What are proteolytic enzymes as a therapeutic supplement?

Overview

Proteolytic enzymes (proteases) help the body digest the proteins in food.
Although the body produces these enzymes in the pancreas, certain foods also
contain proteolytic enzymes. Papaya and pineapple are two of the richest plant
sources, as attested by their traditional use as natural tenderizers for meat.
Papain and bromelain are the names for the
proteolytic enzymes found in these fruits. The enzymes made in the human body are
called trypsin and chymotrypsin.

The primary use of proteolytic enzymes is as a digestive aid for people who have
trouble digesting proteins. However, proteolytic enzymes may also be absorbed
internally to some extent and may reduce pain and inflammation.

Requirements and Sources

People do not need to get proteolytic enzymes from food, because the body manufactures them (primarily trypsin and chymotrypsin). However, deficiencies in proteolytic enzymes do occur, usually resulting from diseases of the pancreas (pancreatic insufficiency). Symptoms include abdominal discomfort, gas, indigestion, poor absorption of nutrients, and passing undigested food in the stool.

For use as a supplement, trypsin and chymotrypsin are extracted from the pancreas of various animals. Bromelain extracted from pineapple stems and papain made from papayas can also be purchased.

Therapeutic Dosages

The amount of an enzyme is expressed not only in grams or milligrams but also in activity units or international units. These terms refer to the enzyme’s potency (specifically, its digestive power). Recommended dosages of proteolytic enzymes vary with the form used. Because of the wide variation, label instructions regarding dosage should be followed.

Proteolytic enzymes can be broken down by stomach acid. To prevent this from happening, supplemental enzymes are often coated with a substance that does not dissolve until it reaches the intestine. Such a preparation is called enteric-coated.

Therapeutic Uses

The most obvious use of proteolytic enzymes is to assist digestion. However, a small double-blind, placebo-controlled trial found no benefit from proteolytic enzymes as a treatment for dyspepsia (indigestion).

Proteolytic enzymes can also be absorbed into the body whole and may help reduce inflammation and pain; however, the evidence is inconsistent. Several studies found that proteolytic enzymes might be helpful for neck pain, osteoarthritis, and post-herpetic neuralgia (an aftereffect of shingles). However, all of these studies suffer from significant limitations (such as the absence of a placebo group), and none provide substantially reliable information.

Studies performed decades ago suggest that proteolytic enzymes may help reduce the pain and discomfort that follow injuries (especially sports injuries). However, a more recent, better-designed, and far larger study failed to find any benefit. Proteolytic enzymes have also been evaluated as an aid to recovery from the pain and inflammation caused by surgery, but most studies are decades old, and in any case, the results were mixed.

A double-blind, placebo-controlled trial published in the 1960s found that use of
proteolytic enzymes helped reduce the discomfort of breast engorgement in
lactating women. A study tested bromelain for enhancing recovery from heavy
exercise by decreasing delayed-onset muscle soreness, but it found no benefits.
Another study, this one using a mixed proteolytic enzyme supplement, also failed
to find any benefits. Two studies failed to find proteolytic enzymes helpful for
reducing side effects of radiation therapy for cancer.

Some alternative medicine practitioners believe that proteolytic enzymes may help reduce symptoms of food allergies, presumably by digesting the food so well that there is less to be allergic to; however, there is no scientific evidence for this proposed use.

Another theory popular in certain alternative medicine circles suggests that proteolytic enzymes can aid rheumatoid arthritis, multiple sclerosis, lupus, and other autoimmune diseases. Supposedly, these diseases are made worse when whole proteins from foods leak into the blood and cause immune reactions. Digestive enzymes are said to help foil this so-called leaky gut problem. Again, however, there is no meaningful evidence to substantiate this theory. Furthermore, one fairly large (301-participant) study failed to find proteolytic enzymes helpful for multiple sclerosis.

Scientific Evidence

Most of the studies described in this section used combination products containing various proteolytic enzymes plus other substances, such as the bioflavonoid rutin.

Chronic musculoskeletal pain. Several studies provide preliminary evidence that proteolytic enzymes might be helpful for various forms of chronic pain, including neck pain and osteoarthritis. A double-blind, placebo-controlled trial of thirty people with chronic neck pain found that use of a proteolytic enzyme mixture modestly reduced pain symptoms compared with a placebo.

Osteoarthritis. Studies enrolling a total of more than four hundred people compared proteolytic enzymes to the standard anti-inflammatory drug diclofenac for the treatment of osteoarthritis-related conditions of the shoulder, back, or knee. The results generally showed that the supplement had benefits equivalent to those of the medication. However, all of these studies suffered from various flaws that limit their reliability; the most important flaw was the absence of a placebo group.

Shingles (herpes zoster).
Shingles is an acute, painful infection caused by the
varicella-zoster virus, the organism that causes chickenpox. Proteolytic enzymes
have been suggested as treatment. However, there is little evidence to support
their use. A double-blind study of 190 people with shingles compared proteolytic
enzymes to the standard antiviral drug acyclovir. Participants were treated for
fourteen days and their pain was assessed at intervals. Although both groups had
similar pain relief, the enzyme-treated group experienced fewer side effects.
However, since acyclovir offers minimal benefit at most, these results do not mean
very much. Similar results were seen in another double-blind study in which 90
people were given an injection of either acyclovir or enzymes, followed by a
course of oral medication for seven days.

Sports injuries. Several small studies have found proteolytic enzyme combinations helpful for the treatment of sports injuries. However, the best and largest trial by far failed to find benefit. A double-blind, placebo-controlled study of 44 people with sports-related ankle injuries found that treatment with proteolytic enzymes resulted in faster healing and reduced the time away from training by about 50 percent. Based on these results, a very large (721-participant), double-blind, placebo-controlled trial of people with sprained ankles was undertaken. This study failed to find benefit with rutin, bromelain, or trypsin, separately or in combination.

Three other small double-blind studies, involving a total of about eighty athletes, found that treatment with proteolytic enzymes significantly speeded healing of bruises and other mild athletic injuries, compared with placebo. In another double-blind trial, one hundred people were given an injection of their own blood under the skin to simulate bruising following an injury. Researchers found that treatment with a proteolytic enzyme combination significantly speeded up recovery. In addition, a double-blind, placebo-controlled trial of seventy-one people with finger fractures found that treatment with proteolytic enzymes significantly improved recovery. However, these studies were performed decades ago and are not quite up to modern standards.

Surgery. Numerous studies have evaluated various proteolytic enzymes as an aid to recovery from surgery, but the results have been mixed. Again, most of these studies are not up to modern standards. A double-blind, placebo-controlled trial of eighty people undergoing knee surgery found that treatment with mixed proteolytic enzymes after surgery significantly improved rate of recovery, as measured by mobility and swelling.

Another double-blind, placebo-controlled trial evaluated the effects of a similar mixed proteolytic enzyme product in eighty individuals undergoing oral surgery. The results showed reduced pain, inflammation, and swelling in the treated group compared with the placebo group. Benefits were also seen in another trial of mixed proteolytic enzymes for dental surgery, as well as in one study involving only bromelain.

A double-blind, placebo-controlled study of 204 women receiving episiotomies
during childbirth found evidence that a mixed proteolytic enzyme product can
reduce inflammation. Bromelain was also found helpful for reducing inflammation
following episiotomy in one double-blind, placebo-controlled trial of
160 women, but a very similar study found no benefit.

Other double-blind, placebo-controlled studies have found that bromelain reduces inflammation and pain following nasal surgery, cataract removal, and foot surgery. However, a study of 154 individuals undergoing facial plastic surgery found no benefit.

A small double-blind, placebo-controlled trial of twenty-four people having surgical extraction of third molars found that serrapeptase given during the procedure reduced postoperative pain and swelling (significant differences on days two, three, and seven).

Safety Issues

In studies, proteolytic enzymes are believed to have proven to be quite safe,
although they can occasionally cause digestive upset and allergic reactions. One
proteolytic enzyme, pancreatin, may interfere with folate absorption. In addition,
the proteolytic enzyme papain might increase the blood-thinning effects of
warfarin and possibly other anticoagulants. The proteolytic
enzyme bromelain might also cause problems if combined with drugs that thin the
blood. In addition, there are concerns that bromelain should not be mixed with
sedative drugs. Finally, bromelain may increase blood concentrations of certain
antibiotics.

Important Interactions

People taking the proteolytic enzyme pancreatin may need extra folate.
People taking warfarin (Coumadin), aspirin, or other drugs that thin the blood
should not take the proteolytic enzymes papain or bromelain except under a
doctor’s supervision. Those taking sedative drugs should not take bromelain,
except under a physician’s supervision.

Bibliography

Akhtar, N. M., et al. “Oral Enzyme Combination Versus Diclofenac in the Treatment of Osteoarthritis of the Knee.” Clinical Rheumatology 23 (2004): 410-415.

Al-Khateeb, T. H., and Y. Nusair. “Effect of the Proteolytic Enzyme Serrapeptase on Swelling, Pain, and Trismus after Surgical Extraction of Mandibular Third Molars.” International Journal of Oral Maxillofacial Surgery 37 (2008): 264-268.

