Best Weight Loss Programs That Work

Eat Sleep Burn

This Eat Sleep Burn program by Todd Lamb will explain to you how you can adhere to a strategy of periodic fasting, which will help you to lose weight promptly and conveniently. Fasting is merely the act of avoiding all food for a specific quantity of time. The Eat Sleep Burn program will show you the most effective times to fast and also the length of time you ought to fast to ensure that you can get the best results. It will also allow you to know exactly what you could eat while fasting such as carbonated water, black coffee, water and also herbal teas. This is an online program that is all about exactly how you can shed fat and get muscle while ensuring that the body has actually been nourished in the very best means possible. That is something that you will have the ability to carry out in a simple manner as you have actually never ever seen before and which is why we need to see it. This is a tried and tested weight loss program that works in support of all your weight-loss desires. You will achieve your fat burning goals in a short duration and without much battle. Read more...

Eat Sleep Burn Summary


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Dietary Supplement Health and Education

Because herbs cannot be sold and promoted in the United States as drugs, they are regulated as nutritional or dietary substances. Nutritional or dietary substances are terms used by the federal government to identify substances not regulated as drugs by the FDA but that are purported to be effective for use to promote health. Herbs, as well as vitamins and minerals, are classified as dietary or nutritional supplements. Because natural products cannot be patented in the United States, it is not profitable for drug manufacturers to spend the millions of dollars and the 8 to 12 years to study and develop these products as drugs. In 1994, the US government passed the Dietary Supplement Health and Education Act (DSHEA). This act defines substances such as herbs, vitamins, minerals, amino acids, and other natural substances as dietary supplements. The act permits general health claims such as improves memory or promotes regularity as long as the label also has a disclaimer stating that the...

Diet Pills and Teenage Girls

Adolescent girls (as well as older women) are the group most vulnerable to the advertising claims of diet pills and other OTC products claiming to reduce weight. Our culture tells girls that being pretty is often more important than being smart or healthy or kind. In desperate attempts to conform to the cultural definition of prettiness, girls may turn to OTC products. This emphasis on physical appearance is one of the major distortions of our society. It fails to recognize that other qualities are far more essential to both an individual's personhood and the entire culture's well-being. What's more, cultural definitions of beauty are variable, depending on many factors.

The Natural Course and Outcome of Eating Disorders and Obesity

The natural course of recovery from eating disorders and obesity has not received much attention in part because once a diagnosable disorder is identified the individual is generally put into some form of treatment. Thus, most examinations of the course and outcome of these disorders rely on studies of patients who are receiving or have received treatment for the problem rather than a natural (untreated) course. This makes it difficult to determine whether therapy is actually helpful in alleviating eating disorders or obesity. Is symptomatic improvement in some individuals a result of treatment or part of the natural course of the disorders Are those who receive treatment representative of patients with the disorders, or do they represent a biased sample Does therapy increase the number of people who improve or does treatment have either no effect or a negative effect on ultimate outcomes These questions need to be addressed with respect to eating disorders. What has been addressed,...

Appetite suppressants

Pharmacological effects on the infant of appetite suppressants such as amfepramone ( diethylpropiorin), dexfenfluramine, fenproporex, mefenorex, norpseudoephedrine, sibutramine, and orlistat have not been studied. Weight reduction in the mother releases contaminants from her fatty tissue, which results in an additional burden on the mother's milk (see Chapter 4.18). Recommendation. Appetite suppressants are contraindicated during breastfeeding. The accidental Intake of a single dose does not require limitation of breastfeeding.

Olive Oil The Mediterranean Diet

It has been speculated for many years that the so-called Mediterranean Diet has a number of health benefits, including reduced risk of heart disease and cancer. In particular, red wine, tomatoes, and olive oil have all been suggested as likely beneficial components of this diet. Recently, two components of olive oil, oleic acid and oleocanthal, have been identified as likely chemopreventive components. These are described below along with lycopene, the proposed chemopreventive constituent of tomatoes.

Pharmacological Tools to Tackle Obesity and Obesity Related Diseases

Emerging issues in the treatment of obesity and related diseases by cannabinoid antagonists The whole body of data mentioned above highlights the role of the endocannabinoid system in feeding and energy balance regulation. Indeed, it was reasonable to hypothesize a therapeutic role for cannabinoid antagonists in the treatment of obesity. SR141716, also named rimonabant (commercialized as Acomplia), is now undergoing multicenter randomized, double-blind phase III trials to assess the effects on weight loss in obese patients with or without comorbidi-ties with dyslipidemia and with type 2 diabetes (323). Moreover, the multitude of patents filed over the last few years claiming the synthesis of novel CB1 receptor antagonists reflects the intense competition in this area (123). Other compounds are under development, such as SLV-319 (Solvay, Weesp, The Netherlands) (129), which is undergoing phase I trials (323). However, at present, little is known about the results of these trials. B....

Stimulants Relaxants Weight Control and Pain

Nervous Synapse

Have you ever poured yourself a steaming hot cup of coffee, taken an aspirin for a headache, used cough medicine, or taken a diet pill These are all examples of drugs used by millions of people to increase energy, relieve pain, or lose weight. These drugs, although widely consumed, can be dangerous at high dosages and can affect an athlete's performance. Amphetamine is the stimulant most abused by athletes and is also widely used by the general population. Amphetamine is the general term for a large group of stimulant drugs (Table 5.1). Amphetamine is a relatively simple molecule other stimulants are variations of amphetamine's basic form. Though amphetamine was first used in the 1930s to treat a variety of medical conditions, including narcolepsy, obesity, and depression, amphetamine-containing drugs (also referred to as amphetamines ) were first used for their ergogenic (energy increasing and fatigue reducing) effects during World War II, when they were given to soldiers to keep...

Cannabinoids in appetite and obesity

Particularly interesting are the opposite effects of the newly developed cannabinoid antagonists. These compounds have been shown to decrease food intake and to regulate body-weight gain, and are expected to provide a new therapeutic approach to treat obesity, a condition that affects up to 27 of the US population and is now considered by the World Health Organization as a global epidemic that poses a serious threat to world health, particularly in adolescents 2 . These experiments clearly demonstrated that activation of central cannabi-noid receptors by endocannabinoids stimulates eating behavior, and provided important evidence for the involvement of a central cannabinoid system in the normal control of feeding. Cannabinoid antagonists and obesity These results suggested a potential for cannabinoid antagonists in the treatment of eating disorders and, in particular, obesity. Therefore, the effect of chronic administration of SR-141716 in pharmacological models more relevant to...

Complementary and Alternative Medicines Dietary Supplements

Legally known as dietary supplements, herbal drugs are part of complementary and alternative medicine (which also includes other more regulated practices such as chiropractic). The path that has led to the virtually unregulated approach to herbal drugs traces back to the heyday of medicine shows and snake-oil salesmen around the turn of the previous century. This period was marked by unsupported, unscientific, and often outrageous claims by the producers of both foods and drugs, which provided few cures and sometimes produced illness or even death. Many things have changed in the interim, from the truth-in-labeling requirements of the 1906 Pure Food and Drug Act to the strict regulation and scientific evaluation of prescription and OTC drugs, but the herbal substances classed as dietary supplements have remained virtually free of governmental oversight to this very day. The most recent legislation in this area is the 1994 Dietary Supplements Health and Education Act (DSHEA), an...

Weight Loss Solutions and Other Dietary Supplements

Nieren Bilder

Ingredients included in weight-loss aids or other dietary supplements can be unsafe, even though the packaging may say that the product is all-natural. Just because a product claims to be made only of natural materials does not mean that it is automatically safe to use. Some substances found in nature are toxic to humans and should not be ingested. For a famous example, simply consider marijuana a naturally growing plant, but an illegal drug that can cause health problems nonetheless. One of the natural ingredients that can be found in weight-loss aids is bitter orange, which contains a stimulant that is chemically similar to ephedrine and may also have the same side effects. Other ingredients, such as usnic acid that may cause liver damage or aristolochic acid that may Over-the-counter diet pills can damage the kidneys, a serious health consequence that can make dialysis or kidney transplant necessary to avoid death. People who abuse ipecac syrup in order to lose weight are at risk...

