foods -- such as pears, cherries, peaches, apples, melons and nuts -- cause breakouts or itching in the throat or around the mouth.
Simple Solution: Talk to your doctor. Check with an allergist if you've ever experienced these symptoms after eating certain foods. If you have oral allergy syndrome, you should avoid fresh fruit and nuts during allergy season, although cooking or peeling fruit can help some people avoid a reaction. Your physician will know best.

Reducing Allergic Reactions to Metals

2010-05-11T22:05:00.001-07:00

Allergic contact dermatitis to the skin caused by some metals is quite commonplace and is often the result of wearing costume jewelry containing nickel; it is especially noted as a problem for women, although it is increasingly been noted in men as well. Cobalt and chromate are also commonplace allergy-inducing metals. Allergic reactions to metals such as nickel can start at any age and may be short-term, or persist for life.
1. Look for the symptoms of a reaction to metal. These will likely include a skin rash, or some other reaction on your skin where the metal has made contact. Blisters and other damage can also occur. If there are blisters present, it may be a type of eczema, known as pompholyx.
2. Get your condition diagnosed by a qualified health professional. Although you might suspect that you are having allergic reactions in response to wearing or touching metallic items, it is important to have your doctor or other health professional confirm your concerns. The doctor can take a skin patch test to test reactions.
3. Avoid wearing costume jewelry unless you know its metallic content. Since a lot of costume jewelry contains nickel, it will likely aggravate your condition. Prefer pure elements rather than amalgams of metals such as gold and silver. Also note that few people have recorded allergic reactions to platinum or titanium.
4. Avoid body piercing unless you are one hundred percent certain of the content of the metal being used.
5. Check to see if you have workplace exposure to metals that are triggering your allergic reaction. If so, find out how the workplace can put practices in place that reduce your exposure.
6. Consider other possible triggers for metallic allergies. Nickel is other products, not just the most obvious. It can be found in washing detergent, canned food, chocolate, tea, wheat, and legumes. For some people, loose change can trigger a reaction. A low-nickel diet is an unrealistic option for avoiding a reaction to nickel, as nickel is in most food but avoiding canned foods and chocolate can help.
Look around your home and work and try to avoid directly touching such items as:

Clothing zippers, hooks and metallic buttons etc.
Metallic holders around makeup items
Kitchen utensils
Stationery
Computer components
Keys
Catches on bags, belts etc.
Sewing items
Tools

7. Wear barrier items. Use gloves, a cloth, oven mitt or some other barrier between your skin and the metallic object when handling them. Consider replacing items that can be replaced, such as wooden spoons for metallic ones, a synthetic watch for a metallic amalgam one (or pure gold if you can afford it!), pens with plastic instead of metallic outer shells etc.

Allergies - 10 Things You Didn't Know

2010-05-09T21:56:00.000-07:00

Allergies of every kind, from mold to milk to metal, are becoming increasingly common in the United States. With a sympathetic nod to those of you bracing yourselves against this spring's burgeoning pollen count, here are 10 allergy facts that don't come up as regularly or reliably as seasonal symptoms do.
1. Allergies can give you a shiner. When hay fever strikes, pressure from nasal congestion can be so great that it causes blood vessels in the face to become constricted. The blood can't flow freely and may pool under the eyes. Blood draining back toward the heart, or venous blood, appears blue in color (compared to arterial blood flowing from the heart, which is red) and, when trapped, results in the appearance of an allergic shiner, sometimes known as "black-eye syndrome."
2. Any organ in the body can be affected by allergies. Sufferers of hay fever (allergic rhinitis) will attest that allergies can cause a runny nose, irritated eyes, and an itchy throat. Some allergic reactions can cause the skin to break out in hives or the intestines to cramp, and allergy-induced asthma takes a toll on the lungs.
"These are the common 'end organs' for allergic disease," explains Asriani M. Chiu, M.D., associate professor of allergy and immunology at the Medical College of Wisconsin. "In a severe allergic response, there can be a systemic reaction that affects multiple body systems. A bee sting, for example, can affect the cardiovascular system and send the body into shock." Consequently, any organ could potentially shut down as a result of reduced blood flow. An anaphylactic response affecting the respiratory system is similarly threatening.
In very rare cases, Dr. Chiu notes, an allergy cell called the eosinophil can target and cause isolated damage to an organ like the esophagus or heart. However, when organs such as the liver or kidneys are affected by an allergy, it's far more likely to be the indirect result of a system-wide reaction.
3. It's not pet hair that gets your dander up. Contrary to popular belief, pet hair is not an allergen—though it's still no fun to clean the sheddings of cats and dogs from your wool coat. Rather, it's the particles of pet dander (dead skin), saliva, and urine trapped in the hair, or airborne in your breathing environment, that prompt allergic reaction.
4. "Allergy-addiction syndrome" lacks credibility. Like a drug addict who craves a chemical that's bad for the body, some people claim to have an addiction to foods to which they are allergic. But paradoxical cravings are most likely explained by a typical psychological trick we play on ourselves: We always want something a little more when we know we can't have it. As Dr. Chiu notes, a child with a food allergy will instinctively spit out food that causes her mouth to itch or her lips to swell. Electing to override that natural survival instinct may be a mild form of masochism, but it's not an addiction.
5. The sharp rise in peanut allergies is still not well understood. The rate of peanut allergies in the U.S. has doubled over the past 10 years, currently affecting between 1 and 2 percent of the population. Prevalence in the U.S. may be explained by our method of processing; dry-roasting is not as popular a method in countries where the allergy is less common. Another prevailing theory is the hygiene hypothesis: Now that we're living in an increasingly sterile environment where diseases are eradicated and bacteria vanquished, the immune system may be seizing on harmless foreign antigens—essentially, protecting our system against a false threat.
A new study reverses recent health strategies. Rather than delaying an introduction to peanuts, the research suggests we might increase tolerance by introducing peanuts earlier and more frequently.
6. Black boys are at especially high risk of having food allergies. A March 2009 study showed that black male children are about four times more likely than the rest of the population to be food allergic. The study of more than 8,200 participants found both food sensitivities and food allergies to be highest among blacks, males, and kids—which leaves these kids right in the demographic crosshairs. Prevalence of food allergy is also higher among persons of lower income. Genetic and environmental factors are being researched, but the cause of food allergies and sensitivities is as yet unknown.
7. Eight foods are responsible for 90 percent of all food allergies. The chief offenders: milk, eggs, peanuts, soy, fish, shellfish, tree nuts, and wheat. As Dr. Chiu explains, some make the list because they're prevalent among children, and others because they prompt lifelong reactions. "A child will 'outgrow' some food allergies, notably milk and egg; as the GI system matures, the system gets better at breaking down the proteins in them that cause an adverse reaction. Other foods, such as shellfish, peanuts, and tree nuts, tend to trigger an allergic response even when broken down, so the reactivity is more apt to be lifelong."
8. A link has been drawn between allergies and obesity—but to date the association is controversial. Some research has suggested that food allergies contribute directly or indirectly to obesity. In 2007, one study published in the journal Diabetes found that a high-sugar, high-fat, low-fiber diet caused an immune response of inflammation, in turn leading to increased insulin resistance, which prompts the body to store more fat.
However, the prevailing wisdom is that allergic disease and obesity are each based on a variety of genetic and environmental factors. The research is not yet conclusive enough to establish a causal link between the two.
9. Nickel allergy is a common culprit of contact dermatitis. If your skin is irritated where contact is made with bracelets, rings, earrings, or eyeglasses, it may be due to nickel content in the metal. Reactions to 24-karat gold or other metals used in fine jewelry (such as platinum or titanium) are rare. Trace amounts of nickel in detergent, nail polish, and makeup, or even in buttons and snaps, however, can cause an itchy rash at the site due to metal allergy.
10. The prevalence of allergies continues to increase. According to the American Academy of Allergy Asthma & Immunology, allergies of every kind—inhaled, ingested, contact, or otherwise—are steadily increasing in rate. Allergic diseases currently affect more than one in five Americans, making them the sixth leading cause of chronic disease in the U.S. If you have pollen or mold allergies, you can check daily counts in your area through the National Allergy Bureau.
"It's important to know what's causing a reaction," Dr. Chiu offers in conclusion. "Healthcare providers and allergy specialists can help identify the specific cause so that you can actually avoid what you're allergic to rather than simply treat symptoms with medication."

10 Odd Allergies

2010-05-07T21:55:00.001-07:00

We’ve all had to deal with the coughing, sneezing, itchy eyes, a rash or some other skin irritation, and maybe even hives. And for what? Usually do to some substance that our body is allergic to, causing annoying and sometimes painful symptoms. It’s safe to say that most people are allergic to something.
Whether it be pet dander, dust, chocolate, or that lovely yellow powdery substance we like to call pollen, most people have to deal with being allergic to one thing or another. Being allergic to dust or pollen or certain types of foods seems common these days, but can you imagine being allergic to something else? Say…the sun? Here’s a list of the top ten oddest allergies.
1. Water – Aquagenic Urticaria. Known as aquagenic urticaria, this condition is said to only affect one out of every 23 million people in the world. Being allergic to water is extremely rare, and most that are allergic to it are confined to their homes. Being allergic to water means being allergic to sweat as well as tears, and even allergic to foods that contain water, such as juices, tea, and coffee. This means that bathing and showering are extremely difficult. The person is hypersensitive to the ions found in non-distilled water, so most have to be very careful when drinking water, or they drink non-distilled water. Here is an article from an actual case of aquagenic urticaria.
2. Sun – Erythropoietic Protoporphyria. It is very rare that people are allergic to the sun, but the allergy does exist. It is said that only 300 people in the world are allergic to the sun. It’s medically known as solar urticaria. There is also a more serious condition known as erythropoietic protoporphyria. When exposed to direct sunlight, the immune system activates inflammatory cells that are within the skin. Most people allergic to the sun are told to limit their exposure and to wear sun block. Others need to wear special clothing or avoid the sun at all costs.
3. Cold – Familial Cold Autoinflammatory Syndrome. Not many people love being in the cold, but imagine being allergic to it. Known as familial cold autoinflammatory syndrome (FCAS) or simply cold urticaria, this allergy is caused by cold temperatures. The cold weather will trigger the body to release histamine in the skin which causes rashes, hives, redness, and swelling. This condition can be deadly, especially if undiagnosed, as most people may at times swim in a cold pool or take a cool shower. Both of these can cause the body to go into shock.
4. Exercise – Anaphylaxis. You’ve probably heard someone joke and say that they are allergic to exercise out of the mere cost of being funny and probably lazy. However, there is in fact a real allergy that makes some allergic to exercising. Only 1,000 people are said to have the allergy. Called exercise-induced anaphylaxis, this allergy is only noticed after someone eats a certain type of food, say peanuts, and goes to exercise. That person can easily eat peanuts without having a reaction, but when exercise is added, the person may experience fainting, vomiting and difficulty breathing.
5. Computers – Electromagnetic Hypersensitivity. Allergies to computers seems almost impossible these days, and even more impossible to imagine. However, computer users have complained or nasal congestion, sneezing, itching, and even headaches after using the computer. Studies have found that computer monitors and other parts contain a chemical called triphenyl phosphate, which is used as a flame retardant. Fortunately, levels of the chemical usually decrease after the computer is used for a longer amount of time.
6. Kissing. Sometimes a kiss isn’t just a kiss. This is exactly the case for those who are said to be allergic to kissing. No we’re not talking about a dwindling marriage either. Though this allergy doesn’t mean one is allergic to another’s lips or…tongue, the person who suffers from this allergy is usually one with a severe food or medicinal allergy. Because of the close contact and sharing of saliva, food particles or particles from medicine can be left in the mouth, causing an allergic reaction in some.
7. Caffeine. Caffeine intolerance is a pretty common ailment. However, there are people that cannot ingest the smallest amount of caffeine without having to deal with life threatening allergic reactions. We all know caffeine to be the wonder drug when we need a little energy boost during the day. Those allergic to caffeine can experience delusions, anxiety attacks, hallucinations, muscle jerks, rashes, hives, heart palpitations, and blurry vision. Some even experience seizures which can be deadly.
8. Nickel – Nickel dermatitis. Nickel dermatitis is said to affect about 1% of the population today. While not a rare allergy, this allergy has become more widely known as the use of cell phones and other technical gadgets has skyrocketed. As more people use cell phones and iPods, there are more cases of nickel allergies popping up throughout the world. An allergy to nickel can make life hard, as many everyday items usually contain it. For instance, coins, jewelry, certain types of clothing, scissors, kitchen utensils, and even metal chairs.
9. Plastic. In today’s world, I can’t imagine being allergic to plastic. As more everyday items are being turned into plastic items in order to be recycled, being allergic to plastic definitely has to be a hassle. Having plastic dermatitis means no drinking from water bottles, no Tupperware, certain types of glasses can’t be worn, no credit cards, or even plastic utensils. This allergy usually causes skin irritation such as a rash, swelling, redness, or itching.
10. Wood. Wood allergies can definitely be troublesome. While people are allergic to certain types of wood or sawdust, there are cases when people are allergic to any type of wood in many types of forms, whether it is dust or solid. Along with wood allergies comes the fact that you can’t touch paper, use a pencil, or be a lumberjack! The allergy can be so strong that it can cause the skin to look as if it was burned. In most cases wood allergies cause skin irritation, coughing, sneezing, and hives.

7 Ways to Alleviate Your Allergy Symptoms

2010-05-04T21:57:00.001-07:00

Short of living in a bubble, there are no cures for allergies. Even with shots and medicines, patients living with allergies still experience flare-ups and symptoms, especially if their allergies are seasonal. Dr. Clifford Bassett, an assistant clinical professor of medicine at Long Island College Hospital, offered these seven tips, which may alleviate the severity of allergy symptoms, making it a little easier for allergy sufferers to enjoy life.
1. Know the Pollen Count You can check the pollen count at The American Academy of Allergy, Asthma and Immunology. “Consider exercising indoors on very high pollen days if you are sensitive to seasonal pollens present in the air,” Bassett said.“Or, perhaps exercise later in the day since certain pollens are higher in the early- to mid-morning. Bassett said to also be aware of the fact that higher levels of pollen are usually found on warm, dry and/or windy days, whereas lower levels of pollen are present on wet, cloudy days.
2. Take a Seaside Vacation Time your vacation during the peak allergy season, Bassett said, and go to the beach – pollen counts are likelier to be lower in areas near water.
3. Eat Healthy Research shows that foods high in antioxidants and omega 3s, which are found in fish particularly, help individuals with asthma, Bassett said.
4. Lather, Rinse, Repeat Take a shower and wash your hair every night before going to bed, Bassett suggested. Remember to change your pillowcases and wash your pajamas often, as these are places where pollens and molds can build up. You may not be able to see them, but you will breathe them in as you are sleeping.
5. Keep Eyes Clear “Gently irrigate your eyelids while your eyes are closed with a mild, tear-free baby shampoo to remove excess allergens and pollutants that may have accumulated,” Bassett said. If you wear contact lenses, or have specific eye allergies, check with your health care provider to learn what kind of eye cleanser is best for you.
6. Breathe 'Fresh' Air Whether driving or at home, keep your windows closed and set the air conditioner to re-circulate to keep out pollen, Bassett said. Clean the filters on the air conditioner frequently, especially during pollen season. If you or someone in your family has extremely bad allergies or asthma, consider a central air-filtration system for your home.
7. Avoid Cross-Reactions Eating certain foods (pears, apples and hazelnuts) may cause allergic reactions if you have seasonal tree allergies, Bassett said. This is due to a cross-reaction between the proteins in the fruits and the pollens. Foods such as melons, tomatoes and oranges may cross-react with grass pollens, and melons, chamomile tea and bananas can cross-react with weed pollens. Symptoms of cross-reactions in allergy sufferers include a tingly mouth or itchy throat.