Baumhackl, U., et al. “A Randomized, Double-Blind, Placebo-Controlled Study of Oral Hydrolytic Enzymes in Relapsing Multiple Sclerosis.” Multiple Sclerosis 11 (2005): 166-168.

Beck, T. W., et al. “Effects of a Protease Supplement on Eccentric Exercise-Induced Markers of Delayed-Onset Muscle Soreness and Muscle Damage.” Journal of Strength and Conditioning Research 21 (2007): 661-667.

Kerkhoffs, G. M., et al. “A Double-Blind, Randomised, Parallel Group Study on the Efficacy and Safety of Treating Acute Lateral Ankle Sprain with Oral Hydrolytic Enzymes.” British Journal of Sports Medicine 38 (2004): 431-435.

Klein, G., et al. “Efficacy and Tolerance of an Oral Enzyme Combination in Painful Osteoarthritis of the Hip: A Double-Blind, Randomised Study Comparing Oral Enzymes with Non-steroidal Anti-inflammatory Drugs.” Clinical and Experimental Rheumatology 24 (2006): 25-30.

How did the New Deal try to solve the problems of the Great Depression?

There were many components to the New Deal that we cannot cover in this short of a space, but the overall strategy employed by FDR was to put into action the economic theories of John Maynard Keynes, who posited that during a great economic recession, private money would flee the market and the government, in order to turn the tide, needed to inject lots of money quickly into the economy, to stimulate growth and reverse the vicious cycle that results from loss of confidence in the market, tightening credit, business failures and job losses. The way the New Deal injected money into the economy was through what is called "Deficit Spending," a process by which the government borrows money and prints excess currency to pay for programs that put people back to work.

The New Deal can be divided into two main components: stimulative action and regulation. Stimulative action included the Social Security Act, which gave widows and orphans direct payments to help them afford basic necessities. This also included unemployment assistance, direct cash payments to unemployed workers to help them pay for basic necessities and in turn, support the businesses that provided those services.

Other components of the stimulative side of the New Deal include the various works projects, like the Works Project Administration, Civilian Conservation Corps, Agriculture Adjustment Bureau, and the Tennessee Valley Authority, among others. All of these programs put unemployed men (and women) to work on large infrastructure projects, thereby improving and expanding the United States' roads, bridges, waterways, farms, irrigation systems, national parks and cities, and creating a virtuous economic cycle of job creation and consumer spending, which in turn prompted more job creation and more consumer spending. 

The regulation component of the New Deal was just as important, because it aimed to reform the failed mechanisms that allowed the financial collapse to occur in the first place. The regulatory programs of the New Deal included (but were not limited to) the Federal Depositors Insurance Corporation (FDIC), to insure depositor's money, the Glass Steagall Act, to prevent savings and loans banks from gambling their depositors money on Wall Street, the creation of the Securities and Exchange Commission (SEC), to police and monitor the trading and marketing of securities on Wall Street, so that investment bankers couldn't sell fraudulent securities and could not lie to their counterparts about the risks  involved in the investments they sold. The regulations also included a Bank Holiday at the very start of the New Deal, to stem the flow of bank runs and return confidence to the financial system, before other regulation could be enacted. The National Industrial Recovery Act (NIRA) aimed to regulate and improve business practices and labor conditions.

All in all, the New Deal was the single largest and most effective government intervention into the economy in this country's history. It succeeded in digging the country out of a long and deep economic depression by allowing the federal government to act as the "lender of last resort," when private citizens and private institutions were unable and/or unwilling to step in.

What are weight loss medications?

Indications and Procedures

By the mid-1990’s, several drugs had come onto the market showing promise in helping people achieve weight loss. The most widely sought and prescribed of these were Fen-Phen (combining serotonergic fenfluramine and amphetamine-like phentermine) and Redux (dexfenfluramine, with similar properties and actions to fenfluramine). Fen-Phen inhibited the brain’s utilization of the neurochemical serotonin, which acts on the brain’s appetite control center in the hypothalamus, and suppressed appetite directly, much as traditional over-the-counter diet pills do. Other drugs, less widely used, included phentermine, mazindol, and fluoxetine.

The hope and early evidence were that these medications would produce improved cardiac function, cholesterol and triglyceride profiles, blood sugar concentrations, and blood pressure; assist in the treatment of bulimia; and reduce weight in the obese and prevent weight gain in those at high risk for it, such as individuals who recently have quit smoking. The drugs were intended to assist those with morbid obesity, obese persons with serious medical conditions, and obese persons who had failed to manage their weight using more conservative nutritional and behavioral methods. At no point did researchers intend the medications as quick fixes for those unwilling to exercise or unwilling to change their eating habits. Nevertheless, many physicians prescribed them to patients who were not significantly obese or who were merely overweight.

Uses and Complications

Multiple studies across many different populations have tended to show the same results: Measurable weight loss in those taking the drugs was between 5 and 15 percent, with weight regained one year after patients had stopped taking the drug. The medications had few initial side effects—dry mouth, constipation, and drowsiness being the most common—and were unlikely to become physically addicting.

Health providers across all disciplines were particularly concerned, however, that some patients were coming to rely on these medications as alternatives to the sustained, hard work of developing lifestyle habits of healthy, proportional eating and exercise. In addition, concerns grew over the drugs’ potential to cause neurotoxicity and primary pulmonary hypertension. Fen-Phen, in particular, was responsible for numerous reports of valvular heart
disease and pulmonary hypertension.

Perspective and Prospects

In 1997, the Food and Drug Administration (FDA) withdrew approval of Fen-Phen and Redux for treating obesity, and their marketing and distribution were discontinued. Class-action lawsuits were filed—former Fen-Phen users alone have filed approximately fifty thousand lawsuits against the makers of the drug—and large settlements were reached for those who had used Fen-Phen and other such drugs.

The government then set its sights on dietary products containing ephedra. Manufacturers claimed that ephedra, a botanical source of ephedrine, is a “fat-burning” supplement that could boost energy and enhance athletic performance, but reports began to surface about seizures, strokes, heart attacks, and even deaths in otherwise healthy users. In 2003, the FDA banned the use of ephedra.

Bibliography

Berke, Ethan M., and Nancy E. Morden. “Medical Management of Obesity.” American Family Physician 62, no. 2 (July 15, 2000): 419-427.

Finn, R. “Pharmacotherapy May Help Some Obese Teens.” Internal Medicine News 38, no. 19 (June, 2005): 45.

Marcovitz, Hal. Diet Drugs. Farmington Hills, Mich.: Lucent Books, 2007.

Mitchell, Deborah R., and David Dodson. The Diet Pill Guide: A Consumer’s Book to Prescription and Over-the-Counter Weight-Loss Pills and Supplements. New York: St. Martin’s Griffin, 2002.

Peikin, Steven R. The Complete Book of Diet Drugs: Everything You Need to Know About Today’s Prescription and Over-the-Counter Weight Loss Products. New York: Kensington Books, 2002.

Whelan, S., and T. A. Wadden. “Combining Behavioral and Pharmacological Treatments for Obesity.” Obesity Research 10, no. 6 (June, 2002): 560-574.

Is there a law in the Declaration of Independence that says people who purchased property from the government would not have to pay property taxes...

The Declaration of Independence was not a law. It was a statement by the colonists that the colonies were now free from the rule of the British government. This document stated that we were now a free and independent country called the United States of America.

There were many ideas stated in the Declaration of Independence. One idea was that all people have certain rights that can’t be given up or taken away. These rights...

The Declaration of Independence was not a law. It was a statement by the colonists that the colonies were now free from the rule of the British government. This document stated that we were now a free and independent country called the United States of America.

There were many ideas stated in the Declaration of Independence. One idea was that all people have certain rights that can’t be given up or taken away. These rights are called the inalienable rights and include the right to life, liberty, and the pursuit of happiness.

Another idea expressed in the Declaration of Independence was that it was the job of the government to protect the rights of the people. The Declaration of Independence stated that when the government fails to protect the people’s rights, the people must replace that government with one that will protect their rights.

Therefore, there was no law in the Declaration of Independence that said that people who bought land from the government would not have to pay property taxes on it. There were no laws in the Declaration of Independence. There were many ideas outlined in it. The Declaration of Independence stated that we were now a free and independent country.

What are nutrition guidelines? |

Introduction

In April 2005, the US Department of Agriculture (USDA)
updated its 1992 food pyramid to a diagram called MyPyramid; this was done several
months after the US Department of Health and Human Services
(HHS) issued the 2005 Dietary Guidelines for Americans. Obesity
rates, particularly in children, had increased government concerns about providing
more effective nutritional guidance. The HHS estimated that 65 percent of adults
in the United States were overweight; more than 30 percent were obese. Many
diseases, such as diabetes, heart disease, and cancers, are associated with excess
body weight.

MyPyramid consisted of six vertical colored sections that represented food groups:
grains (orange), vegetables (green), fruit (red), oils and fats (yellow), dairy
(blue), and meats and beans (purple). A drawing of a human figure climbing steps
on the pyramid’s left side symbolized physical activity. The width of each area
indicated proportions of those foods that should be eaten daily to attain an
adequate intake of vitamins, minerals, and macronutrients. Pyramid variations offered nutritional
suggestions for people with diverse dietary needs, including pregnant or lactating
women, recognizing that individuals’ metabolisms differ according to the physical
demands on their bodies.