Weight Loss Beyond Diet Pills Laxatives and Diuretics

Pills Illness Body Image

Diet pills are not the only OTC drugs that are abused in the battle to achieve weight loss. Laxatives are another substance that people use to lose weight. Normally, people use laxatives to relieve constipation, since they act to irritate intestinal linings and stimulate nerves. Abusers believe that they help them lose weight by rushing food through their bodies. However, laxatives do not actually aid in weight loss, since the nutrients and calories in food, the real culprits in weight gain, have already been taken in by the body before the medicine begins to work. Ironically, because laxatives do not actually work, users feel the need to continue to take them in increasing amounts in the hope that they do. This eventually leads to dependence. Diuretics, or water pills, are abused in a similar way to laxatives. They act by forcing the body to lose fluids, creating the feeling that the user is really losing weight. When the body naturally begins to regain the lost water, people take...

Uses of Dietary Reference Intakes

Each type of reference value is calculated from daily intakes averaged over time (usually one or more weeks). The surveys include, but are not limited to, (1)random selection of healthy individuals and asking them to either report what they have eaten or to maintain food diaries, (2) monitoring overall food production and consumption, and (3) correlating a defined population's health status with the group's food intake. Sometimes the results from the surveys are correlated with the type of assays listed in Table 8.2. The four Dietary Reference Intakes are Estimated Average Requirement (EAR). The EAR is the intake that meets the estimated nutrient need of 50 of the individuals in that group (i.e., infants, children, adult males, adult females, pregnant women, nursing women, the elderly, etc.). It is used to evaluate the adequacy of nutrient intakes of population groups and for planning intakes for group. It can be used in diet planning. The...


It has been suggested that beta-blockers may predispose to obesity by reducing basal metabolic rate via beta-adrenoceptor blockade (197). Thermogenesis in response to heat and cold, meals, stress, and anxiety is also reduced by beta-adrenoceptor blockade, promoting weight gain (SEDA-16, 193). Beta3-adrenoceptors have been implicated in this mechanism (198,199). Since propranolol blocks beta3-receptors in vivo (200), it would be wise on theoretical grounds to avoid propranolol in obese patients nadolol is another non-selective beta-blocker that does not act on beta3-adrenoceptors. A systematic review of eight prospective, randomized trials in 7048 patients with hypertension (3205 of whom were taking beta-blockers) confirmed that body weight was higher in those taking beta-blockers than in controls at the end of the studies (201). The median difference in body weight was 1.2 kg (range -0.4-3.5 kg). There was no relation between demographic characteristics and changes in body weight. The...

Cures For Obesity

There are many cures on the market for obesity, or excess fat. Excess fat is undesirable on the human frame for more than one reason. The most important is that it shortens the life by making double work for the heart, and that it slows up physical and mental processes. This naturally, is the last one those who take obesity cures care about. Excess fat on women tends to detract from their attractiveness to the male sex and from the envy of their sisters. Therefore, that is the FIRST CONSIDERATION of those who seek obesity cures and the strongest reason why they risk their lives to take them. The hard way is dieting and exercise, rational living and obedience to the laws of nature. This isn't as easy as it sounds, especially when one has developed a synthetic appetite for rich fattening foods and natural foods are much harder to get. Not only do I condemn advertised packaged obesity cures but I condemn prescriptions for drugs for this purpose given by registered physicians. You can't...

Weight gain

Users of marijuana generally agree that marijuana increases appetite (Hollister, 1970). However, many regular marijuana smokers may not think about the effect of marijuana on their weight. In a study of 10 controls (non-users), 12 casual users, and 15 heavy marijuana users, significant weight gain was found in both casual and heavy marijuana users after 3 weeks of use (Greenberg et al., 1976). Casual users (use of about 12 times per month) gained 2.8 lbs on average, heavy users (use of about 42 times per month) 3.7 lbs, and non-users gained only 0.2 lbs in the 21-day interval. Weight gain did not appear to be water retention. Weight gain over a longer period of time may be of significant importance to some patients, especially those with diabetes or other health related problems.

Extreme Dieting

Getting high is not the only criteria for drug abuse. Many people who are overly concerned with losing weight misuse drugs to achieve their goals. Instead of dieting and exercise, diet pills have become a popular way of losing weight. While diet pills may not be as physically addicting as some other drugs such as cocaine or heroin, people can still become psychologically dependent on them. This type of addiction is similar to caffeine dependence, but more extreme and with more serious consequences. Abuse of diet pills is a relatively new phenomenon. At some times in history, plumpness was considered a sign of health and beauty, even of prosperity. But during the last few decades, that image has shifted, until today being thin and the thinner the better is equated with being beautiful. There has been a corresponding increase in the desire to lose weight, and an increasing number of ways to do so. The first diet pill was introduced to the public in 1893, and today there are hundreds of...

Herbal Therapy And Nutritional Supplements

Botanical medicine or herbal therapy is a type of complementary alternative therapy that uses plants or herbs to treat various disorders. Individuals worldwide use both herbal therapy and nutritional supplements extensively. According to the World Health Organization (WHO), 80 of the world's population relies on herbs for a substantial part of their health care. Herbs have been used by virtually every culture in the world throughout history, from the beginning of time until now. For example, Hippocrates prescribed St. Johns Wort, currently a popular herbal remedy for depression. Native Americans used plants such as coneflower, ginseng, and ginger for therapeutic purposes. Herbal therapy is part of a group of nontraditional therapies commonly known as complementary alternative medicine (CAM). Unfortunately, CAM therapies are not widely taught in medical schools. A 1998 survey revealed that 75 of 117 US medical schools offered elective courses in CAM or included CAM topics in required...

General Information

The adverse effects of aldesleukin include fever, chills, malaise, skin rash, nausea, vomiting (often resistant to antiemetics), diarrhea, fluid retention, myalgia, insomnia, disorientation, life-threatening hypotension, and the capillary leak syndrome (which can be preceded by weight gain) (SEDA-15, 491) (2).

Introduction to Cancer

It is thought that exposure to an ever increasing number of chemicals (carcinogens) in the environment and the diet may be a significant contributing factor. Occupational factors are thought to account for 6 of cancers, while lifestyle and diet may account for up to 30 . Recognition of these contributing factors is currently leading to major changes in social behavior and legislation (e.g., reduction in cigarette consumption, curbing of smoking in public places, healthier diets, more exercise, more restrictive health and safety rules in working environments). Genetic predisposition is also a factor in some types of cancer.

Preface To The Series

The business of dietary supplements in the Western World has expanded from the Health Store to the pharmacy. Alternative medicine includes plant based products. Appropriate measures to ensure the quality, safety and efficacy of these either already exist or are being answered by greater legislative control by such bodies as the Food and Drug Administration of the USA and the recently created European Agency for the Evaluation of Medicinal Products, based in London. In the USA, the Dietary Supplement and Health Education Act of 1994 recognised the class of phytotherapeutic agents derived from medicinal and aromatic plants. Furthermore, under public pressure, the US Congress set up an Office of Alternative Medicine and this office in 1994 assisted the filing of several Investigational New Drug (IND) applications, required for clinical trials of some Chinese herbal preparations. The significance of these applications was that each Chinese preparation involved several plants and yet was...

Second Generation Effects Teratogenicity

Two neonates who had been given intravenous amiodarone as fetuses at 26 and 29 weeks and whose mothers had also taken it orally developed hypothyroidism (221). The authors suggested that low dietary iodine intake by the mothers may have contributed, by enhancing the Wolff-Chaikoff effect.

General adverse reactions

If liver damage occurs, isoniazid is probably an important factor and it should be stopped before rifampicin or pyr-azinamide (8). Prediction of hepatotoxicity is possible (9). In a case-control study of 60 patients in India, conducted in order to identify features predicting hepatotoxicity, the body mass index was significantly lower (17.2 kg m2) in patients who experienced hepatotoxicity than in controls (19.5 kg m2) (10).

Diet manipulations and treatment

Dietary measures are often suggested for the mildly symptomatic women, although little evidence supports these measures. Women may benefit from frequent and small meals, with high carbohydrate and low fat conLent. Salty foods may be tolerated better in the morning, and sour or tart beverages may be tolerated better than water (Quinlan 2003). An algorithm of treatment would depend on the women's preferences and the availability of the different modes of therapy. It would seem sensible to start treatment with dietary measures, lifestyle modifications and vitamin Bj,. If symptoms persist, treatment with meto-clopramide or diclectine (if available) should be started. The first-and some of the second-generation antihistamines are a good option, and if they fail then ondansetron would be the next choice. Intractable cases arc best treated with intravenous antiemetics and steroids, and rehydration therapy in severe cases, parenteral nutrition should be considered. Vitamin B1 should be...

