FitSugar

What's the Deal With Hypnotherapy?

FitSugar — Thu, 28 Aug 2008 03:30:00 -0700

Let's face it: It's not easy to lose weight, or quit smoking, or get your stress under control. But if you've ever struggled with any of these health concerns, you know that the best solution is simply the one that works for you! So, why not give hypnotherapy a try?

We've heard that Lily Allen used it for weight loss, and I know several other people who have lost weight through hypnosis. Though it may sound a little new age-y, the method really makes a lot of sense, since it gets to the root of your self-control.

When used for health-related matters like dieting and smoking cessation, hypnosis is usually referred to as suggestion therapy. The therapist uses guided relaxation to put the subject into a sort of trance wherein she is susceptible to suggestion. Far from mind control, the trancelike state simply makes you more responsive to ideas - like the fact that you can live without cigarettes or a second piece of pie- that you might normally reject. To hear more about it, read more.

When you are in a hypnotized state, you will likely feel comfortable and relaxed but not really awake, almost as if you are dreaming. The hypnotherapist then makes suggestions in line with your treatment. If you are trying to lose weight, she might tell you that you should always stop eating when you are full. If you are trying to kick the smoking habit, the therapist could suggest that you think cigarettes taste yucky.

Hypnotherapy can be used to treat addiction, as well as anxiety, phobias, insomnia, and depression. The technique is often used in tandem with standard psychotherapy or, in the case of smoking, along with other cessation programs. Regardless of whether you're using it to lose weight or tackle another problem, make sure you're working with a licensed professional.

Have you tried hypnotherapy, or do you know anyone who has? If so, tell me about it below.

Source

Hypnotherapy to Quit Smoking

FitSugar — Tue, 23 Oct 2007 10:15:00 -0700

You might have heard that Lily Allen lost weight using hypnotherapy but have you heard the same technique works for giving up smokes too?

A recent study found that to quit smoking and stay smoke free, hypnotherapy is more effective than going cold turkey or just using the nicotine patches or nicotine gum. Free hypnotherapy was offered to both heart and lung patients after hospitalization, and 50% of the patients using hypnotherapy alone, or with nicotine replacement therapies, stayed smoke free. An interesting aside: a considerably higher percentage of heart patients stayed smoke free compared to lung patients.

If you have had trouble quitting smoking in the past, getting hypnotized could be the answer. If you do smoke, quitting is one of the best things you can do for your health.

I am curious if any of you have tried hypnotherapy for smoking, or dieting? Let me know in the comments section below.

Source

Irritable bowel syndrome

FitSugar — Wed, 08 Oct 2008 17:35:32 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Irritable bowel syndrome (IBS) occurs when muscles in your intestines contract faster or slower than normal. This causes pain, cramping, gassiness, sudden bouts of diarrhea, and constipation.

There are two types of IBS. People who suffer from spastic colon IBS haveconstipation, diarrhea, or both, and often feel pain after eating. Painless diarrhea IBS involves the sudden onset of diarrhea during or after meals, or upon waking.

Between 10 - 20% of the population has IBS at some time. IBS also makes up 20 - 50% of visits to gastroenterologists, or doctors dealing with digestive system problems. The syndrome often starts in adolescents or young adults. It affects almost twice as many women as men, and is often associated with stress.

Signs and Symptoms

Cramping pain in your lower abdomen
Bloating and gas
Changes in your bowel habits
Diarrhea or constipation, or both alternately
Immediate need to move your bowels when you wake up or during or after meals
Relief of pain after bowel movements
Feeling of incomplete emptying after bowel movements
Mucus in your stool

What Causes It?

There are many possible causes of irritable bowel syndrome (IBS). For instance, there may be a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine. There is no abnormality in the structure of the intestine.

IBS can occur at any age, but often begins in adolescence or early adulthood. It is more common in women. More than 80% of IBS patients in the United States are women, according to the American College of Gastroenterology. Predisposing factors may include a low-fiber diet, emotional stress, use of laxatives, a bout of infectious diarrhea, or other temporary bowel inflammation.

Up to 60% of individuals with the syndrome have psychological symptoms, such as anxiety and depression. Levels of the neurotransmitter (brain chemical) serotonin have been found to be low in individuals with IBS.

Diet is also a major cause of IBS. An increased sensitivity or intolerance to certain foods may trigger or worsen symptoms of IBS. Fatty foods, artificial sweeteners (sucralose or Splenda and saccharine or Sweet'N Low), chemical additives (dyes and preservatives), red meat, dairy products (milk, cheese, sour cream), chocolate, alcohol, and carbonated beverages (sodas) may trigger or aggravate episodes. Gluten contained in wheat and barley is also a common trigger for IBS. IBS may affect the absorption of nutrients, causing many individuals to have fewer nutrients available for use in the body.

What to Expect at Your Provider's Office

Your doctor will feel your abdomen to check for signs of pain. Other tests may include a rectal exam, pelvic exam (for women), sigmoidoscopy, stool sample testing, blood and urine tests, ultrasound, and x-rays.

Doctors may also check to see if intolerances to lactose exist. Lactase is an enzyme needed to digest sugars found in dairy products. If an individual lacks this enzyme, they may have problems digesting milk sugars containing lactose. Removing milk and dairy products from the diet for several weeks may be enough to determine if the person is lactose intolerant.

Treatment

The objective of treatment is to relieve symptoms and balance the gastrointestinal tract. Changes in diet may help alleviate symptoms in some. Increasing dietary fiber and eliminating gastrointestinal stimulants, such as caffeine, may help. Anxiety-reducing measures, such as getting regular exercise and seeking counseling for severe anxiety or depression, can also be effective. Balancing the normal bacterial flora in the colon, which include Lactobacillus acidophilus, and balancing the immune system can also be very important in alleviating the symptoms of IBS.

Drug Therapies

Anticholinergic agents -- reduce the pain from bowel spasm by relaxing the muscles in intestines. Anticholinergic drugs include hyoscyamine (Levsin and Levsinex) and dicyclomine (Bentyl).
Antiflatulents -- reduce gas. Antiflatulants influde simethicone (Phazyme or Mylicon).
Antidiarrheal medications -- help decrease and stop diarrhea. Antidiarrheal drugs include loperamide (Imodium) and a combination of diphenoxylate & atropine (Lomotil).
Bulk-producing agents -- such as psyllium (Metamucil) and other fiber supplements can help with diarrhea or constipation.

Complementary and Alternative Therapies

Irritable bowel syndrome (IBS) has many underlying causes that can often be treated with alternative therapies. Stress reduction techniques, such as biofeedback, hypnosis, balancing the normal flora of the digestive system, or counseling, may help.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

Remove known food allergens or irritants. The most common food allergens are dairy products, wheat, corn, peanuts, citrus, soy, eggs, fish, and tomatoes. Your health care provider may want to test for food sensitivities.
Avoid refined foods such as white breads, pastas, and sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Use healthy cooking oils, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
If you suffer from gas, eliminate beans, cabbages, and other "gassy" vegetables from your diet, as well as apple juice, grape juice, bananas, nuts, and raisins.
Fiber supplements can help reduce pain, cramping, and gas.
Taking digestive enzymes 20 minutes before meals can help enhance digestion and normalize bowel function.
One tsp. of raw bran added to each meal provides fiber.
Avoid coffee, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise where possible, 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. oil daily, to help decrease inflammation and improve immunity.
A multivitamin daily, containing the antioxidant vitamins A, C, D, E, the B-vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant effects.
N-acetyl cysteine, 200 mg daily, for antioxidant effects.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. Some probiotic supplements may need refrigeration for best results. Check the label carefully.
Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
Vitamin C, 500 - 1000 mg one to three times daily, as an antioxidant, and for immune support.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
L-theanine, 200 mg one to three times daily, for stress and nervous system support.
Melatonin, 2 - 5 mg one hour before bedtime, for symptoms of IBS. Ask your health care provider about potential drug interactions with the use of melatonin.

Herbs

You can use herbs in the form of dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink two to four cups per day.

Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.
Enteric-coated, standardized peppermint oil, one to two capsules three times a day after meals, for antispasmodic activity.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for Lyme disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. In some cases, such as Lyme disease, a professional homeopath may prescribe specific remedies without considering the individual's constitutional state. Such remedies for Lyme disease include:

Argentum nitricum
Colchicum autumnale
Colocynthis

Acupuncture

Several small studies suggest that acupuncture may be helpful for people who have IBS. Research shows that acupuncture may improve general well-being and reduce bloating. Large-scale trials are still needed.

Acupuncturists treat people with IBS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of IBS, an acupuncturist usually detects a qi deficiency in the spleen and lung meridians. Acupuncturists frequently use moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for treatment of IBS because they believe its effects reach deeper into the body. Because acupuncture is considered safe, and IBS is not easily treated by currently available conventional methods, people with IBS may wish to try acupuncture therapy to improve symptoms.

Chiropractic

There have been no well-designed studies on the effects of chiropractic on individuals with IBS. However, chiropractors report that spinal manipulation may improve symptoms of the condition in some individuals. In these cases, spinal manipulation may have a balancing effect on the nerves that supply impulses to the intestinal tract.

Other Treatments

Electric heating pads, hot water bottles, and long hot baths can relieve painful spasms and cramping in the abdomen.
Regular exercise, such as walking, can reduce stress and encourage bowel movements if you are constipated.
Castor oil pack. Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack, and let it sit for 30 - 60 minutes.
Abdominal breathing helps induce the relaxation response and may aid normal physiological functioning (such as digestion).
Osteopathy is a manual treatment that relies on mobilizing and manipulating procedures in order to relieve complaints. A clinical study found that osteopathy is a promising alternative in the treatment of patients with IBS.
Therapeutic massage may help reduce the effects of stress.
Yoga has been reported in small clinical studies to be helpful in reducing pain and other symptoms of IBS.
Hypnotherapy has been reported also to be beneficial in alleviating symptoms of IBS.

Following Up

Be aware that irritable bowel syndrome itself may cause stress. Strick adherence to an approved diet is very important.

Supporting Research

Berardi PR. Safety and tolerability of tegaserod in irritable bowel syndrome management. J Am Pharm Assoc 2004 Jan-Feb;44(1):41-51.

Camilleri M, Gorman H. Intestinal permeability and irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(7):545-52.

Chang HY, Kelly EC, Lembo AJ. Current gut-directed therapies for irritable bowel syndrome. Curr Treat Options Gastroenterol. 2006;9(4):314-23.

Dorn SD, Kaptchuk TJ, Park JB, et al. A meta-analysis of the placebo response in complementary and alternative medicine trials of irritable bowel syndrome. Neurogastroenterol Motil. 2007;19(:630-7.

Frissora CL. Nuances in treating irritable bowel syndrome. Rev Gastroenterol Disord. 2007;7(2):89-96.

Gawronska A, Dziechciarz P, Horvath A, Szajewska H. A randomized double-blind placebo-controlled trial of Lactobacillus GG for abdominal pain disorders in children. Aliment Pharmacol Ther. 2007;25(2):177-84.

Grigoleit HG, Grigoleit P. Peppermint oil in irritable bowel syndrome. Phytomedicine. 2005;12(:601-6.

Hundscheid HW, Pepels MJ, Engels LG, Loffeld RJ. Treatment of irritable bowel syndrome with osteopathy: results of a randomized controlled pilot study. J Gastroenterol Hepatol. 2007;22(9):1394-8.

Kline RM, Kline JJ, Di Palma J, Barbero GJ. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125-8.

Kuttner L, Chambers CT, Hardial J, et al. A randomized trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. 2006;11(4):217-23.

Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome. Cochrane Database Syst Rev. 2006;(4):CD005111.

Locke GR, Yawn BP, Wollan PC, Melton LJ, Lydick E, Talley NJ. Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population. Aliment Pharmacol Ther 2004 May 1;19(9):1025-1031.

Saha L, Malhotra S, Rana S, Bhasin D, Pandhi P. A preliminary study of melatonin in irritable bowel syndrome. J Clin Gastroenterol. 2007;41(1):29-32.

Talley NJ, Kellow JE, Boyce P, Tennant C, Huskic S, Jones M. Antidepressant Therapy (Imipramine and Citalopram) for Irritable Bowel Syndrome: A Double-Blind, Randomized, Placebo-Controlled Trial. Dig Dis Sci. 2007; [Epub ahead of print].

Tillisch K, Chang L. Diagnosis and treatment of irritable bowel syndrome: state of the art.Curr Gastroenterol Rep. 2005;7(4):249-56.

SWilson S, Maddison T, Roberts L, Greenfield S, Singh S. Systematic review: the effectiveness of hypnotherapy in the management of irritable bowel syndrome. Aliment Pharmacol Ther. 2006;24(5):769-80.

Review Date:
12/7/2007
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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Post-traumatic stress disorder

FitSugar — Wed, 08 Oct 2008 17:35:45 -0700

Overview

Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
Treatment Options
Prognosis/Possible Complications
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Post-traumatic stress disorder (PTSD) is an anxiety disorder that is brought on by memories of an extremely stressful event or series of events that cause intense fear, particularly if feelings of helplessness accompanied the fear. That event may be war, physical or sexual assault or abuse, an accident (such as an airplane crash or a serious motor vehicle accident), or a mass disaster. You can develop PTSD if the event happened to you or even if you witnessed it. It's normal to feel stress when you experience a traumatic event. PTSD persists long after the event and is characterized by the intensity of the feelings, how long they last, how you react to these feelings, and the presence of particular symptoms. More than 5 million adults in the United States are affected by PTSD each year.

Signs and Symptoms

Symptoms of PTSD may develop months or even years after the original traumatic event and may include the following:

Intrusive thoughts recalling the traumatic event
Nightmares
Flashbacks
Efforts to avoid feelings and thoughts that either remind you of the traumatic event or that trigger similar feelings
Feeling detached or unable to connect with loved ones
Depression, hopelessness
Feelings of guilt (from the false belief that you were responsible for the traumatic incident)
Irritability
Hypervigilance (Being overly aware of possible danger)
Hypersensitivity, including at least two of the following reactions: trouble sleeping, being angry, having difficulty concentrating, startling easily, having a physical reaction (rapid heart rate or breathing, increase in blood pressure)

What Causes It?

Experts aren't entirely sure what causes some people to develop PTSD, but many think it happens when you are confronted with a traumatic event and your mind isn't able to process all the thoughts and feelings as it usually does. Scientists studying the brain think there may be some differences in the brain structure or chemistry of those with PTSD. For example, certain areas of the brain involved with feeling fear may be hyperactive in people with PTSD. Other researchers have focused on the hippocampus, the area of the brain responsible for memory and for how we deal with stress, and are investigating whether changes in that area also appear in people with PTSD.

Who's Most At Risk?

How severe the traumatic event was and how long it lasted affect whether you are likely to develop PTSD. These factors also increase the risk:

A history of sexual or physical abuse
Working in a high-risk occupation, such as firefighting or law enforcement
A history of depression or other psychological disorder
Abusing drugs or alcohol
Not having adequate social support
Women are twice as likely as men to show signs of PTSD.

What to Expect at Your Provider's Office

There are no laboratory tests to detect PTSD. Your doctor will ask about your symptoms and ask you to describe the traumatic event. Your doctor will likely also use psychological assessment tools to confirm the diagnosis. You may be asked to see a specialist (such as a psychologist or psychiatrist) for evaluation and treatment.

Treatment Options

Prevention

Early intervention immediately after a traumatic event -- through support groups, psychotherapy, and certain medications -- may help prevent PTSD. Rituals such as prayer or healing ceremonies may be helpful in relieving stress and other effects of the trauma.