Individuals could provide details about their age, gender, height, and exercise
habits on MyPyramid's website in order to generate a nutritional profile of their
daily calorie expenditure and the recommended measurements that they should eat
from each food category to create a diet of varied foods rich in nutrients.
Recommendations incorporated food group options such as whole or refined grain and
vegetable types including dark green and starchy plants. The website presented
menus based on these suggestions. The MyPyramid Tracker enabled users to monitor
their eating and exercising behaviors.

In September 2005, the USDA introduced its MyPyramid for Kids. Educational activities stressed daily exercise and consumption of whole grains, low-fat dairy foods, vegetables, and fruit. The USDA introduced a Spanish-language pyramid in December 2005.

Six years later, in June 2011, a new diagram representing updated US nutrition
guidelines was introduced: MyPlate. Championed by First Lady
Michelle
Obama, the plate image replaced the pyramid with a simpler,
easy-to-understand reminder of what foods, and what portion sizes of these foods,
should be on one's plate. The circular image shows a "plate" divided into four
food groups. Vegetables (green) and fruits (red) take up half of the plate, with
vegetables overtaking more than half of that area. On the right side of the plate
are whole grains (orange) and protein (purple), with whole grains taking up more
than half of that side. A smaller circle sits to the top right of the plate,
representing dairy (blue).

While the plate itself is simple, the campaign behind it is much more comprehensive. The MyPlate website, ChooseMyPlate.gov, created by the USDA, provides numerous educational materials for a healthy, active lifestyle. The website's materials include variations on the plate diagram for children, pregnant women, and older adults; healthy eating and exercise advice; ways to track one's calorie intake and physical activity; and more.

The healthy lifestyle initiative cost about $2 million to roll out in various
phases, from focusing on getting Americans to make half of their plate fruits and
vegetables, to focusing on helping them avoid oversized portions, to replacing
sugary drinks with water. Later phases have included the MyPlate Kids' Place
initiative and the MyPlate on Campus initiative, both released in 2013. The latter
recruits college students to encourage their campus to become active, healthy
eaters. The former is designed for children ages eight to twelve and provides
information for parents and educators, including recipes, games, and activity
sheets for children.

Acceptance and Criticism

Reaction to the 2005 food pyramid was mixed. Nine months after the pyramid was
publicized, its website had been accessed approximately 1.2 billion times and more
than 500,000 registered users had utilized MyPyramid Tracker. Groups endorsing
MyPyramid included the American Heart Association, American Dietetic Association,
and School Nutrition Association. Some nutritionists adapted MyPyramid to design
nutritional programs. Tufts University created a Modified MyPyramid for Older
Adults, emphasizing the best nutrients for geriatric consumers and supplemental
vitamin and calcium sources.

In April 2005, General Mills was the first food manufacturer to incorporate the food pyramid on its packaging. ConAgra Foods started simplifying MyPyramid information for consumers on labels in 2008. The Grocery Manufacturers of America sponsored MyPyramid information printed in the children’s periodical Weekly Reader. Many food producers increased manufacturing of whole grain products to match expanded demand due to the pyramid stressing benefits of those foods.

Some critics claimed that lobbyists representing various sectors of the food
industry influenced the USDA to promote their goods through the food pyramid. Many
critics stated that MyPyramid did not present consumers with the healthiest
options possible. Some physicians promoted alternatives to the guide. Heart
surgeon Robert D. Willix Jr., who asserted that food pyramids contribute to
obesity, urged people to instead follow his Cenegenics Medical Institute Food
Diamond, introduced in 2008, which stresses the consumption of water, vegetables,
and lean proteins.

Similar reactions occurred with the introduction of MyPlate. Many people were
happy to see MyPyramid scrapped, having found it vague and confusing, and
appreciated having a much simpler diagram to work with—the MyPlate diagram shows
what a healthy diet should look like without confusing consumers trying to figure
out what a portion size actually is. While some criticized the government for
interfering with what their children eat, others expressed appreciation for
MyPlate's initiative to improve school lunches. The ChooseMyPlate website,
particularly its SuperTracker and other tools for monitoring one's diet and
physical activity, became a popular resource.

Some in the medical field, though praising MyPlate as an improvement over
MyPyramid, found fault with the plate diagram, however. Once again, Willix
criticized the USDA's choice of diagram and worked to promote his Cenegenics Food
Diamond as a customizable tool for an individual's specific dietary needs,
including those with diabetes and heart disease. Willix also criticized the USDA's
inclusion of dairy in MyPlate, claiming that it can cause numerous problems and
that there are other sources that provide the nutrients found in dairy.

Some in the scientific community found fault with MyPlate not because of its
design but because of its simplification. USDA nutrition guidelines may help
Americans make better food decisions. However, before the government creates their
guidelines, a scientific panel makes recommendations based on the latest research,
and these recommendations are not necessarily all followed during the creation of
a reader-friendly chart. According to the Harvard School of Public Health, this
could mean that many of the panel's health recommendations end up ignored. Harvard
released its own modified version of the plate diagram, which features a higher
ratio of vegetables, balances protein and whole grains as equal, emphasizes water
over dairy (though MyPlate also emphasizes the importance of water outside of the
diagram itself), and adds healthy oils.

Additionally, nutrition guideline diagrams set the standard for all federal
nutritional programs, including public school lunches. This can be a good thing,
and yet Harvard has argued that if certain recommendations from the scientific
panel are ignored, the health of students could be impacted negatively. The
guidelines influence what foods Americans buy, at least for their children.
Therefore, changes to the guidelines, whether in the shape of a pyramid, a plate,
or another diagram altogether, can both help and hurt the food industry while
influencing the health of Americans.

Perspective and Prospects

The US government first offered Americans nutritional recommendations in the 1930s
because of food scarcities during the Great Depression and then during
World War
II. The government’s basic four food groups included meats,
milk, starch, and vegetables and fruit. High-fat diets and inactive lifestyles
contributed to an increasing number of Americans gaining extra weight and
developing cardiovascular and other health problems in the following decades. By
1980, the government developed federal dietary guidelines that nutrition
experts were expected to revise approximately every five years.

The USDA endeavored to create a visual image to assist consumers in choosing
nutritious foods. In 1992, the USDA introduced its first triangle-shaped design,
with horizontal sections indicating specific food groups and numbers of servings.
Foods with the greatest serving amounts, from the grain and cereal group, were
located at the base, and decreasing quantities of servings were placed toward the
peak, where oils, fats, and sugars were clustered. That pyramid did
not specify portion sizes of servings. Although 80 percent of consumers said they
knew that the food pyramid existed, fewer than 10 percent followed its
recommendations, mainly because they were unable to comprehend how to apply
them.

Food groups appropriated aspects of the USDA’s food pyramid. The Boston Oldways
Preservation and Exchange Trust created food pyramids for Mediterranean, Latin
American, and Asian diets. Other pyramids addressed deficiencies that health
professionals perceived in the USDA’s pyramid. The Mayo Clinic designed a pyramid
that stressed the importance of exercise and more fruit and vegetable consumption
than was suggested by the USDA pyramid.

On an international scale, the World Health Organization (WHO) in
collaboration with the Food and Agriculture Organization released nutritional
guidelines in the form of a table in 2002. The table laid out dietary factors
ranging from different types of fats to different types of carbohydrates, among
other nutrients, with daily intake recommendations labeled in percentages or
grams. A modification of the table in the form of a pyramid was also created to
emphasize certain dietary factors, such as unrefined carbohydrates and protein,
that a person should restrict in order to prevent chronic diseases and obesity and
to promote dental health.

Advances in nutrition research by the early twenty-first century necessitated
revising USDA food information. By 2004, the USDA sought to improve the 1992 food
pyramid, increasing educational features and promoting physical activity to
strengthen the 2005 MyPyramid. Given the confusing nature of this pyramid and the
push for Americans to achieve healthier lifestyles by such proponents as First
Lady Michelle Obama, the pyramid diagram was replaced with the MyPlate diagram in
2011. The much simpler design of this diagram is intended to be a starting point
for achieving a healthy lifestyle; numerous additional materials with dietary
recommendations for different groups of people have been created, along with
advice regarding physical activity. The resources on the ChooseMyPlate website are
intended for anyone to access for educational purposes and to measure one's health
in terms of diet and exercise.

As for international nutritional guidelines, the WHO's Department of Nutrition for
Health and Development has dedicated its website to continuous updates of its
nutrition recommendations based on the latest studies, including such topics as
how much iron, calcium, folic acid, sodium, vitamin A, and other nutrients should
be consumed by children of certain ages, pregnant women, and others.

Bibliography

Barclay, Eliza. "What Might Be Missing
from MyPlate? Water." The Salt. NPR, 12 Jan. 2015. Web. 12
Feb. 2015.

ChooseMyPlate.gov. USDA, 2013.

D’Elgin, Tershia.
What Should I Eat? A Complete Guide to the New Food
Pyramid. New York: Ballantine Books, 2005. Print.

"Food Pyramids and Plates: What Should You Really Eat?" Harvard School of Public Health, Sept. 2011.