Organs and Systems Cardiovascular

Two patients with Raynaud's phenomenon (13) and one man with fibromyalgia had all used aspartame 6-15 g day (0.12-0.16 mg kg day) as well as a dietary drink containing aspartame, and no other risk factors were identified. All three described regular keyboarding to the extent of 30 hours per week but had used wrist rests, stretch breaks,'' and other steps to optimize their work practices. Complete resolution of symptoms occurred over 2 weeks after they had eliminated aspartame from the diet, despite no changes in the intensity of keyboarding or other work practices. Nerve conduction velocities had been within normal limits before the withdrawal of aspartame and were not repeated.

Mdma Methylenedioxymethamphetamine Ecstasy

A designer drug, MDMA was created early in the twentieth century and patented by the pharmaceutical company Merck as a potential appetite suppressant. Though never brought to market, in the 1970s psychiatrists began using MDMA on patients after discovering its ability to assist the emotional healing process. According to one estimate, from the 1970s to the mid-1980s about 30,000 doses of MDMA were administered per month. Although illegal in the United States since 1985, MDMA which has come to be known more commonly as Ecstasy continues to be illicitly manufactured and distributed to those seeking euphoria and

Subclass Hamamelidaetakhtajan 1966

The subclass Hamamelidae consists of 11 orders and 24 families, and about 3400 species of plants which are thought to have originated from some tan-niferous Magnoliidae, forced to adapt to a climate of alternating wet and dry seasons in the Upper Cretaceous (Appendix I). These are mostly trees, the flowers of which are tiny, packed in spikes, unisexual, with distinct carpels, and adapted to wind pollination. In this Subclass, the use of alkaloids as chemical weapons has dramatically declined with the advent of tannins and flavonoids. The mechanisms by which tannins impede microbial infestation are enzyme inhibition, substrate deprivation, action on membranes, and metal ion deprivation. When consumed by mammalian, tannins form complexes with salivary glycoproteins and rend the plant unpalatable. Levels of tannins above 5 of the diet induce hemorrhagic gastroenteritis, necrosis of the liver, and kidney damage with proximal tuberal necrosis and death. Proanthocyanidins or condensed...

CB1 Receptors in the Control of Feeding Behaviour

The appetite-stimulating effects of marijuana have been known for centuries and constitute one of the established medicinal uses of cannabis preparations. Today THC (dronabinol Marinol) is clinically used for the treatment of cachexia-anorexia in human immunodeficiency virus (HIV) and palliative care patients. There have also been very promising advances in the development of a cannabinoid receptor antagonist (SR141716A, now named Rimonabant or Acomplia) for the treatment of obesity.

Monitoring and Managing Adverse Reactions

Because most amebicides cause gastrointestinal upsets, particularly nausea, the maintenance of adequate nutrition is important. A discussion of eating habits, food preferences, and food aversions will assist in meal planning. The nurse monitors body weight daily to identify any changes (increase or decrease). The nurse should make sure that meals are well balanced nutritionally, appetizing, and attractively served. Small frequent meals (five to six daily) may be more appealing than three large meals. The nurse may consult the dietitian if necessary.

Gotukola And Fotitieng

Effects Both Gotu-kola and fo-ti-tieng have been used to treat obesity, varicose veins, wounds, and some skin conditions. They may improve attention and concentration, have an antistress tranquilizing effect, stimulate the brain by increasing blood flow, detoxify the body, and energize the cells. They are said to increase longevity.

Other Serotonin Receptors

Prior to the generation of 5-HT2C receptor-deficient mice, studies with nonse-lective agonists had suggested potential roles for this receptor in the serotoner-gic regulation of feeding and anxiety. Consistent with the pharmacological evidence, 5-HT2C mutant mice display hyperphagia-evoked weight gain but also infrequent and sporadic spontaneous seizures, suggesting a globally enhanced neuronal network excitability. Behavioral analysis of 5-HT2C KO mice revealed abnormal performance in a spatial learning task and altered exploratory behavior associated with altered long-term potentiation restricted to the dentate gyrus perforant path synapse (Heisler and Tecott 1999). However, abnormalities of hippocampal function-dependent cognitive function were subtle and did not generalize to contextual fear conditioning.

Animal and in vitro toxicology

Long-term toxicology studies with THC were carried out by the National Institute of Mental Health in the late 1960s (8). These included a 90-day study with a 30-day recovery period in both rats and monkeys and involved not only D9-THC but also D8-THC and a crude extract of marijuana. Doses of cannabis or cannabinoids in the range 50-500 mg kg caused reduced food intake and lower body weight. All three substances initially depressed behavior, but later the animals became more active and were irritable or aggressive. At the end of the study the weights of the ovaries, uterus, prostate, and spleen were reduced and the weight of the adrenal glands was increased. The behavioral and organ changes were similar in monkeys, but less severe than those seen in rats. Further studies were carried out to assess the damage that might be done to the developing fetus by exposure to cannabis or cannabinoids during pregnancy. Treatment of pregnant rabbits with THC at doses up to 5 mg kg had no effect on...

Susceptibility Factors Age

The risk of digoxin toxicity is increased in old people, partly because they have poor renal function and lower body weight, factors that tend to increase the concentration of drug at the active site during steady-state therapy, and partly because they are liable to electrolyte imbalances, such as hypokalemia, which tend to increase the response of the tissues to a given concentration. Other factors, such as altered Na K pump activity, may also contribute to increased tissue sensitivity. This means that the serum digoxin concentration that is associated with an increased risk of toxicity is slightly lower in elderly people than in younger people, and this has been confirmed in a recent study of 899 patients taking digoxin for heart failure or atrial fibrillation (133). No patients with serum digoxin concentrations below 1.4 ng ml had evidence of digoxin toxicity. All patients who had a concentration of 3.0 ng ml or more had severe toxicity. However in the range 1.4-2.9 ng ml there...

Other Psychiatric Disorders

SSRIs have shown effectiveness in a number of more complex behavioral disorders such as obesity (particularly fluoxetine in higher doses), binge eating (sertraline), substance abuse, and to alleviate certain aggressive behaviors such as impulsivity and uncontrolled anger in adults, children, and the demented elderly.

Treatment Options for Depression

Tricyclic Antidepressants (TCAs) Named for their chemical structure, TCAs are the gold standard for treatment of depression because of their effectiveness. They need to be taken every day and take some weeks to work. They have been supplanted by other drugs, notably the SSRIs, because of their tendency to cause weight gain, dry mouth, constipation, sweating, and low blood pressure. Monamine Oxidase Inhibitors (MAOIs) Named for their action in the brain, MAOIs are also very effective. They too must be taken every day and take weeks to become effective. Common side effects include weight gain, dry mouth, insomnia, impaired sexual response, and low blood pressure. Their most troubling side effect is the potential to cause a stroke if you ingest adrenaline or adrenaline-like substances. MAOIs can be used only with a fairly strict diet that avoids foods or medicines that contain adrenaline or adrenaline-like substances. (A full list of the dietary restrictions is found in part IV.) As a...

Encouraging Mediculture

The concept of growing crops for health rather than food or fiber is slowly changing plant biotechnology and medicine. The rediscovery of the connection between plants and health is responsible for launching a new generation of botanical therapeutics that include plant-derived pharmaceutical, multicomponent botanical drugs, dietary supplement, functional foods and plant products, and recombinant

Syndromes of Depression and Their Treatment

TCAs were the mainstays of treatment until the SSRIs came out in the late 1980s. They are very effective, especially in cases of severe depression, but commonly cause weight gain, constipation, light-headedness from low blood pressure, and dry mouth, side effects that are unpleasant enough to make most people choose an alternative. TCAs are sometimes used first in severe depression in spite of their side effects because of some evidence that they are the most effective. Nortriptyline tends to make people drowsy after they take a dose, so may be the best choice if you experience insomnia. You may respond best to MAOIs or SSRIs if you have atypical symptoms, such as excessive sleep and increased weight gain. If the side effect is one that will continue, there are three options. First, you can lower the dose. Unfortunately, the dose at which the side effect disappears may not alleviate depression. Second, you can consider adjunctive treatment. For example, yohimbine can improve the...