Treatment Plan

The treatment for PTSD includes:

Cognitive-behavior therapy -- With the help of a psychotherapist, you learn techniques to manage your thoughts and feelings when you are in situations that remind you of the traumatic event. You may gradually expose yourself to situations and thoughts that cause anxiety, as you build up a tolerance for them and your fear is lessened. Ultimately, the goal of cognitive therapy is to allow you to control your fear and anxiety.
Stress management therapy -- With a therapist, you work to learn relaxation techniques that help you overcome fear and anxiety, and to break the cycle of negative thoughts.
Medication may be used as well.

Drug Therapies

Antidepressants such as selective serotonin re-uptake inhibitors (SSRIs), including sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), or paroxetine (Paxil).
Benzodiazepines, a group of medications sometimes used for anxiety, including lorazepam (Ativan) and alprazolam (Xanax). These drugs have sedating properties and may cause drowsiness, constipation, or nausea. Do not take them if you have narrow-angle glaucoma, a psychosis, or are pregnant. They also interact with other drugs, including some antidepressants (such as Luvox).

Complementary and Alternative Therapies

Conventional psychotherapy, such as cognitive behavior therapy, is the main treatment for PTSD. However, several mind-body techniques may be used as supportive treatments:

Eye Movement Desensitization and Reprocessing (EMDR), in which you move your eyes rapidly from side to side while recalling the traumatic event, seems to help reduce distress for many with PTSD. Doctors aren't sure how it works, and whether it is any better than standard treatment. It's also not clear how long PTSD symptoms are reduced using EMDR.
Biofeedback involves using a machine, at first, to see bodily functions that are normally unconscious and occur involuntarily (for example, heart rate and temperature). As you see how your body reacts to stress, you learn to control the reactions, and eventually you can perform the techniques to control the reactions without using a machine. Some studies suggest that biofeedback, among other forms of relaxation training, may be an effective treatment for some people with PTSD.
Hypnosis has long been used to treat war-related post-traumatic conditions. More recently it has been used in cases of sexual assault (including rape), anesthesia failure, Holocaust survival, and car accidents. Hypnosis induces a deep state of relaxation, which may help people with PTSD feel more safe and less anxious, decrease intrusive thoughts, and become involved in daily activities again. Hypnosis is usually used in conjunction with psychotherapy and requires a trained, licensed hypnotherapist.

Nutrition and Supplements

Although no studies have examined how nutrition can be used to treat PTSD, these general nutritional guidelines may be helpful:

Avoid stimulants, such as caffeine and nicotine.
Avoid alcohol.
Maintain balanced blood sugar to help stabilize mood. For example, eat small, frequent meals that include a small amount of protein. Avoid processed and refined foods.
Eat whole grains, fresh fruits and vegetables, protein from plants (legumes and nuts, for example) and fish to nourish the nervous system.
Inositol (18 g per day), a B vitamin that is found in citrus fruits, vegetables, cereal grains and meats, helps the nervous system function properly and may play a role in reducing depression and anxiety associated with PTSD.

Herbs

Herbs are a generally safe way to strengthen and tone the body's systems. As with any therapy, it is important to work with your doctor to get a clear diagnosis before you start any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerin extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not take tinctures. Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures singly or in combination as noted.

Although studies using herbs specifically to treat PTSD are lacking, some herbs have been studied for symptoms such as depression and anxiety.

Kava kava (Piper methysticum, 100 - 200 mg two to four times per day) may help reduce mild to moderate anxiety, although it has not been studied specifically for PTSD. The FDA has issued a warning concerning kava kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
Valerian (Valeriana officinalis, 150 mg two to three times per day), sometimes combined with lemon balm (Melissa officinalis), has also proven effective for mild to moderate anxiety, although it has not been studied for PTSD either. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian also can affect the liver, so do not take it if you have liver problems.
St. John's wort (Hypericum perforatum, 300 mg three times per day) has been sued to treat mild to moderate depression and may help symptoms of PTSD, though studies are lacking. St. John's wort interacts with numerous other drugs and herbs, and should be avoided when pregnant or nursing. Speak to your doctor before using St. John's wort with any other medications.

The following herbs may help relieve restlessness, nervousness, and anxiety that can be associated with PTSD:

Passionflower herb (Passiflora incarnata)
Ginger (Zingiber officinalis)
Chamomile (Matricaria chamomilla)
Catnip ( Nepeta cataria)
Lemon balm (Melissa officinalis)

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PTSD based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. When being treated with homeopathic remedies, it is possible to experience a brief intensification of symptoms before your condition improves. In the case of PTSD, it is important to have a qualified support team in place to help you handle any worsening of symptoms. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Aconitum -- for recurring panic following a traumatic experience. This remedy is most appropriate for individuals who have heart palpitations and shortness of breath which produce a tremendous fear of death. Aconitum is often the first remedy given for trauma, even if the trauma occurred years ago.
Arnica -- for chronic conditions (such as depression) that occur after a traumatic experience. This remedy is most appropriate for individuals who generally deny that anything is wrong.
Staphysagria -- for individuals who feel fearful, powerless, or unable to speak up or defend themselves.
Stramonium -- for anxiety disorders that occur after a shock or traumatic experience involving violence. The individual for whom this remedy is most appropriate tends to be generally fearful and have night terrors.

Acupuncture

Acupuncture may help with symptoms of PTSD, including insomnia, anxiety, and depression. In one case involving a Vietnam War veteran, acupuncture and relaxation with guided imagery reportedly reduced insomnia, nightmares, and panic attacks over a treatment period of 12 weeks. One study for anxiety (not PTSD-related) found that benefits lasted as long as 1 year after treatment. Acupuncturists treat people based on an individualized assessment of the excesses and deficiencies of qi located in various meridians in the body.

Prognosis/Possible Complications

If PTSD symptoms continue for longer than 3 months, the condition is considered to be chronic (ongoing). Chronic PTSD may become less severe even if it is not treated, or it may become severely disabling, interfering with many areas of life and causing physical complaints.

Supporting Research

Allen SN. Psychological assessment of post-traumatic stress disorder. Psychometrics, current trends, and future directions. Psychiatr Clin North Am. 1994;17(2):327-349.

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1678.

Benjamin J, Levine J, Fuz M, Aviv A, Levy D, Belmaker RH. Double-blind, placebo-controlled, crossover trial of inositol treatment for panic disorder. Am J Psychiatry 1995;152(7):1084-1086.

Blank AS Jr. Clinical detection, diagnosis, and differential diagnosis of post-traumatic stress disorder. Psychiatr Clin North Am. 1994;17(2):351-383.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000.

Brady K, Pearlstein T, Asnis GM, et al. Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial. JAMA. 2000;283(14):1837-1844.

Bryant RA, Moulds ML, Nixon RD, Mastrodomenico J, Felmingham K, Hopwood S. Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. Behav Res Ther. 2006 Sep;44(9):1331-5.

Cahill SP, Carrigan MH, Frueh BC. Does EMDR work? And if so, why?: A critical review of controlled outcome and dismantling research. J Anxiety Disord. 1999;13(1-2):5-33.

Cardena E. Hypnosis in the treatment of trauma: a promising, but not fully supported, efficacious intervention. Int J Clin Exp Hypn. 2000;48(2):225-238.

Chambers RA, Bremner JD, Moghaddam B, Southwick SM, Charney DS, Krystal JH. Glutamate and post-traumatic stress disorder: toward a psychobiology of dissociation. Semin Clin Neuropsychiatry. 1999;4(4):274-281.

Davidson J. Drug therapy of post-traumatic stress disorder. Br J Psychiatry. 1992;160:309-314.

Davies WH, Flannery DJ. Post-traumatic stress disorder in children and adolescents exposed to violence. Pediatr Clin North Am. 1998;45(2):341-353.

Friedman MJ. Progress in the psychobiology of post-traumatic stress disorder: an overview. Semin Clin Neuropsychiatry. 1999;4(4):230-233.

Jacobs WJ, Dalenberg C. Subtle presentations of post-traumatic stress disorder. Diagnostic issues. Psychiatr Clin North Am. 1998;21(4):835-845.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctor's Guide. New York, NY: Warner Books; 1996:249.

Levin P, Lazrove S, Van Der Kolk B. What psychological testing and neuroimaging tell us about the treatment of posttraumatic stress disorder by Eye Movement Desensitization and Reprocessing. J Anxiety Disord. 1999;13(1-2):159-172.

Mason S, Rowlands A. Post-traumatic stress disorder. J Accid Emerg Med. 1997;14(6):387-391.

Medley I. Post-traumatic stress disorder. Br J Hosp Med. 1996;55(9):567-70.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:3-4, 36-37, 364.

Novey DW, ed. Clinician's Complete Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby; 2000:180-181.

Peniston EG. EMG biofeedback-assisted desensitization treatment for Vietnam combat veterans post-traumatic stress disorder. Clin Biofeedback Health. 1986;9(1):35-41.

Pitman RK, Orr SP, Shalev AY, Metzger LJ, Mellman TA. Psychophysiological alterations in post-traumatic stress disorder. Semin Clin Neuropsychiatry. 1999;4(4):234-241.

Raboni MR, Tufik S, Suchecki D. Treatment of PTSD by eye movement desensitization reprocessing (EMDR) improves sleep quality, quality of life, and perception of stress. Ann N Y Acad Sci. 2006 Jul;1071:508-13.

Scherer J. Kava-kava extract in anxiety disorders: an outpatient observational study. Adv Ther. 1998;15(4):261-269.

Schnurr PP, Jankowski MK. Physical health and post-traumatic stress disorder: review and synthesis. Semin Clin Neuropsychiatry.1999;4(4):295-304.

Seidler GH, Wagner FE. Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: a meta-analytic study. Psychol Med. 2006 Nov;36(11):1515-22.

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Sherman JJ. Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials. J Trauma Stress. 1998;11(3):413-435.

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Review Date:
12/18/2006
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Proctitis

FitSugar — Wed, 08 Oct 2008 17:35:32 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Preventive Care
Treatment
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Proctitis is an inflammation of the lining of the rectum causing pain, soreness, bleeding, and a discharge of mucus or pus. Proctitis can last a long or a short amount of time. When the inflammation extends beyond the rectum, the condition is often referred to as proctocolitis. Sometimes it is necessary to treat proctitis the same way as inflammatory bowel disease -- a related disorder characterized by an inflammation of the lining of other parts of the gastrointestinal tract -- is treated.

Signs and Symptoms

Common symptoms of proctitis include:

Anal or rectal pain and discomfort, such as itching
Urgent desire to defecate
Discharge of mucus, pus, or blood
Change in bowel habits, such as constipation or diarrhea
Rectal bleeding
Fever

Causes

Proctitis has both infectious and noninfectious causes. Some infections that cause proctitis include:

Campylobacter
Entamoeba histolytica
Salmonella

Other infections that cause proctitis may be sexually transmitted, such as:

Herpes simplex
Gonorrhea
Chlamydia
Syphilis
Shigella

In addition to these infectious causes, some antibiotic medications used to treat an unrelated infection may actually cause proctitis. While antibiotics selectively inhibit the growth of particular bacteria in the bowel, other microorganisms can withstand the antibiotics, multiply, and cause infection.

Trauma and radiation therapy for cancer of the pelvis or lower abdomen are examples of noninfectious causes of proctitis.

Risk Factors

The following are associated with a high risk of proctitis:

Oral-anal intercourse, particularly with multiple partners
Compromised immune system
Radiation therapy to the lower abdominal or pelvic region
Use of antibiotic medication

Because some people with proctitis also develop inflammatory bowel disease, and related conditions such as Crohn's disease and ulcerative colitis, the risk factors in those instances of proctitis may be similar to the risk factors for inflammatory bowel disease (a family history of inflammatory bowel disease or Jewish ancestry).

Preventive Care

Several steps can be taken to prevent the development of proctitis:

Avoiding anal intercourse may prevent proctitis from being spread by sexual transmission.
A reduction in caffeine, dairy foods, high-fat foods, and artificial sweeteners may lower the risk of proctitis. Studies suggest a link between ulcerative colitis and diets high in these foods.
Stress-reduction techniques such as yoga, tai chi, and deep relaxation, may also lower the risk of proctitis. Studies have shown that stressful situations may induce an inflammation of the lining of the intestines, possibly leading to inflammatory bowel disease.

Treatment

Proctitis is a condition that tends to respond very effectively to a combination of both conventional and complementary therapies. Given the potential for complications from surgery, nonsurgical therapy is preferred for the treatment of proctitis. The specific treatment, however, depends on the cause of proctitis. For example, a doctor may prescribe antibiotics for proctitis caused by bacterial infection. If the inflammation is caused by Crohn's disease or ulcerative colitis, the doctor may recommend corticosteroids or enemas containing non-steroidal anti-inflammatory medication. In addition to these conventional treatments, acupuncture, herbs, and nutritional supplements may also relieve the symptoms of proctitis.

Medications

Antibiotic medication, prescribed by a doctor, effectively treats proctitis caused by the following bacterial infections:

Herpes simplex
Gonorrhea
Chlamydia

When the cause of proctitis is unknown, or when proctitis is caused by radiation therapy, the following drug therapies may be more effective:

Corticosteroids, such as hydrocortisone cream, applied directly to the area
Anti-inflammatory drugs, particularly those used to treat inflammatory bowel disease (such as sulfasalazine and mesalamine), administered orally or as a foam, enema, or suppository

Surgery and Other Procedures

Some symptoms of proctitis, including dilation of the blood vessels on the surface of the inner lining of the rectum or colon, may be treated by a procedure called endoscopic cauterization. Most researchers agree, however, that more aggressive surgery should only be considered when less invasive treatments have proved ineffective.

Nutrition and Dietary Supplements

A comprehensive treatment plan for proctitis may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
Talk to your doctor about the possibility of increasing the level of soluble fiber in your diet through foods such as apples, steel cut oats, and flax seeds. This may help to stimulate easier more solid bowel movements. You should use caution with insoluble fiber (such as Metamucil or psyllium husks), as it can potentially be irritating. Proctitis patients should not use fiber medicinally, even dietary fiber, without first consulting a physician.
Eat foods high in B-vitamins, calcium, and magnesium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Avoid refined foods such as white breads, pastas, and especially sugar.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to two times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources.
Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant, and for immune support.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.
Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
Olive leaf (Olea europaea) standardized extract, 250 - 500 mg one to three times daily, for anticancer and immune effects.
Boswellia (Boswellia serrata) standardized extract, 200 - 400 mg three times daily, for inflammation and gastrointestinal health.

Homeopathy

While no scientific studies have examined the use of homeopathy to prevent or treat proctitis, professional homeopaths may recommend the following remedies for people with symptoms of the disease:

Gambogia -- used to reduce inflammation of the colon and rectum as well as severe bouts of diarrhea. This remedy is particularly useful for those who are extremely fatigued after loose bowel movements.
Natrumsulphuricum -- used to reduce diarrhea, flatulence, and inflammation of the colon and rectum caused primarily by gonorrhea
Sulphur -- used to reduce inflammation of the colon and rectum as well as the itching, burning sensation in the rectum caused by diarrhea

Homeopathic creams for problems in the anal area, such as itching and dryness, may be helpful in relieving symptoms associated with proctitis. Ask your health care provider for more information.

Acupuncture

One promising study of 44 patients with proctitis caused by radiation therapy found that acupuncture "cured" 73% of the patients, "markedly" relieved symptoms in 9% of the patients, and reduced symptoms to "moderate" in 18% of the patients. There were no patients whose symptoms worsened or remained the same following acupuncture treatment.