Gavin, Mary L. "MyPlate Food Guide." KidsHealth. Nemours Foundation, June 2011.

Mitka, Mike.
“Government Unveils New Food Pyramid: Critics Say Nutrition Tool Is Flawed.”
Journal of the American Medical Association 293.21
(2005): 2581–2. Print.

"MyPlate/Food Pyramid Resources." USDA, 7 Aug. 2013.

Neuman, William.
"Nutrition Plate Unveiled, Replacing Food Pyramid." New York
Times. New York Times, 2 June 2011.

"Nutrition."
World Health Organization. WHO, 29 Aug. 2013.

“One Year Later:
Lessons from New Guidelines and Pyramid.” Tufts University Health
and Nutrition Letter 23.12 (2006): 4–5. Print.

What is Williams syndrome? |

Risk Factors

There are no known risk factors. The incidence of Williams syndrome is estimated to be less than 1 in 10,000 people. The disease almost always occurs sporadically. In the few reported examples of familial transmission, the deletion acts as an autosomal dominant mutation. Williams syndrome affects males and females equally.

Etiology and Genetics

Williams syndrome is caused by a loss of DNA from band 7q11.23 of chromosome 7. Therefore while the normal number of chromosomes is maintained, approximately twenty-five genes are lost because of the deletion. This region is referred to as the Williams-Bueren syndrome critical region (WBSCR). The deletion of the WBSCR in chromosome 7 is believed to be the result of unequal crossover events during meiosis. This region is flanked by low copy repeats that increase the likelihood of nonallelic homologous recombination. The deletion arises with equal frequency on the maternally or the paternally inherited chromosome 7. The size of the deletion can vary from 1.5 to 1.8 Mb pairs of DNA. Amongst the deleted genes is the elastin (ELN) gene. Loss of this gene is associated with the connective tissue abnormalities, cardiovascular disease (specifically supravalvular aortic stenosis), and facial dysmorphology found in people with this disease.

Other genes contained in this region include LIMK1 (lim kinase 1), GTF2IRD1 (part of the TFII-1 transcription family), and GTF2I (general transcription factor II, I). Their deletion may be responsible for the characteristic difficulties with visual-spatial tasks. Evidence also exists that the loss of the CLIP2 gene, among others, may contribute to the learning disabilities and other cognitive difficulties seen in Williams syndrome.

Most cases of Williams syndrome occur as random events during the formation of reproductive cells in a parent of an affected individual. These cases occur in people with no history of the disorder in their family. Williams syndrome is an autosomal dominant mutation. Williams syndrome should be distinguished from other syndromes that include developmental delay, short stature, distinctive facies, and congenital heart disease, such as Noonan syndrome
(deletion in chromosome 22q11) and Smith-Magenis syndrome (deletion in chromosome 17p11.2).

Symptoms

The onset of symptoms usually occurs just after birth or during infancy and begins with physical characteristics, irritability, colic, and feeding problems. Almost all cases of Williams syndrome have typical facial features that can be recognized even at birth. Williams patients usually have problems with spatial-visual tasks but have strong abilities in the area of music and spoken language. They often have outgoing and engaging personalities. Children often have delays in walking and speaking; however, the latter improves with age. Motor difficulties persist at all ages. Symptoms progress to abdominal pain in adolescents, diabetes, high blood pressure, heart failure (specifically supravalvular aortic stenosis, SVAS, and supravalvular pulmonary stenosis, SVPS), and hearing loss in adults.

Elastin arteriopathy is present in about 75 percent of Williams individuals, with the most common being SVAS. In most cases, morbidity is due to this aortic narrowing, which can lead to elevated left heart pressure, cardiac hypertrophy, and eventually cardiac failure.

Screening and Diagnosis

The clinical manifestations include a distinct facial appearance, which can be observed early after birth. Other characteristics such as cardiovascular anomalies and hypocalcemia, can be detected via electroencephalogram and routine blood examinations. The deletion in chromosome 7 is not detected through standard karyotyping but rather through fluorescence in situ hybridization (FISH). Testing is routinely performed on peripheral blood leukocytes. FISH testing and karyotype are performed in cytogenetics laboratories.

Prenatal testing is clinically available but is rarely used because most cases occur in a single family member only and no prenatal indicators exist for low-risk pregnancies.

Treatment and Therapy

There is currently no cure for Williams syndrome. Williams syndrome is a complex multisystem medical condition that requires the attention of multiple health care professionals. Initial care often centers on failure to thrive, hypocalcemia, or repair of the cardiac lesion. Physical therapy is helpful to patients with joint stiffness. Developmental and speech therapy can also help affected children; for example, verbal strengths can help make up for other weaknesses. Other treatments are based on a patient’s symptoms.

Prevention and Outcomes

There is no known way to prevent the genetic problem that causes Williams syndrome. Prenatal testing is available for couples with a family history of Williams syndrome who wish to conceive. About 75 percent of those with Williams syndrome have some intellectual disability. Most patients will not live as long as normal, due to complications. Most patients require full-time caregivers and often live in supervised group homes.

Bibliography

Bayes, M., et al. “Mutational Mechanisms of Williams-Beuren Syndrome Deletions.” American Journal of Human Genetics 73 (2003): 131–51. Print.

Cassidy, Suzanne B., and Judith E. Allanson. Management of Genetic Syndromes. 3rd ed. Hoboken: Wiley, 2010. Print.

Farran, Emily K., and Annette Karmiloff-Smith. Neurodevelopmental Disorders Across the Lifespan: A Neuroconstructivist Approach. Oxford: Oxford UP, 2012. Print.

Martens, Marilee. “Developmental and Cognitive Troubles in Williams Syndrome.” Pediatric Neurology. Ed. Olivier Dulac, Maryse Lassonde, and Harvey B. Sarnat. Edinburgh: Elsevier, 2013. 291–93. Print.

Morris, C., H. Lenhoff, and P. Wang. Williams-Beuren Syndrome: Research, Evaluation, and Treatment. Baltimore: Johns Hopkins UP, 2006. Print.

Morris, C. A., et al. “Natural History of Williams Syndrome: Physical Characteristics.” Journal of Pediatrics 113 (1988): 318–26. Print.

What is hyperbaric oxygen therapy?

Indications and Procedures

Hyperbaric oxygen therapy is used in cases that compromise the ability of a person’s red blood cells to distribute oxygen throughout the body. This situation usually results in hypoxia, a condition in which the tissues are starved of the life-giving oxygen that they require.

Adult humans consume about three pounds of food and three pounds of water every day. Through respiration, however, they routinely consume twice that amount of oxygen daily. At least one-third of this oxygen enters the bloodstream for distribution to tissues. If these tissues are deprived of oxygen, a condition called ischemia, then they may be destroyed, making people with lowered oxygen levels vulnerable to diseases and infections.

When the oxygen content of the tissues becomes dangerously low, as in cases of hypoxia, immediate treatment is essential. If such treatment is not given, then the results can be fatal. The most effective treatment, often provided in emergency situations, is to place the patient in a hyperbaric chamber, a sealed container in which the pressure is gradually increased to two or three times greater than that at sea level. Pure (100 percent) oxygen is pumped into the chamber. Patients are typically confined to such chambers from one hour to an hour and a half.

The air that humans usually breathe contains about 21 percent oxygen and 78 percent nitrogen. The air pressure within the hyperbaric chamber can increase the number of oxygen molecules in the bloodstream by up to 2,000 percent. With this dramatic increase, oxygen begins to enter oxygen-starved tissue and bone cells.

The hyperbaric chamber was initially used to save the lives of deep-sea and scuba divers who ascended too fast from the ocean’s depths, causing them to suffer from decompression sickness (the bends), a potentially fatal condition caused by the formation of nitrogen gas bubbles in the bloodstream. Those suffering from the bends are deprived of the life-sustaining oxygen that the body requires to function effectively. It was found that immersing sufferers in a pressurized environment enabled their red blood cells to absorb sufficient oxygen to nourish their tissues and bones.

Most hospitals set aside rooms into which pure (100 percent) oxygen is piped. Patients in need of hyperbaric oxygen therapy are placed in such rooms and may, through tubes in their noses, be fed the oxygen that they need directly. Such treatment is intermediate. When it proves insufficient, placing patients in pressurized atmospheres for specific lengths of time can result in dramatic increases in the amount of oxygen that they can absorb and in subsequent improvement in their conditions.

Uses and Complications

Besides its use in treating people suffering from the bends, the hyperbaric chamber is employed to treat several other life-threatening conditions. Such therapy is routinely used to treat injuries incurred in automobile or motorcycle accidents in which parts of the body are crushed. Treatment in a hyperbaric chamber heightens the delivery of oxygen to damaged tissues and bones. It can control swelling and limit infection.

Some people have wounds that refuse to heal, such as foot ulcers in diabetic patients whose circulatory systems are compromised, resulting in low oxygen levels. Hyperbaric treatment can increase the amount of oxygen in their bloodstreams and promote healing.

Similarly, such bone infections as osteomyelitis
that do not respond to conventional treatment are sometimes controlled by hyperbaric oxygen therapy. The oxygen that such treatment delivers to the bloodstream can control bacterial infections and increase the effectiveness of the body’s defensive white blood cells.