Massage Therapy for Allergy Relief

2010-04-30T03:13:00.000-07:00

In Michiana, the pollen count is through the roof, and that means plenty of folks are sniffling and wiping watery eyes.
Medicines may prevent the symptoms, but nothing is foolproof. That is why some folks swear by massage therapy.
The last thing Melyssa Smith needs is to be slowed down by her seasonal allergies. She's a mom, works and goes to school.
This spring her special weapon against allergy's stuffy nose, runny eyes and headache, is massage.
"I noticed relief, slight relief instantaneously when i got off the table,” says Melyssa. “I notice things were different. It wasn't complete relief for one or two days afterwards, but it lasted longer than any pill I would take."
Research shows stress can exacerbate allergy symptoms by increasing production of histamines, the chemical our body pours out in response to allergens like pollen.
Reduce the stress, relieve the allergic reaction. And, hands down, massage helps you relax, and subsequently, breathe easier.
"It increases the blood flow, and the blood circulation and it clears the mucus from the sinuses and the throat and the nose,” explains massage therapist Sherri Pierce. “It allows relaxation and it loosens the phlegm in the throat as well."
Sometimes Pierce adds hot stones to facilitate lymphatic drainage, blood flow and relaxation.
"With these techniques you have very little side effects,” says Pierce. “You may have some drowsiness, some drainage and coughing within the next 24-48 hours. But after that, you should feel you can breathe a lot easier, more efficiently."
Pierce says the results can last up to three weeks.
While it may help, doctors say, massage therapy is not meant to replace medication for treating allergies. It's a complimentary therapy.

10 Worst Cities for Allergies

2010-04-28T01:54:00.000-07:00

1. Louisville, KY It’s the home of “the most exciting two minutes in sports”—the Kentucky Derby—and now it’s the worst place to live if you have seasonal allergies. Louisville tops the Asthma and Allergy Foundation of America’s 2009 list of worst places to live with allergies, thanks to high levels of pollen and allergens from the area’s fertile soil and green rolling hills. In fact, the whole state may be a tricky place to live since sister city Lexington topped last year’s list.

2. Knoxville, TN Surrounded by the Appalachian Ridge and Valley Province, Knoxville has a humid subtropical climate that encourages the growth of mold. Particularly prevalent from July to late summer, mold causes allergic reactions such as sneezing, itching, nasal discharge, congestion and dry, scaling skin. The best ways to prevent mold allergens in your house are to use central air-conditioning with a HEPA filter to trap spores and to be vigilant about reducing any dampness.

3. Charlotte, NC Based on its employment opportunities, low crime rates and affordable housing, Charlotte was named the best place to live in America by Relocate-America.com in 2008. But based on allergen levels, it’s the third worst in the United States. Located in the nation’s humid subtropical climate zone, Charlotte also struggles with high levels of smog, according to the American Lung Association. The combination of smog and allergens, known as “smollen,” has been shown to worsen allergic reactions, according to Ross Chang, M.D., of the B.C. Society of Allergy and Immunology in Vancouver.

4. Madison, WI “The City of Four Lakes” is one of the fastest-growing cities in Wisconsin. Madison’s fame as a city surrounded by water makes for humid conditions. Humidity does not cause allergies, but it does contribute to proliferation of some types of allergens, such as certain mold spores. Allergy sufferers should try to stay indoors during peak allergen hours. Allergen levels generally peak daily from 10 a.m. to 3 p.m.

5. Wichita, KS Located on the Arkansas River, Wichita calls itself the “Air Capital of the World,” due to its ties to aircraft manufacturers, but allergy sufferers might disagree with that label. Allergens fill the air thanks to Wichita’s sunny, fertile climate. The best ways to prevent allergic reactions to outdoor allergens is to keep the windows in your house and car closed with the air conditioner on, change and wash your clothes after spending time outside, and shower and wash your hair immediately after being outdoors to remove pollen.

6. McAllen, TX Only five miles from the U.S.-Mexico border and the Rio Grande River, McAllen is nicknamed the “City of Palms.” Deciduous trees, including the Rio Grande ash, cedar elm, sugarberry and honey mesquite, are the dominant form of vegetation. Minimize your exposure to these trees by planning the landscape of your property, planning your time outside to coincide with times of low pollen count and keeping up with the local pollen index.

7. Greensboro, NC Greensboro is the second city in North Carolina to make the list. Despite being a beautiful city, allergy sufferers from Greensboro may consider going on vacation to escape the peak pollen season. Traveling to another location may help allergy sufferers enjoy the warm weather and beautiful outdoors during the spring and summer.

8. Dayton, OH In the Miami River Valley, Dayton’s seasons are dominated by hot, muggy summers and cold, dry winters. This humid climate is perfect for the growth of mold, mildew and pollen-dispersing trees and plants. To avoid exposure to mold, limit activities such as gardening, mowing the lawn, working with compost or raking leaves when the mold count is high.

9. Little Rock, AR Tree pollen fills the city during the spring, thanks to Little Rock's proximity to the Ouachita Mountains. Among the earliest pollen producers, trees may release their pollen as soon as January in the southern states. Trees that cause allergic reactions include cedar, elm, hickory, olive, pecan, sycamore and walnut.

10. Augusta, GA Famed for hosting the annual PGA Masters tournament, Augusta is located about halfway up the Savannah River and boasts beautiful lawns and gardens. To maintain your own garden without triggering your allergies, use flowers that are less likely to release airborne pollen, like colorful begonias, daffodils and sunflowers. Safer, low-allergy trees include apple, cherry, dogwood, magnolia or red maple, and fill out your shrubbery with azalea, hibiscus or hydrangea.

Air Pollution Lessen Asthma Inhaler Benefits

2010-04-26T20:48:00.001-07:00

Air pollution, which tends to inflame the airways in people with asthma, might also reduce the effectiveness of the rescue inhalers they count on for quick relief of their asthma symptoms, study findings hint.
Dr. Fernando Holguin, at the University of Pittsburgh, Pennsylvania, and colleagues studied 85 asthmatic children, ages 7 to 12, to determine whether outdoor air pollution had any impact on how well their rescue inhalers worked.
The children all lived in Mexico City, where traffic-related air pollution is usually very high. Fifty-three of the children had mild intermittent asthma, 20 had mild persistent asthma, and 12 had moderate persistent asthma.
As they report in the journal Chest, Holguin and his team found that higher levels of certain air pollutants, specifically nitrogen dioxide and ozone, made the rescue inhalers less effective - not because the devices didn't function properly, but because the children did not seem to respond as well to the medication.
For example, an increase of 10 parts-per-billion in nitrogen dioxide levels in the air seemed to decrease rescue inhaler efficacy by about 15 percent.
According to the U.S. Environmental Protection Agency, current nitrogen dioxide levels in the U.S. average from 10 to 20 parts per billion.
However, inhaled steroids provided some protection against the effects of pollution, Holguin told Reuters Health in an email message.
Among the 25 children in the study who regularly used inhaled corticosteroids to help control persistent asthma, the rescue inhalers provided more effective quick relief.
These findings are consistent with other studies and "may explain why asthmatics are more symptomatic in relation to air pollution," Holguin said. Nonetheless, his group notes the need for further, larger-scale investigations to confirm their findings.

The Worst Allergy Season in Years

2010-04-23T23:30:00.001-07:00

Will 2010's Allergy Season Be as Bad as They Say? If you've been keeping up with the news at all, you know it's bound to be a terrible allergy season this year. Then again, the news reports almost every year that the allergies are supposed to be, in layman's terms, really bad. So what makes this allergy season worse than all of the others?
You may find the answer surprising. Experts report that in most of the country, but especially in the Southeast, there's going to be an overwhelming amount of pollen in the air. This can be attributed to the late and long-lasting winter that swept most of the country months ago. This long winter affected the plants; instead of blooming in spurts as they tend to do when the weather is normal, they continued to lay dormant.
Now that there is a distinct end to winter, they're beginning to bloom all at once, flooding the atmosphere- and your sinuses- with pollen. In addition to the late winter, wind can be blamed for this onslaught of pollen. In areas that are going to be windy this year, the allergy season is going to be worse than ever; wind works to blow pollen from one place to another, which will obviously make allergy season even worse for people that are getting hit by it.
In many places, oak trees are going to be most to blame for allergy problems. Oak trees can produce three to six thousand particles of pollen per cubic meter, while it only takes ten particles to trigger an allergic reaction. Obviously this is bad news for anyone who lives in a heavily wooded area. Some areas are also going to be hit harder than others.
Among places that are claimed by the Asthma and Allergy Foundation of America to be the most challenging to live with for allergy sufferers right now are Knoxville and Chattanooga, Tennessee, and Louisville, Kentucky. However, it's reported that most regions along the southeast and the lower east coast are going to be hit hard as well.
So what can you do if you suffer from allergies and live in an area that's going to be hit hard by the allergy season?
There really isn't any way to completely eliminate allergy problems, aside from avoiding going outside—and even that might not work if your house isn't completely airtight to the outside world. Not to mention that that is an impractical option for many people!
Luckily, there are a few less extreme things you can do to alleviate your symptoms. You can avoid opening your windows, which will let less pollen into your house. And there are many allergy medications available over-the-counter these days which should help alleviate your symptoms at least for a while.

Why Are Allergies Increasing?

2010-04-20T02:06:00.001-07:00

Allergies are increasing at an alarming rate. In the last 30 years, the number of people suffering from allergies in developed countries has grown from 10 percent to 30 percent. Allergies have become widespread in Western populations, where hay fever, eczema, hives and asthma are all more and more prevalent.
Currently, one out of 10 children is asthmatic. Asthma rates in children under the age of five have risen more than 160 percent from 1980-1994 and the mortality rate resulting from this affliction increased 28 percent between those same years.
The reason?
According to Dr. Guy Delespesse, a professor at the Université de Montréal Faculty of Medicine, it all boils down to excessive cleanliness. Allergies can be caused by genetics, air quality, processed foods, stress, tobacco use, etc. Yet our limited exposure to bacteria concerns Dr. Delespesse, who is also director of the Laboratory for Allergy Research at the Centre hospitalier de l’Université de Montréal.
“There is an inverse relationship between the level of hygiene and the incidence of allergies and autoimmune diseases,” says Dr. Delespesse. “The more sterile the environment a child lives in, the higher the risk he or she will develop allergies or an immune problem in their lifetime.” Wow. In our efforts to battle the germs to save ourselves from the filth and squalor that has plagued humankind, have we gone too far?

“Regions in which the sanitary conditions have remained stable have also maintained a constant level of allergies and inflammatory diseases. It’s not just the prevalence but the gravity of the cases,” says Dr. Delespesse. “Allergies and other autoimmune diseases such as Type 1 diabetes and multiple sclerosis are the result of our immune system turning against us.” Why does this happen?
It’s what researchers call the “hygiene hypothesis,” in which the millions of bacteria and viruses that enter the body along with ‘dirt’ spur the development of a healthy immune system–remove that and it throws our immune systems seriously out of whack. “The bacteria in our digestive system are essential to digestion and also serve to educate our immune system. They teach it how to react to strange substances. This remains a key in the development of a child’s immune system,” says Dr. Delespesse.
Although hygiene does reduce our exposure to harmful bacteria it also limits our exposure to beneficial microorganisms. As a result, the bacterial flora of our digestive system isn’t as rich and diversified as it used to be. Mary Ruebush, a microbiology and immunology instructor, and author of the book, “Why Dirt Is Good” (Kaplan), says that when kids put things in their mouths.
For example, “Not only does it allow for “practice” of immune responses, which will be necessary for protection, but it also plays a critical role in teaching the immature immune response what is best ignored.” She deplores the current fetish for the hundreds of antibacterial products that convey a false sense of security and may actually foster the development of antibiotic-resistant, disease-causing bacteria.
Dr. Delespesse recommends probiotics to enrich our intestinal flora. Probiotics are intestinal bacteria that have a beneficial impact on health. They’ve been used for decades to make yogurt. Probiotics have a proven effect on treating diarrhea, and studies are increasingly concluding similar benefits for the immune system and allergies.

Why I Can't Find Allergy Relief?

2010-03-19T03:06:00.001-07:00

Spring is here – and while that means longer, warmer days, budding trees and blooming flowers – it also means misery for millions of people who suffer from seasonal allergies. You know the signs: Red itchy eyes,scratchy nose and throat, runny nose and of course sneezing. And no matter how many remedies some people try – they just can’t find relief.
Here are the top 5 reasons why:
1. You’re not taking the right medications: “If somebody has a cold or sinus infection — the treatment is very different than if they have seasonal allergies,” said Dr. Clifford Bassett, chairman of the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. Bassett said people often reach for cold and sinus medicines even though they are suffering from allergies.
“Sometimes a person will have nasal discharge with allergies – but that doesn’t mean it’s a cold,” he told FOXNews.com. “When you have allergies, you need to take the proper medications such as eyes drops, nasal steroid sprays and antihistamines, which work very well. If you take cold medicines — your symptoms are not going to go away. So a proper diagnosis is very important.”
2. You may have an oral allergy syndrome: Has your mouth ever tingled or been itchy after you’ve eaten a fresh piece of fruit? If it has, you may have an oral allergy syndrome — sometimes called pollen-food allergy syndrome. “About 1 in 3 seasonal allergy sufferers have oral allergy syndrome and it’s more severe during the pollen season,” Bassett said.
“These allergic reactions occur when you have a cross-reaction between the pollen in the air and the proteins in certain fruits and vegetables.” “I’ve even had a patient come in with oral allergy symptoms after she had her morning coffee flavored with hazelnut. It’s very common.” Common cross-reactions occur in the following foods:

Ragweed: melons (watermelon, cantaloupe, honeydew), bananas, cucumbers and zucchini, sunflower seeds, chamomile tea;
Birch tree: apples, pears, plums, peaches, parsnip, kiwi, hazelnuts and apricots; potatoes, carrots, cherries, celery;
Grasses: tomatoes, potatoes, peaches.