Mind-Body Medicine

Although research suggests that stress may be associated with an inflammation of the bowel, scientists have yet to determine whether specific personality types are linked to inflammatory bowel disease. Based on clinical experience, however, some psychiatrists report that inflammatory bowel diseases may be associated with anxiety, anger, aggression, obsession, and a tendency to keep emotions bottled up inside. For these reasons, some researchers suggest that psychotherapy combined with the following stress-reduction techniques may help relieve the symptoms of proctitis:

Biofeedback
Hypnotherapy

Other Considerations

An individual with proctitis should keep the following considerations in mind:

Prognosis and Complications

Complications from proctitis can range from the formation of ulcers and boils to severe bleeding. Proctitis related to ulcerative colitis may even evolve to include more widespread areas of the colon and other parts of the gastrointestinal tract.

Mild forms of proctitis, which often resolve spontaneously or with the application of topical creams and foams, will not require long-term medication. People with more severe forms of proctitis, such as proctitis caused by gonorrhea, are often less responsive to treatment with the failure rate being as high as 35% in some cases. In general, however, the prognosis for individuals with most forms of proctitis is good with proper treatment and follow-up with a health care provider.

Supporting Research

Almallah YZ, Ewen SW, El-Tahir A, et al. Distal proctocolitis and n-3 polyunsaturated fatty acids (n-3 PUFAs): the mucosal effect in situ.J Clin Immunol. 2000;20(1):68-76.

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Sep;72(12):1100-16.

Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gastrointest Dis. 1999;10(1):14-19.

Bartelsman JF, Tytgat GN. Extra-ordinary forms of proctitis. Neth J Med. 1990;37(suppl 1):S52-S56.

Bast A, Haenen GR. Lipoic acid: a multifunctional antioxidant. Biofactors. 2003;17(1-4):207-13.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:339.

Bruzzese E, Raia V, Gaudiello G, et al. Intestinal inflammation is a frequent feature of cystic fibrosis and is reduced by probiotic administration. Aliment Pharmacol Ther. 2004;20(7):813-9.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr. 2006;25(2):79-99.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cohen L, Kitzes R. Early radiation-induced proctosigmoiditis responds to magnesium therapy. Magnesium. 1985;4(1):16-19.

Collins SM, Barbara G, Vallance B. Stress, inflammation and the irritable bowel syndrome. Can J Gastroenterol. 1999;13(suppl. A):47A-49A.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Doron S, Gorbach SL. Probiotics: their role in the treatment and prevention of disease. Expert Rev Anti Infect Ther. 2006;4(2):261-75.

Gonclaves C, Dinis T, Batista MT. Antioxidant properties of proanthocyanidins of Uncaria tomentosa bark decoction: a mechanism for anti-inflammatory activity. Phytochemistry. 2005;66(1):89-98.

Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2(1):37-43.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

Maunder R, Esplen MJ. Facilitating adjustment to inflammatory bowel disease: a model of psychosocial intervention in non-psychiatric patients. Psychother Psychosom. 1999;68(5):230-240.

Melko GP, Turco TF, Phelan TF, Sauers NM. Treatment of radiation-induced proctitis with sucralfate enemas. Ann Pharmacother. 1999;33(12):1274-1276.

Miller AL. Therapeutic considerations of L-glutamine: A review of the literature. Alternative Medicine Review. 1999;4(4):239-248.

Nagata Y, Lee C, Anderson P, et al. Reduction of radiation damage in small intestine of rats by glutamine. Presented at: the 43rd Annual Meeting of the Radiation Research Society and the 15th Annual Meeting of the North American Hyperthermia Society. San Jose, Calif: 1995:178.

Owen RW, Giacosa A, Hull WE, Haubner R, Spiegelhalder B, Bartsch H. The antioxidant/anticancer potential of phenolic compounds isolated from olive oil. Eur J Cancer. 2000a;36(10):1235-1247.

Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life: a systematic review. J Pain Symptom Manage. 2000;20(5):374-387.

Pinto A, Fidalgo P, Cravo M, et al. Short chain fatty acids are effective in short-term treatment of chronic radiation proctitis: randomized, double-blind, controlled trial. Dis Colon Rectum. 1999;42(6):788-796.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40(6):754-760.

Russel MG, Engels LG, Muris JW, et al. Modern life in the epidemiology of inflammatory bowel disease: a case-control study with special emphasis on nutritional factors [see comments]. Eur J Gastroenterol Hepatol. 1998;10(3):243-249.

Rompalo AM. Diagnosis and treatment of sexually acquired proctitis and proctocolitis: an update. Clin Infect Dis. 1999;28(suppl 1):S84-S90.

Schafer DW. Hypnosis and the treatment of ulcerative colitis and Crohn's disease. Am J Clin Hypn. 1997;40(2):111-117.

Scheppach W, Christl SU, Bartram HP, Richter F, Kasper H. Effects of short-chain fatty acids on the inflamed colonic mucosa. Scand J Gastroenterol Suppl. 1997;222:53-57.

Silk DB. Medical management of severe inflammatory disease of the rectum: nutritional aspects. Baillieres Clin Gastroenterol. 1992;6(1):27-41.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Tocchi A, Lepre L, Liotti G, et al. Familial and psychological risk factors of ulcerative colitis. Ital J Gastroenterol Hepatol. 1997;29(5):395-398.

Tytgat GN, Fockens P, Schotborgh RH, Hofer SO. Proctitis. Neth J Med. 1990;37(suppl 1):S37-S42.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs. 2000;9(9):2103-19.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.

Zhang ZH. Effect of acupuncture on 44 cases of radiation rectitis following radiation therapy for carcinoma of the cervix uteri. J Tradit Chin Med. 1987;7(2):139-140.

Zimmermann FB, Feldmann HJ. Radiation proctitis: Clinical and pathological manifestations, therapy and prophylaxis of acute and late injurious effects of radiation on the rectal mucosa. Strahlenther Onkol. 1998;174(suppl 3):85-89.

Review Date:
10/20/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Ulcerative colitis

FitSugar — Wed, 08 Oct 2008 17:35:25 -0700

Overview

Signs and Symptoms
What Causes It?
Risk Factors
What to Expect at Your Provider's Office
Preventive Care
Treatment Options
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Ulcerative colitis is a chronic inflammatory bowel disease that causes ongoing inflammation and ulcers (open sores) in the innermost layers of the large intestine (colon) and rectum. The ulcers bleed and produce pus and mucus, and the inflammation causes the colon to empty frequently, resulting in diarrhea. Ulcerative colitis is similar to Crohn's disease, another inflammatory bowel disease. But while Crohn's disease can occur anywhere in the digestive tract, often in patches, and can spread deeper into tissues, ulcerative colitis is usually confined to the innermost layers of tissue and is uniform throughout the colon. Ulcerative colitis can be painful and have life-threatening complications.

Ulcerative colitis affects more than 500,000 people in the United States. Although the condition most commonly affects those between the ages of 15 and 35, children and older adults may also develop the disease. Ulcerative colitis occurs five times more frequently in those with a Jewish heritage than it does in the general population. There is no cure for ulcerative colitis, but diet and medications can help control the disease.

Signs and Symptoms

The signs and symptoms of ulcerative colitis can vary, depending on how severe the inflammation is and where it is located. The most common signs and symptoms include abdominal pain and bloody diarrhea. The symptoms can range from mild to severe and may come on either very suddenly or more gradually.

Other common symptoms include:

Frequent, even continuous diarrhea
Rectal bleeding
Bloody stool
Urgent desire to defecate
Abdominal cramps and pain
Weight loss
Anemia
Joint aches

People with ulcerative colitis are at increased risk for malnutrition. The condition is also associated with other health problems, including arthritis, eye infections, liver disease, skin rashes, blood clots, or gallstones. Although it is not clear why such problems occur outside the colon, some researchers speculate that they may be linked to a faulty immune system response.

What Causes It?

No one knows what causes ulcerative colitis. The most likely theory is that it is caused by a variety of factors ranging from genetics, faulty immune system reactions, and environmental influences. For example, some people are genetically at risk for the condition (it runs in their family), and bacteria or a virus may then trigger their immune system, which causes inflammation. Because ulcerative colitis is more common in the developed world, it's also possible that a diet high in saturated fat and processed foods contributes to the disease.

Risk Factors

Family history of the disease
Jewish heritage, especially Ashkenazi (European) Jews
A diet high in sugar, cholesterol, and fat (particularly from meat and dairy products)

What to Expect at Your Provider's Office

Your doctor will perform a thorough physical exam as well as a series of tests to diagnose ulcerative colitis. Blood tests may reveal anemia (due to a significant loss of blood) and a high white blood cell count (a sign of inflammation somewhere in the body). Stool samples may indicate whether there is bleeding or infection in the colon or rectum.

The following procedures may be also helpful in distinguishing between ulcerative colitis, Crohn's disease, and other inflammatory conditions.

Colonoscopy -- A colonoscopy, in which a long, flexible, lighted tube with a camera is used to take pictures of the colon, can reveal any inflammation, bleeding, or ulcers along the entire colon wall. Your doctor may also take a biopsy of colon cells to determine whether you have ulcerative colitis or Crohn's disease. This procedure usually requires sedation. A sigmoidoscopy is similar but is used to examine the rectum and lower part of your colon. It can be done without sedation, but may miss inflammation higher in the colon or the small intestine.

Barium enema -- This procedure examines the large intestine with an x-ray. It involves being given barium (a dye) as an enema, which coats the lining of your large intestine and rectum. It is generally not as reliable a test as colonoscopy and is not used when symptoms are severe because of the risk of complications.

Small intestine x-ray -- In this test, you drink a barium "shake" and the doctor takes an x-ray of your small intestine. This test allows doctors to see the small intestine (which can't be seen with colonoscopy) and can help distinguish between ulcerative colitis and Crohn's disease.

Preventive Care

Although there is no known way to prevent ulcerative colitis, the condition can usually be managed with a combination of medication, diet, and lifestyle changes. A low-fat diet rich in fruits, fluids, magnesium, and vitamin C; exercise; and stress-reduction techniques (including hypnosis) may also help prevent recurrences.

Treatment Options

The primary goal in treating ulcerative colitis is to control acute flares of the disease and to maintain remission once it occurs. The type of treatment often depends on the severity of the disease. For example, people with mild-to-moderate ulcerative colitis are usually treated with medications that reduce inflammation and suppress the immune response. More severe cases may require surgery.

Many people with inflammatory bowel diseases use complementary and alternative remedies in addition to prescription medication. Preliminary studies indicate that lifestyle changes, including stress reduction, dietary adjustments (such as including a rich variety of fruits and vegetables and avoiding saturated fat and sugar), specific herbs and supplements, and mind-body techniques (such as hypnosis) may be useful additions to treatment.

Lifestyle

Many people with ulcerative colitis report that stress makes their symptoms worse. Relaxation and stress reduction techniques can be helpful, particularly when used in addition to other forms of treatment. Some techniques to consider:

Biofeedback -- teaches you to control stress-related physical responses (muscle tension, rapid heartbeat) by at first using a feedback machine that lets you see how your body responds. As you learn to control these responses, you no longer need the machine and can practice the technique anywhere.

Yoga, tai chi, or meditation -- These techniques all help you learn to reduce your response to stress.

Progressive muscle relaxation -- This popular technique, which involves tightening and then relaxing specific muscle groups one by one, is simple to learn and can be done anywhere and any time.

Deep breathing -- Breathing in from your diaphragm (allowing your belly to expand, then contract as you exhale) helps relax you and may also help relax your abdominal muscles, which can help with normal intestinal health.

Hypnosis -- A trained and licensed hypnotist can help you relax muscle tension, lessening pain and abdominal bloating.

Exercise may also be very helpful for ulcerative colitis, both in terms of maintaining health and reducing stress. Although exercise is considered safe for those with ulcerative colitis, anyone with a chronic illness should talk to their doctor before starting a new exercise or fitness regimen. It is especially important for people with ulcerative colitis to drink water before exercising and during exercising to prevent dehydration.

Drug Therapies

Although medications cannot cure ulcerative colitis, they can reduce symptoms and help you control your condition. Sometimes, they can induce remission of the disease for a period of time. Medications commonly used to treat ulcerative colitis include:

Sulfasalazine (Azulfidine) -- An older drug that reduces inflammation during acute flare-ups and is usually taken with folic acid. Side effects include abdominal discomfort, nausea, and lowered sperm count. Sulfasalazine can be effective, but newer drugs are available.

Mesalamine (Asacol, Rowasa) -- This drug reduces inflammation during acute flare-ups and helps prevent recurrences, and generally has fewer side effects than sulfasalazine.

Balsalazide disodium (Colazal) -- A different formulation of mesalamine that is designed to deliver the dose directly into the colon. It has fewer side effects.

Corticosteroids (such as budesonide, prednisone, and prednisolone) -- These drugs can reduce inflammation throughout your body but have many side effects, including acne, and an increased risk of infection, osteoporosis, high blood pressure, excessive hair growth, diabetes, and disorders of the eye including glaucoma and cataracts. Corticosteroids also suppress your body's production of the hormone cortisol and cannot be stopped abruptly. They are not for long-term use, but may be used to control flares.

Immune system suppressors -- These medications decrease inflammation by suppressing the immune system. They are sometimes used in combination with steroids to reduce the dose of the steroid medication. These drugs can take several months to work, and all may have significant side effects. Drugs include azathioprine (Imuran), infliximab (Remicade), mercaptopurine (Purinethol), and cyclosporine. Newer drugs in this class that have fewer side effects, such as adalimumab (Humira), are being tested.

Nicotine patches -- Researchers aren't sure why, but nicotine patches seem to help some people find short-term relief during flares, particularly if the person used to be a smoker. The risks of smoking greatly outweigh any potential benefits, so no one who has ulcerative colitis should start smoking as a treatment.

Antidiarrheal medications (such as diphenoxylate, loperamide, or psyllium) -- Medications that treat diarrhea must be used only under medical supervision and with extreme caution. They can slow down the normal movements of the gastrointestinal tract and, in severe cases, may cause a complication known as toxic megacolon.

Surgical Procedures

Approximately 20 - 30% of people with ulcerative colitis must eventually have their colon or colon and rectum removed (colectomy or proctocolectomy) because of massive bleeding, severe illness, rupture of the colon, or the risk of cancer. The surgery often eliminates the disease. To allow for the elimination of waste, the surgeon creates an internal pouch from the small intestine, which empties into the anus. It may result in having five to seven watery bowel movements a day, and about 32% of people who undergo this procedure develop pouchitis, an inflammation of the pouch that is treated with a short course of antibiotics.

Complementary and Alternative Therapies

Diet

Although diet cannot cure ulcerative colitis, some studies suggest that people who eat foods high in saturated fat and sugar and who eat less amounts of fruits and vegetables may be more at risk of developing the disease. Certain foods may also reduce symptoms.

Limit intake of dairy products, which may help lessen diarrhea.
Eat fruits and vegetables, and pay attention to fiber. Although fiber is crucial to a healthy diet, some people with inflammatory bowel disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables instead of eating them raw, and avoid high-fiber foods such as broccoli, cauliflower, and raw apples.
A bland, low-fiber diet may best during acute flares.
Eat five or six small meals a day.
Avoid alcohol.
Certain foods may aggravate symptoms of ulcerative colitis (including chocolate, beans, spicy foods, fats, and artificial sweeteners).