Characteristics And Patterns Of Use And Abuse

METH has been available legally in the U.S. for many years as a therapeutic drug (trade name Desoxyn) used to treat obesity and attention-deficit hyperactivity disorder (ADHD). Illegal street forms are commonly known as speed or meth, which can be self-administered via injection, smoking, nasal inhalation ( snorting ), or oral ingestion. In its highly pure smokable form it is referred to as crystal, ice, crank, or glass. When ingested, the lipophilic compound efficiently penetrates the CNS,11 increasing concentrations of monoamines (particularly dopamine, DA) through multiple mechanisms (see below).12 The intensity of the high and mood alteration

Pituitaryadrenal axis

Syndrome, the predominant symptoms are in part determined by hyperandrogenicity and tend to comprise hypertension, acne, impaired sight, disorders of sexual function, hirsutism or virilism, striae of the skin, and plethora, Cushing's syndrome due to glucocorticoid therapy is likely to cause benign intracranial hypertension, glaucoma, subcapsular cataract, pancreatitis, aseptic necrosis of the bones, and panniculitis. Obesity, facial rounding, psychiatric symptoms, edema, and delayed wound healing are common to these different forms of Cushing's syndrome.

Electrolyte balance

The severity of potassium loss due to glucocorticoids depends partly on the amount of sodium in the diet the most widely used synthetic glucocorticoids cause less potassium excretion than natural hydrocortisone does. Prednisone and prednisolone have a glucocorticoid activity 4-5 times that of hydrocortisone, but their mineralo-corticoid activity is less (see Table 1) even at high dosages they do not cause noteworthy sodium and water retention. Of the major synthetic glucocorticoids, dexa-methasone has the strongest anti-inflammatory, hypergly-cemic, and corticotropin-inhibitory activity sodium retention is completely absent the degree of glucocorti-coid-induced metabolic alkalosis may also be less with dexamethasone than with hydrocortisone or methylpred-nisolone (SEDA-10, 343).

Is dlis a natriuretic hormone

Serum DLIS concentrations are elevated in volume-expanded patients. DLIS can also inhibit Na, K-ATPase. In addition, it has been associated with natriuresis, thus raising the possibility that DLIS play a role in water and sodium homeostasis. Garbagnati demonstrated that children with elevated concentrations of DLIS showed significantly lower natremia, higher urinary and fractional excretion of sodium, and increased systolic blood pressure compared with children with no measurable DLIS concentration (34). Ebara et al. (51) prepared DLIS from cord blood of healthy full-term infants by acetone hydrochloric acid extraction followed by purification with a gelfiltration column and demonstrated natriuretic activity of DLIS in a rat model. Goodline reported a case where the blood pressure of a pregnant woman with preeclampsia was reduced significantly after intravenous treatment with the Fab fragment of anti-digoxin antibody. This was probably because of binding of free DLIS with Fab (52)....

Treatment Options for Insomnia

Antidepressants Amitriptyline and trazodone cause such pronounced sedation that they are seldom used as antidepressants now that there are other antidepres-sants on the market with fewer side effects (see chapter 9). The pronounced sedation they cause makes them effective sleeping aids however. They make good alternatives to benzodiazepines for chronic insomnia because they are not habit-forming and they do not lose their effectiveness. They tend to cause dry mouth, low blood pressure, and may cause weight gain. They are effective for only about 50 percent of people who try them, however. Mirtazapine is also an antidepressant that causes pronounced sedation. Rarely, it can cause agranulocytosis, a potentially life-threatening blood disorder, so it should not be used routinely. Antipsychotics Named for their effects on psychotic symptoms, these medications are powerful tranquilizers and often cause pronounced sedation. They can be helpful to induce sleep. However, they have many other...

Monoamine Oxidase Inhibitors

As with the dietary proscriptions, any medication that increases tyramine can precipitate a hypertensive crisis such medications include numerous over-the-counter preparations for coughs, colds, and allergies. The same rule applies to sympathomimetic drugs (such as epinephrine and amphetamines or cocaine) and dopaminergic drugs such as anti-parkinsonian medications.

The Federal Regulatory Agencies

The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, the food supply, cosmetics, and products that emit radiation. Its code is the Food, Drug and Cosmetic Act of 1938, but it also enforces the provisions in dozens of other laws, including the Controlled Substances Act, the Dietary Supplement Health and Education Act (DSHEA), and the Prescription Drug User Fee Act. A primary duty of the FDA is to approve prescription drugs and OTC medications, and to maintain and enforce drug manufacturing standards.

Ongoing Assessment

The nurse should assess patients receiving the calcium channel blockers for signs of CHF dyspnea, weight gain, peripheral edema, abnormal lung sounds (crackles rales), and jugular vein distention. Any symptoms of CHF are reported immediately to the primary health care provider.

Cognitive development

In 2001, the American Academy of Pediatrics (AAP) put marijuana on its list of drugs that adversely affect infants during breast-feeding. According to the AAP, the active ingredient in marijuana, THC, can be stored in a mother's tissues for several weeks or months and accumulates with continued use. Thomas Hale, author of the book Medications and Mother's Milk, reports that breast milk produced by chronic, heavy marijuana users shows extremely high concentrations of THC. Marijuana taken into the body through breast-feeding can cause sleepiness in the baby, which may lead to slow weight gain and possibly slow overall development. The study also found that babies whose mothers smoke marijuana regularly have a higher risk of dying from Sudden Infant Death Syndrome, or SIDS.

General adverse effects

Salt and water retention due to estrogens can cause weight gain and a rise in blood pressure. Changes in liver function tests can occur and jaundice is sometimes seen. Mild gastrointestinal upsets are not unusual. Unwanted endocrine effects include uncomfortable stimulation of the breasts and endometrial bleeding. In men, estrogens produce gynecomastia. Hypersensitivity reactions are rare and include urticaria, edema, and bronchospasm.

Second Generation Effects Fertility

In 1993, Sharpe and Skakkebaek published a theory that environmental and other forms of exposure of males to estrogens, particularly during fetal life, might explain the increasing incidence of reduced sperm counts and developmental disorders of the male genital system (173). Such exposure could be in part due, for example, to dietary changes in mothers a low-fiber diet results in a great reabsorption of endogenous estrogens, and there is an increasing use in the diet of soya, which is a rich source of phytoestrogens. The topic goes beyond the scope of this volume, but it is not impossible that baseline exposure to estrogens in the diet or environment could increase the sensitivity of individuals to estrogens that are administered therapeutically or for purposes of contraception.

Drug Administration Drug administration route

The reported incidence of adverse skin reactions to transdermal estradiol varies from 2 to over 25 , depending on the transdermal system, climatic conditions, and individual sensitivity. Of 78 women 29 reported one or more adverse events and eight discontinued prematurely (194). The main reasons for premature withdrawal included problems of adhesion, skin reactions, or undesirable systemic effects, such as headache, breast tenderness, weight gain, leg cramps, and unacceptable withdrawal bleeding.

Promoting an Optimal Response to Therapy

The nurse obtains daily weights during the initial period of drug therapy. Patients taking an antihyperten-sive drug will occasionally retain sodium and water, resulting in edema and weight gain. The nurse assesses the patient's weight and examines the extremities for edema. The nurse reports weight gain of 2 lb or more per day and any evidence of edema in the hands, fingers, feet, legs, or sacral area. The patient is also weighed at regular intervals if a weight-reduction diet is used to lower the blood pressure or if the patient is receiving a thiazide or related diuretic as part of antihy-pertensive therapy. Rapid weight gain of 5 lb or more

How to Stop Medication

The Positive and Negative Effects of the Medication You must weigh the effectiveness of the medication against the side effects you experience. Weight gain from imipramine and the need to diet may be unpleasant, but the diminished anxiety and depression may be worth the price. The potential for a life-threatening blood disorder may seem terrible, but that may be better than being stuck in a hospital overwhelmed by hallucinations and delusions. On the other hand, the sexual dysfunction caused by fluoxetine may be enough to dissuade you from its use even though you feel somewhat better on it. Methylphenidate may help your son's dis-ruptiveness in school, but his headaches, stomach cramps, and the potential for stunted growth may override any benefits you see.