“While most people with oral allergy syndrome experience mild symptoms such as itchiness of the mouth and throat… a small percentage of people do have more severe symptoms,” Bassett said. “If that’s the case, see an allergy specialist for an immediate evaluation.”
The good news is that cooking or peeling these fruits and vegetables can help most people avoid reactions, so skip the raw apple and opt for apple sauce or canned fruit instead.
3. Exposure to the wrong plants and flowers: Spring is a time of new beginnings and growth – and for many people that means getting out in the garden. But certain plants and flowers can really put a damper on that “green thumb” if you’re not careful. “Stick to plants that smell and look nice,” Bassett said. “These are usually insect pollinated plants and are not ones that allergy sufferers have to worry about.”
These include: Azaleas, begonias, bougainvilleas, cacti, daffodils, daisies, dahlias, gladiolas, Irish moss, iris’s, lilies, marigolds, orchid, pansies, petunias, snapdragons, sunflowers, tulips, violets and zinnias. “After yard work, leave your clothing outside of your bedroom, brush off shoes, and rinse off glasses,” Bassett said.
4. Lack of planning. “Make sure you check the weather and pollen forecasts before you head outside,” Bassett said.” “It’s important to have what I call an ‘allergy action plan’ in place if you want keep the misery index low.”
If you don’t – you’re asking for trouble especially on days when it’s warm, sunny, dry and windy.“Also, work in the garden on low-pollen days and limit your time to short intervals.” He also recommended wearing a pollen mask while gardening to keep those allergies at bay.
“Pollen counts tend to be higher on these days — so you really want to plan ahead especially if there’s going to be a stretch of days that are increasingly warmer and dryer,” Bassett said. That means exercising inside on these days and curbing the time you spend outdoors.
Unfortunately the good days to be outside for allergy sufferers are cool, drizzly and windless days when pollen counts tend to be lower. Planning around your allergies is also important when it comes to vacation. “Pollen counts can be lower if you’re by a body of water such as an ocean or lake… so take a beach vacation,” he said.
5. Starting treatment too late. “Don’t wait until you’re suffering,” Bassett said. “Pre-treat symptoms when they are mild. Find out which over-the-counter or prescription drug is right for you and begin to take it even before symptoms begin.” It’s not just taking medications early that make the difference — washing away pollen is also very effective.
Bassett calls it the “wash cycle.” “Shampoo and shower nightly to rinse the pollens from skin and hair,” Bassett said. “Use baby tear-free shampoo to gently irrigate around your eyes and nose and make sure you change your cloths before entering your bedroom.” This will reduce the amount of pollen in your bedroom and will ultimately help reduce your allergy symptoms. “By being proactive, you can really reduce those one and two box tissue days, to just a handful of tissues a day,” Bassett said.

Treatment May Help Peanut Allergy

2010-03-17T01:59:00.001-07:00

A daily dose of peanut powder could help some children who are allergic to peanuts, according to a pair of U.S. studies that confirm earlier findings, offering hope that a treatment could come soon. In one study, teams at Duke University in North Carolina and the University of Arkansas for Medical Sciences gave 15 children tiny, but increasing, doses of peanut powder and compared them with eight children who got a placebo.
At the end of the year-long study, children given the treatment were on average able to tolerate 15 peanuts before having an allergic reaction. "We started out literally at about a one-thousandth of a peanut and built that up over time," Dr. Wesley Burks of Duke, who helped lead the study, said in a telephone interview.
"When you take the daily dose it changes your immune system in a certain way and it raises the threshold of how much food it takes to cause a reaction," he said. "Certainly the immune system changes while they're on the therapy and whether you can stop the therapy and it remains changed, that's the big question," Burks said.
In the second study, 12 children treated with peanut powder from age 32 months to 5 years old were monitored to see whether they could safely eat peanuts after the daily treatment stopped. The children were off the treatment for a month before they were given peanuts. Nine of the 12 now have peanuts in their diets, the researchers reported at a meeting of the American Academy of Allergy, Asthma & Immunology in New Orleans.
The research builds on previous studies, in which children were able to tolerate the treatment for more than two years and four appeared to be freed of their peanut allergies. "We are now trying to identify characteristics in those subjects who were able to stop the therapy to better understand who might be a good candidate for this treatment," Burks said in a statement released with the latest studies.
Burks said the results are encouraging but more research is needed before an effective treatment can be developed. "I think, therapy we're still a few years away from," he said. Allergies to peanuts or any other food occur when the body's immune system mistakenly sees compounds from the foods as invaders and creates antibodies to fight them. Scientists say peanut allergies are on the rise worldwide, but nobody knows why.
There is no cure and people with the condition must avoid even the tiniest amount of food containing peanuts. The AAAAI estimates that 4 million Americans have food allergies, with tree nuts and peanuts, which are legumes, the most common. About 150 people die in the United States each year from food allergies, half from peanuts.

Taking the Right Medication For Asthma

2010-03-14T20:20:00.001-07:00

If you are one of the 22 million people in the United States who suffer from asthma, relief can't come fast enough during an attack. That is why finding the right medication is of utmost importance. Asthma is a chronic lung disease that causes recurrent inflammation and narrowing in the airways.
Symptoms include wheezing, coughing and chest tightness, all of which are often worse at night, said Dr. Nathanael Horne, of Allergy and Asthma Medical PC and an assistant attending at St. Vincent’s Hospital, both of which are located in New York City. Asthma triggers differ for each patient, but they include:

Allergens, such as cat dander or tree pollen;
Upper respiratory infections;
Sinusitis;
Acid reflux;
Pollution;
Exercise;
Cold air.

“There is really no cure for asthma, although it can go into remission for an extended period of time,” Horne said. There are two main categories of asthma medications: quick relievers or rescue inhalers, and controller (long-term control) medications, Horne said.
Rescue Inhalers
“Everyone with asthma should have one of these,” Horne said. “For young children there are oral forms, but usually there are inhalers or nebulizers.” The most commonly used rescue inhaler is known as Proventil (albuterol), which relaxes the muscles around the airways in the lungs.
Atrovent is a less commonly used rescue inhaler, Horne said, and it works differently: While it still relaxes the muscles, it works more on the nerves. “These inhalers don’t do anything about inflammation, so they don’t address the underlying problem,” he said. “For many people with mild asthma, that’s all they will need. If someone has severe asthma, they need more medication.”
Controller Medications
If you are having frequent or severe attacks, or you are using your inhaler more than twice a week, you may need to speak to your health care provider about adding a controller medication to your daily regimen, Horne said. There are several classes of drugs within this category.

Corticosteroids. These are the mainstay drugs in treating asthma, and they are powerful anti-inflammatory medications. Examples include budesonide (inhaled) or prednisone (oral).
Designer steroids. “There are new therapies being designed all the time,” Horne said, “and some of these have very little systemic absorbtion, meaning they mostly have their effect in the lungs.” Horne said the latest drugs to catch the public’s attention is an inhaler known as Alvesco (ciclesonide).
Anti-leukotrienes. Leukotrienes are one of the inflammatory chemicals released by the body during an attack of seasonal allergies or in asthma. A drug like Singulair blocks the effects of the leukotrienes.
Mast cell stabilizers. When they are stimulated, the cells in the airways release inflammatory chemicals, Horne said. A mast cell stabilizer such as Intal (cromolyn) will keep the cells from activating. This drug can also be used for exercise-induced asthma.
Long-acting beta agonists. Examples include Serevent or Flovent, and they are known as bronchodilators — they relax the smooth muscles in the walls of the airways. This is done by stimulating the beta receptors that act against bronchoconstriction. Then there is Advair, which is a combination of these two medicines.
Monoclonal antibody. Xolair (omalizumab) is biologic medication, a specific antibody to block allergies. For that reason, it's very expensive, Horne said. It is administered via an injection every two to four weeks and is given only to people with allergic asthma.
Acid reflux medications. Sometimes an asthma patient can benefit from an antacid medication, even if they don’t feel the effects of heartburn, Horne said. They may have silent acid reflux, which can worsen or cause asthma symptoms. However, there is a definite connection.

"Controller medications can be used short periods or they can be used all the time," Horne said. "They just shouldn't be used alone during an acute asthma attack. That's when you use a rescue inhaler. The frequent mistake I see is when a patient is on (only) one inhaler like Advair with no rescue inhaler." Horne suggested that people with asthma track their symptoms using a peak flow diary and asthma action plan, which includes measuring the severity of symptoms using a peak flow meter and then recording your results.

Get Allergy Shot in a Pill For Hay Fever

2010-03-14T10:40:00.000-07:00

A medication that allows hay fever sufferers to get allergy shots in the form of a pill seems to have lasting benefits, a new study finds. The drug, called Grazax, is a prescription medication approved in Europe for the treatment of allergies to grass pollen, one of the major triggers of springtime hay fever.
The pill offers an alternative to allergy shots, which are typically recommended when hay fever symptoms cannot be controlled with standard medication. Allergy shots help prevent symptoms by exposing people to small amounts of the substance to which they are allergic, essentially desensitizing the immune system to the allergen.
Allergy shots are typically given weekly at first, followed by monthly injections over several years. The treatment does not cure hay fever but is generally effective at reducing symptoms. However, the inconvenience and discomfort limits patients' willingness to try allergy shots.
Grazax pills, which dissolve under the tongue, contain a small amount of grass-pollen extract. The drug is taken daily, starting several months before the start of the allergy season and continuing for three years thereafter.
In the new study, researchers looked at the medication's long-term effects in patients who had stopped using it after the recommended three years. They found that, compared with patients who had been given a placebo, Grazax users had one-quarter fewer hay fever symptoms one year after stopping the medication.
They also had less need for antihistamines and other allergy medications, according to a report in the Journal of Allergy and Clinical Immunology. These longer-term findings, the researchers write, support Grazax as a treatment option for people whose hay fever symptoms fail to improve with standard medication.
Dr. Stephen R. Durham, of Imperial College London in the UK, led the study, which was funded by Denmark-based ALK-Abello, the maker of Grazax. Durham and several co-researchers on the study have received research grants and other funds from the drug company. The findings are based on 257 adults with grass pollen allergies, confirmed through allergy tests.
They were randomly assigned to take either Grazax or inactive placebo tablets every day, beginning four to eight months before the next grass pollen season. They continued the therapy for three years. Over those three years and for one year after stopping the treatment, the patients rated their daily symptoms and allergy medication use.
During the year following treatment, patients in the Grazax group reported a 26 percent reduction in symptoms like congestion and itchy, watery eyes compared with the placebo group. They also had a 29 percent reduction in medication use and gave higher ratings to their quality of life. Those differences were similar to those seen during the three years of active treatment, according to the researchers.
During the last year on treatment, 15 percent of Grazax patients had side effects believed to be caused by the treatment — the most common being itching and swelling in the mouth, ear itchiness and throat irritation. A clinical trial aimed at winning approval for Grazax in the U.S. is currently underway.

The Most Common Skin Disorders

2010-03-13T02:40:00.001-08:00

Almost everyone has known the horror of waking up to a glaring-red zit. Acne is the most common skin condition, but it's usually the least severe. Others can be equally embarrassing -- and some can even be life-threatening.
Because skin is the largest body organ, the effects of its disorders are as psychological as they are physical. Acne, eczema, seborrheic dermatitis, skin cancer and psoriasis are the five most common skin disorders, says Dr. Macrene Alexiades-Armenakas, assistant clinical professor at Yale University School of Medicine.
Although these five appear at the top of most lists, there is a lot of disagreement among dermatologists about what their prevalence rates really are, Alexiades-Armenakas said.
1. Acne
Acne is a skin disorder that causes pimples when the passageway that connects the skin’s pores to the oil glands becomes clogged. Acne, which appears most often on the face, neck, shoulders, chest and back, can come in many forms. Whiteheads and blackheads are the most commonly known; nodular and cystic acne are more severe because they form deep in the skin and can cause scars.
Eighty percent of Americans will have acne at some point in their lives, and 60 percent will continue to experience it into adulthood. Factors like heredity can play a role in developing acne, but Alexiades-Armenakas said that hormones are the most important factor.
"In both men and women, the reason it peaks in the teenage years is because growth hormone is released at a very high frequency," Alexiades-Armenakas said. "Production really spikes and valleys in the course of a day, and this surging of the growth hormone is why acne is most severe in the teenage years."
2. Eczema
Eczema is a "grab-bag term," which Alexiades-Armenakas said comes from the Greek word for "boils over." There are three common forms of eczema:

Atopic dermatitis is the most common and is seen most often in children. One to three percent of adults compared to 10 to 20 percent of children have this long-term genetic disease, which causes itchy rashes in the crux of the elbows and behind the knees.
Allergic contact dermatitis begins to show in adulthood and is caused by environmental factors such as cosmetic agents, fragrances and the metals in jewelry.
Nummular dermatitis looks like red and flaky coin-shaped patches of skin and is due to dry skin. This can be very itchy. "In all cases, what you want to do is moisturize the skin, build up the skin barrier and avoid drying out the skin," Alexiades-Armenakas said. "And then, usually, we use corticosteroids for these conditions."

3. Seborrheic Dermatitis
Seborrheic dermatitis, which causes oily, waxy patches to develop on the scalp, is distinct from other forms of dermatitis. It affects 5 percent of people, according to U.S. News and World Report. It can affect babies, typically in the first six months of their lives in the form of "cradle cap" -- a flakey, dandruff-like condition on the scalp. After the symptoms clear up, it rarely appears again until puberty.
4. Skin Cancer
Skin cancer is the most common type of cancer in the United States. According to the American Academy of Dermatology, one million people are diagnosed with skin cancer annually, and 1 in 5 Americans will develop skin cancer in their lifetime. Basal cell carcinoma and squamous cell carcinoma are the most common types of skin cancer. But 75 percent of skin cancer deaths are from melanoma, the third most common form.
Alexiades-Armenakas said that sun damage is on a spectrum with skin cancer because excessive exposure to ultraviolet light is a leading cause and requires physicians to be well-versed in treating it early. "More often than not, a patient will come in, and the lesions that bring them into the office and what their chief complaint is one of these two things: sun damage or hyper-pigmentation," Alexiades-Armenakas said. Genetics play more of a role in basal cell and melanoma than in squamos cell, which is due to sun exposure.
5. Psoriasis
Psoriasis is a chronic and disfiguring genetic disease. It is a buildup of excess skin tissue that looks red and thick and is covered with silvery scales. It first appears on the elbows and knees, but can spread to other parts of the limbs and even the trunk.
Certain forms affect particular areas like the hands, scalp or the joints. "Patients with psoriasis have very poor quality of life because it’s very obvious and it makes the patient extraordinarily self-conscious," Alexiades-Armenakas said. Although there are an array of skin conditions that can plague humans, treatment options for some, including acne, eczema and dermatitis have improved. If you suspect you have any of these conditions, see a dermatologist immediately to evaluate your treatment options.

Have Americans Gone Nuts Over Nut Allergies?