People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral (intravenous) nutrition.

Nutrition and Supplements

Because many people with ulcerative colitis have vitamin and mineral deficiencies (due to decreased appetite and absorption by the colon and excessive diarrhea), your doctor may recommend taking a multivitamin daily.

Folic acid (800 mcg per day) -- Many people who have ulcerative colitis have low levels of folic acid in their blood. In addition, some medications, such as sulfasalzine, may cause levels of folic acid in the body to drop. People with ulcerative colitis also have a higher risk of developing colon cancer, but some studies have found that taking folic acid can reduce that risk. If you take folic acid for a long period, your doctor should monitor your levels of vitamin B12, because folic acid can mask a vitamin B12 deficiency.

Fish oil (3.7 g of EPA and 2.2 g of DHA per day) -- At least one study has found that, compared to placebo, fish oil supplements containing omega-3 fatty acids may reduce symptoms and prevent recurrence of ulcerative colitis. Other studies show different results, however. Some experts suggest that omega-3 fatty acids may prove valuable when used in combination with sulfasalazine or other medications. Do not take high doses of a fish oil supplement if you take blood-thinning medication.

Probiotics -- Several studies indicate that taking probiotics, or "good" bacteria, can help reduce symptoms. The types of probiotics studies have varied: Two studies used a non-disease-causing type of E. coli. Another study found that giving Lactobaccillus, Bifidobacteria, and a non-disease-causing type of Streptococcus to people with chronic pouchitis helped prevent the condition. Sacchromyces boulardi (250 mg two to three times per day) may also help generally improve the health of the intestine.

N-acetyl glucosamine -- Preliminary research suggests that N-acetyl glucosamine supplements or enemas may improve symptoms of inflammatory bowel disease, but more studies are needed to know whether glucosamine would have any effect on ulcerative colitis.

Herbs

Because of the presence of inflammation and the nature of the disease, ulcerative colitis should not be treated with herbs alone. However, herbs may be a useful complement to traditional medical treatment. Remember that herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, you should take herbs with care, under the supervision of a health care provider.

Psyllium seeds (Plantaginis ovatae) -- In one study, people with ulcerative colitis who took 20 g of ground psyllium seeds two times per day with water remained in remission equally as long as when they took the prescription drug mesalamine, and combining the two was even more effective. More research is needed to confirm this finding. Psyllium is a type of insoluble fiber, and may be irritating to some people, especially during flares. Talk to your doctor to determine if psyllium can help you. Some people may have better results using soluble fiber, such as flax seed or oat bran, in combination with or instead of psyllium. Constipation could occur, however. Talk to your doctor about whether this combination is right for you.

Boswellia (Boswellia serrata, 550 mg three times per day for up to 6 weeks) -- Boswellia has anti-inflammatory properties, and one small study suggests that people who took boswellia had similar improvement as people who took the prescription drug sulfasalazine. More research is needed to be sure. Boswellia may interact with other drugs and supplements, so talk to your doctor before taking it.

Other evidence for using herbs to treat ulcerative colitis is mostly lacking. Among the herbs that have been used traditionally to treat inflammation within the digestive tract are:

Slippery elm (Ulmus fulva) is a demulcent (protects irritated tissues and promotes their healing); take 60 to 320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.
Marshmallow (Althaea officinalis) is a demulcent and emollient; drink one cup of tea three times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup boiling water. Strain and cool. Avoid marshmallow if you have diabetes.
Chamomile (Matricaria recutita) is often used to soothe digestive tract. It is usually taken as a tea. Dissolve 3 - 4 g powder (about 3 tsp.) in 1 cup hot water, strain, and cool. Drink three times per day.

Acupuncture

Acupuncture is often used in Traditional Chinese Medicine to treat inflammatory bowel disease, and several studies indicate that it can help provide relief from symptoms in ulcerative colitis. It may be especially useful in combination with traditional medical treatment, as it can help relieve stress as well as pain. Acupuncturists treat people with inflammatory bowel disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians.

Other Considerations

Pregnancy

Symptoms of ulcerative colitis often become worse in pregnancy. Fifty percent of women in remission experience a recurrence of the disease, usually during the first trimester or during the postpartum period. For this reason, women with ulcerative colitis who are or wish to become pregnant should continue medications under the guidance of their doctor. Corticosteroids or sulfasalazine are considered safe during pregnancy. Unlike Crohn's disease, pregnant women with ulcerative colitis are not at increased risk for stillbirths or premature deliveries.

Pregnant women should avoid high doses of vitamins. An obstetrician can provide instructions regarding appropriate multivitamin use during pregnancy.

Prognosis and Complications

If left untreated, people with ulcerative colitis can develop a wide range of chronic, sometimes dangerous complications. Fortunately, however, most of these complications can be treated successfully.

Hemorrhage (excessive bleeding)
Perforation of the colon
Narrowing of the colon, which may cause obstruction
Abscesses (pus-filled pockets of infection) in the colon
Toxic megacolon (grossly swollen colon that may rupture)
Colon cancer
Nutritional problems (including weight loss and reduced muscle mass)
Joint pain and arthritis
Eye infections/inflammation
Mouth ulcers
Liver damage
Blood clots
Depression and anxiety

Although there is no cure for ulcerative colitis other than surgical removal of the colon, many people with the disease lead active lives by controlling their symptoms with medication. In fact, drug treatment is effective for about 70 - 80% of all people with the condition. About 45% of all people with ulcerative colitis are free of symptoms at any given time, but most suffer at least one relapse in any 10-year period.

Supporting Research

Abela MB. Hypnotherapy for Crohn's disease: a promising complementary/alternative therapy. Int Med. 1999;2(2/3):127-131.

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16. Review.

Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gast Dis. 1999;10(1):14-19.

Ball E. Exercise Guidelines for patients with inflammatory bowel disease. Gastroenterology Nursing. 1998;21(3):108-111.

Belluzzi A, Boschi S, Brignola C, Munarini A, Cariani C, Miglio F. Polyunsaturated fatty acids and inflammatory bowel disease. Am J Clin Nutr. 2000;71(suppl):339S-342S.

Biasco G, Zannoni U, Paganelli GM, et al. Folic acid supplementation and cell kinetics of rectal mucosa in patients with ulcerative colitis. Cancer Epidemiol Biomarkers Prevent. 1997;6:469-471.

Blumenthal M, Goldberg A, Brinckman J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000.

Cravo ML, Albuquerque CM, Salazar de Sousa L, et al. Microsatellite instability in non-neoplastic mucosa of patients with ulcerative colitis: effects of folate supplementation. Am J Gastroenterol. 1998;93:2060-2064.

Dichi I, Frenhane P, Dichi JB, et al. Comparison of omega-3 fatty acids and sulfasalazine in ulcerative colitis. Nutrition. 2000;16:87-90.

Ewaschuk JB, Tejpar QZ, Soo I, Madsen K, Fedorak RN. The role of antibiotic and probiotic therapies in current and future management of inflammatory bowel disease. Curr Gastroenterol Rep. 2006 Dec;8(6):486-98. Review.

Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana L, et al. Randomized clinical trial of Plantago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol. 1999;94:427-433.

Geerling BJ, Stockbrugger RW, Brummer RJ. Nutrition and inflammatory bowel disease: an update. Scand J Gastroenterol. 1999;34(suppl 230):95-105.

Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhea and inflammatory bowel diseases. J Gastroenterol Hepatol. 2000;15:489-493.

Gupta I, Parihar A, Malhotra P, et al. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2:37-43.

Haas L, McClain C, Varilek G. Complementary and alternative medicine and gastrointestinal diseases. Curr Opin Gastroenterol. 2000;16:188-196.

Joachim G. The relationship between habits of food consumption and reported reactions to food in people with inflammatory bowel disease-testing the limits. Nutr Health. 1999;13(2):69-83.

Joos S, Wildau N, Kohnen R, et al. Acupuncture and moxibustion in the treatment of ulcerative colitis: a randomized controlled study. Scand J Gastroenterol. 2006;41:1056-1063.

Levenstein S, Prantera C, Varvo V, et al. Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol. 2000;95(5):1213-1220.

Ling SC, Griffiths AM. Nutrition in inflammatory bowel disease. Curr Opin Clin Metab Care. 2000;3(5):339-344.

Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001;73(suppl):430S-436S.

Meister D, Ghosh S. Effect of fish oil enriched enteral diet on inflammatory bowel disease tissues in organ culture: differential effects on ulcerative colitis and Crohn's disease. World J Gastroenterol. 2005 Dec 21;11(47):7466-72.

Reif S, Klein I, Lubin F, Farbstein M, Hallak A, Gilat T. Pre-illness dietary factors in inflammatory bowel disease. Gut. 1997;40:754-760.

Rembacken BJ, Snelling AM, Hawkey PM, Chalmers DM, Axon ATR. Non-pathogenic Escherichia coli versus mesalazine for the treatment of ulcerative colitis: a randomized trial. Lancet. 1999;354:635-639.

Salvatore S, Heuschkel R, Tomlin S, et al. A pilot study of N-acetyl glucosamine, a nutritional substrate for glycosaminoglycan synthesis, in pediatric chronic inflammatory bowel disease. Aliment Pharmacol Ther. 2000;14:1567-1579.

Shimizu T, Kitamura T, Suzuki M, Fujii T, Shoji H, Tanaka K, Igarashi J. Effects of alpha-linolenic acid on colonic secretion in rats with experimental colitis. J Gastroenterol. 2007 Feb;42(2):129-34.

Sturniolo GC, Mestriner C, Lecis PE, et al. Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis. Scand J Gastroenterol. 1998;33(6):644-649.

Wu HG, Liu HR, Tan LY, Gong YJ, Shi Y, Zhao TP, Yi Y, Yang Y. Electroacupuncture and moxibustion promote neutrophil apoptosis and improve ulcerative colitis in rats. Dig Dis Sci. 2007 Feb;52(2):379-84.

Review Date:
3/19/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Crohn's disease

FitSugar — Wed, 08 Oct 2008 17:35:24 -0700

Overview

Signs and Symptoms
What Causes It?
Risk Factors
What to Expect at Your Provider's Office
Preventive Care
Treatment Options
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Crohn's disease is a chronic inflammatory bowel disease that causes ongoing inflammation of the intestinal tract. It is similar to ulcerative colitis, another inflammatory bowel disease. However, while ulcerative colitis usually is confined to the innermost layer of the large intestine and rectum, Crohn's disease can occur anywhere in the intestine, often in patches surrounded by healthy tissue, and can spread deeper into the tissues. Symptoms include chronic bloody or watery diarrhea, abdominal pain, fever, and loss of appetite. Symptoms tend to wax and wane, with the disease becoming active or going into remission several times during the person's lifetime.

Crohn's disease can cause intestinal obstructions, ulcers (most often in the lower part of the small intestine, the large intestine, or the rectum), fistulas (hollow passages from one part of the intestine to another), and anal fissures (a crack in the anus or the skin around the anus that can lead to infection). In addition, people with Crohn's disease are at risk of malnutrition, because their intestine cannot absorb all the needed nutrients from their diet.

Crohn's disease affects 2 - 7 out of 100,000 people and researchers believe that these numbers are growing. It develops mostly between the ages of 15 - 40, although children and older adults may also develop the condition. There is no cure for Crohn's disease. Medication and strict diets can help control the condition. Some people with the condition will require surgery to remove part of the digestive tract at some point in their lives. However, surgery does not cure the disease.

Signs and Symptoms

The most common signs and symptoms of Crohn's disease are diarrhea and abdominal pain. The symptoms can range from mild to severe.

Diarrhea (with or without blood)
Abdominal pain and bloating
Fatigue
Poor appetite
Weight loss
Fever
Nausea and vomiting
Floating stools (which is caused by poor digestion of fat)

Crohn's disease can also be associated with other medical conditions, including arthritis, osteoporosis, eye infections, blood clots, liver disease, and skin rashes.

What Causes It?

No one is sure what causes Crohn's disease. Theories include a faulty immune system response triggered by bacteria or a virus; genetics, since about a quarter of people who have Crohn's disease also have a close relative with the disease; and a diet high in saturated fat and processed foods, since Crohn's disease is more common in the developed world. It is likely that several factors may be involved in the disease.

Risk Factors

Jewish heritage (three to six times more likely than the general population)
European (particularly Scandinavian) ancestry
Family history of inflammatory bowel disease
Cigarette smoking
Living in an industrialized country (particularly an urban area)
Diet high in sugar and saturated fat and low in fruit and vegetables

What to Expect at Your Provider's Office

Your doctor will perform a thorough physical exam as well as a series of tests to diagnose Crohn's disease. Blood tests may reveal anemia (due to a significant loss of blood) and a high white blood cell count (a sign of inflammation somewhere in the body). Stool samples may indicate whether there is bleeding or infection in the colon or rectum.

The following procedures may be also helpful in distinguishing between ulcerative colitis, Crohn's disease, and other inflammatory conditions.

Colonoscopy -- A colonoscopy, in which a long, flexible, lighted tube with a camera is used to take pictures of the colon, can reveal any inflammation, bleeding, or ulcers along the entire colon wall. This procedure usually requires sedation. A sigmoidoscopy is similar but is used to examine the rectum and lower part of your colon. It can be done without sedation, but may miss inflammation higher in the colon or the small intestine.
Capsule endoscopy -- In this test, you swallow a small capsule with a camera in it, and the camera takes pictures as it passes through the length of your digestive tract. The capsule then passes out of the body through your stool. The test is generally safe, but if there is an intestinal obstruction the capsule may become trapped. Your doctor will run other tests to make sure you do not have an obstruction before using this procedure.
Barium enema -- This procedure examines the large intestine with an x-ray. It involves being given barium (a dye) as an enema, which coats the lining of your large intestine and rectum. It is generally not as reliable a test as colonoscopy.
CT scans -- This imaging technique allows your doctor to look at the entire intestine and can help locate intestinal obstructions or fistulas.

Preventive Care

Although there is no known way to prevent Crohn's disease, the condition can usually be managed with a combination of medication, diet, and lifestyle changes. Exercise can help prevent the stress and depression that often accompany Crohn's disease, and quitting smoking can reduce symptoms. Eating a diet rich in fruit and vegetables can also help lessen symptoms.

Treatment Options

The primary goal in treating Crohn's disease is to control acute flares of the disease and to maintain remission for as long as possible. The specific type of treatment often depends on how severe the symptoms are. For example, people with mild-to-moderate symptoms are usually treated with medications that reduce swelling and suppress the immune system. More severe cases may require surgery.

Many people with inflammatory bowel diseases use complementary and alternative remedies in addition to prescription medications. Preliminary studies indicate that lifestyle changes, dietary adjustments (such as eating a rich variety of fruits and vegetables and avoiding saturated fat and sugar), and specific herbs and supplements may be useful additions to treatment.

Lifestyle

Stress

Many people with Crohn's disease report that stress makes their symptoms worse. Relaxation techniques and mind-body exercises, such as yoga, tai chi, and meditation, are worth considering, particularly when used in addition to other forms of treatment. In addition, studies suggest that hypnosis may improve immune function, increase relaxation, decrease stress, and ease feelings of anxiety.

Exercise

Exercise is helpful for those with Crohn's disease, both in terms of maintaining health and reducing stress. Although exercise is considered safe for people with Crohn's disease, anyone with a chronic illness should talk to their doctor before starting a new exercise or fitness regimen. It is especially important for people with Crohn's disease to drink water before exercising and during exercise to prevent dehydration. Extreme changes in body temperature during exercise should also be avoided.