Preadministration Assessment

The nurse takes a dietary history, focusing on the types of foods normally included in the diet. Vital signs and weight are recorded. The skin and eyelids are inspected for evidence of xanthomas (flat or elevated yellowish deposits) that may be seen in the more severe forms of hyperlipidemia.

See also Anorectic drugs General Information

Although it resembles amfetamine structurally, the appetite suppressant fenfluramine does not produce central nervous system stimulation in therapeutic doses. Dexfenfluramine, the dextrorotatory isomer, was previously widely marketed as an appetite suppressant in the management of obesity. It appears to be a pure serotonin receptor agonist without the dopaminergic and sympathetic activity of the racemic mixture. Fenfluramine, dexfenfluramine, and phentermine have been used alone or in combination as an alternative to diet and surgery in the management of obesity. This therapy was halted in 1997 after reports of valvular lesions affecting almost one-third of patients treated with these drugs. The combination of fenfluramine and phentermine is called fen-phen.

Drug Drug Interactions Fluoxetine

Following the withdrawal of the fenfluramines, alternative combinations have been explored as appetite suppressants. In an open study of a combination of phentermine + fluoxetine in 16 obese patients with binge-eating disorder, in the setting of cognitive behavioral therapy, there were significant reductions in weight, binge frequency, and psychological distress by the end of treatment however, the patients regained most of the weight within 1 year (101). At follow-up at 18 months there was still a reduction in binge eating in patients who continued maintenance treatment. The results did not support the long-term value of adding phentermine fluoxetine to cognitive behavioral therapy for binge-eating disorder. It is worth emphasizing that it is not known whether phentermine fluoxetine is also associated with cardiac valvulopathy. Moreover, the recognition that phentermine is a monoamine oxidase inhibitor (102) raises further concerns about its safety.

Hempseed Humanitys Best Single Food Source

The byproduct of pressing hempseed for its nutritious vegetable oil is a high protein seed cake. Hempseed cake was one of the world's principal animal feeds until this century.* Hempseed can supply a nearly complete diet for all domesticated animals (dogs, cats), many farm animals and poultry, and allows animals maximum weight gain for less than current feed costs. And without any need for artificial growth steroids or other drugs currently poisoning the human race and food chain.

History And Legal Status

Despite these early warning signs of the potential dangers of GHB, several nutritional supplement companies started promoting GHB in the 1980s as a way for bodybuilders to stimulate the production of growth hormones, enhance muscle mass, and reduce body fat. However, scientific studies have yet to prove that GHB can indeed increase muscle mass or assist in weight loss. GHB could easily be found in bulk quantities in many health food stores during this time and was also promoted as a way to ease anxiety and depression because of its potent sedative properties.

Organs and Systems Liver

Of 17 patients who were given gemtuzumab, three developed grade 3 hyperbilirubinemia, and five developed grade 3-4 hepatic transaminitis after a median of 13 days, including one who developed veno-occlusive disease (4). This patient had abrupt onset of weight gain, associated with ascites, abdominal distension, acute hepatic failure, and right upper quadrant pain, and died. As a possible mechanism gemtuzumab may selectively target CD33-expressing cells in hepatic sinusoids, activate stellated cells, damage sinusoidal endothelial cells, and cause sinusoidal vasoconstriction or ischemic hepatocyte necrosis. Liver histology showed sinusoidal injury with extensive sinusoidal fibrosis, centrilobular congestion, and hepatocyte necrosis (5).

The Stigma of Addiction

Addiction is a term with pronounced negative connotations. Declaring that the relationship between a user and a substance is an addiction typically indicates both that the substance is being misused and that the relationship is shameful or unhealthy. An addict is by the very use of this term typically labeled as dangerous and self-destructive. Yet not all observers hold that addiction is undesirable or that the terms addict and addiction are pejorative. These terms can be used as objective, denotative terms, just as obesity can be used descriptively without the negative connotations. But for the most part, addicts and their addictions are cast in an array of negative roles, from the pitiful prisoner of uncontrollable foreign desires to dangerous individuals ready to do anything to satisfy their appetites. Different notions of addiction abound, but they are almost uniformly negative, usually differing only in how culpable the addicts are thought to be for their own addictions. This...

Symmetrical Cleavage of 3Carotene

Dietary administration of retinal, the direct precursor of the Drosophila visual chro-mophore, 3-hydroxy-retinal (8), thus bypassing the need for dietary sources of carotinoids. Hunziker's group then isolated a cDNA encoding the chicken j8-carotene-15,15'-dioxygen-ase (9), and the groups of Blaner and Cunningham isolated the mouse homolog (10,11) and demonstrated that this enzyme catalyzed the symmetrical cleavage of p-carotene into two molecules of retinaldehyde.

Antidiabetic Activity

The prevention of diabetes is an urgent worldwide public health concern. Obesity and insulin resistance induced by overeating and physical inactivity typically characterizes the period preceding onset of type 2 diabetes. Shigeta et al. 62 have shown that caloric restriction and physical exercise have obvious importance. They stress that actively promoting healthy eating and sleeping habits should be considered for the prevention of obesity and insulin resistance.

Pregnancy Category None

Intoxicated persons can be unaware of what they are doing and unaware of what is going on around them, additional hazards on top of the drug's sometimes dangerous physical effects. As with other substances accidental dosage can occur. Cases are documented of agricultural workers and gardeners being affected by apparently rubbing their eyes after contact with jimson weed or other datura plants a case report also exists of absorption through the skin. Contamination of food is known, and unsuspecting persons have used wine and honey made from the plants. Rats on a 90-day diet including jimson weed seed experienced lower cholesterol levels, less weight gain, and increased weight of livers. Investigators running the experiment described the consequences of chronic jimson weed seed diet as undesirable, but of course humans do not eat the seeds as a regular food. In this experiment female rats were more affected by jimson weed than males. Jimson seed meal has also been found to harm...

Formation of Retinyl Esters

Dietary retinyl esters are also processed in mucosal cells of the intestine through sequential de-esterification re-esterification reactions Retinyl esters are then incorporated into chylomicrons and pass from the intestine into the lymph fluid where lipolysis occurs, resulting in the formation of chylomicron remnants that continue to harbor retinyl esters. Chylomicron remnants containing retinyl esters en-

Mobilization of Body Vitamin A Stores

RBP seems to be critical for retinol transport to tissues, especially when the diet is deficient in vitamin A. Mice that are null for RBP expression exhibit reduced levels of serum retinol levels however. these mice seem to function normally, at least with respect to vision, if retinol is supplemented in the diet (19). Retinol dissociates from RBP on reaching these extrahepatic tissues and likely enters the target cell by passive diffusion (18). Although a receptor-mediated form retinol uptake has been proposed (20, . , it is unclear how this contributes to the overall cellular uptake of retinol which has been repeatedly shown to enter the cell rapidly by passive diffusion (18).

Regulatory Issues Affecting Herbal Medicines

The US Food and Drug Administration (FDA) regulates drugs and requires that they be both safe and effective. Most herbal products are classified as dietary supplements or foods and are marketed pursuant to the Dietary Supplement Health and Education Act of 1994. FDA requires these to be safe for consumers but does not require demonstration of efficacy as long as they are not marketed for prevention or treatment of disease (8,9). Herbal products are regulated differently in other countries. In the United Kingdom, any product not granted a license as a medical product by the Control Agency is treated as a food and cannot carry any health claim or medical advice on the label. Similarly, herbal products are sold as dietary supplements in the Netherlands. In Germany, herbal monographs called the German Commission E monographs are prepared by an interdisciplinary committee using historic information, chemical, pharmacological, clinical and toxicological studies, case reports,...

Relieving Anxiety and Fear

The patient with newly diagnosed diabetes often has many concerns regarding the diagnosis. For some, initially coping with diabetes and the methods required for controlling the disorder creates many problems. Some of the fears and concerns of these patients may include having to give themselves an injection, having to follow a diet, weight control, the complications associated with diabetes, and changes in eating times and habits. An effective teaching program helps relieve some of this anxiety. The patient in this situation needs time to talk about the disorder, express concerns, and ask questions.