Cancer patients undergoing radiation
may suffer from scarring and compression of important blood vessels, thereby inhibiting the circulation of oxygen throughout the body. Hyperbaric oxygen therapy aids in increasing such circulation, permitting oxygen to reach damaged cells and keep them from dying. This treatment is often used in treating patients with head and neck cancers.

Carbon monoxide
poisoning is a pernicious and potentially fatal form of poisoning. Because carbon monoxide is colorless and odorless, it can affect whole families confined in closed houses with defective heating systems. When victims of such poisoning are rescued, immediate hyperbaric oxygen treatment is essential. Such treatment pumps essential oxygen into the bloodstream and aids the body in expelling carbon monoxide. If treatment is given without delay, then damage to the central nervous system and red blood vessels can be circumvented.

This therapy is being used increasingly in the treatment of burn victims, in whom it may reduce swelling, limit infection, and decrease the effects of lung damage resulting from inhaling smoke and overheated air. Because hyperbaric oxygen therapy is often a choice of last resort for people who are dangerously ill, the risks are high and the rate of fatalities is considerable.

Perspective and Prospects

With the remarkable growth of new procedures in medicine, the outlook for hyperbaric oxygen therapy is bright. Once used almost exclusively to treat the bends, such therapy currently is being found effective in dealing with any health problem in which the circulation of oxygen throughout the body is compromised.

Bibliography

A.D.A.M. Medical Encyclopedia. "Hyperbaric Oxygen Therapy." MedlinePlus, August 30, 2012.

Jain, K. K. Textbook of Hyperbaric Medicine. 5th ed. Cambridge, Mass.: Hogrefe, 2009.

Mayo Clinic. "Hyperbaric Oxygen Therapy." Mayo Foundation for Medical Education and Research, October 27, 2011.

Oregon Health and Science University Evidence-Based Practice Center. Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke. Rockville, Md.: Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2003.

Sheldon, Lisa Kennedy. Oxygenation. 2d ed. Sudbury, Mass.: Jones and Bartlett, 2008.

Stuart, Annie. "Hyperbaric Oxygen Therapy." Health Library, November 26, 2012.

What were the effects of the Women's Rights Movement of the middle to the late 1800s?

The women's rights movement of the mid-1800s helped build the political foundations and social networks upon which the later push for temperance and women's suffrage depended. The organizational prowess of leaders such as Elizabeth Cady Stanton and Lucretia Mott led not only to the Seneca Falls Convention in 1849, with its "Declaration of Sentiments," which would comprise the platform of the movement, but also served as an example and encouragement to other civically minded women...

The women's rights movement of the mid-1800s helped build the political foundations and social networks upon which the later push for temperance and women's suffrage depended. The organizational prowess of leaders such as Elizabeth Cady Stanton and Lucretia Mott led not only to the Seneca Falls Convention in 1849, with its "Declaration of Sentiments," which would comprise the platform of the movement, but also served as an example and encouragement to other civically minded women around the country to become politically active.  

As a result, women began to agitate for and gain the right to vote and own property (under certain circumstances) in certain western states and territories such as Wyoming (in 1869) and Utah (in 1870). Partly also as a result of the Second Great Awakening, and with the help of their churches, women around the country began to meet outside their homes to discuss the havoc that alcohol  wrecked on their lives, causing husbands to become abusive, to gamble away their money, and even to prostitute their wives and daughters in some extreme cases. The push to ban or curb the sale of alcohol and the campaign for universal women's suffrage, became inextricably linked.

Although the 18th and 19th amendments (Prohibition and Women's Suffrage, respectively) did not pass congress until 1920, the politicization of women in the mid-1800s gave women a voice in politics that they had lacked before. Although women such as Susan B. Anthony and Stanton could not vote, they came to have national profiles, and went on lecture circuits speaking to both men and women around the country, influencing the way those men voted. 

What is amphetamine abuse? |

Causes

Amphetamines are rapidly absorbed once ingested. When they reach the brain, they cause a buildup of the neurotransmitter dopamine. This leads to a heightened sense of energy, alertness, and well-being that abusers find to be pleasurable and productive for repetitive tasks. Tolerance develops rapidly, leading to the need for higher doses.

Amphetamines are easy to obtain, often through diversion from legal use, and they are relatively inexpensive. Using them does not carry the social stigma or legal consequences associated with the use of other stimulants, such as methamphetamine and cocaine.

Risk Factors

Amphetamine abuse is widespread and has been present almost since their introduction for medical use in the 1930s. Amphetamines were widely abused by soldiers during World War II to maintain alertness during long hours on duty. They are still used by some military personnel in combat settings.

After the war, amphetamines became popular among civilians, especially students who used them to keep awake for studying and as appetite suppressants and recreational drugs. By the 1960s, about one-half of all legally manufactured amphetamines were diverted for illegal use. With greater control over distribution of commercially manufactured amphetamines, manufacture by clandestine laboratories increased dramatically. In addition, the Internet has become a popular source for nonprescription amphetamines.

Abuse now occurs primarily among young adults (age eighteen to thirty years). A common venue for their abuse is the rave, an all-night music and dance concert or party. Use among males and females is evenly divided, except for intravenous use; in this case, males are three to four times more likely to use the drug intravenously. Abusers can rapidly become both physically and psychologically dependent on amphetamines, with a compulsive need for the drug.

Symptoms

Physical symptoms of amphetamine abuse include euphoria, increased blood pressure, decreased or irregular heart rate, narrowing of blood vessels, dilation of bronchioles (the breathing tubes of the lungs), heavy sweating or chills, nausea and vomiting, and increases in blood sugar. High doses can cause fever, seizures, and cardiac arrest.

Frequent, high-dose abuse can lead to aggressive or violent behavior, ending in a psychotic state indistinguishable from paranoid schizophrenia. Features of this state include hallucinations, delusions, hyperactivity, hypersexuality, confusion, and incoherence. One such delusion is formication, the sensation of insects, such as ants, crawling on the skin. Long-term use can result in permanent memory loss.

Screening and Diagnosis

Routine blood and urine testing do not detect amphetamines in the body. Abusers who use pills or who snort amphetamine leave no outward signs of the abuse. Smokers may use paraphernalia to use the drug. Abusers who inject the drug will have needle marks on their skin.

A change in behavior is the primary clue to amphetamine abuse. The abuser develops mood swings and withdraws from usual activities and family and friends. Basic responsibilities and commitments are ignored or carried out erratically. The abuser becomes hostile and argumentative. Any change in a person’s appearance, such as sudden weight loss, or in behavior, such as agitation or change in sleep patterns, should be addressed. Such changes may indicate amphetamine abuse. Experts recommend that parents focus their concern with the youth’s well-being, and not on the act of abuse.

Treatment and Therapy

Symptoms of amphetamine withdrawal can develop within a few hours after stopping use. Withdrawal symptoms include nightmares, insomnia or hypersomnia (too much sleep), severe fatigue or agitation, depression, anxiety, and increased appetite. Severe depression can produce suicidal thoughts. Withdrawal symptoms usually peak within two to four days and resolve within one week.

No specific medications are available for directly treating amphetamine abuse. However, antidepressants can be helpful in the immediate and post-withdrawal phases.

The National Institute on Drug Abuse recommends psychotherapeutic intervention utilizing a cognitive behavioral approach. Such an approach helps the abuser learn to identify counterproductive thought patterns and beliefs and to change them so that his or her emotions and actions become more manageable. The abuser is also taught how to improve coping skills to address life’s challenges and stresses. Narcotics Anonymous and amphetamine-specific recovery groups are also helpful.

Prevention

As there are medical indications for amphetamines, experts recommend that prescription formulations be kept from potential abusers. Pill counts should be taken regularly. Young people should be taught the differences between medical use and illegal abuse. Parents should ensure that their children are not attracted to social settings or activities where amphetamine abuse is or might be encouraged or tolerated.

Bibliography

Abadinsky, Howard. Drug Use and Abuse: A Comprehensive Introduction. 7th ed. Belmont: Wadsworth, 2011. Print.

Julien, Robert M. A Primer of Drug Actions. 11th ed. New York: Worth, 2008. Print.

Kuhn, Cynthia, Scott Swartwelder, and Wilkie Wilson. Buzzed: The Straight Facts about the Most Used and Abused Drugs from Alcohol to Ecstasy. 3rd ed. New York: Norton, 2008. Print.

Lowinson, Joyce W., et al., eds. Substance Abuse: A Comprehensive Textbook. 4th ed. Philadelphia: Lippincott, 2005. Print.

Rogge, Timothy. “Substance Abuse—Amphetamines.” MedlinePlus. US Natl. Lib. of Medicine, 21 May 2014. Web. 28 Oct. 2015.

In the Alchemist, how does the boy meet Fatima?

I need to give a little bit of backstory in order to explain the circumstances in which Santiago meets Fatima.  

Earlier in the novel, Santiago is pursuing his Personal Legend.  Unfortunately he got robbed.  Santiago was forced to take on work with a crystal merchant.  Both men learn from each other, but Santiago's teachings pay off financially.  The merchant and Santiago gain a large amount of wealth.  With his new financial stability, Santiago continues...