2010-03-11T21:07:00.001-08:00

Five years ago, at a San Francisco elementary school, a nurse stood by to ensure that the children scrubbed their hands as they arrived, while their packed lunches were confiscated and searched for nut products. The measures were a precaution to protect a 5-year-old boy at the school who had a severe nut allergy.
In 2006 a town in Connecticut felled three hickory trees more than 60 feet high after a resident learned that the trees leaning over her property produced nuts and complained that they posed a threat to her grandson, who had nut allergies.
Recently, a Massachusetts school district evacuated a school bus full of 10-year-olds after a stray peanut was found on the floor. Do these safeguards seem a little, well, nuts? Harvard professor Dr. Nicholas Christakis thinks so.
One of Christakis' children attends school in the district that ordered the bus evacuation, and the episode prompted the physician and social scientist — best known for his work on the social "contagiousness" of characteristics such as obesity and happiness — to write a commentary, published in the British Medical Journal, questioning whether these so-called precautions are snowballing into something more like a societal hysteria.
Of the roughly 3.3 million Americans who have nut allergies, about 150 die from allergy-related causes each year, notes Christakis. Compare those figures with the 100 people who are killed yearly by lightning, the 45,000 who die in car crashes and the 1,300 who are killed in gun accidents. As a society, Christakis says, our priorities have become seriously skewed, and it's largely a result of fear. "My interest is in understanding [the reaction to nut allergies] as a spread of anxiety," he says.
Between 1997 and 2007, the number of children under 18 who suffered from food allergies jumped 17%, according to the Centers for Disease Control and Prevention. Experts don't disagree that the incidence of food allergies has increased, but there isn't much consensus as to why.
Some researchers suggest that an overly hygienic lifestyle may hamper the body's ability to build up proper immunities; others believe the statistical rise is a combination of a real increase in allergies and an increase in the number of patients seeking diagnosis (i.e., getting allergy tests that turn up very low levels of reaction that might otherwise have gone undiscovered). "You have to distinguish between an epidemic of diagnoses and an epidemic of allergies," says Christakis.
No one would disagree that children who suffer from life-threatening allergies need to be protected, but the growing trend of demonizing nuts only fuels anxiety, Christakis says. Instilling in the general public the idea that nuts are a "clear and present danger" does little beyond heightening panic. "There are kids with severe allergies, and they need to be taken seriously," he says, "but the problem with a disproportionate response is that it feeds the epidemic."
There's even some evidence to suggest that establishing nut-free zones or nut-free schools may be detrimental to children's health, and increases their risk of developing nut allergies. A study cited by Christakis in his article revealed that, of 86,000 Jewish children living in the U.K. and Israel, those who had more exposure to peanuts earlier in life were less likely to become allergic later on.
In the U.K., where peanuts are an infrequent part of the diet, nearly 2% of the children studied developed allergies; in Israel, where peanuts are a common part of the diet, from infancy onward, only 0.17% of children had a nut allergy.
But Dr. Robert Wood, chief of the Pediatric Allergy and Immunology department at Johns Hopkins Children's Center, cautions against putting too much stock in such epidemiological studies. "The reality is that the vast majority of kids — 95% plus — have no potential to get peanut allergies no matter what you do," he says, "and there's ½ % to 1% who are going to get it no matter what you do."
Although the findings of the U.K.-Israel study are intriguing, he says, they apply to a very small percentage of children, and more research needs to be done to determine the true impact of early nut exposure. (There is a study currently underway, says Wood, but the results won't be available for another three years.)
Despite the occasional cases of nut over-precaution, Wood thinks the public generally approaches the allergy risk with common sense. "There are definitely situations where we see a fear of the allergy that develops far out of proportion to the true risk, but for the vast majority of schools, things are mostly on balance and in perspective," says Wood, who treats some 2,000 allergy patients.
Further, he says, it's important to recognize that the appropriate protective measure depends on the age group in question. "We recommend very different approaches between an early preschooler and a late-elementary schooler," he says. "We view preschool children as being at true risk — sharing food, having messy hands. There are many reactions that occur from those kinds of exposures," he says.
"I think that having peanut-free preschools is a totally reasonable, justifiable thing to do." For children in the fourth or fifth grade, however, he says minor precautions like specialized seating arrangements in the cafeteria are probably unnecessary.
Still, on blogs run by moms of children with nut allergies, there is a consistent rallying cry for nut-free zones. The concern is airborne nut dust, which can be inhaled, or oily nut residues that can come into contact with children's skin. Wood, who has been allergic to nuts all his life, says these parents' worries may be exaggerated.
The danger may depend on the severity of the allergy, but it has much more to do with the degree of contact, he says. "Nut oils or the kinds of things that might be in a classroom — it's very rare for that exposure to cause anything more than a localized reaction," he says. "On the other hand, if you're a preschooler and your hands are in your mouth a lot, all bets are off."
As for nut dust in the air, Wood says it can cause severe reactions — but only under specific circumstances, with high concentrations of nut dust in a confined space. At a baseball game, for example, where nut dust is quickly dispersed in the air, the risk of an allergic reaction is low.
But if you linger in the small waiting room of a restaurant with a dish of nuts and servers who keep passing through with plates of nuts, your risk of an allergic reaction is higher, he says.
But like Christakis, Wood cautions against excessive alarm. "It's an unfortunate situation," says Wood, "if a family with an inaccurate perception of the allergy leads a child to believe that a Snickers bar from 50 feet away is a lethal weapon."

Cured Peanut Allergies by Eating Peanuts?

2010-03-09T02:41:00.001-08:00

In 2008, Gideon Lack of King's College London published a startling study comparing the rate of peanut allergies in children in London with that of children in Tel Aviv. The study of 10,000 Jewish children, which appeared in the Journal of Allergy and Clinical Immunology, found that kids in the U.K. were almost 10 times as likely to have a peanut allergy as their peers in Israel, says Lack.
Why the disparity? Although Lack can't draw conclusive explanations from his observational study, he suggests that one reason may have to do with early exposure. In Israel, children are typically introduced to peanuts much earlier than in Europe and North America.
Lack points to a popular Israeli snack food called Bamba (like peanut-flavored Cheez Doodles), which youngsters start eating as early as infancy. That early exposure may desensitize children to peanuts, even in kids with a family history of food allergies.
The theory has gained enough traction that the National Institutes of Health is funding a seven-year study, also led by Lack, involving 640 children at high risk of allergy. Half of the study participants will avoid peanuts, while the other half will consume them regularly from 11 months to 3 years of age. Researchers will measure the rate of allergy in both groups by age 5.
The findings, which are expected by 2014, could mark a significant change in the way doctors handle food allergies. The conventional treatment has long been no treatment at all — essentially, patients are simply advised to avoid problem foods altogether. But a growing number of studies indicate that such an approach may someday be a thing of the past.
In a recent experiment presented at the February meeting of the American Association for the Advancement of Science, Andrew Clark of Cambridge University recruited 23 peanut-allergic children and fed them precise doses of crushed peanuts every day. At first they showed the typical allergic reactions: lots of itching, coughing and reddening of the skin.
But after just three months, most of the kids were able to eat five peanuts a day with no reaction; at the end of year, the majority of them could safely eat 32 peanuts, which meant they no longer needed to read food labels for possible nut contamination.
Clark has just embarked on a three-year, $1.5 million controlled trial to test the same treatment in 104 children with peanut allergies. Similar studies are also under way at Duke University and Mount Sinai Medical Center in New York City, among other places.
The experimental treatment, called oral immunotherapy, aims to desensitize the body to allergens like peanuts by training the immune system to make peace with them. Most food allergies — whether to peanuts, eggs, milk or shellfish — are a result of the immune system misidentifying a food as a dangerous toxin.
The body wages war with the invader, and the by-product is an allergic reaction — anything from a minor itch or swelling to a severe asthma attack, which in extremely rare cases and if left untreated can lead to death. Immunotherapy is designed to build up the body's tolerance to such "toxins" by gradually increasing patients' exposure to them over several weeks or months, says Hugh Sampson, who runs the Jaffe Food Allergy Institute at Mount Sinai.
"We start at the microgram level, scale up to milligrams and may end with grams [of peanuts]," says Sampson, but he warns people not to try the program at home. "Every patient has an adverse reaction when we increase the dose," and in severe cases, the patient may need immediate medical attention.
The evidence so far seems to suggest that many cases of milk, egg, peanut and wheat allergies can be treated, at least in the short term. In human studies, tolerance to problem foods appears to last as long as the treatment is in progress. "The question is, Is this just a treatment, or can it be a cure?" asks Cambridge University's Clark, whose study on toddlers is designed to help furnish an answer.

Bikini Wax Mishaps

2010-03-09T01:59:00.001-08:00

All Jennifer (not her real name) wanted was a smooth bikini line. But within 24 hours of getting a wax at a reputable New York City salon, an infection crept in. She developed a fever of 102, chills, and pain in her left thigh. "I thought I'd caught a cold," she says, "but after five days, the pain was worse."
Her doctor diagnosed her with cellulitis, a potentially life-threatening bacterial infection of the skin and the underlying tissue. Jennifer spent the next 15 days in the hospital hooked up to an IV that pumped her full of antibiotics and heavy-duty painkillers. She also had surgery to drain the infection. "One doctor said I could have lost my leg!" she recalls. "It took me months to recover physically and emotionally from the whole ordeal — a steep price to pay for a little vanity."
While there are no reliable stats on waxing-related complications, Jennifer's experience wasn't unique. This past March, the state of New Jersey nearly banned Brazilian waxes after two women landed in the hospital as a result of them (one of the women filed a lawsuit against the state cosmetology board). And in 2007, an Australian woman with type 1 diabetes almost died of a bacterial infection she got after a bare-it-all wax.
What makes them risky? "Pubic hair is there for a reason — to protect the sensitive skin and mucous membranes in the genital region," explains Linda K. Franks, M.D., an assistant clinical professor of dermatology at the New York University School of Medicine. "Getting a wax literally strips away that layer of protection."
Waxing can also pull off tiny pieces of the skin's outermost layer, creating a portal through which bacteria can enter the body. What's more, the process creates inflammation, which can trap bacteria beneath the skin. All of this sets the stage for skin infections (including staph), folliculitis (infection of the hair follicles), and ingrown hairs.
"Anytime you compromise the integrity of the skin, you're going to increase your risk of infection," Franks says. She advises people who have diabetes, chronic kidney or liver disease, skin conditions such as eczema or psoriasis, or weakened immune systems to avoid waxing altogether. For everyone else, there are simple ways to ward off danger:
Choose a facility carefully - Before you make an appointment, drop by to see how clean the place is, or ask a friend to recommend a salon she trusts. Be sure the cosmetologist or aesthetician you choose is licensed by your state and has received training in Brazilian waxing, says Rosanne Kinley, past president of the National Interstate Council of State Boards of Cosmetology.
Ask about the wax - "Hard wax is best. It's gentler and adheres to the hair, not the skin," Kinley says. "Speed wax, which is soft and sticky, is applied with a roller applicator, and while it's fast and easy, it's more painful and more likely to tear skin." Sugaring, a natural method that's kinder to the skin than waxing, is a good alternative. Look for products that are chemical-free; Shobha contains nothing but sugar, water, lemon juice, and glycerin.
Keep an eye on hygiene - Before beginning the process, the practitioner should scrub up or (at least) apply hand sanitizer. Double dipping into the wax is taboo because it introduces bacteria into the pot. "The waxer should have brand-new spatulas available for each swipe to your skin," Kinley says. To prevent burns, she should check the wax's temperature on the inside of her wrist before applying it to your skin. If you don't see the practitioner taking these steps, speak up.
Prevent irritation - For a few days following your wax, apply an over-the-counter topical antibiotic cream and an anti-inflammatory 1 percent hydrocortisone cream to the area, says Bruce Robinson, M.D., an associate clinical professor of dermatology at the Mount Sinai Medical Center in New York City. This will ease irritation and help ward off potential infection.
Know the signs of infection - Check yourself with a hand mirror (look for inflamed ingrown hairs, rashes, or raw, open sores or cuts). "See a doctor ASAP if you develop redness or swelling in the area, an itching or burning sensation, peeling of the skin, or a fever," Robinson says.

Tips To Lowering Your Heart Rate to Prevent a Heart Attack

2010-03-03T03:42:00.000-08:00

Italian researchers found that having a resting heart rate above 70 beats per minute (bpm) increases your risk of dying of heart disease by at least 78 percent. Follow the tips below to help drop your bpm and improve your odds.
Attack your cardio - Run hard, don't just jog. "Exercise increases your heart's efficiency, reducing the number of heartbeats you need to achieve bloodflow," says Dr. John Elefteriades, the chief of cardiothoracic surgery at Yale University. Interval training can increase your heart's stroke volume (the amount of blood it pumps with each heartbeat) by about 10 percent, but slower, sustained running has no effect on it, according to an American
College of Sports Medicine study. Try a four-minute run at 90 percent of your maximum heart rate, and then jog for three minutes at 70 percent. Repeat the interval three times. Do this routine three times a week, as the study participants did. Keep track with a Suunto t3c Heart Rate Monitor.
Trade massages with her - Regular massages may soothe a rapid heartbeat. Relaxation techniques reduce your body's production of adrenaline, norepinephrine, and epinephrine, stress hormones that rev up your heart in the face of danger, says Atman P. Shah, M.D., an assistant professor of medicine at UCLA. A 2007 British study found that people who received an hour of reflexology treatment (a type of foot or hand massage) had rates that averaged almost 8 bpm lower than when they went without.
Don’t try to hold it - If you gotta go, you really should go. Taiwanese researchers who studied 40 people with early heart disease found that the stress of having a full bladder steps up the heart rate by an average of 9 bpm. When your bladder expands, it increases activity in your sympathetic nervous system. This may cause your coronary vessels to constrict, forcing your heart to beat more often — all of which might boost your heart-attack risk.
Sleep more soundly - The neighbor's barking dog can wreak havoc on your heart rate. In a 2007 study, Australian researchers used sound to wake people multiple times. After each noise-induced arousal, heart rates spiked an average of 13 bpm. Try Hearos Xtreme Protection Series earplugs — they can reduce noise by 33 decibels.
Savor some snapper - In a 2007 UCLA study, people who took a 1-gram fish-oil capsule every day reduced their resting heart rates by an average of 6 bpm after just 2 weeks. Fish oil may help your heart respond better to your vagus nerve, which controls heart rate. The result is a slower resting heart rate and better heart-rate responsiveness, says Dariush Mozaffarian, M.D., Dr. P.H, a cardiologist at Brigham and Women's Hospital and Harvard medical school.

Things That Will Make You Happier

2010-03-03T03:39:00.000-08:00

Some scientists have argued that happiness is largely determined by genetics, health and other factors mostly outside of our control. But recent research suggests people actually can take charge of their own happiness and boost it through certain practices. "The billion-dollar question is, is it possible to become happier?" said psychologist Sonja Lyubomirsky of the University of California, Riverside.
"Despite the finding that happiness is partially genetically determined, and despite the finding that life situations have a smaller influence on our happiness than we think they do, we argue that still a large portion of happiness is in our power to change."
Lyubomirsky spoke here Saturday at the annual meeting of the American Association for the Advancement of Science. She and colleagues last year reviewed 51 studies that tested attempts to increase happiness through different types of positive thinking, and found that these practices can significantly enhance well-being. The results were published in the Journal of Clinical Psychology.
Here are five things that research has shown can improve happiness:
1. Be grateful: Some study participants were asked to write letters of gratitude to people who had helped them in some way. The study found that these people reported a lasting increase in happiness – over weeks and even months – after implementing the habit. What's even more surprising: Sending the letter is not necessary. Even when people wrote letters but never delivered them to the addressee, they still reported feeling better afterwards.
2. Be optimistic: Another practice that seems to help is optimistic thinking. Study participants were asked to visualize an ideal future – for example, living with a loving and supportive partner, or finding a job that was fulfilling – and describe the image in a journal entry. After doing this for a few weeks, these people too reported increased feelings of well-being.
3. Count your blessings: People who practice writing down three good things that have happened to them every week show significant boosts in happiness, studies have found. It seems the act of focusing on the positive helps people remember reasons to be glad.
4. Use your strengths: Another study asked people to identify their greatest strengths, and then to try to use these strengths in new ways. For example, someone who says they have a good sense of humor could try telling jokes to lighten up business meetings or cheer up sad friends. This habit, too, seems to heighten happiness.
5. Commit acts of kindness: It turns out helping others also helps ourselves. People who donate time or money to charity, or who altruistically assist people in need, report improvements in their own happiness.