Drug Administration Drug formulations

Low-dose oral contraceptives based on the older proges-togens are relatively well tolerated in the short term, better so than the products that preceded them and those that came later. Two placebo-controlled studies with the combination of levonorgestrel 100 micrograms and ethinylestradiol in 704 patients over six cycles showed no differences in unwanted effects compared with placebo in particular there was no evidence of weight gain (299).

TTie Retinoid Cycle in Visual Processes

Dietary sources of vitamin A also provide the metabolites that are necessary for vision. The ingestion and processing of j3-carotene ex retinyl esters to retinol and the transport of RBP-retinol complexes to target tissues was discussed earlier in this chapter, and the ret- promised in visual processes. However, the defective vision phenotype of these animals is reversed by dietary administration of 9-cis-retinal-which can also form a Schiff base with rhodopsin (creating isorhodopsin) that functions as a photon detector in the visual process similar to 11-cis-retinal (84).Interest-ingly, RPE65 shares around 40 sequence identity with the dioxygenase that catalyzes the symmetrical cleavage of p-carotene into two molecules of retinal (7, 8) however, the functional significance of the relationship to the j3-carotene dioxygenase is completely unknown.

Educating the Patient and Family

Failing to comply with the prescribed treatment regimen may be a problem with patients taking an oral antidiabetic drug because of the erroneous belief that not having to take insulin means that their disease is not serious and therefore does not require strict adherence to the recommended dietary plan. The nurse informs these patients that control of their diabetes is just as important as for patients requiring insulin and that control is achieved only when they adhere to the treatment regimen prescribed by the health care provider. To control diabetes, follow the diet and drug regimen prescribed by the health care provider exactly. Avoid alcohol, dieting, commercial weight-loss products, and strenuous exercise programs unless use or participation has been approved by the health care provider.

Drug administration route

In general, intensive therapy produces lower blood glucose concentrations and HbA1c concentrations. This may result in worsening of proliferative retinopathy (155), or weight gain M14.42.9 . Pens can develop inaccuracies in rare instances, which may be unnoticed by the patient (156). Clogging of the system is often the cause. The result is diabetic coma or ketoacidosis, but this is not more frequent than with other systems. When needles are not regularly renewed, infections may emerge. The usefulness of devices for constant subcutaneous, intravenous, or intraperitoneal insulin administration is well established. To establish feedback systems reliable, constantly functioning insulin sensors are essential, but they have been in a developmental phase for more than 25 years, and no long-acting glucose sensors for non-experimental use are yet available (157). Experience with pumps in large groups of patients has been reported (158-160). When starting intensive therapy, temporary worsening...

Novel Uses for RXRActive Compounds

In intestinal cells, this protein transports cholesterol into the lumen of the intestine, effectively reducing cholesterol uptake by the cell and ultimately lowering blood cholesterol levels. In the case of agonists, this effect is amplified because RXR agonists (rexinoids) also decrease bile acid secretion through the activation of RXRFXR heterodimeric complexes (243,244) (Table 7.4). Because bile acids are important vehicles for cholesterol dissolution and gener- ally promote cholesterol absorption in the gut, the effect of RXR-mediated induction of ABCl expression has an even more dramatic effect on serum cholesterol levels. In addition, the ABCl protein mediates cholesterol efflux from macrophages that contribute to atherosclerotic processes (240). The development of additional RXR-selective ligands will clearly be at the forefront of retinoid biology in the future. However, there are problems with rexi-noid therapy, including disruptions in...

Fooddrug Interactions

Food-drug interactions may be pharmacokinetic or pharmacodynamic in nature. Certain foods alter activity of drug metabolic enzymes, and especially CYP3A4 appears to be the key enzyme in food-drug interaction (94). It has also long been recognized that intake of food and fluid can alter the extent of drug absorption. This alteration may be related to alteration of physiological factors in the gut such as gastric pH, gastric emptying time, intestinal motility, hepatic portal blood flow or bile flow rate. Moreover, direct interaction of food with drug may also alter bioavailability such as adsorption of a drug in insoluble dietary component, complex formation of a drug with a metal ion or partitioning of a drug in dietary fat. Food may be able to alter performance of modified released oral formulation (95). It has been recognized that smoking, intake of charcoal-broiled food or cruciferous vegetables induce the metabolism of multiple drugs, whereas grapefruit juice increases...

Vitamins Are Naturally Occurring

One of the substances commonly treated as a vitamin is niacin, which is synthesized from the essential amino acid tryptophan. The ratio is approximately 60 mg of tryptophan being required to produce 1 mg of niacin (1). This has led to niacin requirements being expressed as niacin equivalents (NE), based on the amount of tryptophan in the diet. It must be kept in mind that tryptophan is essential and is the precursor to the neurotransmitter serotonin in addition to being part of protein structure. Therefore, niacin can be thought of as tryptophan sparing. 1.1.4 Normal Constituent of the Diet. With the exception of cholecalciferol,all of the other compounds that we treat as vitamins are normal constituents of our diets, with most found in more than one food group. The situation with cholecalciferol is such that, except for the small part of the world's population that obtains its protein from marine species, neither cholecalciferol nor ergocalciferol from irradiation of the plant sterol...

Gwendolyn A McMillin PhD and Joshua A Bornhorst PhD

Elements are the basis of all things. However, human exposure to significant amounts of some elements can lead to adverse health effects including death. Laboratory testing can help identify unrecognized exposures as well as monitor-associated decontamination efforts. Regular testing is also important to identify exposures in populations that are at high risk for exposure to a specific toxic element. For example, aluminum is important to monitor in dialysis patients. Lead is important to monitor in children that live in areas in which environmental lead contamination is prevalent. Mercury is important to monitor in dental workers and individuals for whom predatory fish frequents the diet. Arsenic and cadmium are important to monitor in certain industrial settings. Iron is important to monitor for individuals at risk for iron overload. The quality of laboratory results depends on collection of the appropriate specimen and efforts to minimize external contamination of the specimen with...

TABLE 523 I Contraceptive Hormones Continued

Weight loss is often as difficult to manage as weight gain. When a patient taking the female hormones has a decrease in appetite and loses weight, the nurse encourages the individual to increase protein, carbohydrates, and calories in the diet. Small feedings with several daily snacks are usually better tolerated in those with a loss of appetite than are three larger meals. Patients are encouraged to eat foods that they like. Dietary supplements may be necessary if a significant weight loss occurs. A dietitian may be consulted if necessary. Weights are usually taken on a weekly, rather than daily, basis.

Gerontologie Alert

Anorexia (loss of appetite resulting in the inability to eat) is a common occurrence with the antineoplastic drugs. Is it not uncommon for the patient to report alterations in the sense of taste during the course of chemotherapy. The nurse assesses the nutritional status of the patient before and during treatment. Small, frequent meals (five to six meals daily) are usually better tolerated than are three large meals. Breakfast is often the best tolerated meal of the day. The nurse stresses the importance of eating meals high in nutritive value, particularly protein (eg, eggs, milk products, tuna, beans, peas, and lentils). Some patients are able to eat high-protein finger foods such as cheese or peanut butter and crackers. Nutritional supplements may also be prescribed. The nurse monitors the patient's body weight weekly (or more often if necessary) and reports any weight loss. If the patient continues to lose weight, a feeding tube may be used to administer a...

Riboflavin Vitamin B

3.6.2 Riboflavin Uptake and Chemistry (Fig. 8.28). Most dietary riboflavin is eaten as the FAD or FMN coenzymes. Intestinal pyrophosphatases and phosphatases produce free ribo-flavin, which is actively transported in the proximal area of the small intestine into systemic circulation. Because of its poor water solubility, it is transported on albumin and immunoglobulin proteins. Conversion to the coenzyme forms occurs inside the cells that need these coenzymes.

Combinations of oral hypoglycemic drugs

In 585 patients in a double-blind, randomized, placebo-controlled, multicenter study lasting 16 weeks nateglinide 40 mg tds alone, troglitazone 200 mg day alone, and the combination were compared (35). The combination was most effective in lowering HbA1c. The most frequent adverse effects were mild hypoglycemia, most often in the combination group. Three patients (two in the combination group and one in the troglitazone alone group) withdrew because of hypoglycemia. Most of the withdrawals were related to increased liver enzymes and weight gain, known adverse effects of troglitazone. Twelve patients withdrew because of predefined changes from baseline (transaminases more than 200 and alkaline phosphatase and bilirubin more than 100 over baseline) seven were taking troglitazone alone, four combined therapy, and one placebo.