I need to give a little bit of backstory in order to explain the circumstances in which Santiago meets Fatima.  

Earlier in the novel, Santiago is pursuing his Personal Legend.  Unfortunately he got robbed.  Santiago was forced to take on work with a crystal merchant.  Both men learn from each other, but Santiago's teachings pay off financially.  The merchant and Santiago gain a large amount of wealth.  With his new financial stability, Santiago continues searching for his Personal Legend.  His next destination is the pyramids, so he joins a caravan traveling in that direction. 

Santiago meets an Englishman travelling in this caravan.  The man is studying to be an alchemist, and he wants to learn from a master alchemist, who lives at an oasis.  Unfortunately for Santiago, the caravan is forced to stop at the alchemist's oasis in order to avoid warring tribes.  The Englishman enlists Santiago to help him search the oasis.  Santiago asks a few people, but none of them know anything about an alchemist.  That is until Fatima shows up at the well.  Santiago is immediately love struck by her beauty.  

At that moment, it seemed to him that time stood still, and the Soul of the World surged within him. When he looked into her dark eyes, and saw that her lips were poised between a laugh and silence, he learned the most important part of the language that all the world spoke—the language that everyone on earth was capable of understanding in their heart. It was love.

At the Englishman's prodding, Santiago finally asks Fatima about the alchemist.  She tells the Englishman where to go, fills her water vessel, and walks away. 

How are CAM practitioners educated and trained?

Overview

The education and training of practitioners of complementary and alternative medicine (CAM) are widely varied, as these practices encompass any type of therapy that is not considered conventional or scientifically proven. Many of these therapies, however, have a long history in other cultures. CAM education and training may involve rigorous courses of study similar to those for a medical degree or for postdoctoral training. However, some CAM education consists of only minimal training, such as a six-week course that leads to a certificate. Even within the same discipline, training and certification requirements may vary widely from state to state, because there is no national regulatory body to oversee the process.

The education and training of CAM practitioners are the focus here, so the discussion will cover only those areas of unconventional therapy with standard educational or training programs. Covered here are acupuncturists, chiropractors, homeopaths, massage therapists, naturopaths, and integrated medicine programs that combine conventional medicine with CAM practice.

Many other types of CAM practitioners, such as aromatherapists, crystal therapists, reflexologists, reiki practitioners, and native or indigenous healers, study for long periods with experienced experts in their field. However, no particular training programs, educational courses, recognized requirements, or state or national certifications are available in the United States for these practitioners.

Practitioners

Acupuncturist. Acupuncture is a standard accepted
practice in the Chinese medicine tradition; however, it is relatively new in the
United States and, as such, varies from state to state in education and
certification requirements and venues. About forty states have established
criteria for persons seeking to practice acupuncture. Nonmedical professionals, to
become licensed as an acupuncturist, must take a four-year course of study and a
board examination. Persons with a medical background, such as medical doctors,
dentists, nurses, and chiropractors, must often complete a rigorous course of
study too, including classroom study (a minimum of three hundred hours) and
clinical acupuncture practice, before becoming licensed.

Courses in acupuncture focus on anatomy, physiology, and other areas that are
typical for any type of medical practice. Courses also include detailed study of
the nervous and vascular systems so that a practitioner has a thorough
understanding of needle insertion and the body’s reaction to it. A practitioner of
acupuncture may also be trained in other aspects of Chinese traditional
medicine.

Two bodies certify and accredit acupuncture colleges and practitioners in the United States: the Accreditation Commission for Acupuncture and Oriental Medicine and the American Board of Medical Acupuncture. These organizations provide continuing education and examinations for practitioners and oversight for educational programs in the United States. They also provide standards for acupuncturists trained in other countries who wish to practice in the United States.

Chiropractor. This branch of CAM may be one of the most highly
regulated in the United States. The Council on Chiropractic Education (CCE) is an
accreditation body for chiropractic schools, and its accreditation criteria are
recognized by the U.S. Department of Education. CCE regulates all training
programs for chiropractors. The American Chiropractic Association, a
leading professional organization for chiropractors, provides continuing medical
education and other resources to practitioners.

A chiropractic training program must include a minimum of 4,200 hours of class time, laboratory work, and clinical experience and must include courses in orthopedics, neurology, and physiotherapy (all with a focus on clinical practice of manipulation and spinal alignment). Chiropractors may also pursue studies in a specialty, such as orthopedics, sports medicine, or rehabilitation.

After completion of a doctor of chiropractic (D.C.) program, student practitioners must pass a four-part examination from the National Board of Chiropractic Examiners and must pass a state examination to be licensed. In some areas, the state examination takes the place of the national examination.

Homeopath. The education and training of a homeopath can take
varied courses. Programs designed for medical doctors or others with medical
training tend to focus on homeopathy and its application,
assuming that those with a medical degree would already have a basic background in
medicine and medical practice. Other courses, geared to those who do not have a
medical background, focus more on medical education, such as anatomy and
physiology, but also train students in homeopathy practices and principles.

A few states in the United States offer training in homeopathy (Arizona, California, Colorado, Florida, Massachusetts, and Utah, and the District of Columbia). Admission requirements for courses of study vary widely; some require a medical doctor (M.D.) or similar degree, and others enroll students with little or no medical background. Because homeopathy itself is not regulated in the United States, anyone can use the word “homeopath” to describe themselves or their type of work. However, a person cannot identify himself or herself as a homeopathic doctor or imply to the public that he or she is practicing medicine if he or she does not hold a medical license.

Several programs offer homeopathic education, but no single certification is recognized throughout the United States. Each state has its own standards for licensing this type of care. Some homeopaths are licensed in a conventional type of medicine and may hold a degree as an M.D. or as a nurse practitioner. In Arizona, Connecticut, and Nevada, M.D.’s and D.O.’s (doctors of osteopathy) can be licensed as homeopathic physicians. Homeopathic assistants, who practice under the supervision of a homeopath, are licensed in Arizona and Nevada.

Organizations such as the Council for Homeopathic Certification and the American Board of Homeotherapeutics offer certifications to homeopaths who have completed certain requirements: for example, M.D.’s or D.O.’s who pass oral and written exams in homeopathy. Upon completing these exams, the successful candidate is awarded a diplomate of homeotherapeutics (D.Ht.). Even though the Department of Education does not recognize any one organization as a certifying body, homeopathic practitioners use the standards upheld by these organizations to maintain competency and to encourage self-regulation.

Massage therapist. Most U.S. states regulate the practice of
massage
therapy in some way with a type of governing board providing
certification or licensure. Usually, a massage therapist must complete some course
of training and pass a board examination to be licensed. However, the requirements
vary widely from state to state. Education provided in massage therapy schools
typically requires about five hundred hours of study and involves courses in
anatomy, physiology, motion and body mechanics, and clinical massage practice.
Licensure also may involve passing a nationally recognized test, such as the
National Certification Examination for Therapeutic Massage and Bodywork or the
Massage and Bodywork Licensing Examination.

Naturopath. There are two basic types of naturopath: traditional
and naturopathic physicians. Education and training for traditional naturopaths
vary from nondegree certificate programs to undergraduate degree programs. After
completion of a degree program, a traditional naturopath can certify with the
American Naturopathic Medical Certificate Board and become a naturopathic
consultant. Traditionally, these types of naturopaths do not practice medicine and
thus do not require a license.

A naturopathic physician must have a doctor of naturopathic medicine (N.D., or N.M.D. in Arizona) degree from an accredited school of naturopathic medicine. Only four schools in the United States (in Washington, Oregon, Arizona, and Connecticut) are accredited for this type of education. The N.D. involves four years of graduate-level study in a standard medical curriculum, with added courses in natural therapeutics. Practitioners must then pass a state board licensing examination. (In the state of Utah, naturopathic doctors must complete a residency before starting a practice.)

Practitioners often work as primary care clinicians, but some states do not recognize the D.M. degree, so practitioners in these areas cannot legally practice medicine. Generally, they may still practice traditional naturopathic medicine. Two states, South Carolina and Tennessee, specifically prohibit the practice of naturopathy in any form.

The Council of Naturopathic Medical Education is a governing body that provides
accreditation for education in naturopathy. The American Naturopathic
Certification Board provides testing and continuing education for this
profession.

Alternative Medicine. http://www.pitt.edu/~cbw/altm.html.

American Academy of Acupuncture. http://medicalacupuncture.org.

American Association of Naturopathic Physicians. http://naturopathic.org.

American Chiropractic Association. http://www.acatoday.org.

American Massage Therapy Association. http://www.amtamassage.org.

International Website for Professional Homeopathy. http://www.world-of-homeopathy.info.

National Center for Complementary and Alternative Medicine. “Selecting a Complementary and Alternative Medicine Practitioner.” Available at http://nccam.nih.gov/health/decisions/practitioner.htm. Discusses choosing and evaluating a practitioner and provides questions to ask a practitioner about his or her education.

Tierney, Gillian. Opportunities in Holistic Health Care Careers. Rev. ed. New York: McGraw-Hill, 2007. This book addresses the job outlook, educational requirements, regulation, and salaries for many CAM practitioners.