Smoking

Cigarette smoking is a risk factor for Crohn's disease and studies have shown that it may worsen symptoms. If you smoke, you should quit.

Drug Therapies

Although medications cannot cure Crohn's disease, they can reduce symptoms and help you control your condition. Sometimes, they can induce remission of the disease for a period of time. Medications commonly used to treat Crohn's disease include:

Sulfasalazine (Azulfidine) -- An older drug that reduces inflammation during acute flare-ups and is usually taken with folic acid. Side effects include abdominal discomfort, nausea, and lowered sperm count. Sulfasalazine can be effective, but newer drugs are available.
Mesalamine (Asacol, Rowasa) -- This drug reduces inflammation during acute flare-ups and helps prevent recurrences, and generally has fewer side effects that sulfasalazine.
Corticosteroids (such as budesonide, prednisone, and prednisolone) -- These drugs can reduce inflammation throughout your body but have many side effects, including acne, and an increased risk of infection, osteoporosis, high blood pressure, excessive hair growth, diabetes, and disorders of the eye including glaucoma and cataracts. Corticosteroids also suppress your body's production of the hormone cortisol and cannot be stopped abruptly. They are not for long-term use, but may be used to control flares.
Immune system suppressors -- These medications decrease inflammation by suppressing the immune system. They are sometimes used in combination with steroids to reduce the dose of the steroid medication. These drugs can take several months to work, and all may have significant side effects. Drugs include azathioprine (Imuran), methotrexate (Rheumatrex), infliximab (Remicade), and cyclosporine. Newer drugs in this class that have fewer side effects, such as adalimumab (Humira), are being tested.
Antibiotics -- Antibiotics may be prescribed to help treat fistulas and ulcers. Ciproflaxin (Cipro) and metronidazole (Flagyl) are most commonly used.
Antidiarrheal medications (such as diphenoxylate, loperamide, or psyllium) -- Medications used to treat diarrhea must be used only under medical supervision and with extreme caution. They can slow down the normal movements of the gastrointestinal tract and, in severe cases, may cause a complication known as toxic megacolon.

Surgical Procedures

Although surgery will not cure Crohn's disease, three out of four people with the condition will eventually have resections (parts of their colons removed) to close fistulas or to remove a severely damaged part of your intestine. In some cases laparoscopic surgery (which uses a smaller incision) can be done, leading to fewer complications and shorter hospital stays. Strictureplasty, in which a balloon is inserted into the intestine and expanded, is sometimes done when the intestine has become too narrow from scar tissue.

Complementary and Alternative Therapies

People with Crohn's disease often cannot absorb all the nutrients their bodies need, due to damage in the intestine, or they find it difficult to eat because of abdominal pain and nausea. Some medications may also lower needed nutrients in the body. For example, sulfasalazine reduces the body's ability to absorb folate while corticosteroids can reduce levels of calcium. Making sure that you get enough nutrients is a crucial part of treating Crohn's disease. People with significant malnourishment, severe symptoms, or those awaiting surgery may require parenteral (intravenous) nutrition.

Nutrition

Although diet cannot cause or cure Crohn's disease, some studies suggest that people who eat foods high in saturated fat and sugar or who eat processed foods may be more likely to develop the disease. Certain foods may also reduce symptoms and make recurrences of the disease less likely.

Eating fruits and vegetables, lowering fat, and eliminating sugar may reduce the risk of developing Crohn's disease. Although a low-fiber diet is one of the risk factors for developing Crohn's disease, some people with Crohn's disease find that fiber makes symptoms worse. If fiber bothers you, steam or bake your vegetables rather than eating them raw, and avoid high fiber fruits such as apples.
Certain foods may aggravate symptoms of Crohn's disease – most often, dairy products, fats, and spicy foods. People with Crohn's disease may want to avoid these foods.
Eat five or six smalls a day.
If symptoms are severe, an elemental diet may be recommended. Elemental formulas are liquid diets that contain only the basic building blocks of food and need not be broken down into smaller substances along the digestive tract. Some people find it difficult to stick to an elemental diet, but after a period of time, often other foods can be reintroduced. One study suggests that adding omega-3 fatty acids to an elemental diet may boost its nutritional content and make it more likely that people with Crohn's disease will adhere to it.

Vitamins and Minerals

Because of decreased appetite, malabsorption, chronic diarrhea, side effects of medication, and surgical removal of parts of the digestive tract, many people with Crohn's disease have vitamin and mineral deficiencies. In particular, people with Crohn's disease may lack adequate vitamin D, B12, and K, plus folic acid, calcium, and zinc. Your doctor may recommend that you take a multivitamin daily.

Zinc (25 mg), folic acid (800 mcg), vitamin B12 (800 mcg) -- These vitamins are used by the body to repair cells in the intestine. In addition, drugs such as sulfasalazine and methotrexate may case levels of folic acid in the body to drop, requiring supplementation.

Vitamin D (1,000 IU per day) -- is necessary to maintain strong bones. People with Crohn's disease, especially those who take corticosteroids, often have low levels of vitamin D and are at risk for osteoporosis.

Fish oil (2.7 g per day) -- Omega-3 fatty acids found in fish oil may help fight inflammation and reduce the chances of recurrence, but studies have been mixed. The study with the most positive results used a special type of fish oil – "enteric-coated free-fatty-acid form" – that is not sold commercially. Some researchers suggest that measuring the blood levels of different types of fatty acids may help determine if fish oil would be useful. Do not take high doses of a fish oil supplement if you take blood-thinning medication.

Saccharomyces boulardi (250 mg three times per day to 500 mg four times per day) -- One small study indicated that this type of "good" bacteria helped people with Crohn's disease reduce the incidence of diarrhea. However, other studies have shown mixed results.

Glutamine (400 mg four times per day) -- is an amino acid found in the body that that helps the intestine function properly. While there is no evidence that glutamine specifically helps reduce symptoms of Crohn's disease, it may be beneficial for overall intestinal health. Glutamine is best taken on an empty stomach. Do not take glutamine is you are diabetic or have seizures.

Herbs

Because of the presence of inflammation and the nature of the disease, Crohn's disease should not be treated with herbs alone. However, herbs may be a useful complement to traditional medical treatment. Remember that herbs can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

The evidence for using herbs to treat Crohn's disease is mostly lacking. Among the herbs that have been used traditionally to treat inflammation within the digestive tract are:

Slippery elm (Ulmus fulva) is a demulcent (protects irritated tissues and promotes their healing). Take 60 -320 mg per day. One tsp. powder may be mixed with water and drunk three to four times a day.
Marshmallow (Althaea officinalis) is a demulcent and emollient; drink one cup of tea three times per day. To make tea, steep 2 - 5 g of dried leaf or 5 g dried root in one cup boiling water. Strain and cool. Avoid marshmallow if you have diabetes.
Cat's claw (Uncaria tomentosa, 250 mg per day) is an anti-inflammatory.
Boswellia (Boswellia serrata, 1,200 mg three times per day for up to 8 weeks) has anti-inflammatory properties, and a few small studies suggest that it may be effective in treating Crohn's disease. However, more research is needed to be sure. Bsowellia may interact with other drugs and supplements, so talk to your doctor before taking it.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of Crohn's disease symptoms (such as diarrhea) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Mercurius -- for foul-smelling diarrhea that may have streaks of blood accompanied by a sensation of incomplete emptying. This remedy is most appropriate for individuals who tend to feel exhausted following bowel movements, experience fluctuations in body temperature, perspire frequently, and have a thirst for cold fluids.
Podophyllum -- for explosive, gushing, painless diarrhea that worsens after eating or drinking. Exhaustion often follows bowel movements, and the individuals for whom this remedy is appropriate may experience painful cramps in the lower legs and feet.
Veratrum album -- for profuse, watery diarrhea accompanied by stomach cramps, bloated abdomen, vomiting, exhaustion, and chills. The diarrhea tends to worsen as a result of eating fruit. The individual for whom this therapy is appropriate tends to crave cold liquids.

Acupuncture

Acupuncture has long been used in Traditional Chinese Medicine to treat inflammatory bowel disease. One study in Germany found that acupuncture and moxibustion were effective specifically for treating Crohn's disease. Acupuncturists treat people with inflammatory bowel disease based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is used because its effect is thought to reach deeper into the body than using needles alone.

Other Considerations

Pregnancy

Women who are in remission at the time of conception generally have normal pregnancies and healthy babies. However, women with active disease are more prone to miscarriages, spontaneous abortions, and stillbirths. Symptoms often get worse during pregnancy. For this reason, women with active Crohn's disease who are or wish to become pregnant should continue medications under the guidance of their doctor. Corticosteroids or sulfasalazine are considered relatively safe during this time.

Pregnant women should avoid high doses of vitamins. An obstetrician can provide instructions regarding taking multivitamins during pregnancy. The herbs cat's claw (Uncaria tomentosa) and turmeric (Curcuma longa) are not recommended during pregnancy or breastfeeding.

Prognosis and Complications

A number of complications can develop from Crohn's disease. Many can be successfully treated.

Narrowing of the colon, which may cause obstruction
Perforation of the colon
Abscesses (pus-filled pockets of infection) in the colon
Toxic megacolon (grossly swollen colon that may rupture)
Fistulas (abnormal hollow passages that lead from one part of the intestine to another, or to other organs)
Infection of the blood (sepsis)
Colon cancer
Nutritional problems (including weight loss and reduced muscle mass)
Joint pain and arthritis
Osteoporosis (bone loss)
Gallstones
Eye infections/inflammation
Mouth ulcers, gum inflammation, and dental cavities
Liver damage
Blood clots
Depression and anxiety
Anemia

Although there is no cure for Crohn's disease, many people with the disease lead active lives by controlling their symptoms with medication. Over time, however, Crohn's disease is less responsive to treatment. Within 10 years of diagnosis, 71% of people will need surgical removal of the affected intestine, and many experience at least one relapse in any 10-year period.

Supporting Research

Abela MB. Hypnotherapy for Crohn's disease: a promising complementary/alternative therapy. Integr Med. 2000;2(2/3):127-131.

Ammon HP. Boswellic acids in chronic inflammatory diseases. Planta Med. 2006 Oct;72(12):1100-16.

Anton PA. Stress and mind-body impact on the course of inflammatory bowel diseases. Semin Gastrointest Dis. 1999;10(1):14-19.

Ball E. Exercise guidelines for patients with inflammatory bowel disease. Gastroenterol Nurs. 1998;21(3):108-111.

Belluzzi A, Boschi S, Brignola C, Munarini A, Cariani G, Miglio F. Polyunsaturated fatty acids and inflammatory bowel disease. Am J Clin Nutr. 2000;71(suppl):339S-342S.

Belluzzi A, Brignola C, Campieri M, Pera A, Boschi S, Miglioli M. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med. 1996;334(24):1557-1560.

Bernell O, Lapidus A, Hellers G. Risk factors for surgery and postoperative recurrence in Crohn's disease. Ann Surg. 2000;231(1):38-45.

Blumenthal M, ed. Herbal Medicine. Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000.

Bock S. Integrative medical treatment of inflammatory bowel disease. Int J Integr Med. 2000;2(5):21-29.

Brignola C, Belloli C, De Simone G, et al. Zinc supplementation restores plasma concentrations of zinc and thymulin in patients with Crohn's disease. Aliment Pharmacol Ther. 1993;7:275-280.

Chowers Y, Sela B, Holland R, Fidder H, Simoni FB, Bar-Meir S. Increased levels of homocysteine in patients with Crohn's disease are related to folate levels. Am J Gastroenterol. 2000;95(12):3498-3502.

Cosnes J, Beaugerie L, Carbonnel F, Gendre JP. Smoking cessation and the course of Crohn's disease: an intervention study. Gastroenterology. 2001;120(5):1093-1099.

Dear KL, Hunter JO. Colonoscopic hydrostatic balloon dilation of Crohn's strictures. J Clin Gastroenterol. 2001;33(4):315-318.

Farmer M, Petras RE, Hunt LE, Janosky JE, Galadiuk S. The importance of diagnostic accuracy in colonic inflammatory bowel disease. Am J Gastroenterol. 2000; 95(11):3184-3188.

Favier C, Neut C, Mizon C, Cortot A, Colombel JF, Mizon J. Fecal ß-D-Galactosidase production and Bifidobacteria are decreased in Crohn's disease. Dig Dis Sci. 1997;42(4):817-822.

Feagan BG, Fedorak RN, Irvine EJ, et al. A comparison of methotrexate with placebo for the maintenance of remission in Crohn's disease. N Engl J Med. 2000;342:1627-1632.

Geerling BJ, Badart-Smook A, Stockbrügger RW, Brummer R-JM. Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr. 2000;54:514-521.

Geerling BJ, Houwelingen AC, Badart-Smook A, Stockbrügger RW, Brummer R-JM. The relation between antioxidant status and alterations in fatty acid profile in patients with Crohn disease and controls. Scand J Gastroenterol. 1999a;34:1108-1116.

Geerling BJ, Stockbrugger RW, Brummer R-JM. Nutrition and inflammatory bowel disease: an update. Scand J Gastroenterol. 1999c;34(suppl 230):95-105.

Gilman J, Shanahan F, Cashman KD. Determinants of vitamin D status in adult Crohn's disease patients, with particular emphasis on supplemental vitamin D use. Eur J Clin Nutr. 2006 Jul;60(7):889-96.

Gionchetti P, Rizzello F, Venturi A, Campieri M. Probiotics in infective diarrhea and inflammatory bowel diseases. J Gastroenterol Hepatol. 2000;15:489-493.

Gupta I, Parihar A, Malhotra P, Singh GB, Ludtke R, Safayhi H, Ammon HPT. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2:37-43.

Haas l, McClain C, Varilek G. Complementary and alternative medicine and gastrointestinal diseases. Curr Opin Gastroenterol. 2000;16:188-196.

Hampe J, Cuthbert A, Croucher JP, et al. Association between insertion mutation in NOD2 gene Crohn's disease in German and British populations. Lancet. 2001; 357:1925-1928.

Heuschkel RB, Menache CC, Megerian JT, Baird AE. Enteral nutrition and corticosteroids in the treatment of acute Crohn's disease in children. J Pediatr Gastroenterol Nutr. 2000;31(1):8-15.

Joachim G. The relationship between habits of food consumption and reported reactions to food in people with inflammatory bowel disease-testing the limits. Nutr Health. 1999;13(2):69-83.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 220.

Joos S, Brinkhaus B, Maluche C, Maupai N, Kohnen R, Kraehmer N, Hahn EG, Schuppan D. Acupuncture and moxibustion in the treatment of active Crohn's disease: a randomized controlled study. Digestion. 2004;69(3):131-9.

Keane J, Gershon S, Wise RP et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001;345(15):1098-1104.

Kuroki F, Iida M, Tominaga M, et al. Multiple vitamin status in Crohn's disease. Dig Dis Sci. 1993;38(9):1614-1618.

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Loudon CP, Corroll V, Butcher J, Rawsthorne P, Bernstein CN. The effects of physical exercise on patients with Crohn's disease. Am J Gastroenterol. 1999;94(3):697-703.

Macdonald A. Omega-3 fatty acids as adjunctive therapy in Crohn’s disease. Gastroenterol Nurs. 2006 Jul-Aug;29(4):295-301.

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Nielsen AA, Jorgensen LG, Nielsen JN, Eivindson M, Gronbaek H, Vind I, et al. Omega-3 fatty acids inhibit an increase of proinflammatory cytokines in patients with active Crohn's disease compared with omega-6 fatty acids. Aliment Pharmacol Ther. 2005 Dec;22(11-12):1121-8.