TABLE 51 Sleep Hygiene Techniques

Melatonin is a naturally occurring pineal gland peptide hormone available in OTC formulations. The FDA classifies it as a nutritive or dietary supplement. As dietary supplements are not reviewed by the FDA, the strength and purity of mela-tonin cannot be guaranteed. When taken orally, melatonin alters circadian rhythms, lowers core body temperature, and reduces daytime alertness. Melatonin may be particularly effective when the normal circadian cycle is disrupted (e.g., jet lag, shift work). Also unregulated, valerian may alleviate mild, short-term insomnia, but safety and efficacy have not been established.

Bibliography and further readings

Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D and Fluoride, Food and Nutrition Board, Institute of Medicine, National Academy Press, Washington, DC, 1997. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin Be, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline, Food and Nutri Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium and Carotenoids, Food and Nutrition Board, Institute ofMedicine, National Academy Press, Washington, DC, 2000. Dietary Reference Intakes for Vitamin A, Vitamin K Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc, Food and Nutrition Board, Institute of Medicine, National Academy Press, Washington, DC, 2001.

Part of the Problem The Miscategorization of Drugs within the Regulatory Framework

It is one thing, however, to remark that drug policy conforms to the framework of prescription legend and controlled-substance Schedules in theory, and quite another to observe whether it does so in practice. Clearly, there are bizarre discrepancies between the theoretical framework and the way in which specific drugs are categorized. These discrepancies account for many of the inconsistencies in policy outlined in the earlier chapters of this book, and they are a major source of disagreement in public discussion in all areas across the board. Many of these questions have already been asked. Why, for instance, is heroin classed as Schedule I but morphine as Schedule II despite their functional equivalence How can ephedra, when marketed as a dietary supplement, remain essentially unregulated, while its active ingredient, marketed as the medication ephedrine, is a fully regulated prescription pharmaceutical And how can we reconcile the fact that in one case, that of the prescription...

The Root of the Problem Inconsistent Foregrounding and Sidelining

Return for a moment to the full spectrum of drugs across the board prescription pharmaceuticals, OTC medications, herbal medicines and dietary supplements, common-use drugs like alcohol, tobacco, and caffeine, religious-use drugs, sports-enhancement drugs, and illegal drugs. Under the account of weighing harms and benefits explored just now which is assumed to be central, at least in theory, to the federal framework and Appeals to harms and benefits typically fall into rough categories physical harms and benefits, psychological harms and benefits, societal harms and benefits, and economic harms and benefits. These categories are imprecise and often overlapping, but nonetheless important. What is central to the troubled discourse about drugs is that harms and benefits in each of these rough categories are disparately weighted in different areas of drug theory, policy, and practice. As will be seen, the physiological benefits of drug use play a larger role in the harm-prevention...

Other Prescription Hypnotics

Small doses of sedating TCAs (e.g., amitriptyline, doxepin) are sometimes used as hypnotics. Patients with chronic pain may particularly benefit from this treatment strategy TCAs are frequently used to potentiate the benefits of traditional pain medications. They are potent inhibitors of REM sleep, and their discontinuation is often associated with REM rebound. Anticholinergic and adrenergic side effects and toxicity in overdose must be weighed against potential benefits. Mirtazapine is a newer sedating antidepressant that targets both the noradren-ergic and serotonergic systems. It may be a useful alternative to the tricyclic antidepressants as it is less anticholinergic and less toxic in overdose. Mirtazapine has strong antihistaminic activity that may cause significant weight gain with chronic use. Certain sedating anticonvulsants are reasonable third and fourth line sleep aids or add-on hypnotics for patients who do not respond or become tolerant to standard hypnotics. Bipolar...

Opioid analgesics and other centrally acting analgesics

Buprenorphine and norbuprenorphine levels were determined from 10 random breast-milk samples collected over 4 successive days from a lactating woman during buprenorphine maintenance therapy with 8mg d. Concentrations ranged from 1.0-14.7 and 0.6-6.3 ng ml, respectively. Considering the peak concentrations, a fully breastfed child would ingest 3.2 jig kg daily - i.e. approximately 2 of the weight-adjusted maternal dose (Grimm 2005). Another case report of a mother taking 4 mg d calculated a relative dose of 1 (Marquct 1997). A study of 20 mother-child pairs observed lower milk production and weight gain of the breastfed newborn of mothers receiving a 3-day course of epidural buprenorphine analgesia (Hirose 1997). Although clearance may be slower

Endocannabinoids In Relation To Feeding And Appetite

In parallel into other brain centers where they exert antagonistic actions on food intake. Thus, the NPY AGRP expressing neurons increase feeding, whereas those that express POMC CART inhibit feeding. The stimulatory effects of cannabis products on appetite has been anecdotally known for centuries. A9-THC as well as other exogenous cannabinoids also produce hyperphagic effects under laboratory conditions in most human and animal models (Kirkham and Williams, 2001 Croxford, 2003 Berry and Mechoulam, 2002, Mattes et al., 1994) however, no effect (Graceffo and Robinson, 1998) or a reduction in food intake (Miczek and Dixit, 1980) has been reported. The hyperphagia induced by A9-THC is cannabinoid CB1-receptor mediated as it is reversed by the selective CB1 antagonist SR141716A and not by SR144528, an antagonist for the CB2 receptor (Williams and Kirkham, 2002). In addition, following temporary food restriction, CBj knockout mice eat less than their wild-type littermates (Di Marzo et al.,...

Pregnancy Category X

Nandrolone is used to treat breast cancer and anemia, and the drug has improved asthma and Sjogren's syndrome, a disease that destroys salivary, sweat, and tear glands. Healing action on cornea afflictions has been observed, and rat experiments have explored nandrolone's potential for speeding recovery from tooth extractions. A skin cream containing nandrolone is used against eczema. Human research indicates that the drug can improve osteoporosis, a disease causing brittle bones, although results conflict on how long the improvement lasts. Among some diabetics with a kidney condition called Kimmelstiel-Wilson syndrome, nandrolone has helped both renal and eyesight difficulties. In kidney dialysis, patients' experimental use of nandrolone was able to improve weariness, increase muscle mass, and fight malnutrition. The compound has helped AIDS (acquired immunodeficiency syndrome) patients build up weight, muscles, and strength. The substance has also been given in hopes of...

Other features of the patient

In patients with reduced respiratory reserve, such as those with emphysema, severe obesity, cor pulmonale, and kyphoscoliosis, opioids must be used with caution. The relative benefits and harms of using opioids in patients taking monoamine oxidase inhibitors, those with a history of drug abuse, asthma, hepatic impairment, hypotension, raised intracranial pressure, or head injury, and during pregnancy or breast feeding, should be carefully considered. Dextropropoxyphene, pethidine, and methadone should be used with caution (SEDA-21, 85).

Human Host Iron Metabolism

The reticuloendothelial macrophages, predominately in the liver and spleen, contain approximately 600 mg in ferritin and hemosiderin the bone marrow approximately 300 mg, the liver parenchyma approximately 1,000 mg and muscle and other cells approximately 400 mg. Only 3-4 mg circulate in a plasma labile pool bound to transferrin. This labile pool, also subject to diurnal variation, turns over seven to eight times a day resulting in approximately 20 mg that is loaded and delivered principally to the bone marrow for hemoglobin synthesis. While total dietary iron intake is about 10-15 mg, only 1 mg (10 ) is absorbed through the intestine. One milligram is also excreted in sweat, urine or feces each day. Thus the majority of the daily hemopoietic iron requirements originates mainly from macrophage recycling of heme iron and also from ferritin store transfer. The spleen and liver reticuloendothelial cells normally digest phagocytosed erythrocytes at a rate sufficient to...