What is faith healing? |

Overview

The practice of faith healing is common to most if not all religions. Examples
of faith healing include the Buddhist focus on healthy karma created
by mind/body balance, the practice of Ruqya in Islam, the Zohar of
Jewish mysticism, and the Christian belief that adherents may claim physical
health as a benefit of salvation.

While occurring throughout history and in all societies, faith healing in
Western culture may be more expressive of the individualistic nature of postmodern
society. Religious meaning is increasingly found within the context of personal
faith and encounter as opposed to the inclusive experience offered by
institutions. Practitioners of faith healing also tend to be individual
charismatic healers operating either in a religious context or in New Age and
mentalist constructs of paranormal healing through the forces of nature.

Faith healing differs from more general exercises in prayer. It is intensely personal and more individualistic than group or shrine contexts, in which healing is experienced through a holy place, through a saint, or through intercessory prayer.

Issues

Medical analyses of faith healing have not produced any final results concerning its effectiveness. Studies devoted to the general issues of spirituality and health, or the relation of prayer to healing, have focused upon selected recipients, such as ethnic groups, religious congregations, or medical groupings. Faith healing is more difficult to isolate in that it occurs within an intensely personal and often independent context. The most prominent faith healers in contemporary American and European societies operate as independent entities. While these figures may host large meetings, the groups themselves are not expressive of any one culture or religious tradition.

The importance of the entire issue of spirituality and health is demonstrated by the creation of a number of medical centers devoted to investigating the relationship between healing and prayer. These centers include the Center for Spirituality, Theology, and Health at Duke University; the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital; and the George Washington Institute for Spirituality and Health.

Two primary challenges faced by researchers as they study the spectrum of faith/prayer and healing are the problem of establishing basic parameters under which the studies can be conducted and the issues of verification and falsification. At the same time, the medical community has willingly joined forces with the religious in asserting the value of positive attitudes and the exercise of faith in obtaining physical and emotional healing.

Bibliography

Ateeq, Mohammad, Shazia Jehan, and Riffat Mehmmod. "Faith Healing; Modern Health Care." Professional Medical Journal 21.2 (2014): 295–301. Print.

Brown, Candy Gunther, et al. “Study of the Therapeutic Effects of Proximal Intercessory Prayer (STEPP) on Auditory and Visual Impairments in Rural Mozambique.” Southern Medical Journal 103.9 (2010): 864–69. Print.

MacNutt, Francis. Healing. Reprint. London: Hodder, 2001. Print.

McGuire, Meredith B. Ritual Healing in Suburban America. New Brunswick: Rutgers UP, 1998. Print.

Vellenga, Sipco J. “Hope for Healing: The Mobilization of Interest in Three Types of Religious Healing in the Netherlands Since 1850.” Social Compass 55 (2008): 330–50. Print.

What is a rash? |

Causes and Symptoms

Rashes may have many different causes: infection, inflammation, irritation, an allergic reaction, and systemic disease. Rashes usually vary in color from pale pink to red. They take many different forms: flat, raised, puffy, scaly, blistery, or crusted. They may be pruritic. Rashes may involve a small portion of the skin or cover much of the body. They may come in characteristic shapes, such as a bull’s-eye, or may appear irregular. A rash may be accompanied by other signs and symptoms that help the health care provider determine the cause of the rash, or a rash may form part of a constellation of signs and symptoms diagnostic of another disease or disorder.

Infectious rashes may be caused by bacteria, viruses, or fungi. For example, impetigo is caused by either staphylococcal or streptococcal bacteria, cold sores are caused by a herpesvirus, and athlete’s foot is caused by a fungus. Some infectious rashes are highly contagious among children or family members and others.

Rashes associated with inflammation include allergic responses to drugs, certain foods, stings, and poison ivy. Allergic rashes are typically red and itchy. They may be flat or may arise as wheals. Many allergic rashes are merely annoying, but some can be part of a life-threatening condition called anaphylaxis. Symptoms of anaphylaxis include blockage of the airways, a rash, and cardiac problems. Children can go into anaphylactic shock after eating a food to which they are highly allergic (such as shellfish, peanuts, or strawberries) or after being stung by a bee.

A common, but not usually serious, rash in infants is heat rash, or miliaria rubra. It is also called “prickly heat.” This rash is most common in hot and humid environments and on areas of the body covered by tight clothing.

Many of the so-called childhood diseases are characterized by fever and rash: measles, rubella (German measles), chickenpox, and fifth disease. The rash associated with each of these has distinctive features that help in the diagnosis of the disease. For example, the child with fifth disease has bright red cheeks, the so-called “slapped cheek” phenomenon, and a fine lacy rash on the trunk and extremities. The rash of rubella begins on the face and spreads rapidly to the trunk, arms, and legs. All these childhood diseases are related to systemic viral infections. Scarlet fever, on the other hand, is a streptococcal infection accompanied by a rash. Again, the characteristics of the rash help in making the diagnosis: It has a fine sandpaper-like feeling when touched.

Treatment and Therapy

The treatment of rashes depends on the cause. A common rule of thumb is that if a rash is wet, the treatment is to dry it, and vice versa. For example, an oozing rash such as that caused by poison ivy may be relieved by a drying paste that relieves itching, while a dry rash may be best treated with an ointment or by an oatmeal bath.

Some rashes will resolve on their own, and the main job of parents and health care providers is to relieve a child’s unpleasant symptoms, such as itching, that go along with the rash. Patients with rashes that itch need to receive medications to relieve itching, such as antihistamines, so that they will not complicate their condition by scratching the affected skin. Most antihistamines, however, cause the side effect of sleepiness. Soothing oatmeal baths or moisturizing lotions can relieve itching without causing sleepiness.

Treatments for rashes can be either topical or systemic. Topical treatments are put directly on the skin. For example, athlete’s foot is treated with topical ointment or powder containing an agent that will kill the fungus that causes the condition. Impetigo, on the other hand, is usually treated with systemic antibiotics to kill the causative bacteria.

A mainstay of dermatological treatment is steroid medications. Topical steroids such as hydrocortisone cream or ointment are applied directly to the skin and may be covered with a dressing. In some cases, as in a serious case of poison ivy, steroids may be given orally or by injection. Steroids have potential serious adverse effects, so most health care providers use them sparingly. They should almost never be used on the face or eyelids unless so prescribed by a physician.

Perspective and Prospects

Rashes are an extremely common problem in childhood and adolescence. Parents can often diagnose rashes themselves and treat them with appropriate over-the-counter products. Rashes that are associated with other symptoms, whose origin is unclear, or that fail to clear up in a reasonable amount of time should be evaluated and treated by a qualified health care provider.

Bibliography

Goldsmith, Lowell A., Gerald S. Lazarus, and Michael D. Tharp. Adult and Pediatric Dermatology: A Color Guide to Diagnosis and Treatment. Philadelphia: F. A. Davis, 1997.

Litin, Scott C., ed. Mayo Clinic Family Health Book. 4th ed. New York: HarperResource, 2009.

MedlinePlus. "Rashes." MedlinePlus, August 26, 2013.

Middlemiss, Prisca. What’s That Rash? How to Identify and Treat Childhood Rashes. London: Chancellor Press, 2010.

NIH News in Health. "Red, Itchy Rash? Get the Skinny on Dermatitis." NIH News in Health, April 2012.

Pongdee, Thanai. "Scratching the Surface on Skin Allergies." American Academy of Allergy Asthma & Immunology, February 2011.

Porter, Robert S., et al., eds. The Merck Manual Home Health Handbook. Whitehouse Station, N.J.: Merck Research Laboratories, 2009.

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What are natural treatments for insomnia?

Introduction

Many people have a serious problem getting a good night’s sleep. Lives have become simply too busy for many to get the eight hours really needed. To make matters worse, many people have insomnia. When a person does get to bed, he or she may stay awake thinking for hours. Sleep itself may be restless instead of refreshing.

Most people who sleep substantially less than eight hours a night experience a variety of unpleasant symptoms. The most common are headaches, mental confusion, irritability, malaise, immune deficiencies, depression, and fatigue. Complete sleep deprivation can lead to hallucinations and mental collapse.

The best way to improve sleep involves making lifestyle changes: eliminating caffeine and sugar from one’s diet, avoiding stimulating activities before bed, adopting a regular sleeping time, and gradually turning down the lights. More complex behavioral approaches to improving sleep habits can be adopted too.

Many drugs can also help with sleep. Such medications as Sonata, Lunesta,
Ambien, Restoril, Ativan, and Xanax are widely used for sleep problems. Of these,
only Lunesta has been tested for long-term use. All of these medications are in
essence tranquilizers and, therefore, have a potential for
dependence and abuse; the newer sleep-inducing drug Rozerem (ramelteon) acts like
an enhanced version of the supplement melatonin and is not thought to have such
potential.

Antidepressants can also be used to correct sleep problems. Low doses of
certain antidepressants immediately bring on sleep because their
side effects include drowsiness. However, this effect tends to wear off with
repeated use. For chronic sleeping problems, full doses of antidepressants can
sometimes be helpful. Antidepressants are believed to work by actually altering
brain chemistry, which produces a beneficial effect on sleep. Trazadone and
amitriptyline are two of the most commonly prescribed antidepressants when
improved sleep is desired, but most other antidepressants also can be helpful.