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Rioux JD, Daly MJ, Silverberg MS, et al. Genetic variation in the 5q31 cytokine gene cluster confers susceptibility to Crohn disease. Nat Genet. 2001;29:223-228.

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Russel MG. Changes in the incidence of inflammatory bowel disease: what does it mean? Eur J Intern Med. 2000;11(4):191-196.

Shanahan F. Probiotics and inflammatory bowel disease: is there a scientific rationale? Inflamm Bowel Dis. 2000;6(2):107-115.

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Szulc P, Meunier PJ. Is vitamin K deficiency a risk factor for osteoporosis in Crohn's disease? [commentary]. Lancet. 2001;357(9273):1995-1996.

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Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 76-77.

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Review Date:
3/18/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Sinus headache

FitSugar — Wed, 08 Oct 2008 17:35:11 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Sinus headaches cause a dull, deep, throbbing pain in the front of your head and face. They are caused by an inflammation in your sinuses (air-filled cavities around your nose, eyes, and cheeks). Bending down or leaning over generally makes the pain worse, as does cold and damp weather. Sinus headaches often begin as soon as you get up in the morning, and may be better by afternoon. Sinus headaches can be difficult to diagnose, however, because symptoms are similar to tension headaches and migraines.

Signs and Symptoms

Sinus headaches generally have these symptoms:

Pressure-like pain in one specific area of your face or head (for example, behind your eyes)
Face is tender to the touch
Pain is worse with sudden movements of the head and bending forward
Worse pain in the morning (because mucus has been collecting and draining all night)
Sudden temperature changes, like going out into the cold from a warm room, worsen the pain
Headache often starts when you have a bad cold or just after

Other symptoms may be related to sinus inflammation (sinusitis):

Postnasal drip with sore throat (pharyngitis)
Yellow or green discharge from your nose
Red and swollen nasal passages (nasal congestion)
Mild to moderate fever
General sense of not feeling well (malaise)
Fatigue

Migraines can also feel worse when you bend forward and can be accompanied by nasal congestion. But a migraine is more likely to be made worse by noise or light, and to be accompanied by nausea.

Causes

Sinus headaches can be caused by sinus congestion and inflammation (called sinusitis). Sinusitis, in turn, is caused by either a respiratory infection (such as a cold or flu) or allergies (like hay fever). Healthy sinuses allow mucus to drain and air to circulate throughout the nasal passages. When sinuses become inflamed, these areas get blocked and mucus cannot drain. When sinuses become blocked, they provide a place for bacteria, viruses, and fungus to live and grow rapidly. Although a cold is most often the culprit, sinusitis can be caused by anything that prevents the sinuses from draining.

Risk Factors

History of allergies (especially hay fever) or asthma
Nasal polyps (swellings in the nasal passage), nasal bone spurs, nasal or facial tumor, deviated septum, or cleft palate
Climbing or flying to high altitudes
Frequent swimming and/or diving

Diagnosis

Your doctor will ask questions in order to distinguish sinus headaches from migraines or tension headaches. If you have had a recent cold, allergy flare-up, and/or symptoms of sinusitis, that helps make a definite diagnosis.

Your doctor will look in your nose to check for congestion and nasal discharge. He or she will also press on areas of your face to check for tenderness. Transillumination (shining a light through the sinuses) is another simple method that your doctor may use to look for sinus inflammation; if the light does not shine through, your sinuses may be congested.

If your doctor suspects chronic sinusitis, he or she may order imaging tests, including an x-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI). If your doctor suspects allergies may be causing your sinusitis, he or she may suggest an allergy test. Sometimes, a referral to a specialist – known as an ear, nose and throat (ENT) doctor or an otolaryngologist – is necessary. This specialist may perform a nasal endoscopy using a fiber optic scope to look at your sinuses.

Treatment Approach

The best way to avoid or get rid of a sinus headache is to treat the underlying sinus inflammation. Your doctor may prescribe antibiotics or corticosteroids. Lifestyle changes, such as using a humidifier or irrigating your nasal passages with salt water, may also help. Several dietary supplements and herbs may help prevent colds and flu or shorten their duration, or work together with antibiotics to treat your infection and support your immune system.

Lifestyle

Doing the following things can help reduce congestion in your sinuses:

Using a humidifier
Using a saline nasal spray
Inhaling steam 2 to 4 times per day (for example, sitting in the bathroom with the shower running)
Quickly treating allergic and asthma attacks

Other techniques that might help include:

Stretches for the head and neck
Relaxation techniques (see Mind/Body Medicine section)

Medications

Antibiotics - Your doctor may prescribe antibiotics if he or she suspects you have a bacterial infection. are prescribed if a bacterial infection is present or suspected. To treat acute sinusitis, you may take from 10 to 14 days of antibiotics. Treating chronic sinusitis may take longer, usually 3 to 4 weeks.

Nasal corticosteroids - These prescription sprays reduce inflammation of the nose and help relieve sneezing, itching, and runny nose. They are most effective at reducing symptoms, although it can take from a few days to a week after you start using them to see improvement.

Beclomethasone (Beconase)
Fluticasone (Flonase)
Mometasone (Nasonex)
Triacinolone (Nasacort)

Antihistamines - Antihistamines are available in both oral and nasal spray forms, and as prescription drugs and over-the-counter remedies, to treat allergies. Over the counter antihistamines are short-acting and can relieve mild to moderate symptoms. All work by blocking the release of histamine in your body.

Over-the-counter antihistamines: Include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist). These older antihistamines can cause sleepiness. Loratadine (Claritin), a newer antihistamine, does not cause drowsiness.
Prescription antihistamines: These medications are longer-acting than over-the-counter antihistamines and are usually taken once a day. They include fexofenadine (Allegra) and cetrizine (Zyrtec).

Decongestants - Many over-the-counter and prescription decongestants are available in tablet or nasal spray form. They are often used with antihistamines.

Oral and nasal decongestants: Include Sudafed, Actifed, Afrin, Neo-Synephrin. Some decongestants may contain pseudoephedrine, which can raise blood pressure. People with high blood pressure or enlarged prostate should not take drugs containing pseudoephedrine. Nasal decongestants can cause "rebound congestion," where the nasal passages swell. Avoid using nasal decongestants for more than 3 days in a row, unless specifically instructed by your doctor, and do not use them if you have emphysema or chronic bronchitis.

Surgery and Other Procedures

For chronic sinusitis that doesn’t respond to medication, your doctor may recommend endoscopic sinus surgery, which may be done to remove polyps or bone spurs. Enlarging the sinus opening is also sometimes recommended. A newer procedure called balloon rhinoplasty involves inserting a balloon inside the sinus cavity and then inflating it.

Surgical procedures for sinuses are performed by an ENT specialist.

Nutrition and Dietary Supplements

Several supplements may help prevent or treat sinus headaches, either by reducing sinus inflammation or by helping to ward off colds. (See Sinusitis for more details.) Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

Bromelain - Several studies suggest that bromelain, an enzyme derived from pineapples, may help reduce inflammation and swelling and relieve symptoms of sinusitis. However, not all studies found any benefit. Bromelain is often combined with quercetin a flavonoid (plant pigment responsible for the colors found in fruits and vegetables) that may act as an antihistamine. Bromelain may increase the risk of bleeding, so people who take anticoagulants (blood-thinners) should not take bromelain without talking to their doctor first. Taking bromelain with ACE inhibitors may cause a drop in blood pressure (hypotension).
Quercetin - Quercetin is a flavonoid, a plant pigment responsible for the colors found in fruits and vegetables. In test tubes, it inhibits the production and release of histamine, which causes allergy symptoms such as a runny nose and watery eyes. It’s often combined with bromelain, a supplement made from pineapples. However, there is not yet much evidence that quercetin would work the same way in humans. More studies are needed. Some people may prefer water-soluble forms of quercetin, such as hesperidin methyl chalcone (HMC) or quercetin chalcone.
Probiotics (Lactobacillus) - Probiotics, or "friendly" bacteria, may be helpful if you are taking antibiotics for sinusitis. They may also reduce your chances of developing allergies.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

As with supplements, there are many herbs that may help reduce your chances of getting a sinus headache by preventing or treating a cold, enhancing your immune function, or reducing sinus inflammation.

Eucalyptus (Eucalyptus globulus) - Laboratory studies show that eucalyptus oil has strong antibacterial properties. Studies in animals and test tubes also found that eucalyptus oil acts as an expectorant (helping get rid of mucus in the respiratory passages, which might help sinusitis). It’s often used to treat congestion from a cold or flu. One study found that people who took 200 mg of an extract of eucalyptus oil (cineole) three times per day had a greater reduction in symptoms of sinusitis than those who took placebo.

Essential oil monoterpenes - A combination of essential oils, including eucalyptus, a citrus oil, and an extract from pine, has been suggested for several respiratory illnesses, including sinusitis. One study found that people with viral sinusitis who took essential oil monoterpenes did better than people who took placebo. However, more studies are needed.

Sinupret (A proprietary formulation containing Sambucus nigra or European elder, Rumex acetosa or common sorrel, Primula veris or cowslip, Verbena officinalis or European vervain, Gentiana lutea or gentian) - In two studies, Sinupret was found to be more effective than placebo in relieving symptoms of sinusitis. The herbs it contains may work by thinning mucus and helping the sinuses to drain, and they may also help strengthen the immune system.

Although adequate research is lacking, other herbs that have been used traditionally to treat headaches include:

Chinese skullcap (Scutellaria baicalensis)
Devil's claw (Harpagophytum procumbens)
Feverfew (Tanacetum parthenium)
Willow bark (Salix spp.)

Homeopathy

One of the most common reasons people seek homeopathic care is to relieve chronic headaches. In general, there have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for sinus headaches based on their knowledge and clinical experience. In one study of homeopathy for sinusitis, more than 80% of the participants had significant improvement in their symptoms after taking the homeopathic remedy for 2 weeks.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

The following are remedies commonly prescribed for sinus congestion and headache:

Arsenicum album - for throbbing, burning sinus pain that is relieved by lying upright in a cool room with open windows
Belladonna - for throbbing headaches that come on suddenly and feel worse with motion and light; pain is partially relieved by pressure, standing, sitting, or leaning backwards
Bryonia - for headaches with a steady, sharp pain that occurs most often in the forehead but may radiate to the back of the head; symptoms tend to worsen with movement and light touch, but firm pressure alleviates the pain; the person for whom this remedy is most appropriate is usually irritable and may experience nausea, vomiting, and constipation
Hepar sulphuricum - for headaches described as "a nail being driven between the eyes;" these types of headaches are often accompanied by thick, yellow nasal discharge; symptoms tend to worsen with movement and light touch of the scalp and improve with pressure
Iris versicolor - for throbbing headaches that occur on one side of the head, especially after eating sweets; visual disturbances may also occur; these headaches are worse in the early morning, during spring and fall, and symptoms tend to worsen with vomiting
Kali bichromicum - for sinus headaches and congestion; pain often occurs between and behind the eyes; symptoms generally progress throughout the morning, worsen with cold and motion, and improve with warmth and pressure
Mercurius - for raw, swollen nostrils; this remedy is most appropriate for individuals whose pain feels as though the head has been placed in a vise; pain may also extend to the teeth; symptoms tend to worsen at night and the individual may alternate between sweating and having the chills; nasal discharge may be bloody
Natrum muriaticum - for headaches and congestion associated with allergies
Pulsatilla - for headaches triggered by eating rich, fatty foods, particularly ice cream; pain may move around the head but tends to be concentrated in the forehead or on one side of the head and may be accompanied by digestive problems or occur around the time of menstruation; symptoms tend to worsen at night and with coughing and blowing the nose; children often develop these symptoms while at school
Silicea - for sinus pain that improves with pressure, head wraps, and warm compresses
Spigelia - for stinging, burning, or throbbing sinus pain that often occurs on the left side of the head; symptoms tend to worsen with cold weather and motion but may be temporarily relieved by cold compresses and lying on the right side with the head propped up

Acupuncture

Although studies are few and have found conflicting results, some people may find that acupuncture helps relieve symptoms of sinusitis. An acupuncturist diagnoses headaches not as migraine, tension, or sinus, but rather as conditions deriving from "energetic" imbalances. Acupuncturists usually describe sinusitis as "dampness" which creates inflammation and congestion in the mucus membranes. This dampness is cleared by strengthening the spleen meridian and by working with the stomach meridian. Practitioners often perform needling therapy and/or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) for this condition.

Chiropractic

Although no studies have examined using chiropractic to treat sinusitis, some practitioners suggest that it may decrease pain and improve sinus drainage for some people.

Mind/Body Medicine

For headaches in general, relaxation techniques can be helpful. That's especially true if the headaches are chronic and recurrent, as sinus headaches can be. You may want to try these techniques:

Biofeedback to control muscle tension
Learn to meditate, breathe deeply, or try other relaxation exercises, such as yoga or hypnotherapy.

Other Considerations

If you are not better in a few weeks, your primary care physician may send you to see an ENT specialist for tests to find the cause of your sinus congestion.

Pregnancy

Sinus congestion often acts up during pregnancy. There are many herbs and medications that pregnant and breastfeeding women should not use. Check with your doctor before using any herbs or supplements if you are pregnant or breastfeeding.

Warnings and Precautions

You should seek emergency medical attention if you experience the following:

Sudden and severe headache that persists or increases in intensity over 24 hours
A sudden, severe headache that you describe as "your worst ever," even if you are prone to headaches
Chronic or severe headaches that begin after age 50
Headaches accompanied by memory loss, confusion, loss of balance, change in speech or vision, or loss of strength in or numbness/tingling in any one of your limbs
Headaches accompanied by fever, stiff neck, nausea and vomiting (may indicate meningitis)
Severe headache localized to one eye, accompanied by redness of the eye (may indicate acute glaucoma)

Supporting Research

Adler M. Efficacy and safety of a fixed-combination homeopathic therapy for sinusitis. Adv Ther. 1999;16(2):103-111

Annequin D, Tourniaire B, Massiou H. Migraine and headache in childhood and adolescence. Pediatr Clin North Am. 2000;47(3):617-631.

Baghdikian B, Lanhers M, Fleurentin J, et al. An analytical study, anti-inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri. Planta Med. 1997;63:171–176.

Blumenthal M. The Complete German Commission E Monographs. Austin, Tex: American Botanical Council. Boston: Integrative Medicine Communications; 1998.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:240-243.

Cady RK, Schreiber CP. Sinus headache or migraine? Considerations in making a differential diagnosis. Neurology. 2002;58(9 Suppl 6):S10-S14.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 88-89, 217-220.

Folweiler DS, Lynch OT. Nasal specific technique as part of a chiropractic approach to chronic sinusitis and sinus headaches. J Manipulative Physiol Ther. 1995;18(1):38-41.

Friese KH, Zabalotnyi DI. Homeopathy in acute rhinosinusitis: a double-blind, placebo controlled study shows the efficiency and tolerability of a homeopathic combination remedy. HNO. 2007 Apr;55(4):271-7.

Gobel H, Schmidt G, Soyka D. Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994;14:228-234.

Guo R, Canter PH, Ernst E. Herbal medicines for the treatment of rhinosinusitis: a systematic review. Otolaryngol Head Neck Surg. 2006 Oct;135(4):496-506. Review.

Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006394. Review.

Helms S, Miller A. Natural treatment of chronic rhinosinusitis. Altern Med Rev. 2006 Sep;11(3):196-207. Review.

Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim Care. 29(2):231-261.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 206, 238-239.