Acetyl coenzyme A choline CH3 acetylcholine acetylcholine CH3

Dopamine, norepinephrine and epinephrine are products of the metabolism of dietary phenylalanine. This is an interesting sequence of reactions in that we will be discussing not only the three neurotransmitters formed but also considering the DOPA precursor and its use in the treatment of Parkinson's Disease. These molecules are also called catecholamines. Catechol is an ortho dihydroxyphenyl derivative. Degradation of the final product in the pathway, epinephrine, can be accomplished by oxidation (monoamine oxidase - MAO)or methylation (catecholamine O-methyl transferase - COMT). The diagram on the next page illustrates the scheme of successive oxidations which produce the various catecholamines.

Pregnancy Category C

Seed from opium poppies is a food product commonly used in breads, cakes, and candies. Consumption of amounts found in a normal meal can cause a false opiate positive in drug screens controversy exists about whether further analysis of results from such testing can show that poppy seed was the cause. Poppy seed oil is a comparatively unfamiliar product, but animal tests indicate it has good potential for human nutrition. In some parts of the world iodized poppy seed oil has been used instead of iodized salt to treat goiter and has been suggested as a means of preventing nervous endemic cretinism caused by iodine deficiency in the diet of pregnant women. Iodized poppy seed oil is taken up by cancerous portions of a liver, giving the substance clinical usefulness if anticancer drugs are blended into it, as the drugs then concentrate exactly where they are needed in the liver. Results from animal research have led investigators to speculate that consuming normal...

Organs and Systems Metabolism

In 47 patients with severe migraine unresponsive to clo-nidine, pizotifen 1.5 mg for 6 months more than halved the incidence of attacks in 30 patients and 12 became headache-free. Weight gain was a problem in some subjects (2). In an open, multicenter study of the use of pizotifen 1.5 mg at night to prevent migraine in 834 patients, the most frequent adverse effects were drowsiness, although in one-third of the affected patients this was transient, and weight gain, with an average increase of 0.7 kg over 2 months (3).

Chemical Nature of Phytoantimutagenic Compounds

More than 500 compounds belonging to at least 25 chemical classes have been recognized as possessing antimutagenic protective effects 93 . In recent years, there has been an increased interest in identifying the antimutagenic and anticar-cinogenic constituents of both dietary and medicinal plants all over the world. The major classes of antimutagenic compounds are briefly described.

The Role of the Government

People who are alarmed by the harmful ingredients found in dietary supplements advocate stricter governmental regulation of those substances. They are not satisfied that supplements are classified as foods and thereby Canada currently has a system of harsher regulations of natural health products, that country's classification for dietary supplements. In 2004, the government formally began regulating natural health products under the Natural Health Products Directorate (NHPD). The NHPD maintains certain safety and quality levels that manufacturers of dietary supplements must meet. Many in the United States would like the FDA to adopt a similar practice.

Female Teen Athletes Use Less Diet Drugs

The results of a 2004 study called ATHENA (Athletes Targeting Healthy Exercise and Nutrition Alternatives) suggest that female teens who participate in team sports at school tend to have very healthy eating habits and seem deterred from using diet pills and performance-enhancing drugs. The study included 928 female students from 40 participating sports teams at 18 high schools, with an average age of 15.4 years.36

Assays for Mutagenicity and Antimutagenicity

Another promising approach is the use of human-derived hepatoma cells that have maintained the activities of phase I and phase II enzymes that are usually lost during cultivation 164 . Some of the drug-metabolizing enzymes, for example CYP1A1, CYP1A2, CYP2E1, aryl hydrocarbon hydroxylase (AHH), UPDGT, and GST, are represented in an inducible form, therefore these are useful tools for the identification of protective compounds 165, 166 . Natarajan and Darroudi 167 established a method for micronucleus assay using HepG2 cells also, a protocol for single-cell gel electrophoresis (SCGE) assay has been developed and validated 168, 169 . These models enable the detection of genotoxic effects of problematic compounds viz. safrole, hexamethylphosphoramide (HMPA), isatidine, and certain mycotoxins, which give false negative results in other in vitro assays. In vivo mutagenicity studies with rodents, mainly bone marrow micronucleus assays and chromosomal aberration tests with peripheral...

Miscellaneous Compounds

Efforts continue to define the usefulness and unwanted effects of tibolone, with its unusual mixed spectrum of estrogenic, progestogenic, and androgenic effects. There is a widespread view that it could be preferable to other compounds in countering osteoporosis in post-menopausal women, particularly regarding adverse effects (114r). In an Italian study of 200 women taking different forms of HRT, estradiol with medroxyprogesterone acetate was compared with continuous tibolone 2.5 mg day (115Cr). Mastodynia sufficient to require withdrawal was less common with tibolone (4 vs. 13 ), as was irregular bleeding (19 vs 42 ), but there was modest weight gain 23 of users reported a gain of at least 2 kg because of which half of them suspended treatment. Only half of the original women were still taking treatment in each group 2 years after the start of therapy.

Phony Business Method

I have been doing research on the dietary effects of certain drugs on cattle. Unfortunately, my laboratory is on a minute budget and is not set-up properly for the manufacturing of 5-methoxy-N, N-dimethyltryptamine, A3-tetrahydrocannabinol, and tropinone. I feel these are important substances to gain knowledge for my project, so please send me the following

Food Drug Interactions

The disposition of quazepam 20 mg, in the fasting state and 30 minutes after the consumption of meals containing different amounts of dietary fat, has been studied in a three-arm, randomized, crossover study in nine healthy men (1). Plasma concentrations of quazepam and its metabolite, 2-oxoquazepam, were measured for up to 48 hours after dosing. The peak concentrations of quazepam 30 minutes after low-fat and high-fat meals were 243 and 272 , respectively, of those in the fasted state. The AUCs of quazepam from 0 to 8 hours and from 0 to 48 hours were increased by both the low-fat and high-fat meals by 1.4-2 times. Quazepam was well tolerated, with no significant difference in the Stanford Sleepiness Scale between fasted and fed conditions. Thus, food significantly increased the absorption of quazepam but did not prolong the half-life. Quazepam is lipophilic it would therefore be more highly dissolved in a fatty meal and more available for absorption.

New York New York April 19 1963

Amphetamine is well known for its high activity as a central nervous stimulant, and it is used in certain preparations for the control of obesity by depressing the appetite, and for elevating the mood in depressive states by providing a temporary feeling of well being in the patient. It was very surprising, therefore, to find that these allyl substituted derivatives exhibit such excellent properties as analgesia, tranquilizing, antidepressant, and appetite controlling, at doses devoid of central nervous stimulation. This useful separation of desirable from undesirable pharmacological actions would certainly not be expected on the basis of the known actions of amphetamine.

Case 7 Drug Interactions between Prescription and Alternative Medications

John's wort has shown efficacy against mild to moderate depression in some but not all clinical trials. The hypothesized mechanism of action overlaps with that of prescription medicine, calling into question the classification of St. John's wort as a dietary supplement and not a drug. This plant is also known to stimulate enzymes in the body that normally metabolize both Cyclosporin A and many other important medications, including warfarin, digoxin, irinotecan, indinavir, carbamazepine, fluoxet-ine, simvastatin, and oral contraceptives. When metabolism is stimulated, these drugs are cleared more rapidly, producing a drop in blood levels a so-called drug interaction. No such information or warning is provided on the St. John's wort label, as would be required for prescription or OTC preparations. Even though Mary Jo carefully researched the clinical evidence and the products and followed the instructions, a drastic and very Who or what is at fault for Mary Jo's need for a...

Conclusions and Perspectives

Zeaxanthin is an important dietary carotenoid and can be converted to violax-anthin by zeaxanthin epoxidase. The gene for zeaxanthin epoxidase, with sense and antisense constructs, was transformed in potato (Solanum tuberosum). Both approaches (antisense and cosuppression) resulted in higher levels of zeaxanthin accumulation in potato tubers. In addition, a-tocopherol was elevated up to two- to threefold in the genetically transformed lines 113 . This provides an example of the use of an antisense approach to knocking out one metabolic pathway gene to modulate the content of vitamin E.

Ethnomedicines and Drug Discovery

Maining 20 use plant products as ingredients for several drugs 7 . Currently, 119 drugs of modern medicines are derived from 90 plants, of which 74 are of eth-nomedicinal origin. The search for drugs and dietary supplements from ethnome-dicinal sources has accelerated in recent times therefore, the ethnopharmacolo-gists and natural products chemists are combing the earth surface for lead compound of therapeutic potential.

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