Too Sick To Travel

2010-02-23T02:45:00.001-08:00

For Carol Margolis, it was an almost-ruptured eardrum. She’d flown with a bad cold and sinus congestion, which made it difficult to equalize the pressure in her ears. After her doctor told her she’d nearly torn the lining between the inner and outer ear, and suggested she stay away from planes for a few weeks, she grounded herself. “My hearing is too precious to risk,” says Margolis, who runs a travel Web site in Lake Mary, Fla. “I paid the change fees and stayed put.”
Not everyone makes the same choice. A recent poll by TripAdvisor suggests 51 percent of air travelers say they’d rather fly while infected with the flu than pay a $150 airline change fee. A similar survey by msnbc.com found nearly 60 percent of travelers would fly infected instead of taking the hit to their pocketbook.
That’s something worth considering as we approach the peak of the flu season. For every one Margolis, there’s at least one other passenger who refuses to cancel. Like Amanda, who asked me not to reveal her last name. She flew with the flu, even though she didn’t want to.
“I called Southwest to bump my flight by a day, and while the rep was kind, she couldn’t do anything but offer me the opportunity to pay the $300 change in fare,” she says. “Since this was not a possibility for me, I reluctantly dosed myself with cold medicine and endured the unending stares of everyone on the shuttle, in the security line and boarding around me on my flight and endured the most miserable six hours of my life flying.”
In case you’re wondering why Amanda wouldn’t let me publish her last name, have a look at the comments other travelers left for her when she confessed to being an infected passenger. When should you add yourself to the “no-fly” list?
When your doctor tells you to stay home
“Some symptoms are just too high-risk to consider flying at all,” says Steven Schueler, an emergency room physician and chief executive of DSHI Systems, a health information systems company. If you suspect you may be too sick to fly, he recommends a medical risk assessment that considers both the seriousness of the symptoms as well the potential diagnosis. And if your doctor says don’t fly — don’t fly.
If the Centers for Disease Control says so
The CDC won’t necessarily come out and say, “Don’t fly if you have such-and-such,” but it does publish a helpful page on infectious diseases it’s trying to shield travelers from. Certainly, it’s safe to assume that if you have something like Tuberculosis, you might want to check yourself into a hospital instead of board a plane. The CDC site has suggestions to help avoid the spread of Swine Flu that should also be heeded.
If you’re on the sick list
The list comes to us courtesy of Michael Zimring, the director of the Center For Wilderness & Travel Medicine in Baltimore: Don’t fly if you’ve had a significant sinus congestion, surgery on a lower extremity, a recent heart attack or cardiac surgery, uncontrollable heart failure, or recent abdominal or neurosurgery.
“A patient of mine just had an emergency appendectomy and he wants to leave for Vegas in a few days,” he says. “That is a no-no.” Why? The patient will have residual air in his abdomen from the surgery and when he gets to altitude, the air will expand within the closed confines of his abdomen and cause major problems. Ouch!
If you can’t get around much anymore
“Generally speaking, someone should not fly if they are unable to walk about 150 feet or climb one flight of stairs without becoming short of breath,” says Mark Gendreau, an assistant professor of emergency medicine at Tufts University School of Medicine.
“Keep in mind that commercial flight subjects us to both physiologic and environmental challenges.” Such as? Cabin pressure is set to 5,000 to 8,000 feet above sea level, he notes, which results in a lower oxygen saturation in your bloodstream, in addition to the expansion of gases in body cavities.
If you’re really nervous
The worsening of an underlying anxiety condition can be a cause for cancellation, too, according to Margaret Lewin, the medical director of Cinergy Health, a Miami health insurance company. Fear of flying is no laughing matter to the estimated 1 in 5 people who suffer from it, and should be taken into account when you plan a flight.
Aerophobia can be treated, and you should always have a Plan B. “You’re best protected if you consider possible problems ahead of time,” she says, adding that flight or trip cancellation insurance should be considered. Note that many policies have exceptions for pre-existing conditions, so only a “cancel for any reason” policy is likely to cover an anxiety disorder.
Another thing to consider is the return trip. If you’re feeling unwell now, and decide to fly anyway, could your condition worsen by the time you’re ready to return? Myles Druckman, the vice president of medical services for International SOS, a medical healthcare company, says it happens more than you’d think.
“It is good practice to only travel when you are well,” he says. “If you have a symptoms of illness, you should address these concerns prior to travel, particularly if you plan to travel internationally. It is important to consider that your symptoms may worsen while on a trip, and this may require you to seek medical attention locally.”
That’s all well and good, but it would help if the travel industry — particularly airlines — loosened their onerous change rules when a customer fell ill. On legacy carriers, change fees and fare differentials often exceed the value of the original ticket, forcing passengers to choose between flying sick or throwing a ticket away. No one should have to make that choice.

Fish Oil - Evidence From Epidemiological Studies

2010-01-29T00:12:00.000-08:00

Fish oils are unique because they contain high levels of n-3 PUFAs that are relatively low in vegetable oils and animal fats. n-3 PUFAs that are present in fish oil include docosahexaenoic acid (C22:6, DHA), eicosapentaenoic acid (C20:5, EPA), and docosapentaenoic acid (C22:5, DPA).
Vegetable oils including corn oil and safflower oil contain high levels of n-6 PUFAs including linoleic acid (C18:2, LA). International epidemiological studies have provided evidence that dietary factors are important determinants of large bowel cancer in different populations worldwide.
Cancer statistics in Japan for 2001 published by the Foundation for Promotion of Cancer Research indicate that there is an upward trend in age-adjusted mortality rates for colon cancer from 1955 to 1999.3 According to this report, the death rates due to colon cancer in Japanese men and women in 1955 were 2.9 and 3.0, respectively, whereas they increased to 14.7 and 9.8, respectively, in men and women in 1999.
Interestingly, animal fat consumption in 1960 was about 25 g/day (per capita), whereas in 1999 it increased to about 58 g/day. Meat intake was increased from 19 to 78 g/day (per capita), whereas grain consumption decreased from 453 g to 245 g/day during these years.
In fact, meat consumption has been found to be associated with an increased risk for the development of colon adenomas in Japan. The change in dietary habits in Japan may, in part, explain the time trend in colon cancer mortality. The importance of types of dietary fat differing in fatty acid composition rather than total fat cannot be discounted.
A recent report by an expert panel assembled by the American Institute for Cancer Research and the World Cancer Research Fund came to a scientific consensus that evidence for an association between the intake of saturated fat and/or animal fat and colon cancer risk is very strong.
Continuing population studies reveal that mortality data for colorectal cancer in 22 European countries, the U.S., and Canada correlate with the consumption of animal fat. Eating a diet rich in n-3 PUFAs, as present fish and fish oil, may decrease the risk of colorectal cancer.
Caygill et al. reported an inverse correlation between fish and fish oil consumption and colorectal cancer. This inverse relationship was significant for both male and female patients with colorectal cancer, whether the intakes were in the current period or 10 years or 23 years before cancer mortality.
It is noteworthy that these effects were only observed in countries with a high (>85 g/day) animal fat intake. Also, the Mediterranean diet, which is rich in olive oil and fish, is associated with a low risk of colorectal cancer. The results of these epidemiological studies suggest that diets high in saturated fats increase the risk of colorectal cancer, whereas diets high in n-3 PUFAs reduce the risk.

Clinical Tested of Herbal Remedies - Artichoke

2009-10-08T20:17:00.000-07:00

Artichokes were greatly valued by the ancient Greeks (fourth century B.C.) for treating digestive disorders. Clinical studies have been conducted on aqueous extracts of the leaves. The extracts characteristically contain caffeoylquinic acid derivatives, including caffeic acid, chlorogenic acid, and cynarin (1,5-dicaffeoylquinic acid) (Kraft, 1997).

Cynara-SL™ contains 320 mg per capsule of a dried aqueous extract called LI 120, with an herb-to-extract ratio of 3.8 to 5.5:1. It is manufactured in Germany by Lichtwer Pharma AG and distributed in the United States by Lichtwer Pharma U.S., Inc. This extract is marketed in Europe as Hepar-SL forte®.

Valverde Artischocke, which is manufactured by Novartis Consumer Health GmbH in Germany, is not provided in the United States. The tablets contain 450 mg of a dried aqueous extract called CY-450 with a ratio of 25 to 35:1. Artichoke preparations may relieve digestive complaints through increases in the formation and flow of bile.

The increased flow of bile is called choleresis. Bile is excreted from the liver, stored in the gallbladder, and released into the intestine. Bile acids form a complex with dietary fats in the intestine and thereby assist in their digestion and absorption (Kraft, 1997).

In addition, stimulation of bile production results in reduced serum cholesterol, as cholesterol is pulled from the blood to be converted into bile acids. The increased flow of bile may also be beneficial for patients with irritable bowel syndrome (IBS) (Walker, Middleton, and Petrowicz, 2001).

Cynara-SL (LI 120) - Choleresis (Bile Secretion)

A mode of action study using the Lichtwer product Cynara-SL (Hepar-SL) demonstrated that artichoke extract increased the flow of bile. Administration of six capsules (1.92 g) intraduodenally caused a peak increase (100 to 150 percent compared to baseline) in bile one hour later (Kirchhoff et al., 1994).

According to Dr. David Heber, this study inferred, but did not clearly demonstrate, therapeutic benefit for dyspepsia; the one-day study was too short, was not conducted on subjects with dyspepsia, and the product was not delivered orally.

Valverde Artischocke - Hyperlipoproteinemia (Elevated Cholesterol Levels)

A study with the Novartis product Valverde Artischocke on 131 patients with elevated cholesterol (total serum cholesterol greater than 280 mg/dl) reported a 20.2 percent decrease in cholesterol, compared to 7.2 percent in the placebo group.

The product was given in a dose of 900 mg, twice daily, before meals, for six weeks (Englisch et al., 2000). This well-conducted trial indicates efficacy of Valverde Artischocke in the treatment of elevated cholesterol.

A review of metabolic, pharmacological, and clinical studies described two postmarketing surveillance studies (Kraft, 1997). The first study, reported by Held (1991), included 417 patients with hepatic and biliary tract disease who were treated for four weeks with artichoke leaf extract (product not named).

Prior to the study, the average duration of symptoms of abdominal pain, bloating, meteorism, constipation, lack of appetite, and nausea was four months. Elimination of these symptoms occurred in 65 to 77 percent of patients after one week, and in 52 to 82 percent of patients after four weeks.

The second postmarketing surveillance study was published by Fintelmann (1996) and Fintelmann and Menssen (1996). It included 553 subjects with dyspepsia who were administered the Lichtwer product Hepar-SL. The authors reported a clinically impressive and statistically significant improvement for 87 percent of patients within six weeks of treatment.

In a subset of 302 patients for whom cholesterol values were routinely determined, serum cholesterol and serum triglyceride concentrations dropped significantly (p <>

Walker, Middleton, and Petrowicz (2001) reported an analysis of another patient subset with key symptoms of irritable bowel syndrome (279 in number). These patients experienced significant reductions in symptoms (71 percent) after six weeks of treatment with six capsules per day, with improvement noted within ten days.

Although the initial survey by Fintelmann and Menssen (1996) did not include all the diagnostic criteria for IBS, patients were included if they had at least three of five key symptoms.

No adverse reactions or side effects were reported in the clinical studies described. The Fintelmann (1996) postmarketing study reported that 1.3 percent of 553 subjects experienced mild reactions, such as flatulence, feeling of weakness, and hunger.

Standardization of Botanical Preparations

2009-10-07T20:16:00.000-07:00

Standardization is probably one of the most controversial terms used to describe herbal supplements. Most would agree that the goal of standardizing herbal products is to provide product consistency and thus a reliable health benefit.

However, the term has been defined in several different ways. Standardization can mean the establishment of a consistent biological effect, a consistent chemical profile, or simply a quality assurance program for production and manufacturing.

How the process of standardization is applied depends, in part, on whether the active constituents in the botanical are well established. For that reason, the European Union has defined three categories of botanical products:

Those containing constituents (single compounds or families of compounds) with known and acknowledged therapeutic activity that are deemed solely responsible for the clinical efficacy;
Those containing chemically defined constituents possessing relevant pharmacological properties which are likely to contribute to the clinical efficacy; and
Those in which no constituents have been identified as being responsible for the therapeutic activity (Lang and Stumpf, 1999).

The standardization of active ingredients in botanical preparations is a well-established procedure that has been used for over a century. Before sophisticated chemical analytical methods were available, and when the active principles were unknown, preparations were standardized to biological activity.

This was accomplished with the help of bioassays: measurements of activity in animals or animal tissues. Bioassays were especially important tools for normalizing the activity of powerful drugs, such as digitalis, in which small variances in the glycoside content could lead to sufficient differences in the cardiac stimulating effect that could be dangerous.

Still today, the potency of digitalis preparations is determined using a pigeon assay, which compares the activity of the new preparation to that of a standard preparation (U.S. Pharmacopeia [USP], 2004b).

In those instances in which the chemical constituents deemed responsible for the clinical efficacy (active ingredients or active components) are known and easily measured, chemical analysis can indirectly determine biological activity. With the advent of more sophisticated chemical analytical techniques, it became more efficient to replace bioassays with the measurement of chemical constituents.

Standardization of a botanical product with established active components is achieved by adjusting the preparation to contain a defined level of active substance or group of substances in the dosage form. This can be achieved by adjusting the final amount of raw material (i.e., extract or powdered herb) in the dosage form so as to include a consistent amount of active constituent.

It can also be achieved by including a consistent amount of raw material that contains a consistent amount of active ingredient. In the latter case, the consistency of the raw material is achieved by blending different lots of material. As an example, milk thistle preparations contain silymarin, which is accepted as the active component of the botanical.

So, the amount of product in the dosage form could be either a fixed amount of silymarin in a variable amount of total extract, or a fixed amount of extract that has been adjusted to contain a fixed amount of silymarin. Guidelines for the standardization of specific botanical preparations can be found in pharmacopoeial monographs.

These guidelines include the methods used to determine the levels of active ingredients. As an example, the United States Pharmacopeia defines belladonna extract as containing not less than 1.15 g, and not more than 1.35 g, of alkaloids (measured as atropine [dl-hyoscyamine] and scopolamine via high performance liquid chromatography [HPLC]) in 100 g extract (USP, 2004a).

The European Pharmacopoeia defines standardized belladonna leaf dry extract as containing not less than 0.95 percent, and not more than 1.05 percent, total alkaloids calculated as hyoscyamine measured via titration (European Pharmacopoeia [Ph Eur], 2002a).