Karkos PD, Leong SC, Arya AK, Papouliakos SM, Apostolidou MT, Issing WJ. 'Complementary ENT': a systematic review of commonly used supplements. J Laryngol Otol. 2007 Aug;121(:779-82. Review.

Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am. 2001;85(4):1077-1084.

Melzer J, Saller R, Schapowal A, Brignoli R. Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis. Forsch Komplement Med (2006). 2006 Apr;13(2):78-87. Review.

Pryse-Phillips W. Guideline for the diagnosis and management of migraine in clinical practice. Can Med Assoc J 1997; 156:1273-87.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 89-93, 120-122.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 238.

Review Date:
12/27/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Attention deficit hyperactivity disorder

FitSugar — Wed, 08 Oct 2008 17:35:11 -0700

Overview

Signs and Symptoms
What Causes It?
Risk Factors
What to Expect at Your Provider's Office
Preventive Care
Treatment Options
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Attention deficit hyperactivity disorder (ADHD) is a developmental disorder characterized by inattention, hyperactivity, and impulsivity. It is the most commonly diagnosed behavioral disorder of childhood, affecting between 3 - 5% of school-aged children. Although many people occasionally have difficulty sitting still, paying attention, or controlling impulsive behavior, people with ADHD find that these symptoms greatly interfere with everyday life. Generally, these symptoms appear before age 7 and can lead to difficulties in school and in social settings. One- to two-thirds of all children with ADHD continue to exhibit symptoms as adults. Diagnosis can be controversial, since there are no lab tests for ADHD and no objective way to measure behavior. There is also disagreement about the best way to treat ADHD, but early intervention can improve a child's educational and social development.

Signs and Symptoms

A person is considered to have ADHD if they demonstrate at least 6 symptoms from the following categories for at least 2 months. In diagnosing children, the symptoms must appear before age 7 and pose a significant challenge to everyday functioning in at least two areas of life (usually home and school). Most children do not exhibit all the symptoms, and they may be different in boys and girls (with boys perhaps being more hyperactive and girls more inattentive).

Inattention

Fails to pay close attention to details or makes careless mistakes
Has difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish tasks
Has difficulty organizing tasks and activities
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work, homework)
Loses things necessary for tasks or activities
Is easily distracted
Is forgetful in daily activities

Hyperactivity and Impulsivity

Fidgets with hands or feet or squirms in seat
Does not remain seated when expected to
Runs or climbs excessively in inappropriate situations (in adolescents or adults, may be feelings of restlessness)
Has difficulty playing or engaging in leisure activities quietly
Acts as if "driven by a motor"
Talks excessively
Blurts out answers before questions are completed
Has difficulty waiting his or her turn
Interrupts or intrudes on others

What Causes It?

No one is sure what causes ADHD. Although environment may play a role, researchers are increasingly looking to find answers in the structure of the brain.

Altered brain function -- Brain scans have revealed a number of differences in the brains of ADHD children compared to those of non-ADHD children. For example, many children with ADHD tend to have altered brain activity in the prefrontal cortex, a region thought to be the brain's command center, which may impair their ability to control impulsive and hyperactive behaviors. Researchers also believe hyperactive behavior in children can be caused by excessive slow-wave (or theta) activity in certain regions of the brain.
Heredity -- ADHD seems to run in families.
Maternal or childhood exposure to certain toxins -- Women who smoke, drink, and are exposed to PCBs during pregnancy are more likely to have children with ADHD. Children who are exposed to lead or PCBs are more likely to develop the disorder.

Risk Factors

Heredity: children with ADHD usually have at least one first-degree relative who also has the disorder.
Gender: ADHD is four to nine times more common in boys than in girls (some experts believe that the disorder is underdiagnosed in girls, however).
Prenatal and early postnatal health: maternal drug, alcohol, and cigarette use; exposure of the fetus or infant to toxins, including lead and PCBs; nutritional deficiencies and imbalances.
Other behavioral disorders, particularly those that involve excessive aggression (such as oppositional defiant or conduct disorder).

What to Expect at Your Provider's Office

Because there is no objective test for ADHD, diagnosing the condition is difficult and a number of tests and observations may be used. For this reason, it is crucial to make sure the doctor who evaluates you or your child has training in diagnosing ADHD.

To evaluate a child, the doctor will take a complete medical history and do a thorough exam to check for conditions that may mimic ADHD, such as hyperthyroidism or problems with vision, hearing, and sleeping. Because many symptoms show up at home or school rather than the doctor's office, you may be given questionnaires to fill out. Your child's teacher may be interviewed. Your doctor will seek to determine not only how the child behaves but also where the behavior occurs and how long it lasts. Children with ADHD have long-lasting symptoms that typically show up during stressful situations or situations that require sustained attention (such as schoolwork).

Diagnosing an adult with ADHD can be even more challenging. Because your symptoms would have appeared when you were young, your doctor may try to find out as much as they can about you when you were a child, getting information from your parents or former teachers. (If your symptoms are recent, you are not considered to have adult ADHD.) In addition to ruling out the other conditions mentioned above, your doctor may also check for depression and bipolar disorder, which can mimic ADHD.

Preventive Care

Because the cause or causes of ADHD are not known, there is no way to prevent the condition. It may be managed with medication, behavioral therapy, and lifestyle changes.

Treatment Options

How to treat ADHD, particularly in children, is subject to controversy. Current treatment involves therapy or medication, or a combination of both. In fact, studies show that medication by itself, without some form of therapy, is not likely to improve a child's outcome in the long-term. Family therapy, behavioral therapy, social skills training, and parent skills training are often employed. Many parents investigate nutritional therapies (such as elimination diets or high-dose vitamins), but so far there is no evidence that they are effective. Preliminary evidence indicates that homeopathy and mind-body techniques, particularly biofeedback, may help improve behavior in children with ADHD.

Lifestyle

Parent skills training offered by skilled clinicians provides parents with tools and techniques for managing their child's behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior and can be performed by parents and teachers working together therapists and doctors. For example, older children with ADHD may be rewarded with points or tokens, or even written behavioral contracts with their parents. Creating charts with stars for good behavior may be effective for younger children. On the other hand, timeouts may be used to discourage undesirable behavior. Other techniques include:

Establishing rules that are easily understood, developmentally appropriate, and not unduly harsh
Avoiding repeated commands once the child has been reminded of the consequences
Disciplining the child before becoming too angry and frustrated
Following disciplinary actions with praise when the child adheres to the rules and behaves appropriately

In addition to behavioral intervention at home, modifications in the classroom environment (or work, in the case of adolescents or adults) are significant aspects of the treatment plan. Hyperactive children do best in highly structured circumstances under the direction of a teacher experienced in handling their disruptive behavior and capable of adapting to their distinctive cognitive style. Since group interactions are often particularly challenging, social skills training, appropriate classroom placement, and explicit rules of engagement with peers are essential.

Adults with ADHD may benefit from a variety of behavioral interventions including cognitive remediation, couple therapy, and family therapy.

Drug Therapies

Stimulant medications are the most widely researched and commonly prescribed treatments for ADHD. Although researchers do not fully understand how these drugs improve ADHD symptoms, studies indicate that they boost the amount of dopamine in the brain, a chemical that is associated with activity; and serotonin, a chemical associated with mood and well-being. Medications prescribed for ADHD include:

Methylphenidate (Ritalin) -- a stimulant and most commonly used medication for ADHD; effective in 75 - 80% of people with the condition; not recommended for children under 6 years of age
Dextroamphetamine (Dexadrine) -- a stimulant that is effective in 70 - 75% of people with ADHD; not recommended for children under 3 years of age
Atomoxetine (Strattera) -- the first nonstimulant medication approved to treat ADHD, Strattera increases the levels of both dopamine and norepinephrine in the brain. Strattera was first developed as an antidepressant and, as with all antidepressants, carries a "black box" warning that it may increase thoughts of suicide in young children and teenagers.

The most common side effects from these medications are trouble sleeping, decrease in appetite, and nervousness.

Complementary and Alternative Therapies

According to a recent survey, many parents use complementary and alternative treatments for their children with ADHD, with nutritional therapies the most common. Although studies show at best conflicting results, if your child appears sensitive to certain foods, talk to your doctor about eliminating them for a brief period to see if his symptoms improve. Putting a child on any diet should only be done under the supervision of your doctor.

Diets

The Feingold diet was developed in the 1970s by Benjamin Feingold, who believed that artificial colors, flavors, and preservatives, as well as naturally occurring salicylates (chemicals similar to aspirin that are found in many fruits and vegetables), were a major cause of hyperactive behavior and learning disabilities in children. Studies examining the diet's effect have been mixed. Most show no benefit, although there is some evidence that salicylates may play a role in hyperactivity in a small number of children. Because the Feingold diet is difficult to adhere to and also involves changes in family lifestyle (children are encouraged to participate in creating meals, for example), you should talk with your doctor before attempting it.

Other dietary therapies may concentrate on eating foods that are high in protein and complex carbohydrates, and eliminating sugar and artificial sweeteners from the diet. However, studies show no relation between sugar and ADHD. In one study, children whose diets were high in sugar or artificial sweeteners behaved no differently than children whose diets were free of these substances. This was true even among children whose parents described them as having a sensitivity to sugar.

Vitamins and Minerals

Magnesium (200 mg per day) -- Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion. Some experts believe that children with ADHD may be exhibiting the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.

Vitamin B6 -- Adequate levels of vitamin B6 are essential for the synthesis of essential brain chemicals including serotonin, dopamine and norepinephrine, the chemicals affected in children with ADHD. One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children. However, the study used a high dose of B6, which could cause nerve damage (although none occurred in the study), and other studies have shown that B6 has no effect on behavior. Because high doses can be dangerous, do not give your child B6 without your doctor's supervision.

Zinc (35 mg per day) -- Zinc regulates the activity of neurotransmitters, fatty acids, and melatonin, all of which are related behavior. Several studies have found that zinc may help improve behavior, but the effects were modest at best. Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.

Essential fatty acids -- Fatty acids, such as those found in fish and fish oil (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids), are "good fats" that play a key role in normal brain function. Experts have suggested them as a treatment for ADHD; however, studies have shown no clear benefit in improving behavior.

L-carnitine -- L-carnitine is an amino acid derivative that is involved in energy production in the body. One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine, but further research is needed to confirm any benefit. Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

Herbs

Several herbal remedies for ADHD are sold in the United States and Europe, but few scientific studies have investigated whether these herbs improve symptoms of ADHD. One or more of the following calming herbs may be recommended for people with ADHD:

Roman chamomile (Chamaemelum nobile)
Valerian (Valerian officinalis)
Lemon balm (Melissa officinalis)
Passionflower (Passiflora incarnata)

Other herbs commonly contained in botanical remedies for ADHD include:

Gingko (Gingko biloba) -- used to improve memory and mental sharpness.
American ginseng (Panax quinquefolium ) and gingko -- One study suggests that gingko in combination with ginseng may improve symptoms of ADHD.

Massage

Relaxation techniques and massage can reduce anxiety and activity levels in children and teens. In one study, teenaged boys with ADHD who received 15 minutes of massage for 10 consecutive school days showed significant improvement in behavior and concentration compared to those who were guided in progressive muscle relaxation for the same duration of time.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

In a study of 43 children with ADHD, those who received an individualized homeopathic remedy showed a significant improvement in behavior compared to children who received placebo. The homeopathic remedies found to be most effective included:

Stramonium -- for children who are fearful, especially at night
Cina -- for children who are irritable and dislike being touched; whose behavior is physical and aggressive
Hyoscyamus niger -- for children who have poor impulse control, talk excessively or act overly exuberant

Biofeedback

Mind-body techniques such as hypnotherapy, progressive relaxation, and biofeedback may be useful in treating children and adolescents. Through these techniques, children are often able to learn coping skills that will stay with them for the rest of their lives. These treatments allow children to gain a sense of control and mastery, increase self-esteem, and decrease stress.

Biofeedback operates on the principle that children can be trained to modify brain activity associated with ADHD and increase brain activity associated with attention. Several studies have shown positive results.

Other Considerations

Prognosis and Complications

As many as half of all children with ADHD who receive appropriate treatment learn to control symptoms and function well as adults. Research suggests that children who receive treatment that combines therapies such as medication, behavioral therapy, and biofeedback are less likely to have behavioral problems as they grow up. In most cases, ADHD can be effectively managed throughout life.

Supporting Research

American Academy of Pediatrics. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 2000;105(5):1158-1170.

Arnold LE, Pinkham SM, Votolato N. Does zinc moderate essential fatty acid and amphetamine treatment of attention deficit/hyperactivity disorder? J Child Adolesc Psychopharmacol. 2000;10:111-117.

Arnold LE, Kleykamp D, Votolato N, Gibson RA, Horrocks L. Potential link between dietary intake of fatty acid and behavior: pilot exploration of serum lipids in attention-deficit hyperactivity disorder. J Child Adolesc Psychopharmacol. 1994;4(3):171-182.

Baumgaertel A. Alternative and controversial treatments for attention-deficit/hyperactivity disorder. Pediatr Clin of North Am. 1999;46(5):977-992.

Bekaroglu M, Aslan Y, Gedik Y. Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry. 1996;37(2):225-227.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:160, 107.

Burgess J, Stevens L, Zhang W, Peck L. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr. 2000; 71(suppl):327S-330S.

Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child. 1993;69:564-568.

Daruna JH, Dalton R, Forman MA. Attention deficit hyperactivity disorder. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. 16^th ed. Philadelphia, Pa: W.B. Saunders Company; 2000:100-103.

Field T, Quintino O, Hernandez-Reif M, Koslovsky G. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence. 1998;33(129):103-108.

Frei H, von Ammon K, Thurneysen A. Treatment of hyperactive children: increased efficiency through modifications of homeopathic diagnostic procedure. Homeopathy. 2006 Jul;95(3):163-70.

Gutgesell H, Atkins D, Barst R, et al. Cardiovascular monitoring of children and adolescents receiving psychotropic drugs: a statement for healthcare professionals from the Committee on Congenital Cardiac Defects, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 1999; 99(7):979-82.

Heinrich H, Gevensleben H, Strehl U. Annotation: neurofeedback - train your brain to train behaviour. J Child Psychol Psychiatry. 2007 Jan;48(1):3-16.

Holtmann M, Stadler C. Electroencephalographic biofeedback for the treatment of attention-deficit hyperactivity disorder in childhood and adolescence. Expert Rev Neurother. 2006 Apr;6(4):533-40. Review.

Kanarek R. Does sucrose or aspartame cause hyperactivity in children? Nutr Rev. 1994;52(5):173-175.

Kidd P. Attention deficit / hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev. 2000;5(5):402-428.

Knochel JP. Disorders of magnesium metabolism. In: Fauci AS, Braunwald E, Isselbacher KJ, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill Companies, Inc; 1998:2263.

Kozielec T, Starobrat-Hermelin B. Assessment of magnesium levels in children with attention deficit hyperactivity disorder. Magnes Res. 1997;10(2):143-148.

Krummel D, Seligson FH, Guthrie HA. Hyperactivity: is candy causal? Critical Reviews in Food Science and Nutrition. 1996;36(1 and 2):31-47.

Lamont J. Homoeopathic treatment of attention deficit hyperactivity disorder; a controlled study. Br Homoeopath J. 1997;86:196-200.

Linden M, Habib T, Rodojevic V. A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul. 1996;21(1):35-49.

Lubar J, Swartwood MO, Swartwood JN, O'Donnell PH. Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavioral ratings and WISC-R performance. Biofeedback Self Regul. 1995;20(1):83-99.