Principal Proposed Natural Treatments

Although the scientific evidence is not definitive, the herb valerian and the
hormone melatonin are widely accepted as treatments for certain forms of
insomnia.

Valerian. Valerian has a long traditional use for
insomnia, and today it is an accepted over-the-counter treatment for insomnia in
Germany, Belgium, France, Switzerland, and Italy. However, the evidence that it
really works remains inconsistent and incomplete. A systematic review concluded
that valerian is safe but probably not effective for treating insomnia. However,
there have been some positive results, with both valerian alone and valerian
combined with other herbs.

Valerian is most commonly recommended to be used as needed for occasional insomnia. However, the results of the largest and best-designed positive study found benefits only regarding long-term improvement of sleep. In this double-blind, placebo-controlled trial, one-half of the participants took 600 milligrams (mg) of an alcohol-based valerian extract one hour before bedtime, while the other one-half took placebo. Valerian did not work right away. For the first couple of weeks, valerian and placebo had similar affects. However, by day twenty-eight, valerian’s effectiveness increased. Effectiveness was rated as good or very good by participant evaluation in 66 percent of the valerian group and in 61 percent by doctor evaluation, whereas in the placebo group, only 29 percent were so rated by participants and doctors.

Although positive, these results are a bit confusing, because in another large study, valerian was effective immediately. Other studies, most of relatively low quality, found immediate benefits too. To further confuse the matter, four later studies of valerian failed to find evidence of any benefit; one was a four-week study that included 135 people given valerian and 135 given placebo. The most recent trial, a two-week study of 405 people, reported “modest benefits at most.”

A study of 184 people that tested a standardized combination of valerian and
hops had mixed results. Researchers tested quite a few
aspects of sleep (such as time to fall asleep, length of sleep, and number of
awakenings) and found evidence of benefit in a few. This use of multiple outcome
measures makes the results somewhat unreliable.

Other studies have compared valerian (either alone or with hops or melissa) with benzodiazepine drugs. Most of these studies found the herbal treatment approximately as effective as the drug, but because of the absence of a placebo group, these results are less than fully reliable. Mixed results like these suggest that valerian is at most modestly helpful for improving sleep.

Melatonin. The body uses melatonin as
part of its normal control of the sleep-wake cycle. The pineal gland makes
serotonin and then turns it into melatonin when exposure to light decreases.
Strong light (such as sunlight) slows melatonin production more than does weak
light, and a completely dark room increases the amount of melatonin made. Taking
melatonin as a supplement seems to stimulate sleep when the natural cycle is
disturbed. It may also have a direct sedative effect.

Although not all studies were positive, reasonably good evidence indicates that
melatonin is helpful for insomnia related to jet lag. One
of the best supporting studies was a double-blind, placebo-controlled study that
enrolled 320 travelers crossing six to eight time zones. The participants were
divided into four groups and given a daily dose of 5 mg of standard melatonin, 5
mg of slow-release melatonin, 0.5 mg of standard melatonin, or placebo. The group
that received 5 mg of standard melatonin slept better, took less time to fall
asleep, and felt more energetic and awake during the day than the other three
groups. Mixed results have been seen in studies involving the use of melatonin for
ordinary insomnia, insomnia in swing-shift workers, and insomnia in elderly
people.

A four-week double-blind trial evaluated the benefits of melatonin for children with difficulty falling asleep. A total of forty children who had experienced this type of sleep problem for at least one year were given either placebo or melatonin at a dose of 5 mg. The results showed that the use of melatonin helped participants fall asleep significantly more easily. Benefits were also seen in a similar study of sixty-two children with this condition. The long-term safety of melatonin usage has not been established. One should not give a child melatonin except under physician supervision.

Many persons stay up late on Friday and Saturday nights and then find it difficult to go to sleep at a reasonable hour Sunday night. A small, double-blind, placebo-controlled study found evidence that the use of melatonin 5.5 hours before the desired Sunday bedtime improved the ability of participants to fall asleep.

Benefits were seen in a small double-blind trial of persons in a pulmonary intensive care unit. It is difficult to sleep in an ICU, and the resulting sleep deprivation is not helpful for those recovering from disease or surgery. In this study of eight hospitalized persons, 3 mg of controlled-release melatonin significantly improved sleep quality and duration.

Blind people often have trouble sleeping on any particular schedule because there are no light cues available to help them get tired at night. A small, double-blind, placebo-controlled crossover trial found that the use of melatonin at a dose of 10 mg per day synchronized participants’ sleep schedules.

Some people find it impossible to fall asleep until early morning, a condition called delayed sleep phase syndrome. Melatonin may be beneficial for this syndrome.

In addition, people trying to stop using sleeping pills in the benzodiazepine family may find melatonin helpful. A double-blind, placebo-controlled study of thirty-four persons who regularly used such medications found that melatonin at a dose of 2 mg nightly (controlled-release formulation) could help them discontinue the use of the drugs. There can be risks in discontinuing benzodiazepine drugs, however, so persons should consult a physician for advice.

Other Proposed Natural Treatments

Acupressure or acupuncture may be helpful for
insomnia, but the supporting evidence remains weak. A single-blind,
placebo-controlled study involving 84 nursing home residents found that real
acupressure was superior to sham acupressure for improving sleep quality. Treated
participants fell asleep faster and slept more soundly. In a similar study,
researchers found that performing acupressure on a single point on both wrists for
five weeks improved sleep quality among residents of long-term-care facilities
more than did lightly touching the same point. Another single-blind, controlled
study reported benefits with acupuncture but failed to include a proper
statistical analysis of the results. For this reason, no conclusions can be drawn
from the report. In a third study, ninety-eight people with severe kidney disease
were divided into three groups: no extra treatment, twelve sessions of fake
acupressure (not using actual acupressure points), or twelve sessions of real
acupressure. Participants receiving real acupressure experienced significantly
improved sleep compared to those receiving no extra treatment. However, fake
acupressure was just as effective as real acupressure. Also, a small
placebo-controlled trial involving sixty adults with insomnia found that three
weeks of electroacupuncture improved sleep efficiency and decreased wake time
after sleep onset.

In a trial involving twenty-eight women, six weeks of auricular acupuncture, in which needles are placed in the outer ear, was more effective than sham acupuncture. However, in a carefully conducted review of ten randomized trials involving auricular acupuncture or acupressure (using magnetic pellets), researchers were unable to draw conclusions because of the poor quality of the studies.

Preliminary evidence suggests that Tai Chi, an ancient Chinese practice
involving graceful movements combined with meditation, may benefit some people who
have trouble sleeping. In one randomized study, a certain form of Tai Chi was more
effective than health education after twenty-five weeks in persons with moderate
insomnia.

Numerous controlled studies have evaluated relaxation
therapies for the treatment of insomnia. These studies are
difficult to summarize because many of the trials involved therapy combined with
other methods, such as biofeedback, sleep restriction, and
paradoxical intent (trying not to sleep). The type of relaxation therapy used in
the majority of these trials was progressive muscle relaxation. Overall,
the evidence indicates that relaxation therapies may be somewhat helpful for
insomnia, although not dramatically so. For example, in a controlled study of
seventy people with insomnia, participants using progressive relaxation showed no
meaningful improvement in the time taken to fall asleep or in the duration of
sleep, but they reported feeling more rested in the morning. In another study,
twenty minutes of relaxation practice was required to increase sleeping time by
thirty minutes.

One small double-blind study found a particular Ayurvedic herbal combination
helpful for insomnia. Herbs used for anxiety are commonly recommended for insomnia
too. As noted, hops and lemon balm have been studied in combination with valerian.
One double-blind study found that the antianxiety herb kava taken
alone may aid sleep for people whose insomnia is associated with anxiety and
tension. However, a fairly large study failed to find kava helpful for ordinary
insomnia. There are serious concerns that kava may occasionally cause severe liver
disorders.

The substance GABA (gamma-aminobutyric acid) is a naturally occurring neurotransmitter that is used within the brain to reduce the activity of certain nerve systems, including those related to anxiety. For this reason, GABA supplements are sometimes recommended for treatment of anxiety-related conditions, such as insomnia. However, there are no studies whatsoever supporting the use of GABA supplements for this purpose. It appears that, when taken orally, GABA cannot pass the blood-brain barrier and, therefore, does not even enter the brain.

One small study hints that the fragrance of lavender essential oil might aid sleep. Slight evidence exists to support the use of magnesium or probiotics (healthy bacteria) for insomnia in the elderly.

The herb St. John’s wort and the supplement 5-hydroxytryptophan have shown promise as treatments for depression. Because prescription antidepressants can aid sleep, these natural substances have been suggested for insomnia. However, there is no direct evidence that they are effective. A double-blind trial of twelve persons without insomnia found no sleep-promoting benefit with St. John’s wort.

Other herbs reputed to offer both antianxiety and anti-insomnia benefits include ashwagandha, astragalus, chamomile, He shou wu, lady’s slipper, passionflower, and skullcap. However, there is no supporting evidence to indicate that any of these really work. Finally, a number of supplements might offer benefits for improving mental function during periods of sleep deprivation.

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