An important distinction can be made between single chemical compounds that are active ingredients and active components of a mixture. For example, hyoscyamine as an isolated compound may be an active ingredient in a pharmaceutical formula. However, as a component of belladonna extract, and one of several alkaloids in the extract with activity, it is an active component of the extract.

Standardization to active constituents can ensure consistency between lots produced by the same manufacturer.However, it is just one step toward comparing a proprietary preparation that has been tested in clinical studies with another proprietary preparation of the same botanical.

Even if the claimed level of constituents is accurate, the inherent variability in the undefined portion of the extract must be considered. In addition, different formulations or routes of administration may affect the bioavailability (levels of active components present at the site of action in the body).

Identifying Botanical Product Guidelines

2009-10-06T20:15:00.000-07:00

As demonstrated, therapeutic effect is a result of the following variables: botanical identity, chemical profile, formulation, bioavailability, and dose. Therefore, characterization of botanical products, in publications and scientific studies, needs to include all of that information.

An adequate description of botanical products is needed in order to ensure a consistent therapeutic effect. It is also needed to be able to compare products and to conduct statistical analyses on the results of multiple trials. Editors of scientific, particularly medical, literature need to be cognizant of the breadth of information required.

The Journal of Natural Products, published by the American Chemical Society and the American Society of Pharmacognosy, provides guidance to its authors in the characterization of botanical substances. It requires that experimental biological material be authenticated as to its identity and that the herbarium which holds the voucher specimen be given along with the voucher number.

It further requires that the scientific name (genus, species, authority citation, and family) be given. It also requires authors who purchase dried “herbal remedies” or other materials from companies to deposit a specimen in an herbarium, for future access.

It requires that the extraction procedure be specified when studying a commercially available extract and that the identification of the extract be supported by an HPLC trace of known secondary metabolite constituents (Journal of Natural Products, 2003).

NCCAM, in its guidelines for clinical trial grant applications, suggests that when plant material is used in a trial, it be accompanied by a botanical description, extraction procedure, the quantity of any known active constituent(s), as well as identity and stability tests.

When a product is used, information about the manufacturing process, analysis for impurities, and quality controls for manufacturing must be included. In addition, disintegration/dissolution rates are required to estimate bioavailability (NCCAM, 2003).

Preparations and Formulations of Botanical Products

2009-10-05T20:14:00.000-07:00

Herbs are sold in many forms, as fresh plant material in the produce department of a grocery store, and as dried plant material in bulk, tea bags, capsules, or tablets. Fresh or dried plant material can be prepared as extracts, either sold in liquid form, or dried and formulated into tablets or capsules, both hard and soft.

The diversity in plant preparations is illustrated by those available for commercially supplied Asian ginseng roots, which are graded according to their source, age, part of the root, and method of preparation (Bahrke and Morgan, 1994).

The root can be used fresh, or prepared as “white” ginseng (peeled and dried) or “red” ginseng (steamed and dried). The fresh root is often thinly sliced and taken with or without honey, or it can be boiled in soup. White or red ginseng can be powdered, extracted, or made into a tea (Yun and Choi, 1998).

The different ginseng root preparations differ in their chemical composition. As an example, we know that the heating process in the production of red ginseng converts the malonylginsenosides to their ginsenoside counterparts and also results in other chemical transformations (Chuang et al., 1995).

The preparations described are, by definition, of different strengths and composition. Thus the type of preparation will have an influence on the recommended dose. Teas prepared with hot water are usually quite dilute in contrast with extracts that are more concentrated.

So it follows that the type of preparation must be taken into account in determining the dose. For example, peppermint tea may be drunk by the cupful, while peppermint oil is administered in doses of five hundredths of a milliliter (Wren, 1988).

The type of preparation, and formulation of the preparation, will have an influence on the ability of the chemical components of the herb to be assimilated into the body. This is especially a concern with tablets and capsules whose contents must first dissolve before being absorbed.

Coatings on the surface of tablet or capsules may be designed to either accelerate or delay dissolution (release of chemical constituents) in the gastrointestinal tract. As an example, garlic products often have enteric coatings to delay dissolution until the garlic preparation reaches the intestine.

The reason for this is that garlic powder contains the enzyme allinase, which is necessary to produce the active constituent allicin, and that enzyme is destroyed by the acidic pH of the stomach. Studies on the effectiveness of Kwai garlic to reduce elevated serum cholesterol levels have been inconsistent.

A review found a highly significant difference in effectiveness between studies conducted before 1993 and those conducted in 1993 and later. The authors found that the amount of allicin released under simulated gastrointestinal conditions correlated well with the success or failure of the tablets to lower serum cholesterol values.

The sharp decline in the effectiveness of the tablets is paralleled by sharp declines in both the acid resistance and the allicin release from the tablets, apparently caused by a change in the coating of the tablet (Lawson, Wang, and Papadimitriou, 2001).

Preparations

Teas and Decoctions

A tea, or infusion, is made by pouring boiling water over finely chopped plant material (usually leaves and flowers). The mixture is allowed to stand for a period of time before straining. The usual ratio is 500 ml (1 pint) ofwater to 30 g (1 oz) plant material.

Adecoction is made by adding cold water to the plant material and then heating it to a boil. The mixture is allowed to simmer before cooling and straining. Decoctions are often made of roots, bark, and berries, which may require more forceful treatment than more fragile plant parts such as leaves and flowers.

The same proportions of water to plant material apply, but it is best to start with 800 ml (1½ pints) to allow for evaporation. Teas and decoctions may be consumed either hot or cold.

Plant Juices

Freshly harvested plant parts can be pressed to release their juices. The shelf life of the expressed juice is usually extended by pasteurization or by rapid, ultra-high-temperature treatment. In addition, alcohol may be added as a preservative.

Tinctures

A tincture is made by soaking the plant material in a solution of alcohol and water for a period of time followed by filtering. Tinctures are sold in liquid form and are useful for both concentrating and preserving an herb. They are made in different strengths that are expressed as ratios.

Traditionally, a ratio of 1 part herb to 5 or 10 parts liquid (1:5 or 1:10) has been used. These ratios represent 100 g (3½ oz) plant material in 500 ml (1 pint) of solvent, or 100 g plant material in 1000 ml (2 pints) solvent.

Extracts

Extracts are concentrated preparations that can be in liquid, viscous, or powdered form. They are prepared from fresh or dried plant material by distillation, maceration (soaking then filtering), or percolation. The extraction liquid or solvent is chosen for its chemical properties, as it will selectively extract components in the plant that match those chemical properties.

Typical solvents include water-alcohol mixtures, glycerin (a colorless, odorless, syrupy, sweet liquid), oils, supercritical gases (carbon dioxide can be liquefied at certain temperatures and pressures), hexane, methylene chloride, acetone, and ethyl acetate.

Some or all of the liquid solvent can then be evaporated to make a dry extract, which can be easily placed into capsules or made into tablets. This is often accomplished by evaporating the liquid in the presence of a carrier such as cellulose, lactose, maltodextrose, or even dried plant material.

Again, ratios are used to describe the strength of the extract. Most crude plant materials have a content of roughly 20 percent extractable substances which corresponds to an herb to extract ratio of 5:1. If the extract is further purified, even greater ratios can be obtained.

However, this means that some components of the plant have been selected over other components. For example, the standardized ginkgo extracts, which are made in a multistep purification process, are highly purified extracts with an average ratio of 50:1.

This ratio means that 50 parts of plant material went into producing one part extract. Essentially the extract is a concentration of certain flavonoids and terpenes present in ginkgo leaves.

Syrups

Medicinal syrups are viscous liquids that contain a minimum of 50 percent sugar, more typically 65 percent, added to a plant extract. This high concentration of sugar acts as a preservative.

Oils

Oils can be produced by pressing or extracting plant materials such as seeds and fruits. Crude oils can be refined by distillation. Alternatively, medicinal oils can contain plant substances dissolved in oil. These oil-based extracts are typically used as salves or in other topical applications.

Formulations

Tablets

Tablets are made by compressing powdered or granulated material. Besides the active ingredients, tablets may contain diluents, binders, lubricants, coloring, and flavoring agents. They also contain disintegrators that help the compressed tablet to dissolve when it comes in contact with water.

Tablets can be coated with sugar, dyes, fat, wax, or film-forming polymers. The function of the coating may be to extend the life of the tablet by protecting the active ingredients.

It also may be to control or delay the release of the active ingredient. Coated tablets may mask any unpleasant taste of the active ingredient and may make the tablet easier to swallow.

Capsules

Hard gelatin capsules consist of a two-part cylindrical shell. They usually enclose plant material or dried extracts. Soft gelatin capsules are spherical, oval, oblong, or teardrop shaped and consist of a gelatin shell enclosing semisolid or liquid contents.

The composition of the capsule can be designed to control the release of the contents. For example, an enteric coating, which resists the acid in the stomach, will dissolve in the intestine when the pH rises above 7.

Lozenges

Lozenges have a tabletlike appearance but differ in that they are not made by compression. They are molded or cut from a gummy mass. Lozenges are designed to release the active ingredient slowly in the mouth while being sucked or chewed. They are often made with sugar, gums, gelatin, and water.

Assuring Plant Identify

2009-10-04T20:12:00.000-07:00

The primary way to identify plant material is through physical examination of the features of the entire plant, especially the flowers. Those features are compared to descriptions in plant taxonomy books and/or to specimens whose identity has already been established by a botanist.

When a specimen is identified by a botanist, it is said to be authenticated. Sensory information, referred to as organoleptic features (color, texture, smell, taste), can also yield information on the identity of whole, chopped, or milled plant material.

Further information on identity of milled or powdered plant material is provided by microscopic examination that allows for viewing of tissue structures, organization, cell types, and cell contents. Chemical constituents are also important in identification.

Plants contain thousands of chemical components, including basic proteins and sugars necessary for metabolism and structure. They also contain secondary compounds that were originally thought not to be essential to the life of the plant, but have important medicinal qualities for mammals.

The best known of these secondary components are the alkaloids, a group which includes nicotine, caffeine, morphine, and cocaine. Other classes of secondary compounds include phenolics, terpenoids, and steroids (Trease and Evans, 1978).

Chemical analysis can be useful in identification even when physical examination of plant structures is not possible, such as with fine powders and extracts. For any material studied scientifically, or sold in retail, a sample should be retained for a period of time.

This sample could be examined in the future, should any questions arise regarding identity or quality. In the case of fresh plant material, this can be a voucher specimen that is pressed and dried.

If the test material is milled or powdered, or even in final product form, a retained sample, in that form, may still be used to answer any possible inquiries that might arise regarding identity or quality.

Voucher Specimens

Voucher specimens include the whole plant, or representative parts of the plant (ideally including flowers and seeds), pressed, dried, and fastened to an 11.5" by 16.5" card. Included along with the plant material is information as to the location and environment from which the plant was collected.

Prepared in this way, the taxonomic identity of the specimen can be determined by a botanist. The specimen also serves as a lasting record. Millions of plant specimens have been collected and stored in herbaria, to serve as reference collections of the world’s flora.

Most universities and many private organizations that work with plants house herbaria. The largest herbarium in the United States is the National Herbarium in Washington, DC, which houses 4.5 million specimens and contains collections from the exploration of North America in the 1800s (www.nmnh.si.edu).

The world’s largest herbarium is the Royal Botanical Gardens in Kew, England, with over seven million specimens from all over the world, including 250,000 type specimens (specimens that define taxonomic species) (www.rbgkew.org.uk).

Voucher specimens are the most appropriate form of identification for primary suppliers of botanicals, i.e., farms, collectors, and those who have access to the entire plant.

Organoleptic Identification

Sensory, or organoleptic, information is very useful to those experienced with plant materials in establishing identity. Sight, touch, smell, taste, and sound can also assist in assessment of the quality of the material. Organoleptic features are included in the following characterization of cinnamon bark (Cinnamomum verum J. Presl.):

The matt pieces of bark, 0.2 to 0.7 mm thick, in the form of single or double compounds quills, light brown on the outside and somewhat darker on the inside; the surface longitudinally striated and the fracture is short and splintery. The odor is characteristic and pleasantly aromatic. The taste is pungently spicy, somewhat sweet and mucilaginous and only slightly sharp. (Wichtl, 1994, 148)

Microscopic Identification

Characteristic tissue structures, tissue organization, cell types, and cell contents can be viewed under magnification. For example, the glandular (rounded, multicellular) hairs common to mint leaves are quite distinct from the stellate (star-shaped) hairs of witch hazel leaves when viewed under a microscope.

The addition of chemical reagents to the microscope slide can verify the presence and location, or absence, of starch grains, calcium carbonate, and/or oxalate crystals, as well as lignin (a plant cell wall component). Starch grains will appear purple following the addition of iodine, and their size and pattern are indicative of certain plants.

Lignin will appear red with the addition of acidic phloroglucinol solution and is present in the cell walls of woody plants. The appearance of uncharacteristic components is an indication of adulteration or substitution.

Chemical Identification

Simple chemical tests can be performed on milled or powdered plant material by adding a few drops of a particular chemical reagent to the plant material. These tests usually indicate the presence or absence of a characteristic class of chemical constituent, for example, steroids or alkaloids.

The presence of alkaloids, for example, can be determined by a purple (reddish-brown) color reaction following addition of Dragendorff’s reagent (a solution of potassium bismuth iodide).

Extracts of plant material can be analyzed in more detail for characteristic compounds using spectroscopic analysis and chromatographic techniques. Spectroscopic analyses employ light absorption techniques to analyze classes of compounds.

They include ultraviolet (UV), infrared (IR), and Fourier-transfom infrared (FTIR) spectroscopy. Chromatographic techniques allow for the isolation and quantification of individual compounds.

Components of the mixture are separated through chemical affinity to either the mobile phase (liquid or gas) or the stationary phase (solid substance such as silica over which the mobile phase runs).

These techniques include thin layer chromatography (TLC), high performance thin layer chromatography (HPTLC), gas chromatography (GC), capillary electrophoresis (CE), and high performance liquid chromatography (HPLC).

Plant extracts examined using either spectroscopic or chromatographic techniques will display a characteristic profile, or “fingerprint,” which is useful in identification. Even without chemical identification of all the individual components, a particular pattern accompanied with the identification of a few components can be an assurance of identity.

Chemical analysis is often offered as proof of identity of plant material, but it is not necessarily enough by itself. To prove this point, Dr. Alvin B. Segelman (1995) demonstrated that belladonna alkaloids added to sterilized cow dung could pass the U.S. Pharmacopeia chemical identification test.

However, when the material was examined microscopically itwas clear that itwas neither belladonna leaves nor roots. Conversely, if plant material has been depleted chemically, through extraction, it may pass microscopic examination due to the remaining cell structure, but not chemical analysis.

Therefore, both physical characterization (microscopic examination) and chemical analyses are needed for optimal identification. When the results of chemical analysis are given as descriptors of a product, some indication of the test method must be provided.

For example, extracts of St. John’s wort (Hypericum perforatum L.) are often described as standardized to 0.3 percent hypericins. Hypericin is one of a group of biologically active dianthrones (phenolic compounds) in the herb that includes hypericin, pseudohypericin, protohypericin, and protopseudohypericin. The dianthrones in the extract can be measured using either UV spectroscopy or HPLC.