Lyon MR, Cline JC, Totosy de Zepetnek J, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci. 2001;26(3):221-228.

Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila). 1987;26:406-411.

MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 1999;56:1073-1086.

Noorbala AA, Akhondzadeh S. Attention-deficit/hyperactivity disorder: etiology and pharmacotherapy. Arch Iran Med. 2006 Oct;9(4):374-80. Review.

Richardson AJ. Omega-3 fatty acids in ADHD and related neurodevelopmental disorders. Int Rev Psychiatry. 2006 Apr;18(2):155-72. Review.

Richardson AJ, Puri BK. The potential role of fatty acids in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2000;63(1/2):79-87.

Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactive disorder (ADHD): positive response to magnesium oral loading test. Magnesium Research. 1997; 10(2):149-156.

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Review Date:
3/25/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Herpes simplex virus

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Herpes simplex virus (HSV) infections are very common worldwide. HSV-1 (usually known as a cold sore) is transmitted through kissing or sharing drinking utensils, and HSV-2 (usually known as genital herpes) through sexual contact. You may be infected and not show symptoms for a long time. Often symptoms are triggered by exposure to the sun, fever, menstruation, emotional stress, a weakened immune system, or an illness.

There is not cure for herpes, and once you have it, it is likely to recur; however, some people may have one outbreak and then never have another one. In between herpes outbreaks, the virus lies dormant (as if it is hibernating or sleeping) in nerve cells.

While exposure to HSV-1 is extremely common – as many as 90% of American adults have been exposed to the virus – and there is no stigma to having a cold sore, HSV-2 or genital herpes can cause embarrassment. Although there is no cure for genital herpes, an infected person can take steps to preventing spreading the disease and can continue to have a sex life.

While most herpes infections do not cause serious complications, infections in infants and in people with weakened immune systems or herpes infections that affect the eyes can be life-threatening.

Signs and Symptoms

HSV-1

Small, painful blisters filled with fluid around the lips or edge of the mouth
Tingling or burning around the mouth or nose (often a few days before blisters appear)
Fever
Sore throat
Swollen lymph nodes in neck

HSV-2

Small red blisters or open sores on genitals or inner thighs; in women, often occur inside the vagina
May be painful or not
In women, vaginal discharge
Fever, muscle aches
Headache Painful urination
Swollen lymph glands in the groin

Causes

HSV-1 is transmitted through saliva. Kissing, using the same eating utensils, sharing personal items (such as a razor), and receiving oral sex from someone who has HSV-1 can cause you to contract the virus.

HSV-2 is a sexually transmitted disease.

Both herpes viruses can be contagious even if the infected person does not have active symptoms or visible blisters.

Also, a mother can pass the infection to her baby during vaginal birth, especially if there are active blisters around the vagina at the time of delivery.

Risk Factors

Oral herpes (cold sores)

Everyone is at risk for oral herpes from HSV-1. In fact, studies suggest that by adolescence 62% of Americans are infected with HSV-1 and by the time people are in their 40s, 90% have been infected.

Genital herpes

All sexually active people are at risk for genital herpes. Having multiple sexual partners puts you at even greater risk. Women have a greater risk of being infected after sex with an unprotected partner than men do. Estimates of how many Americans are infected range from 20% to 30%.

Other factors

People with weakened immune systems, such as people with HIV/AIDS or those who take immunosuppressant drugs to treat an autoimmune disease or because of organ transplant, are at increased risk for severe cases of herpes.

Diagnosis

In many instances, your doctor is able to make the diagnosis of herpes from examining you and no tests are required. If your doctor is not 100% certain, however, then he or she make take a sample from the blisters to test for the virus. Finally, there is a blood test that may be helpful for making a diagnosis, especially if your doctor suspects herpes but you don't have an active infection.

Preventive Care

HSV-1

Avoiding kissing people with visible core sores
Don't share personal items
Wash your hands frequently
If you have HSV-1, be careful touching your eyes and genitals; don't perform oral sex on your partner
Use sunscreen
Reduce stress

HSV-2

Avoid having sex if you or your partner has an outbreak (active infection) of herpes. Herpes outbreaks are not always obvious and your partner may be contagious without you knowing it. Anyone involved in an ongoing sexual relationship with a partner infected with HSV-2 should get counseling from a healthcare practitioner on how to best keep yourself safe.
Avoid touching the sores
Use or have your partner use a latex condom (even when sores are not visible)
Limit the number of sex partners

Treatment Approach

Herpes cannot be cured, so the goals of treatment are to reduce the number of outbreaks and to lessen symptoms when you do have an outbreak.

Cold sores usually go away by themselves in no more than 1 to 2 weeks. Using medications may shorten the outbreak and decrease discomfort.

Antiviral medications for genital herpes can reduce outbreaks and help speed recovery when an outbreak does occur. They can also lessen the chances of spreading the virus.

Coping with the emotional and social aspects of having genital herpes is part of treatment. Relaxation techniques and support groups can help.

Lifestyle

For cold sores, applying either heat or cold to blisters may help relieve pain. Try ice or warm compresses.

For genital herpes, wear cotton underwear and avoid tight fitting clothes as they can restrict air circulation and slow the healing of lesions.

Be sure to tell your partner or potential partner that you have herpes.

Medications

Antiviral medicines - may help shorten the duration of a herpes outbreak and suppress recurring outbreaks. For genital herpes, there are two types of therapy: episodic and suppressive. With episodic therapy, you take medication at the first sign of an outbreak and for several days to shorten the duration or prevent a full outbreak. With suppressive therapy, you may take medication daily to keep outbreaks from occurring. Antiviral medications include:

Acyclovir (Zovirax)
Famciclovir (Famvir)
Valacyclovir (Valtrex)

Topical medications (for oral herpes) - include the antiviral cream Penciclovir (Denavir) and an over-the-counter cream, docosanol (Abreva).

Nutrition and Dietary Supplements

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable healthcare provider.

Lysine (1 to 3 g per day) - Although not all studies agree, several studies suggest that lysine may help reduce the number of recurring outbreaks of cold sores and possibly genital herpes. Most of the studies have involved people with cold sores or with both cold sores and genital herpes. A few studies also suggest that lysine may help shorten the duration of an outbreak. The evidence is somewhat stronger for cold sores: the research to date is not entirely conclusive, lysine supplements have been used to help treat or prevent mouth and genital lesions caused by herpes. Taking lysine supplements or increasing lysine in your diet (from foods like fish, chicken, eggs, and potatoes) may speed recovery time and reduce the chance of recurrent breakouts of the herpes infection. If you have high cholesterol, heart disease, or high triglycerides (type of fatty material in the blood, generally measured when you have your cholesterol checked), it is best, at this point, not to use lysine because animal studies suggest that this supplement may raise cholesterol and triglyceride levels.
Propolis - A resin made by bees, propolis is loaded with flavonoids (antioxidants that help fight infection and boost immune function). Test tube studies show it can stop HSV-1 and HSV-2 from reproducing. One small study of people with genital herpes compared an ointment made from propolis to Zovirax ointment. People using propolis saw the lesions heal faster than those using topical Zovirax. More studies are needed to say for sure whether propolis works.
Zinc - In test tubes, zinc is effective against HSV-1 and HSV-2. In one small study in people, those who applied zinc oxide cream to cold sores saw them heal faster than those who applied a placebo cream.

Herbs

Lemon balm (Melissa officinalis) - Several studies suggest that topical ointments containing lemon balm may help heal cold sores. In one study, for example, those who applied lemon balm cream to their lip sores saw a reduction in redness and swelling after two days.
Aloe (Aloe vera) - Preliminary evidence suggests that aloe gel used topically may improve the symptoms of genital herpes in men. In two studies, men who used the aloe vera cream (0.5% aloe) saw lesions heal faster than those who used a placebo cream. It isn't know whether aloe vera would also help heal cold sores.
Rhubarb cream (Rheum palmatum) - In one Swiss study, a cream made from sage (Salvia officinalis) and rhubarb was as effective as Zovirax in healing cold sores. Sage by itself was not beneficial. More research is needed.
Eleutherococcus or Siberian ginseng (Eleutherococcus senticosus/Acanthopanax senticosus) -Although not all studies agree, one 6-month study of 93 people with genital herpes found that Siberian ginseng reduced the frequency, severity, and duration of outbreaks. This herb should not be taken if you have high blood pressure, obstructive sleep apnea (repeated, prolonged periods when breathing stops while sleeping), narcolepsy (frequent day time sleeping), are pregnant or breastfeeding.
Peppermint oil (Mentha x piperita ) - In test tubes, peppermint oil has stopped a number of viruses from reproducing, including herpes. However, it isn't known whether peppermint oil would have any effect on the herpes virus in humans.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the remedies described below for the treatment of herpes based on their knowledge and experience. One study of 53 people with genital herpes did show that the majority had improvement in their symptoms and were less likely to have recurrent outbreaks when treated with homeopathy. Participants in this study were followed for up to 4 years.

Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for each individual.

For cold sores:

Natrum muriaticum - for eruptions at the corners of the mouth that occur during periods of emotional stress and tend to worsen in the daytime
Rhus toxicodendron - for eruptions consisting of many small blisters that itch intensely at night
Mercurius - for children who drool and may have a fever
Sepia - for outbreaks that do not improve with other homeopathic remedies; this remedy is most appropriate for individuals who tend to have a lack of energy and don't tolerate cold weather

For genital lesions:

Graphites - for large, itchy lesions in individuals who are overweight
Natrum muriaticum - for eruptions that occur during periods of emotional stress and symptoms that tend to worsen in the daytime
Petroleum - for lesions that spread to anus and thighs; symptoms tend to worsen in winter and improve in summer
Sepia - for outbreaks that do not improve with other homeopathic remedies; this remedy is most appropriate for individuals who tend to have a lack of energy and don't tolerate cold weather

Mind/Body Medicine

Support groups - Having genital herpes can impact your social and emotional life. In fact, if you have herpes, it is quite common to feel depressed, angry, and even guilty. Worrying about possible rejection by someone with whom you are hoping to become intimate is also typical. Joining a support group where members share experiences and problems can help relieve the stresses associated with having genital herpes. If you are in a committed relationship, seeing a couples' therapist with your partner may also be helpful.
Relaxation techniques - Using relaxation techniques, such as yoga, guided imagery, and meditation, on a daily basis may help you feel better overall and cope with stresses related to having herpes.
Self-hypnosis - Self-hypnosis using guided imagery may also help relieve stress. In one 6-week training program, participants with frequently recurring genital herpes were able to reduce outbreaks by nearly 50% and improve their mood, including reducing feelings of depression and anxiety.
Other - Individual therapy with a psychiatrist, psychologist, or social worker; and techniques such as biofeedback can help reduce emotional symptoms associated with herpes.

Other Considerations

Pregnancy

Herpes viruses can be transmitted to a newborn during vaginal delivery, especially if the mother has active lesions in the vagina at the time of delivery. Herpes infections in newborns can be life-threatening or cause disability. Delivery by cesarean section (C-section) will be recommended to avoid infecting the baby.

Special Populations

Newborns – herpes infections contracted during delivery from the mother can lead to meningitis, herpes infection in the blood, chronic skin infection, and may even be fatal.

You are more likely to have severe, frequent outbreaks and to experience complications from herpes if your immune system is suppressed from:

HIV or AIDS
Chemotherapy for cancer
Long-term use of high doses of corticosteroids
Medications that intentionally suppress the immune system

Warnings and Precautions

If you are diagnosed with genital herpes, you should be tested for other sexually transmitted diseases such as chlamydia and gonorrhea.

Prognosis and Complications

Herpes is a chronic, recurrent infection. The initial symptoms usually appear within 1 to 3 weeks of exposure to the virus and last 7 to 10 days (for cold sores) or 7 to 14 days (for genital lesions). Usually the number of outbreaks is greatest in the first year and higher for HSV-2 genital lesions than HSV-1 cold sores. Each year after that, the number of outbreaks usually goes down and they become less severe. But you can never completely get rid of the virus.

Complications of herpes include:

Herpetic keratitis – herpes infection of the eye leading to scaring within the cornea and possible blindness
Persistent herpes infection, without lesion-free periods
Herpes infection in the esophagus
Herpes infection of the liver which can lead to cirrhosis (liver failure)
Encephalitis and/or meningitis (serious brain infections)
Lung infection
Eczema herpetiform – widespread herpes across the skin

Supporting Research

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Ames M. Herpes: Comprehensive treatment strategy. Int J Integra Med. 2000;2(5):6-9.

Beauman JG. Genital herpes: a review. Am Fam Physician. 2005 Oct 15;72(:1527-34. Review.

Binns SE, Hudson J, Merali S, Arnason JT. Antiviral activity of chacterized extracts from Echinacea spp. (Heliantheae: Asteraceae) against herpes simplex virus (HSV-I). Planta Med. 2002;68(9):780-783.

Brennan P. Homeopathic remedies in prenatal care. J Nurse Midwifery. 1999;44(3):291-299.

Carson CF, Ashton L, Dry L, Smith DW, Riley TV. Melaleuca alternifolia (tea tree) oil gel (6%) for the treatment of recurrent herpes labialis. J Antimicrob Chemother. 2001;48(3):450-451.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 259-260.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:1080-1086.

Fiore C, Eisenhut M, Krausse R, Ragazzi E, Pellati D, Armanini D, Bielenberg J. Antiviral effects of Glycyrrhiza species. Phytother Res. 2007 Sep 20; [Epub ahead of print]

Fox PA, Henderson DC, Barton SE, et al. Immunological markers of frequently recurrent genital herpes simplex virus and their response to hypnotherapy: a pilot study. Int J STD AIDS. 1999;10(11);730-734.

Fried RG. Nonpharmacologic treatments in psychodermatology. Dermatol Clinics. 2002;20910;177-185.

Gaby AR. Natural remedies for Herpes simplex. Altern Med Rev. 2006 Jun;11(2):93-101. Review.

Godfrey HR, Godfrey NJ, Godfrey JC, Riley D. A randomized clinical trial on the treatment of oral herpes with topical zinc oxide/glycine. Altern Ther Health Med. 2001;7(3):49-56.

Griffith RS, Walsh DE, Myrmel KH, Thmpson RW, Behforooz A. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica. 1987;175(4):183-190.

Gruzelier JH. A review of the impact of hypnosis, relaxation, guided imagery and individual differences on aspects of immunity and health. Stress. 2002;5(2):147-163.

Hijikata Y, Tsukamoto Y. Effect of herbal therapy on herpes labialis and herpes genitalis. Biotherapy. 1998;11(4):235-240.

Huleihel M, Isanu V. Anti-herpes simplex virus effect of an aqueous extract of propolis. Isr Med Assoc J. 2002;4(11 Suppl):923-927.

Jenaer M, Henry MF, Garcia A, Marichal B. Evaluation of 2LHERP in preventing recurrences of genital herpes. Institut International 3IDI. Br Homeopath J. 2000;89(4):174-177.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 234.

Koch C, Reichling J, Schneele J, Schnitzler P. Inhibitory effect of essential oils against herpes simplex virus type 2. Phytomedicine. 2007 Oct 30; [Epub ahead of print]

Koytchev R, Alken RG, Dundarov S. Balm mint extract (Lo-701) for topical treatment of recurring herpes labialis. Phytomedicine. 1999;6(4):225-230.

L-lysine. Monograph. Altern Med Rev. 2007 Jun;12(2):169-72.

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Review Date:
12/23/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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