UV spectroscopy will provide information as to absorption of light by compounds at a specific wavelength. Thus UV spectroscopy will indicate the total quantity of the dianthrones in the extract (as well as other compounds that absorb light at the tested frequency), and the results can be described as total hypericins.

In contrast, HPLC analysis allows for the separation and quantification of the individual compounds. HPLC allows the quantities of hypericin, pseudohypericin, and other dianthrones to be determined individually. Therefore, the quantity of total hypericins as determined by UV will be different from the amount of the individual hypericin as quantified by HPLC.

As another example, the U.S. Pharmacopeia (2004) method of measuring the alkaloids in belladonna extract via HPLC will give a slightly different number from the European Pharmacopoeial (Ph Eur) method which measures total alkaloid content via titration (Ph Eur, 2002). Thus in describing the amount of any constituent in a botanical, the method of analysis must be indicated.

Identifying Plants By Name

2009-10-03T20:10:00.000-07:00

Purple coneflower, black samson, red sunflower, comb flower, cock-up-hat, Indian head, and Missouri snakeroot are all common names for the same plant as defined by its Latin binomial, Echinacea purpurea (L.) Moench (Hobbs, 1994).

Another plant, also known locally in the U.S. Midwest as snakeroot, has a completely different Latin name: Parthenium integrifolium L. Confusion over the similar common names is thought to be the cause of exportation of Parthenium root as Echinacea purpurea root to Europe.

The substitution of Parthenium for Echinacea has raised doubt over which plant material was used in clinical trials conducted in Germany before 1986 (Awang and Kindack, 1991). Common names are not definitive, as demonstrated in the previous example.

Different plants may have the same common name, or the same plant may have different common names. Common names are given in the local language and often vary depending upon the region. In contrast, the scientific name, or Latin binomial, is a definitive name, and if used properly should eliminate confusion.

The name is composed of the taxonomic categories of genus and species followed by the name of the scientific authority, or authorities, who officially described the plant. Thus in the binomial for garlic, Allium sativum L., the “L.” at the end is an abbreviation for Linnaeus, the famous botanist of the 1700s.

Scientific names are based on guidelines laid down by the International Code of Botanical Nomenclature (ICBN). These rules were originally established in 1930 and are periodically revised (Greuter et al., 2000). According to the ICBN, the Latin binomial is accompanied by a published description and a “type” specimen upon which that description is based.

Although Latin names are definitive, they can be revised. All taxonomic revisions are conducted according to a detailed set of guidelines established by the ICBN. An old name can be replaced by a new one, or the definition of a name can be altered.

When the definition is altered, but the name remains the same, both authorities are listed after the binomial, with the previous authority listed in parentheses. As an example, we have the name for milk thistle, Silybum marianum (L.) Gaertn.

Latin names are commonly listed with the taxonomic family to which they belong. Milk thistle is in the sunflower family, or Asteraceae. Thus, the complete name for milk thistle is Silybum marianum (L.) Gaertn., Asteraceae.

The American Herbal Products Association (AHPA) has attempted to solve the confusion over common names by establishing definitive common names to be used in trade. In a publication titled Herbs of Commerce, AHPA has defined common trade names by pairing them with their Latin binomials (McGuffin et al., 2000).

The FDA, in its dietary supplement labeling regulations, has recognized the common names listed in Herbs of Commerce as official trade names (CFR 21 Part 101.36, 1997).

Identifying and Characterizing Botanical Products

2009-10-02T20:05:00.000-07:00

When referring to a botanical product in a scientific report, details such as the scientific name of the plant, plant part, preparation, formulation, and dose must be included as the basis of any discussion of therapeutics. Without a full description of the test material, there can be no assurance of a reproducible effect.

Dr. Varro Tyler addresses the lack of proper characterization of botanical materials in clinical study publications. The omissions he describes are still more common than not, even in the most prestigious medical journals.

The need for guidelines in the characterization of botanicals has been acknowledged by the National Center for Complementary and Alternative Medicine of the U.S. National Institutes of Health (NCCAM). NCCAM recently added a description of characterization parameters expected of botanical products to the grant application guidelines on their Web site.

An unfortunate recent example of an inadequately described product was a report of a trial studying the effectiveness of echinacea for the prevention of experimental rhinovirus colds. The authors acknowledge in their report that three species of echinacea are used medicinally and that different echinacea preparations differ in their chemical composition.

They therefore present chemical analysis of the test sample as 0.16 percent cichoric acid with almost no echinacoside or alkamides (Turner, Riker, and Gangemi, 2000). However, the paper does not state whether the echinacea preparation was powdered plant material or an extract.

Further, we are not told the species or the plant part (the flowering tops and/or roots of echinacea are both commonly used). When I contacted the lead author, Dr. Turner, it was apparent that he was not informed of the taxonomic identity of the material that he tested, although he did tell me it was powdered plant material.

Further inquiries by Dr. Tyler of the supplier led to the information that the material was 85 percent Echinacea purpurea root and herb with 15 percent E. angustifolia root extract powder. However, Dr. Tyler and I were still puzzled, as the results of the chemical analysis did not fit the suggested identification.

The combination of E. purpurea root and herb with E. angustifolia root would be expected to contain both alkamides and echinacoside, as alkamides are present in both species and echinacoside is present in E. angustifolia roots. Lack of adequate identification can lead not only to scientific confusion, but also to substitutions that can have toxic consequences.

In one incident the similar-looking leaves of a species of digitalis (Digitalis lanata Ehrhart) were accidentally substituted for plantain (Plantago lanceolata L.), thereby causing heart arrhythmia (Slifman et al., 1998).

In several other incidents confusion over traditional Chinese names led to the substitution of guang fang-ji root, also known as fang-chi (Aristolochia fangchi Y.C. Wu ex L.D.), for han fang-ji (Stephania tetrandra S. Moore) root. Unfortunately, the use of the Aristolochia species caused liver failure and death in several individuals (Vanhaelen et al., 1994).

OTC and RX Drugs

2009-10-01T20:01:00.000-07:00

Before a botanical product is marketed as a drug with a claim to diagnose, treat, cure, or prevent a disease, it must first be approved by the FDA. The revision of the Food, Drug, and Cosmetic Act in 1962 required all drugs marketed after that time to be proven both safe and effective.

This revision presented the FDA with the challenge of updating its approval of hundreds of drugs already on the market that had not been proven effective. The FDA set up panels of experts to review the active ingredients of these drugs, many of which were sold over-the-counter.

However, many herbal products were found to be either unsafe, ineffective, or simply lacking sufficient evidence to evaluate (Tyler, 1993). In order to obtain drug status for a new botanical product, or for one that failed a previous evaluation, manufacturers must submit a New Drug Application (NDA) to the FDA.

This requirement holds whether the new drug is to be sold as an OTC or Rx drug. The NDA must contain evidence of the product’s safety and efficacy. This evidence is usually in the form of pharmacological studies, ranging in scope from in vitro assays and small animal studies to randomized, double-blinded clinical trials in humans, with an emphasis on the clinical studies.

The benefit to pharmaceutical firms which manufacture synthetic chemical drugs is that their research is rewarded by patent protection for a substantial period of time. However, as most herbs have previously been marketed in a traditional form, and thus are not new or unique, they are not eligible for patent protection.

There are some exceptions when a botanical is prepared in a unique form (for example, the ginkgo extract EGb 761) or for a previously unknown use. Without patent protection, most manufacturers are unwilling to spend the money necessary to conduct the research required for a new drug application.

In addition, manufacturers may find it easier to forego scientific studies as they can easily sell their products as dietary supplements. The Commission on Dietary Supplement Labels (1997) recommended that the FDA establish a “review panel for OTC claims for botanical products that are proposed by manufacturers for drug uses” (p. 57).

However, in April 1998 the FDA published a notice responding to the commission report, indicating that the agency considers such a review to be “premature” at this time. The FDA did not give an explanation for their decision (FDA Notice, 1998).

Petitions formally requesting that valerian and ginger be recognized as old OTC drug ingredients were filed with the FDA in 1994. Nearly six years later, the agency issued a response provisionally accepting the supporting data, which was largely European, but only under very stringent conditions.

Valerian and ginger have yet to become OTC drugs. Numerous experts agree that a select number of botanicals are proper candidates for OTC drug status.

Although this would mean that some plant extracts would be available both as dietary supplements and OTC drugs, it is likely that many American consumers who currently would not use a certain herb as a dietary supplement would accept and use that same herb if it were offered as a drug that has received FDA (government) approval.

Likewise, physicians, pharmacists, and other health care providers would be far more inclined to recommend, or at least not discourage, the use of an herba OTC drug. The reasons being that OTC drugs are manufactured under stricter good manufacturing practices, and OTC products have mandatory labeling which includes dosage recommendations, cautions, and warnings.

Although manufacturers of botanical products are welcome to submit their products for review under the new drug approval process, it does not appear that the FDA is prepared to actively welcome OTC applications for botanicals as old drug ingredients.

That is, for a botanical to achieve OTC status, it must have all the scientific research required for a new drug. It is unlikely to be “grandfathered in” as an old drug without that documentation.

Dietary Supplement Health and Education Act (DSHEA)

2009-09-30T20:00:00.000-07:00

DSHEA defines the term dietary supplement as an herb or other botanical or concentrate, constituent, extract, or combination of any botanical that is intended for ingestion as a tablet, capsule, or liquid, is not represented for use as a conventional food or as a sole item of a meal or the diet, and is labeled as a dietary supplement.

This includes new drugs that were marketed as botanicals prior to such approval; it does not include a botanical approved as a new drug, or authorized for investigation as a new drug, and not previously marketed as a dietary supplement. Botanicals are not classified as food additives.

Dietary supplement products are allowed to contain botanicals that have been present in the food supply and in a form in which the food (botanical) has not been chemically altered. Dietary supplement ingredients marketed in the Unites States before October 15, 1994, are regarded as safe because of their long history of use.

Those ingredients not marketed before then are “new” ingredients. At least 75 days before introduction into commerce, manufacturers must provide the FDA with information that shows the new botanical can reasonably be expected to be safe under conditions of use or labeling.

DSHEA states that a botanical is considered unsafe under one of two conditions: (1) it presents a significant or unreasonable risk of illness or injury under conditions of use recommended or suggested in labeling, or (2) it is a new botanical for which inadequate information exists to provide reasonable assurance that it does not present a significant or unreasonable risk of illness or injury.

In any case, the FDA shall have the burden of proof to show that a botanical is unsafe. A botanical is also considered unsafe if it is prepared, packed, or held under conditions that do not meet current good manufacturing practice regulations (GMPs).

For the moment, the preparation and packaging of dietary supplements is covered by the same GMPs that apply to conventional foods. However, DSHEA authorizes the FDA to establish separate GMPs for dietary supplements, and rule making by the FDA is imminent.

The label must identify the product by the term dietary supplement. Botanical dietary supplement labels must list the name of each ingredient, the quantity of such ingredients, or, if a proprietary blend, the total quantity of all ingredients. The label must also identify any part of the plant from which the ingredient is derived.

Botanical dietary supplements are misbranded if they are represented as conforming to such official compendium as USP and fail to do so, fail to have the identity and strength which they represent to have, or fail to meet the quality, purity, or compositional specifications, based on validated assays or other appropriate methods, which they are represented to meet.

Literature, including an article, a chapter in a book, or an official abstract of a peer-reviewed scientific publication which appears in an article shall not be defined as labeling when used in connection with the sale of botanicals to consumers provided that it is not false or misleading, does not promote a particular manufacturer or brand of botanical, is displayed or presented with other items on the same subject matter so as to present a balanced view of the available scientific information on a botanical, and, if displayed in an establishment, is physically separate from the botanical and does not have appended to it a sticker or other method that associates it with the product.

Under DSHEA, a statement for a botanical dietary supplement may be made if the statement describes how a botanical is intended to affect the structure or function of humans, characterizes the documented mechanism by which a botanical acts to maintain such structure or function, or describes general well-being from consumption of a botanical.

The statement must contain, prominently displayed and in bold-faced type, the following: “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

The FDA published a final rule in the Federal Register on February 7, 2000 (docket No. 98N-0044), which describes how the agency will distinguish disease claims from structure/function claims. The rule permits health maintenance claims (“maintains a healthy circulatory system”), other non-disease claims (“for muscle enhancement,” “helps you relax”), and claims for common, minor symptoms associated with life stages (“for common symptoms of PMS,” “for hot flashes”).

It does not allow for claims regarding diseases (“prevents osteoporosis”) or implied disease claims (“prevents bone fragility in postmenopausal women”) (FDA, 2000). As with all food labeling, statements must be truthful and not misleading.

Statements of nutritional support may be made without prior FDA review, but the manufacturer must notify the FDA within 30 days of marketing a product with a new claim and must have substantiation for the claim. Criteria for substantiating a claim are not yet defined by the FDA.

However, advertising guidelines for benefit statements for dietary supplements have been published by the Federal Trade Commission (1998) and can be found on their Web site (www.ftc.gov). DSHEA establishes that a botanical is not a drug solely because its label or labeling contains a statement of nutritional support. Also, a botanical shall not be deemed misbranded if its label or labeling contains directions or conditions of use or warnings.

DSHEA established a presidential commission to study and provide recommendations for the regulation of label claims and statements for botanicals, including the use of literature in connection with the sale of botanicals, and procedures for evaluation of such claims.

The seven members of the Commission on Dietary Supplement Labels were appointed by the president to evaluate how best to provide truthful and scientifically valid information about dietary supplements to consumers. The commission’s final report, which was submitted to the president and Congress in November 1997, included guidance regarding statements of nutritional support and the substantiation of such claims.

The commission recognized that under DSHEA, botanical products should continue to be marketed as dietary supplements, when properly labeled. However, they recommended that a review panel be established to review claims for OTC drug uses (Commission on Dietary Supplement Labels, 1997).

DSHEA also established an Office of Dietary Supplements (ODS) within the National Institutes of Health (NIH). The purposes of the office are to explore the potential ability of botanicals to improve health care and to promote scientific study of the benefits of botanicals in maintaining health and preventing chronic disease.

The director of the ODS is to conduct and coordinate scientific research relating to botanicals that can limit or reduce the risk of diseases such as heart disease, cancer, birth defects, osteoporosis, cataracts, or prostatism, collect results of scientific research related to botanicals and compile a database, and serve as a principal advisor to the NIH, the Centers for Disease Control and Prevention (CDCP), and the commissioner of the FDA on issues relating to botanicals and scientific issues arising in connection with the labeling and composition of botanicals.

Currently the ODS, in collaboration with the National Center for Complementary and Alternative Medicine (NCCAM), sponsors six botanical research centers. The ODSWeb site hosts two databases: one containing information regarding federally funded research on dietary supplements (CARDS, “Computer Access to Research on Dietary Supplements”) and the other containing scientific literature regarding dietary supplement ingredients (IBIDS, “International Bibliographic Information on Dietary Supplements”).

The ODS is also conducting systematic reviews of the literature in order to determine areas needing research and to assist in the development of clinical guidelines. Fact sheets with information on the most commonly used botanicals are in preparation.

The ODS, again in conjunction with NCCAM, has sponsored clinical trials on St. John’s wort and ginkgo. Several dozen other trials on botanicals are currently listed on the NCCAM Web site. The ODS is also currently supporting the development of validated analytical methods, standards, and reference materials for the most commonly used botanicals.

Regulation of Botanicals in the United States

2009-09-29T19:58:00.000-07:00

At least four regulatory classifications are now possible for botanicals in the United States:

Food
Dietary supplement
Over the-counter (OTC) drug, and
Prescription (Rx) drug.

However, most botanical products are regulated as dietary supplements according to provisions in the Dietary Supplement Health and Education Act (DSHEA) of 1994.

Plants have, at one time, supplied virtually all cultures with food, clothing, shelter, and medicines. It is estimated that approximately 10 to 15 percent of the roughly 300,000 species of higher plants have a history of use in traditional medicine.

By contrast, only 1 percent of plant species have a history of food use (McChesney, 1995). One hundred years ago, herbs were well established as medicines in the United States. They were widely listed in the United State Pharmacopeia (USP) and prescribed by physicians.

Herbal tinctures, extracts, salves, and so forth, were the materia medica of the day. Regulation of medicines in this country began when the authority to set and enforce drug safety standards was given to the Food and Drug Administration (FDA) in 1938.

The passage of the Food, Drug, and Cosmetic Act gave the FDA the responsibility to prosecute the adulteration or misbranding of foods, drugs, and cosmetics. Herbal preparations soon gave way to single-entity chemical drugs. WorldWar II created a demand for more powerful drugs of all kinds, particularly antibiotics and trauma treatment agents.

The federal government urged drug companies, then largely botanical crude-drug houses, such as Merck, Lily, and Parke-Davis, to invest in new synthetic chemistry-based research. Single-entity chemicals were more consistent, easier to measure, and judged more specific in their therapeutic focus than botanical preparations.

In 1951, Congress passed the Durham-Humphrey Act which defined a prescription drug as any drug that because of its toxicity or other potential for harmful effect or method of use is not safe for use except under the supervision of a practitioner licensed by law to administer such a drug (Young, 1995).

Manufacturers at that time had to position their drugs as either Rx or OTC. In 1962, the Food, Drug, and Cosmetic Act was expanded to require all drugs marketed at that time to be proven both safe and effective. The FDA then issued guidelines for safety and efficacy testing requirements for new drugs.

As a result, new drugs now required the FDA’s approval before marketing. Old drugs were permitted to remain on the market as long as their ingredients and labeling remained unchanged. In 1972, the FDA began a comprehensive review of all OTC drug products to assess their safety and efficacy.

Drug ingredients found to be generally recognized as safe and effective (GRASE) were placed into Category I and approved for marketing. Those determined to be unsafe or ineffective were placed in Category II and banned from use in any OTC drug.

If safety and efficacy could not be determined due to a lack of information, then the ingredient went into Category III. With few commercial sponsors to conduct safety and efficacy studies, many botanicals, listed as possible or known ingredients in OTC products, were relegated to Category II status and some were placed in Category III.

With few herbs retaining drug status after the OTC review, the botanical industry had no other regulatory option but to offer their products as foods. In the late 1970s, the FDA began to apply the food additive provisions of the Food, Drug, and Cosmetic Act to botanicals.

Under provisions added to the Federal Food, Drug, and Cosmetic Act of 1958, food additives already on the market in 1958 were accepted without FDA review. However, substances added to the food supply after this date were required to gain FDA approval prior to marketing, unless they were considered GRAS (generally recognized as safe).

A fair number of herbs were included on a list of GRAS food additives that had been prepared by the Flavor and Extract Manufacturers Association as flavorings for alcoholic beverages. However, the FDA viewed commonly used herbs as unapproved food additives and therefore subject to FDA approval prior to marketing.

This interpretation led to a series of bitterly fought court cases and several herbs being taken off the market. Congress passed the Nutrition Labeling Education Act of 1990 (NLEA) to reform food labeling and to allow, for the first time, a new class of health claims based on disease-nutrient relationships.

For the most part, this legislation did not apply to botanicals because of the way it was written and the way it was interpreted by the FDA. With lawsuits between herbal manufacturers and the FDA commonplace, a group of leading herb companies met with Senator Orrin G.

Hatch (R-Utah) and Congressman Bill Richardson (D-New Mexico) who drafted legislation that became the Dietary Supplement Health and Education Act of 1994. This law was passed by Congress and signed into law by President Clinton on October 25, 1994. This was the first time a U.S. law defined the terms herb or botanical.

Herbs For Eyes

2009-09-28T19:54:00.000-07:00

The eyes are the windows to the soul, and sight is one of our most valued senses, however sometimes we take it for granted until we begin to lose our prefect vision. Most often it is some type of malnourishment that causes our eyes to loose focus.

Sometimes it is a symptoms of another progressive disease. But for the common eyesight degeneration, I have seen people reclaim their good vision several months after incorporating an herbal program to their life. I have also seen people who have worked on their core problem with herbs improve their eyesight as a side effect of taking herbs and supplements.

You can use herbs to tone the eye muscle, relieve and nourish stressed or irritated eyes, and bring circulation to the eyes. All this can help restore better vision and increase the general health of your eyes.

Appropriately named, eyebright (Euphrasia officinalis) is an herb used to nourish, cleanse, tone, and strengthen the eyes. Eyebright has been used internally and externally for eye problems of all shorts. For better vision take internally. Eyebright usually comes in capsules and is many times found with other astringent herbs.

Its antibacterial effects make it an excellent tea to be used as an eyewash for conjunctivitis (pink eye) or sore, irritated, or itchy eyes. To use eyebright as an external eyewash, you have two options. If you have the herb in a capsules, empty one capsule per cup of water (one cup at a time should be more than sufficient).

If you are using the herb in bulk form, four heaping teaspoons equals about one capsules of powder. Then follow these steps:

Put herb in a cup of water, and bring to a boil.
Boil 10 minutes.
Let cool, and strain mixture well. (That's better than a sharp stick in the eye!)
Use a glass dropper to administer to eyes as needed. Do not touch the glass dropper to the eye, however; this will contaminate the mixture with the dropper, unless you sterilize first.
Store the mixture in a glass container in the refrigerator. Do not keep mixture longer than three to four days.

Bilberry fruit (Vaccinium myrtillus) is a potent herbal antioxidant source. Its ability to neutralize free radicals in the brain and the eyes makes it a powerful protector for the eyes. The part used historically is the fruit, sometimes also called huckleberry or blueberry.

British pilots during World War II used bilberry to improve their vision for night flying. Some reported improve vision within two weeks of using bilberry, and long term use of this safe herb will prove most beneficial. Bilberry's ability to strengthen blood capillaries also makes it an excellent tonic for people who bruise easily.

Bilberry used with eyebright and beta carotene makes a powerful combination to nourish and protect the eyes and to strengthen vision. It also works well for light-sensitive individuals. Bilberry is also used for diabetes, diarrhea, and mild inflammation.

Zinc and vitamins E, A, and C all work well to protect our vision and are all contained in eyebright and bilberry. Another practice you can choose to help tone the eyes is a cold water splash every morning and each night. Simply fill your sink with some cold water, cup the water in your hands, and splash your eyes.

The cold will help muscle retract, will tighten capillaries, and will tone your eyes. Many find this very refreshing and strengthening to their eyes. When poor eyesight is caused by a lack nutrients, herbs can restore eyesight safely and sometimes very quickly.

Herbs For Endometriosis

2009-09-27T19:54:00.000-07:00

Endometriosis is a female concern involving the presence of tissue similar to the lining of the uterus located (and usually growing) at other sites in the pelvis. Symptoms include painful menstruation, infertility, and, if left untreated, adhesions which attach themselves to other pelvis areas, such as the fallopian tubes, ovaries, uterine muscles, colon, and bladder.

These adhesions pull pelvic organs out of alignment and cause other painful problems. Many woman have hysterectomies for relief of this problem. Possible causes of this overgrowing tissue may be linked to hormonal imbalance, especially excess estrogen production, that cause tissue to grow wildly.

Estrogen dominance can be caused by an improper diet, prescription medications, xinoestrogens (plastics and petroleum products), and dioxins (herbicides and pesticides).

Pau d'arco is utilized by many women as a blood cleanser and dissolve cysts. Use pau d'arco to help in all ailments that are related to abnormal growths, such as cysts, cancer, tumors, and endometriosis. As always, combinations of herbs and sometimes supplements can speed your recovery.

Use sarsaparilla and pau d'arco aids in dissolving cysts and tissue overgrowth while sarsaparilla aids your body in progesterone production, which will help balance estrogen levels sometimes related to endometriosis.

For extra benefits, and more hormonal balancing effects, add the following combination along with your pau d'arco and sarsaparilla: golden seal, capsicum, ginger, uva ursi, crampbark, squawvine, blessed thistle, red raspberry, and false unicorn.

Extra vitamin C can enhance this herbal program. Soy estrogens from plant sources are known as phyto-estrogens and offer a very mild form of estrogen. They bind the estrogens receptors, making it difficult for "bad" estrogen to be effective. This makes soy valuable in helping to balance estrogen levels, especially when those levels are in excess.

As with anything to a hormonally include nature (this includes supplemental, over the-counter hormones such as melatonin or DHEA supplements) do not take hormones unless you first discuss it with your doctor. It might also be wise to consume only animal products that are labeled hormone-fee or organic.

Herbs For Eczema

2009-09-26T23:19:00.000-07:00

Eczema is described as a superficial inflammation of the skin, an itchy red rash often accompanied by small blisters that weep and become encrusted. Topically, eczema will be treated medically with locally applied steroid hormones to help reduce inflammation; however, since drugs can do damage to the body, try these safe herbal remedies first.

To help yourself get the best treatment possible you will need to understand which type of eczema you are exhibiting. Knowing this will help you better understand what you cause might be and will govern the approach to your treatment. Like I say over and over, finding your cause is a big part of finding your cure.

Some eczema is caused by allergy, some by lack of circulation, and some by something from the outside that your skin is contacting. For the sake of simplicity, we will work with an herb or two that serves to cleanse the blood via the liver and the lymphatics. Remember that the skin is always as clean as the blood is.

Some of these herbs will work to help your body chemistry balance, which will eventually cause your symptom to disappear. Once you find out the root of this problem, you can add herbs or make lifestyle changes to help you with the cause. For instance, if you have eczema related to a lack of circulation in the legs, incorporating an invigorating exercise program along with taking herbs that stimulate circulation will get to the core of your problem.

Oregon grape (Berberis Aquifolium) is probably the most widely used and accepted herbal remedy for chronic skin conditions such as eczema, dermatitis, and psoriasis, all skin inflammation disease. Its best use for helping eczema is in liquid extract or tea, and it can be used internally as well as externally.

Oregon grape goes to the liver and lymphatics, help purify blood, and serve as a mild laxative. It contains a powerful natural antibiotic similar to golden seal and has been used to clear up skin conditions of all kinds. Oregon grape is also used for acne, and detoxification.

It gets to the source of skin problems because it helps regulate bile flow, decreases liver congestion, promotes the digestion of fats, and helps relieve constipation, all of which contribute to skin ailments. Combinations used together to cleanse and feed the skin include burdock root, Oregon grape, pau d'arco, vitamins A and E, and zinc.

Because you will either make or purchase Oregon grape in a liquid form, it will be easy to apply to affected areas on the skin. Apply to a test area, such as the back of your hand, for several days each day, and watch how it works for you. You may want to apply it straight, or you can add it to your natural shampoo for eczema in the scalp.

Externally, you can also add the herb calendula (from marigold flowers), known for its soothing effects on the skin. Mix it with some aloe vera, and apply as a paste to affected areas. If you do not yet know the source of your eczema, eliminate any possible causes of skin irritants, such as toxic and industrialized chemicals.

Make a note if you have changed any of your soaps or laundry detergents. Some eczema can be triggered by allergies, so make a food diary and eliminate red meat, citrus fruits, and sugar from your diet, and see if your problem clears. This will help you learn what might be triggering this condition, too. Cleanse the bowel for quicker relief of all skin ailments.

Herbs For Earaches

2009-09-25T23:19:00.000-07:00

Oh, your aching head! Earaches are painful ailments usually brought on by an infection and can not only be painful but also cause dizziness. Many times earaches are common childhood complaint caused by allergies; make sure that there are no foreign objects in the ear before using herbs topically.

Some ear infections start with the growth of fungus on the ear drum. This can happen especially in warm, moist climates or when a person swims frequently. The following remedies will help you or your child fight the infection causing the earache and also help fight the fungus or infection locally.

Some infections can be aggravated by excess mucus production, and testing for food allergies is a good idea. Common food allergies involve wheat and sugar, so it will be helpful to eliminate these foods completely from your diet while fighting an infection.

Mucus and ear wax can hidden in the ear canal, leaving you vulnerable to earaches, infections, and dizziness. Sometimes a lack of essential fatty acids is the culprit in the excess production of ear wax. Consider supplementing with an Omega-3 oil, lecithin, or flax seed oil supplement to help emulsify some of that wax build-up. A capsule or two daily of any of these is useful.

We have already talked about Echinacea being a great remedy for colds, allergies, and other ailments. This is just one of those all-around safe herbs that is helpful for all types of infections. Echinacea can dry up excess mucus and can serve to heal earaches that are due to excess mucus in the sinus cavities.

Other herbal combinations you can take with your echinacea to help fight infection include garlic and mixture of parthenium, yarrow, myrrh, and capsicum. These all work synergistically to kill infection and lessen mucus; the capsicum acts as stimulator to increase the effectiveness of all herbs.

After infection is over, an herbal calcium supplement will aid your body in rebuilding tissue that need healing. Think of calcium as the "knitter" in the body; it helps wounds heal by supplying the ingredients your body needs to rebuild. Herbs rich in calcium and silicon (silicon is also food for the structural system) include oatsraw, horsetail, dulse, and rosemary.

Going right to the source with herbal infection fighters and pain relievers can speed up the healing process. Two to three drops directly into the earusing lobelia, garlic, mullein, or tea tree oil has been used with success for earaches for adults and children alike.

However, please avoid placing any drops in ears that have had tubes surgically inserted. Warm the oil up slightly by placing the oil bottle in a hot pan of water for a minute or so first. This makes it feel better and makes the oil less viscous, helping it slide easily into the ear canal.

This will all serve to soothe the canal and fight infection locally. Another home remedy helpful for ear pain involves a large onion. Here's the remedy:

Bake the onion until soft.
Cut the onion in half.
Let the onion cool until you can stand to place your finger into the center.
Lay the flat side of each half on each ear, and wrap the onion snugly around your head (you can do one at a time if you keep the other half of the onion warm.)
Keep on until the onion cools.

Not only does this help to relieve pain, but it can clear mucus congestion, too. Eliminate toxins from the body with bowel cleansing to help any ailment. Enemas for both children and adults can bring relief fairly quickly. Add some garlic to the enema water to give an extra bacterial-fighting boost to the body and speed recovery time.

Ear coning is used by some to get sinus and ear ache relief. Do not attempt ear coning alone, however. It is wise to have an experienced practitioner do this for you, or have someone teach you and your partner how do it for each other.